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PRITCHETT & HULL ASSOCIATES, INC. 3440 OAKCLIFF RD NE STE 110 ATLANTA GA 30340-3006 Write for our catalog of other product descriptions and prices. 2015 Edition Copyright © 1997, 1998, 2004, 2010 by Pritchett & Hull Associates, Inc. All rights reserved. No part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Pritchett & Hull Associates, Inc.
Throughout this book, where Pritchett & Hull Associates, Inc. was aware of names of products for which a trademark has been claimed, such names have been printed in initial capital letters (e.g., Medic Alert).
Published and distributed by: Pritchett & Hull Associates, Inc. Printed in the U.S.A. This book is to help you learn and should not be used to replace any of your doctor’s advice or treatment.
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ormal blood pressure Blood pressure (BP) is the force that moving blood puts on the artery walls. As the heart pumps out blood, pressure on the arteries is at its highest. This peak pressure is the systolic pressure.
peak pressure (systolic)
Between heartbeats, the arteries are more relaxed, but they stay tense enough for smooth blood flow to all parts of the body. This tension is the diastolic pressure.
diastolic pressure
Stages of BP for adults 18 years and older:
Systolic
Diastolic
(top number)
Normal*
(bottom number)
less than 120
and
less than 80
High normal BP (pre-hypertension)
130–139
or
80–89
Stage 1 hypertension
140–159
or
90–99
Stage 2 hypertension
160 or more
or
100 or more
* Normal blood pressure readings for those with diabetes or chronic kidney disease is 140/90.
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H
igh blood Pressure (HBP) Most people with chronic HBP have what is called essential hypertension. Though this type of HBP tends to “run in the family,” most of the time the cause is not known. Sometimes HBP is caused by a medical problem such as a kidney disease. This type is called secondary hypertension. Treating the main problem can cause the blood pressure to go down. Some drugs or other compounds can raise blood pressure at times in some people. (Examples: birth control pills, some arthritis medicines, some “cold” remedies, caffeine, chewing tobacco) When a person stops using these, blood pressure can sometimes go down.
T
reatment Treatment to control HBP or its complications will include making good choices about: • medicines • body weight • what you eat and drink • regular exercise • not smoking • stress management
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What you eat and drink Making good choices about what you eat will play a big part in your efforts to control HBP. Follow the “DASH” diet plan. Choose foods, drinks and seasonings that are: • low in sodium, fat and cholesterol • high in fiber, potassium, calcium and magnesium • moderately high in protein
Sodium Sodium is an important mineral. It helps your body balance the level of fluids inside and outside of the cells. To keep up this balance, the body needs very little sodium each day. Yet, most of us eat 3,000 to 6,000 mg of sodium each day. (Our most common sources of sodium are restaurant and processed foods.) People with high blood pressure should limit their sodium to 1,500 2,400 mg a day or less. We can’t prove that too much salt in the diet causes high blood pressure, but we can tell you that in countries where One level teaspoon a lot of salt is eaten, blood of salt equals about pressures are the highest. 2,000 mg of sodium.
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How to fix low-sodium foods: • Rinse foods before cooking or eating them. This can remove some of the sodium from frozen or canned foods. • Season foods with fresh dried herbs, vegetables, fruits or no-salt seasonings. • Do not cook with salt or add salt to foods at the table. • Make your own breads, rolls, sauces, salad dressings, vegetable dishes and desserts when you can. • Prepare fresh or use canned, unsalted vegetables. These have less sodium than most processed foods. For example:*
Instead of: 1 cup of cooked canned peas: 400 mg of sodium
Use: 1 cup of fresh, cooked peas: 2 mg of sodium
1⁄ 2
1⁄ 2
cup of Minute Long Grain and Wild Rice: 570 mg of sodium
cup of cooked rice: 1 mg of sodium
• Buy water-packed tuna and salmon. Break up into a bowl of cold water, and let stand for 3 minutes. Rinse, drain and squeeze out water. • Bake, broil, steam, roast or poach meats without salt. *Sodium contents of foods from USDA Handbook #456.
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1 cup 1∨ 2
Fat & cholesterol Many people with high blood pressure also have high blood cholesterol. Having a high blood cholesterol level puts you at risk for heart disease. Choose foods that are low in fat and cholesterol. Saturated fat is the most harmful to your body. Animal foods like steak, butter and cheese have a lot of saturated fat. These foods also have cholesterol in them. Cutting the fat in your diet will also help cut calories. So if losing weight is one of your treatment goals, lowfat, low-cholesterol eating will help.
How to fix low-fat, low-cholesterol foods: • Bake, broil, steam, roast or poach foods. Serve without fatty sauces. • Cook more fish and poultry (light meat). Trim off all excess fat before cooking. • Drain all meats on a paper towel after cooking. The towel will soak up extra grease or fat. • Season foods with herbs, fruits and vegetables. Do not cook with saturated fat (butter, lard, bacon, etc.). • Cook with small amounts of vegetable oils (monounsaturated or polyunsaturated). Make salad dressings with small amounts of these oils.
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The DASH diet This eating plan can help you control high blood pressure. Daily Food Group Servings Grains & grain products
major source of energy & fiber
1 cup raw, leafy vegetable 1/2 cup cooked vegetable 6 oz vegetable juice
tomatoes, potatoes, carrots, peas, squash, broccoli, turnip greens, collards, kale, spinach, artichokes, beans, sweet potatoes
rich sources of potassium, magnesium & fiber
4–5
6 oz fruit juice 1 medium fruit 1/4 cup dried fruit 1/2 cup fresh, frozen or canned fruit
apricots, bananas, dates, grapes, oranges, orange juice, prunes, raisins, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, tangerines and strawberries
important sources of potassium, magnesium & fiber
2–3
8 oz milk 1 cup yogurt 11/2 oz cheese
skim or 1% milk, skim or low-fat buttermilk, nonfat or lowfat yogurt, lowfat and nonfat cheese
major sources of calcium & protein
3 oz cooked meats, poultry or fish
select only lean meats; trim away visible fats; broil, roast or boil instead of frying; remove skin from poultry
rich sources of protein & magnesium
11/2 oz or 1/3 cup nuts 1/2 oz or 2 Tbsp seeds 1/2 cup cooked dry beans
almonds, filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils
rich sources of energy, protein magnesium, potassium, fiber
limited
1 Tbsp sugar 1 Tbsp jelly/jam 1/2 oz jelly beans 8 oz lemonade
maple syrup, sugar, jelly, jam, fruit-flavored gelatin, jelly beans, hard candy, fruit punch, sorbet, ices
Sweets should be low in fat
limited
1 tsp soft margarine 2 Tbsp lowfat mayonnaise 2 Tbsp light salad dressing 1 tsp vegetable oil
soft margarine, lowfat mayonnaise, light salad dressing, vegetable oil (such as olive, corn, canola, or safflower)
DASH has 27% of calories as fat, including fat in or added to foods
7–8
Fruits
Nuts, seeds & dry beans
no more than 2
4–5 a week
Sweets
Fats & oils
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Notes
whole wheat bread, English muffin, pita bread, bagel, cereals, grits, oatmeal, crackers, unsalted pretzels and popcorn (eat whole grains when possible)
4–5
Meats, poultry & fish
Sample Foods
1 slice bread 1 oz dry cereal 1/2 cup cooked rice, pasta or cereal
Vegetables
Low-fat or nonfat dairy foods
Serving Size
Food labels One way to buy foods with less fat, cholesterol, sodium or sugar is to check the Nutrition Facts on the label. Fats and sugar will be given in grams (g). Sodium and cholesterol will be in milligrams (mg). Buy foods that list 140 mg of sodium or less on the label. This list will help you read sodium labels: sodium free
5 mg or less/serving
very low sodium
35 mg or less/serving
low sodium
140 mg or less/serving
low sodium meal
140 mg or less of sodium per 31/2 oz (100g)
reduced sodium
light in sodium
no salt added, unsalted, without added salt
At least 25% less sodium than the regular version 50% less sodium than the regular version no salt added during processing (only used for foods that usually have salt added)
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8
fat free
less than 0.5 g/serving
low-fat
3 g of fat or less/serving
low saturated fat
1 g of saturated fat or less/serving
reduced fat
at least 25% less fat than the regular version
light in fat
50% less fat than the regular version
low-cholesterol
less than 20 mg/serving
low-calorie
40 calories or less/serving
Alcohol Drinking too much alcohol can raise blood pressure. It can also make HBP harder to control, even with medicines. Most of the time, even people with high blood pressure can have a drink now and then. But if you don’t drink, it’s best not to start. The Dietary Guidelines for Americans suggests that for overall health, women should limit their alcohol to no more than one serving a day. Men should have no more than two servings a day.
One serving of alcohol is: • 11⁄2 oz of 80 proof whiskey or 1 oz of 100 proof or • 5 oz of wine or • 12 oz of beer
And if you are trying to lose weight, keep in mind that alcoholic drinks have calories. There are about 70 to 180 calories in a drink, depending on the kind.
Potassium If you are taking a diuretic (water pill), you may be advised by your doctor to eat more potassium and/or take a potassium supplement. You may need to prevent the loss of too much potassium when fluids pass out of the body. Ask your doctor about potassium if he or she has given you a diuretic. Do not take a potassium supplement unless your doctor tells you to. These foods are high in potassium: apricots bananas orange juice spinach milk and yogurt
dried beans and peas green beans potatoes prunes & prune juice tomatoes
fish fresh pork peaches squash
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Body weight If you weigh 10 to 20% more than you should, your doctor will most likely tell you to lose weight. The DASH diet lets you lose weight slowly without losing your health. On the DASH diet you learn what to eat and in what amounts. Your body thinks “all is well,” and weight comes off and stays off. Regular exercise at the same time makes a good diet work even better. Here are some tips to help you get started. • Choose a good variety of foods from all the basic food groups. • Control serving sizes. • Find a good cookbook or two that contain healthy, tasty recipes for some foods that you like. • Watch the fats and oils. Salads are great, but many salad dressings are very high in fat (and calories). • Avoid foods and drinks sweetened with sugar. These are high in calories. There is no magic formula for losing weight. But if you change your eating habits to follow the DASH diet and limit your sodium and sugar use, you can lose weight and keep it off for life.
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Regular exercise Regular exercise can do many things for you. It can: • help lower high blood pressure • help you lose weight • relieve stress • improve your self-image • reduce your risk of having a heart attack Since you have HBP, your doctor should prescribe the amount and type of exercise that is safe for you. Most of the time blood pressure has to be controlled before you add exercise to your treatment. Your doctor may also suggest that you join a medically supervised exercise program for the best results.
You do not have to do hard exercise to begin to benefit from physical activity. Many activities (such as walking) if done for about 30 minutes most days can help.
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Once your doctor has approved a type and amount of exercise for you, here are some tips to help you stick to it: 1. Start off slowly. Pay attention to how your muscles and body feel. 2. Do something you enjoy. You simply won’t keep doing an exercise if you don’t like it. 3. Choose an exercise partner. This may help you enjoy it more. 4. Warm up before and cool down and stretch after you exercise.
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Warm up
Exercise
Cool down
Walk slowly for 5–10 minutes.
Brisk walking, cycling or swimming for 30–45 minutes most days.
Walk slowly for 5–10 minutes, then stretch your muscles.
Stress management Stress can raise blood pressure sharply and may make your HBP level worse. We all feel stress in our lives at times. When you feel the tension rising, try one of these to ease the stress: • breathe slowly and deeply to relax • take a brisk walk • soak in a warm bath • watch a funny video • meditate or do a relaxation exercise
Not smoking Smoking is very bad for your heart and lungs. If you have HBP and are also a smoker, your risks for heart disease, lung disease and stroke are much higher. Smoking is even more dangerous for women who use oral contraceptives (birth control pills). So think about it, and try anything to quit smoking. Most hospitals have stop-smoking clinics to help you. Or, check the App Store or Google Play for anti-smoking aids to add to your phone or tablet. 13
Medicines If changes in eating habits and other lifestyle changes do not lower blood pressure enough, then medicine is needed. Most people need to stay on a blood pressure medicine for life. But some may only need to take pills for a while. It depends on how well the other parts of your treatment work. These are the kinds of drugs used most often to lower HBP: • Diuretics—water pills that help the body get rid of excess salt and fluid • ACE (Angiotensin Converting Enzyme) inhibitors— block the making of angiotensin, a body chemical that causes arteries to tighten • Angiotensin II receptor blockers—keep the body’s arteries from being too tight • Beta-blockers—slow down the heart rate; help keep the heart from beating too hard • Calcium antagonists (also called calcium channel blockers)—keep artery muscles from squeezing too tight • Vasodilators—relax artery muscles so they stay open more easily • Sympathetic nerve inhibitors—(such as alpha blockers and central/peripheral alpha-antagonists) keep the body’s arteries from being too tight • Combined alpha and beta blockers—help prevent the body’s arteries from being too tight; help keep the heart from beating too fast or too hard 14
If you need HBP medicine, ask your doctor or druggist how it works to help lower your blood pressure. Write the drug name here and what it does for you:
Always take your medicine just as your doctor tells you. If there are side effects from the drug, be sure to let your doctor know right away. He or she may need to change the dose or change to another drug. CAUTION: Never reduce the dose Be patient. Sometimes or stop taking your medicine unless your you may have to try doctor tells you to. This could 2 or 3 drugs before cause serious problems. finding the right one for you—one that lowers your blood pressure without unpleasant side effects.
Over-the-counter-drugs People with HBP should use over-the-counter drugs only as approved by their doctor or druggist. Some non-prescription drugs contain sodium or vasoconstrictors. Vasoconstrictors can raise blood pressure by causing blood vessels to narrow.
Check your BP regularly. Your doctor may suggest you buy a device to check your blood pressure at home.
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S
ome final words High blood pressure is called the “silent killer” because you may not have any symptoms while the damage is being done. Long-term HBP can lead to other diseases such as kidney failure, heart attack, heart failure or stroke. You now know what treatment of HBP includes. You and your doctor are partners in your treatment. Keep in touch with him or her to check your progress and know if your treatment needs to be changed. Learn to eat right, watch your weight, take medicines as prescribed, exercise regularly, manage your stress, don’t smoke and check your blood pressure regularly. These will increase your chances for a full, healthy life.
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otes
Pritchett & Hull Associates, Inc. bringing Patients & Health together since 1973 Limited list of topics include: • Cardiac cath • Stroke • Angioplasty • Diabetes • Heart surgery • Traumatic brain injury • Pacemaker • Brain surgery • Exercise • Kidney failure
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Write or call toll-free for a free catalog of all products and prices at 1-800-241-4925 or visit P&H online at www.p-h.com
pecial thanks to: W. Dallas Hall, MD Professor Emeritus Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA
e believe that you have the right to W know as much as you can about your
health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.
Pritchett & Hull Associates, Inc. 3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3006
1-800-241-4925 www.p-h.com
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