High Blood Pressure Preview of The Teaching Book

Handout Table of Contents

Hypertension About high blood pressure Possible problems

page #

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

People most at risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 High blood pressure and pregnancy Preeclampsia

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10.3-10.4

Signs and symptoms Saving energy Medicines

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10.1-10.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-13

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-14.1

Changes in bladder or bowel function Dehydration

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Water retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Steps toward prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 What you eat and drink

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18.1-24

The DASH food plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18.1-18.3 Sodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-20 Fats and cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Dietary fiber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21.1-21.2 Minerals in your food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21.3 Food labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-23 Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Body weight

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-25.2

Losing weight

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-26.1

Regular exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-28 No tobacco products Stress relief

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Learn to relax

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Deep breathing exerices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Fixed image exercies

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Muscle by muscle relaxation

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Follow-up care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Facts about taking your own blood pressure How to take your blood pressure

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36-37

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38-39

Keep these in mind when taking your blood pressure Blood pressure chart Resources

HBP G

. . . . . . . . . . . . . . . . . . . . . . . . . . . .40

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

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HBP

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Diagnosis: Hypertension Education Materials for:

Suggested Initial Visit • • • •

patient learning assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . introduction, 5-7 pain assessment and control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PN*, 3-29 outcome goals assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 advance directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AD*, 3-11

• • • • • • •

Visit 1 — Begin discharge instruction for patient, family and/or caregiver on: outcome goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6 disease characteristics (About high blood pressure) . . . . . . . . . . . . . . . . . . . . . . 7-8 pregnancy measures (if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.1-10.4 home safety measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PM*, 22-45 care team phone numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RK*, 3 safety outside the home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PM*, 46-47 infection control guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PC*, 3-4

Additional Suggested Education Visits Visit 2 — Continue teaching as in visit 1 adding: • • • • •

medicines & side effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 -14.1 and RK*, 51-52 bowel and bladder functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-17 how to measure and document weight . . . . . . . . . . . . . . . . 25 - 25.2 and RK*, 29 losing weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-26.1 and RK*, 19-26 dietary measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.1-24 and RK*, 9-13, 19-26 Visit 3 — Continue teaching as in visit 2 adding:

• people most at risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 • follow-up care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Visit 4 — Continue teaching as in visit 3 adding: • signs and symptoms of high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 • signs and symptoms of dehydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 • signs and symptoms of water retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Continued on next page. *KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

HBP G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

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1

Diagnosis: HTN

page 2

Visit 5 — Continue teaching as in visit 4 adding: • controllable risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-34 • how to reduce stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-34 Visit 6 — Continue teaching as in visit 5 adding: • intake and output . . . . . . . . . . . . . . . . . . . . . . . . . . 16-17 and AS*, 33-34 and RK*, 43 Visit 7 — Continue teaching as in visit 6 adding: • saving energy and body movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-13 • possible problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Visit 8 — Continue teaching as in visit 7 adding: • blood pressure monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36-40 A. taking your own blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36-37 B. how to take your blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38-39 C. device use and safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 • blood pressure chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 • resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

HBP G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

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2

Medical Record #:

HTN

Patient:

Outcome Goals Assessment

Teacher:

Learner(s):

Teacher:

Learner(s):

Teacher: signature(s)

signature(s)

Page #s

Goals

Met

Date

V

Explanation of Variance

initials

code

Patient, family and/or significant other will be able to: 1. Describe HTN

7-8

a. (during pregnancy)

(10.110.4)

2. Name the recommended treatments

12-15, 18-35

3. Describe how to make changes to prevent further damage

18-35

4. Identify proper safety measures for the home

PM*, 22-45

5. Use infection control guidelines

PC*, 3-4

6. Identify any pain, assess and rate it and name the recommended treatment methods to control pain

PN*, 3-29

7. Explain how and when to call the health care agency, hospital or doctor using the emergency phone numbers 8. Describe the medications: how much and when to take, any side effects and effects certain foods may have on how medicines work 9. Explain how bowel and bladder functions can be affected by HTN medicines

RK*, 3 1414.1 and

RK*, 51-52 15-17

10. Demonstrate how to measure and document weight

2525.2 RK*, 29

Continued on next page. *KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

HBP G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

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Medical Record #: Patient:

HTN Outcome Goals Assessment

page 2

Learner(s):

Teacher: Teacher:

Learner(s):

Teacher: signature(s)

signature(s)

Page #s

Goals

Met

Date

V

Explanation of Variance

initials

code

Patient, family and/or significant other will be able to: 18.1-24, 26-26.1 and RK*, 9-13, 19-26

11. Describe ways to modify diet to help control HTN

12. Name three risk factors of HTN

10, 18-34

13. Keep follow-up visits as directed

35

14. Name the signs and symptoms of HTN

11

15. Describe the signs and symptoms of dehydration and/or water retention

16-17

16. Utilize medicines, treatment and equipment as ordered by the doctor or nurse

12-15 18-35

17. Demonstrate ways to reduce stress

30-34

18. Demonstrate how to monitor fluid intake and output

16 -17, AS*, 33-34 and

RK*, 43 19. Explain how saving energy with proper movement can help keep blood pressure under control

12-13

20. Name the things that may make HTN worse and how to avoid them

18-34

21. Demonstrate how to use and care for a blood pressure monitoring device

36-41

22. Identify additional resources and sources of support

42

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

HBP G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

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HBP

Outcome Goals DATE BEGUN

DATE COMPLETED

You will be able to:

1. Explain what it means to have HBP (high blood pressure) 2. Understand your treatment plan 3. Know how to make changes to prevent further damage

4. Know safety measures for your home 5. Know how to take steps to keep from getting diseases or infections

6. Identify any pain you may have, understand how to explain it to others and know how to control it

7. Know how and when to call the health care agency, hospital or doctor using the emergency phone numbers

8. Understand your medicines—how much and when to take, any side effects and effects certain foods may have on how your medicines work

9. Know how your bladder and bowel functions can be affected by HBP medicines

10. Measure and document your weight 11. Change your diet to help control HBP 12. Name three risk factors of HBP

13. Agree to see your doctor for follow-up visits as needed Continued on next page.

HBP ✔

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outcome goals DATE BEGUN

page 2

DATE COMPLETED

14. State the signs and symptoms of HBP 15. List the signs and symptoms of dehydration and water retention

16. Take medicines and treatments and use equipment as ordered by your doctor or nurse (wear a medical alert bracelet for high blood pressure)

17. State how to reduce stress 18. Keep track of the fluids going in and out of your body

19. State how saving energy with proper movement can help keep your blood pressure under control

20. List the things that may make your HBP worse and how to avoid them

21. Use and care for your blood pressure monitoring device

22. State how to find other resources and sources of support

HBP 7

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About high blood pressure Blood pressure (BP) is the force that blood moving through the arteries puts on the artery walls. When the pressure is too high, it can damage the artery walls and reduce blood flow to body tissues. This is called high blood pressure (HBP) or hypertension (HTN).

HBP is sneaky. You can have it and not know it.

That’s why it is called “the silent killer.” Most of the time, HBP can’t be cured. But it can be controlled with the right treatment.

Normal blood pressure As the heart pumps blood, the pressure on the artery walls is at its highest. This peak pressure is called the systolic pressure.

Between heartbeats, the arteries are more relaxed as the blood flows to all parts of the body.

This relaxed pressure is called the diastolic pressure.

Blood pressure is recorded with a set of 2 numbers such as 130/85 (130 over 85). The top number (130) is the systolic pressure, and the bottom number (85) is the diastolic pressure. The top number is always the highest.

peak pressure (systolic)

diastolic pressure

Your doctor or nurse will tell you in what range your blood pressure should be. Ask your nurse for a chart to keep track of your blood pressure.*

Continued on next page.

HBP ✔

* p. 41

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HBP

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about high blood pressure

page 2

Types and causes of high blood pressure Most people with chronic HBP have what is called primary or essential hypertension. Though this type of high blood pressure tends to “run in the family,” most of the time the cause is not known.

Sometimes high blood pressure can be caused by a medical problem such as kidney disease. This type of high blood pressure 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, alcohol, cocaine, nicotine.)

Continued on next page.

HBP ✒

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about high blood pressure

page 3

When blood pressure is high You have high blood pressure if 3 or more blood pressure checks in a row show a top number of 140 or higher and a bottom number higher than 90. This is how blood pressure is rated: Rate

Normal*

Systolic

Diastolic

(top number)

(bottom number)

less than 120

and

less than 80

Pre Hypertension

120–139

or

80–89

Stage 1 Hypertension

140–159

or

90–99

Stage 2 Hypertension

160 or more

or

100 or more

* Very low blood pressure readings (less than 90 systolic, less than 60 diastolic) should be checked by your doctor.

If you have diabetes, your levels are different.

They are: Rate

Normal*

HBP ✔

Systolic

Diastolic

(top number)

(bottom number)

less than 130

and

less than 80

Pre Hypertension

130–139

and

80–89

Stage 1 Hypertension

140–159

or

90–99

Stage 2 Hypertension

160 or more

or

100 or more

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8.1

Possible problems In the early stages, HBP may cause few problems. But over the years, uncontrolled high blood pressure begins to damage the heart, blood vessels, brain, eyes and kidneys. Without treatment, the risks are: • heart failure • heart attack • stroke • kidney failure • reduced eyesight • hypertensive crisis (sharp rise in blood pressure to greater than 200/120, causing severe headache and/or vomiting)

HBP ✒

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People most at risk • African Americans are about twice as likely to have high blood pressure (HBP) as whites.

• Children of parents with HBP are 6 times as likely to have HBP if both parents have it. If one parent has it, the child is 4 times as likely to have it, too. HBP often shows up earlier in these children, sometimes even in the teens.

• Overweight people have high blood pressure more often than people who are at a healthy body weight.

• Men are somewhat more likely than women to have HBP before age 45. But after 45, women and men have about the same chance of having it.

HBP

HBP HBP HBP

HBP 5

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10

High blood pressure and pregnancy If you have high blood pressure and are pregnant, or planning on getting pregnant, it is important that you work with your doctor or nurse. Having high blood pressure during pregnancy can cause some complications.

Your doctor or nurse can plan a treatment just for you.

Some women develop high blood pressure during their pregnancy. This is called gestational hypertension. Most of the time, it goes away after you give birth, but it increases your risk for developing high blood pressure later on.

Complications High blood pressure can affect both you and your baby.

Your kidneys, or other organs, can be damaged, and your baby may be born prematurely or have a low birth weight.

In severe cases, high blood pressure can cause preeclampsia.

If this is not treated, it can be life-threatening for you and your baby.

It could be that you don’t experience any complications.

In fact, most pregnant women with high blood pressure give birth without any problems. You and your baby have the best chance for staying healthy when you continue with regular follow-up appointments with your doctor.

Continued on next page.

HBP ✒

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10.1

high blood pressure and pregnancy

page 2

Controlling your blood pressure There are things you can do before and during your pregnancy to keep your blood pressure under control. Make healthy lifestyle choices about: • eating and drinking • exercising regularly • keeping your weight within a healthy range • not smoking • taking blood pressure medicine, if you need to

Be sure to talk to your doctor about any overthe-counter or prescription drugs you are taking.

You may need to stop taking them or change your dose because of your pregnancy. Always ask your doctor before taking any new medicine.

HBP ✒

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10.2

Preeclampsia Preeclampsia (pre-e-klamp-se-uh) is a condition that happens when you have high blood pressure (above 140/90) and a lot of protein in your urine. This may be a sign of kidney disease. It usually does not start until you have been pregnant for at least 20 weeks.

What it means Preeclampsia can affect you and your baby. Your kidneys, liver or brain can be damaged. (Sometimes, preeclampsia leads to eclampsia.

When this happens, seizures occur.

If not treated, these can cause a coma, brain damage or even death when left untreated.) Also, your placenta may not get enough blood. This keeps your baby from getting all the oxygen and nutrients it needs to be healthy. Your baby may be born prematurely, have a low birth weight or be stillborn (dead at birth).

You and your baby have the best chance for staying healthy when preeclampsia is found and treated early.

It is usually detected through blood pressure checks and urine tests during regular visits with your doctor or nurse.

It is important that you keep all appointments with your doctor. That way he or she can closely monitor you and your baby and adjust any treatment(s) as needed.

Your doctor or nurse may tell you that bed rest or medicine is the best treatment for you, during your pregnancy. Or, he or she may decide to give you drugs to treat your high blood pressure during your pregnancy. Your blood pressure usually returns to normal a short time after delivery.

Continued on next page.

HBP ✒

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10.3

preeclampsia

page 2

Symptoms If you have one or more of these symptoms, tell your doctor or nurse: • trouble seeing—blurry vision, short-term loss of vision or being sensitive to light • severe or constant headaches

Call your doctor right away, if any of these symptoms become severe!

• unusual anxiety • dizziness

• sudden swelling of face, hands, ankles or feet • producing less urine than normal • pain in the upper part of the abdominals (stomach muscles), most likely under the ribs on your right side

Risk factors Certain conditions make you more likely to develop preeclampsia than others, including: • having high blood pressure before pregnancy • having high blood pressure or preeclampsia in an earlier pregnancy • having a family member (mother, sister, aunt) who had preeclampsia • being obese before pregnancy • being pregnant at an age younger than 20 or older than 40 • having a pregnancy with more than one baby • having diabetes, kidney disease, rheumatoid arthritis, lupus or scleroderma

HBP ✔

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10.4

Signs & symptoms The signs and symptoms of HBP can be: • headaches

• confusion

• feeling dizzy

• difficulty breathing

• weak feeling in arms or legs

• nosebleeds

• becoming more and more tired

• blurred vision • palpitations

You may not have any symptoms. This is why high blood pressure is sometimes called “the silent killer.”

Your blood pressure can change from one minute to the next when you: • exercise • become tense • change your position (for instance, sitting to standing) • have pain • sleep

HBP ✔

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11

Saving energy Saving your energy can help keep your blood pressure under control. Using your energy wisely can help you stay healthy. It also keeps you from getting tired easily and lets you do more tasks throughout the day.

Here are some tips to make tasks easier and use less energy: • Relax. Spread your activities throughout the day, and do them at your own pace.

• Plan ahead. Do the things that take more energy when you are at “your best” during the day.

• Let people help you. Give some tasks to family and friends.

• Rest in between activities.

• Work slowly, and don’t feel bad about not finishing a task. Finish it when you don’t feel tired.

• Do not lift heavy objects (more than 5-10 lbs). Use a rolling table to move objects from one place to another.

Continued on next page.

HBP

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12

saving energy

a page 2

• Work at a height that is easy to reach so you don’t have to bend or stretch to reach things.

• Get plenty of sleep. Avoid caffeine and any noise or light in your room.

Also:

• Try not to bend over quickly.

• Get up slowly from bed. Go from lying to sitting to standing.

• Keep things you use often close by. Set up a kitchen workspace so you don’t have to reach or bend over to get what you need.

HBP

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13

Medicines Your doctor has prescribed medicine to help you lower your blood pressure. Many people stay on a blood pressure medicine for life. Others only take pills for a while. It depends on how well the other parts of your treatment work.

Your nurse will tell you about your medicines. Ask him or her for a chart to keep track of them.▲ Read the label on any over-the-counter medicine before you buy it. Many contain a lot of sodium. Avoid high sodium antacids and over-the-counter cold and sinus medicines.

Ask your doctor, pharmacist or nurse which over-the-counter medicines you can take.

Ask your doctor, nurse or pharmacist before taking any other drugs.

If any of your medicines don’t seem to be working, let your doctor or nurse know.

Never double up on your dose of high blood pressure medicine if you skip a dose. Call your doctor or nurse and let him or her know.

Continued on next page.

HBP ✔

▲ RK, 51-52

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14

Medicines

page 2

Side effects Some high blood pressure medicines cause side effects like: • weakness • headaches • feeling tired • dry cough • weight loss • depression • dry mouth • chest pain • nausea/vomiting • swelling • dehydration(loss of water from the body) • slow pulse (less than 50-60 beats per minute) • changes in bladder and bowel function You may or may not have any side effects from your medicine. If you do, tell your doctor or nurse about them. If they are bad, your medicine may need to be adjusted, changed or stopped.

HBP ✔

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14.1

HBP

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Changes in bladder or bowel function Some medicines may cause: • frequent urination • blood in your urine • change in urine color • diarrhea • constipation (straining to have a bowel movement) Straining may raise your blood pressure.

Ask your nurse to list any other side effects you may have from your medicine(s):

Medicine

HBP

Possible Side Effects

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15

HBP

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Dehydration You can get dehydrated (when your body does not have enough water) from limiting your fluids or from some medicines. You may be dehydrated if you: • are thirsty often

• have dark urine

• have dry, cracked lips

• have a headache

• have dry skin

• are dizzy or lightheaded

• urinate less often

If you think you are dehydrated, call your doctor or nurse.

Your nurse will give you a chart to keep track of the fluids going in and out of your body.▲ This will help your nurse know if you are getting enough fluids.

HBP ✔

▲ RK, 43 and AS, 33-34

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16

Water retention This is when kidneys hold salt and water in the body.

When your body retains water, you may: • have swelling in your legs and ankles • urinate less often • have soreness or swelling in the upper right part of your body • gain weight fast (more than 3 pounds in one or two days) If this happens, call your doctor or nurse.

Your nurse will give you a chart to keep track of your weight.▲ Check your weight every day. Try to weigh yourself: • at the same time every day (in the morning if you can) • on the same scale • without clothes or with light clothes Your nurse will also give you a chart to keep track of the fluids going in and out of your body.■ This will help your nurse know if you are retaining water.

HBP 8

▲ RK, 29

■ RK, 43 and AS, 33-34

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17

Steps toward prevention There are some things you can do to control your high blood pressure and prevent complications. You can make good choices about: • what you eat and drink • body weight • regular exercise • not smoking or using other tobacco products • stress relief

HBP 5

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18

What you eat and drink Making good choices about what you eat and drink will help you control your high blood pressure. Follow the “DASH” food plan. It has foods, drinks and seasonings that are: • low in sodium, fat and cholesterol • high in fiber, potassium, calcium and magnesium • moderately high in protein

The DASH food plan This plan comes from the Dietary Approaches to Stop Hypertension (DASH) clinical study. Following this balanced diet has been proven to lower blood pressure.

Food groups On the DASH plan, you choose what to eat from the eight food groups. Each group is an important part of this healthy, balanced food plan.

You can choose any food you want from each group.

If you don’t like a food choice, choose another food from the same group. Having a good mix from all the food groups gives you the healthy balance you need.

How much and how often In the DASH food plan, the Daily Servings tell you how many servings you should eat from each group. The Serving Size tells you how much of each kind of food makes a serving.

The daily servings listed are for a person who needs 2,000 calories a day. You may need more or less than this.

Ask your doctor if 2,000 calories is right for you. Your nurse can give you a plan based on what you need each day.▲

Continued on next page.

HBP 8

▲ RK, 19-26

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18.1

what you eat and drink

page 2

The DASH Food Plan Daily Food Group Servings

Serving Size

Sample Foods

Notes

1 slice bread 1 oz dry cereal 1/2 cup cooked rice, pasta or cereal

whole wheat bread, English muffin, pita bread, bagel, cereals, grits, oatmeal, crackers, unsalted pretzels and popcorn

major source of energy & fiber

1 cup raw, leafy vegetable

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

Low-fat or nonfat dairy foods

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

Meats, poultry & fish

no more than 2

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

Nuts, seeds & dry beans

4–5 a week

11/2 oz or 1/3 cup nuts 1/2 oz or 2 Tbsp seeds

almonds, filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils

rich sources of energy, magnesium, potassium, protein, fiber

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

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

Grains & grain products

7–8

Vegetables 4–5

Fruits

Fats & oils

2–3

Sweets 5 a week

1/2 cup cooked vegetable

6 oz vegetable juice

1/2 cup cooked dry beans

Ask your nurse to give you a meal plan to get you started on the DASH food plan.▲ Continued on next page.

HBP 8

▲ RK, 19-26

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18.2

what you eat and drink

page 3

Foods to watch out for Watch out for fat, cholesterol and sodium. Here are some foods to avoid, or to use lightly: • salad dressings, mayonnaise • fatty meat • whole milk and whole milk products, including sour cream, butter and cheese • soy sauce • canned food • frozen dinners

Substitutes For foods that can be bad for your blood pressure, there are healthy, good-tasting substitutes. Give them a try.

• fat-free or low-fat salad dressings and mayonnaise If you wish to use a salt substitute, ask your doctor or nurse first.

• unsalted, fat-free popcorn • fat-free or low fat ice cream and other desserts • low-sodium sauces • low-fat types of butter, sour cream, cream cheese and mayonnaise • low-salt cold cuts and cheeses • fresh or frozen fruits and vegetables

Continued on next page.

HBP ✔

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18.3

Sodium Sodium is an important mineral. It helps your body balance the level of fluids inside and outside the cells.

To keep up this balance, your body needs little more than 200 mg (milligrams) of sodium a day. Yet most of us eat 3,000 to 6,000 mg each day—more than enough for a whole week. Your doctor may want you to limit your sodium. So, ask your doctor or nurse how much sodium is right for you.

The most common source of sodium is table salt. We can’t prove that too much salt in the diet causes high blood pressure, but we can tell you that in countries where a lot of salt is eaten, blood pressures are the highest. A good way to begin cutting down on your sodium is to stop salting your food.

One level teaspoon of salt has about 2,300 mg of sodium.

Most of the sodium we eat has been added to food before we buy it. Canned or pre-packaged foods often have sodium in them—sometimes a lot. Make sure you’re not eating too much of this “hidden” salt. Read the labels on the foods you buy to see how much sodium they contain.

Continued on next page.

HBP ✒

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19

sodium

page 2

How to fix low-sodium foods: • Season foods with fresh or dried herbs, vegetables, fruits or no-salt seasonings.

• Do not cook with salt or add salt to foods after they are on 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® Wild Rice: 570 mg of sodium

1 cup

1⁄2

cup of cooked, white 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.

• Try using lemon juice instead of salt. This works pretty well for some foods even though lemon juice tastes nothing like salt. Start by using just a bit, and then add to taste. *Sodium contents of foods from USDA Handbook #456.

HBP ✒

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20

Fats & cholesterol Though fats and cholesterol don’t raise blood pressure directly, 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 animal 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 goals, low-fat, 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. It may be OK to cook poultry with the skin on, but remove the skin before eating the poultry.

• 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 (canola, olive, peanut, safflower, sunflower, corn, cottonseed, soybean, sesame). Make salad dressings with small amounts of one of these vegetable oils.

HBP ✒

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21

Dietary fiber You get fiber from plant foods (like fruits and vegetables). There is no fiber in foods that come from animals. There are 2 basic kinds of fiber — soluble and insoluble. Most plant foods contain some of both kinds. But there are some foods that contain more of one than the other. Both kinds of fiber are good for you.

Soluble fiber Soluble fiber helps in lowering your blood cholesterol levels. And lower cholesterol levels help to reduce your risk for heart disease. If you have diabetes, soluble fiber can help to control your blood glucose levels, too.

Soluble fiber is found mostly in: • • • • • • •

HBP ✒

vegetables fruits beans barley brown rice oats oat bran

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21.1

Insoluble fiber Insoluble fiber helps prevent constipation (if you drink enough fluids during the day too). It does this by adding “bulk” to your stool. This may help to prevent colon cancer, since it shortens the amount of time waste stays in your body.

Insoluble fiber is found mostly in: • wheat • wheat bran • other whole grains

HBP ✔

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21.2

Minerals in your food Minerals are found in the earth’s crust. Plants get minerals from the soil. Animals get minerals from eating plants and drinking water that runs off the earth’s crust. So foods that come from both plants and animals contain minerals.

Your body needs more of some minerals than others.

These are called bulk minerals. Those that are needed in smaller quantities are called trace minerals. No matter whether bulk or trace, your body must have minerals to be healthy.

Bulk minerals Bulk minerals include: • Calcium - helps control muscle contractions (tightening). Because of this, it helps control your heartbeat.

• Magnesium - is needed to relax muscles after they contract. This helps control your heart’s rhythm.

• Sodium - determines the fluid balance in your body. If your body gets more sodium, it must also keep more water to maintain the proper balance. A high sodium diet may lead to high blood pressure.

• Potassium - helps to regulate your blood pressure. This helps reduce your risk for stroke or heart disease.

• Phosphorus - helps maintain the pH balance of your blood. It is required for the proper flow of energy in your body.

HBP ✒

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21.3

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 or less of sodium per serving on the label. This list will help you to read sodium labels:

This phrase

means

• sodium free

5 mg of sodium or less in a serving

• very low sodium

35 mg or less in a serving

• low sodium

140 mg or less in a serving

• low sodium meal

140 mg or less of sodium per 31⁄2 oz (100 g)

• reduced sodium

1 serving has no more than 75% of the sodium in the regular product (this can still be high in sodium)

• light in sodium

50% less sodium than the regular version

• no salt added, unsalted, without added salt

no salt added during processing -only used for foods that usually have salt added (these can still be high in sodium)

Some other helpful terms for you to know: • low-fat

3 g of fat or less/serving

• low-saturated fat

1 g saturated fat or less/serving

• low-cholesterol

less than 20 mg/serving

• low-calorie

40 calories or less/serving

Continued on next page.

HBP ✔

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22

food labels

page 2

Reading food labels Most food products have nutrition facts on their labels.

You can use these facts to choose foods that have less fats, cholesterol and sodium. Some labels list the daily values for a diet of 2,000 and 2,500 calories. Your own calorie needs may be more or less than this. Ask your nurse or dietitian what they are. Also, ask him or her any questions you have about a diet that’s right for you and how to get started Serving Size Serving sizes are what all the other numbers in the label are based on. If you are on a special diet for your blood pressure, compare the serving sizes on the labels and in your food plan. Sometimes they may be different.

2% REDUCED FAT MILK Serving Size 1 cup (236ml) Servings Per Container 1 Amount Per Serving Calories 120

Calories from Fat 45

% Daily Value* Total Fat 5g

Daily Value Footnote Daily Values are set by the government and are based on current nutrition suggestions for a general, wellbalanced diet. For people with high blood pressure, some daily values may be different.

If you follow the DASH plan, you will want your daily cholesterol intake at 150mg, instead of 300mg.

Ask your nurse or dietitian about other differences in your daily values.

HBP ✒

8% 15%

Saturated Fat 3g Trans Fat 0g Cholesterol 20 mg

7%

Sodium 120 mg

5%

Total Carbohydrate 11g

4% 0%

Dietary Fiber 0g Sugars 11g Protein 9g Vitamin A

10%

•

Vitamin C

4%

Calcium

30%

•

Vitamin D

25%

Calories are for 1 serving

% Daily Value (based on 2,000 calories) shows how much of the different nutrients are in a serving Example: 2,300mg = total sodium for one day 120mg = sodium in 1 serving of this food (or 5% of the total sodium you can eat in one day)

* Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:

Products that are too small for the nutrition label should have a phone number that you can call to get this information.

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23

Alcohol Drinking too much alcohol can raise blood pressure. It can also weaken the heart and harm the liver and pancreas. For most people, it’s OK to have a drink now and then. But if you don’t drink, it’s best not to start.

One serving of alcohol is: • 1 1⁄ 2 oz of 80 proof whiskey or 1 oz of 100 proof or • 5 oz of wine or • 12 oz of beer The Dietary Guidelines for Americans suggests that for overall health, women should limit their alcohol to no more than one drink a day. Men should have no more than two drinks a day.

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.

70 to 180

calories

HBP ✒

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24

Body weight Your healthy body weight range is determined by your height and body frame. Use this chart to find your healthy weight range.

National Height/Weight Guidelines Height*

Healthy Weight

in pounds † BMI ∆ of 19–25

4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4" 6'5" 6'6"

91–118 94–123 97–127 101–131 104–136 107–140 111–145 114–149 118–154 121–159 125–163 129–168 132–173 136–178 140–183 144–188 148–194 152–199 156–204 160–210 164–215

*without shoes †without clothes

Moderate Overweight

Severe Overweight

in pounds † BMI ∆ of 25–29

in pounds † BMI ∆ of 29 or over

119–137 124–143 128–147 132–152 137–157 141–162 146–168 150–173 155–178 160–184 164–189 169–195 174–201 179–206 184–212 189–218 195–224 200–231 205–237 211–243 216–249

138 or over 144 or over 148 or over 153 or over 158 or over 163 or over 169 or over 174 or over 179 or over 185 or over 190 or over 196 or over 202 or over 207 or over 213 or over 219 or over 225 or over 232 or over 238 or over 244 or over 250 or over

∆

BMI stands for body mass index

Adapted from Dietary Guidelines for Americans, fourth edition, 1995, U.S. Department of Agriculture and U.S. Department of Health and Human Services.

Continued on next page.

HBP ✒

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body weight

page 2

BMI is a good indicator of total body fat, which is related to the risk of disease and death. The score is valid for both men and women but it does have some limits.

The limits are: • It may overestimate body fat in athletes and others who have a muscular build.

• It may underestimate body fat in older persons and others who have lost muscle mass.

Continued on next page.

HBP ✒

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25.1

body weight

page 3

If you are 10% or more over your healthy body weight, it is much harder to control your blood pressure. Extra weight makes your heart have to work harder. Your nurse will give you a chart to keep track of your body weight.▲ Try to weigh yourself: • at the same time each day • on the same scale • without clothes or with few clothes If you are over your healthy weight, your doctor or nurse may want you to lose weight. Talk with him or her about this.

HBP ✒

▲ RK, 29

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25.2

Losing weight Your nurse or a dietitian can help you set up a healthy weight loss program. Here are some tips: • Lose weight gradually. Fast weight loss and fad diets are very unhealthy. Unless your doctor or nurse says it’s OK, you should lose no more than 1 to 2 pounds a week.

• Choose items from each of the food groups to make sure you are eating a well-balanced diet and getting all the different nutrients you need.

• Read food labels and choose foods that are lower in fat and calories.

• Ask your nurse to help you adjust the number of daily servings you eat from each of the food groups. Your nurse can also give you a meal plan ▲ to help with this.

• Find a good cookbook that contains healthy, tasty, low-salt recipes.

• Exercise more, if your doctor says it’s OK. Regular exercise helps you lose weight and makes it easier to keep extra weight off.

There is no magic formula for losing weight. But if you change your eating habits, you can lose weight and keep it off for life.

Talk with your doctor, nurse or dietitian before starting any diet.

Continued on next page.

HBP G

▲ RK, 19-26

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26

losing weight

page 2

Here are some healthy tips to keep in mind when you are trying to lose weight: • Limit smoked or pickled foods. These tend to have a lot of salt in them.

• Eat small portions.

To lose weight, reduce the size of the portions you would usually take.

Cut them down slowly so you won’t notice any difference.

• Keep low-calorie snacks on hand, such as: – carrot and celery sticks – apple slices – rice cakes – low-fat frozen treats – low fat gelatin – low-fat cottage cheese – air-popped popcorn – fresh broccoli or cauliflower pieces • Avoid sweetened drinks, such as lemonade, sweet tea and soft drinks.

• Choose low-fat, or no-fat dairy products instead of regular.

• Reduce the amount of saturated fat in your diet. Eat no more than 30% in fat for all the calories you eat each day. Avoid all trans-fats.

• Eat more fruits and vegetables and whole grains.

These will help you feel full so you may eat less.

HBP G

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26.1

Regular exercise Regular exercise can do many things for you. It can: • help lower blood pressure • help you lose weight and keep it off • relieve stress • improve your self-image • reduce your risk of having a heart attack You don’t have to do hard exercise to begin benefitting from physical activity. Many activities (such as walking), if done for about 30 minutes most days, can help. Or you can do more. It depends on what you like to do and if you are training for a high level of fitness. The point is to get moving in some way and to keep at it.

Check with your doctor before starting any exercise program.

The most important exercise for your heart is aerobic exercise. Walking, jogging, running, swimming, dancing and cycling are aerobic. With aerobic exercises your body uses more oxygen and your heart rate increases.

Warming up before exercise and stretching and cooling down afterwards are a part of any good exercise.

Continued on next page.

HBP ✒

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27

regular exercise

page 2

To help you get moving, do these: • First see your doctor. Find out how much exercise is safe for you and how long you should exercise.

Get advice on your exercise choices. Your doctor may refer you to a physical therapist.

• Start with stretching exercises. Your doctor or physical therapist can suggest some. Or have someone help you with passive exercises. These are exercises done by having someone else move your arms and legs for you.

• Do something you enjoy. You probably won’t keep doing an exercise if you don’t like it. Pick more than one kind of exercise so you don’t get bored.

• Get a friend to work out with you if you don’t like exercising alone.

• If you are able to, add more exercise each day in these ways: - Walk to the mailbox.

- Walk back and forth through your house, or walk around it.

- Do more housework and yardwork.

HBP °°°

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28

No tobacco products If you don’t already know what smoking and other uses of tobacco products can do to your health, here are some of the risks that tobacco users face: • heart disease, heart attack and stroke • lung disease and lung cancer • fatty buildup in the arteries • poor blood flow Smoking does not cause HBP, but it does increase the risk of heart and coronary artery disease. Smoking narrows and injures artery walls and speeds up hardening of the arteries.

If you smoke, do your heart a favor and quit. It may take more than one try, but don’t give up. Most towns now have stop-smoking clinics to help you. Your hospital is a good place to call about such a group.

Second-hand smoke is also bad for you. Avoid smoke-filled places. Ask others not to smoke around you.

HBP 5

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Stress relief Stress can raise blood pressure sharply and may add to the cause of high blood pressure. We all feel stress in our lives at times. When you feel the tension rising, try one of these to ease the stress: • Get away from whatever is causing the stress.

• Breathe slowly and deeply to relax.

• Have a massage.

• Take a brisk walk.

• Soak in a warm bath.

• Watch a funny video.

• Talk to a friend.

• Meditate or do a relaxation exercise. Ask your nurse for information about these.

• Mow the lawn, weed the flower beds or plant new flowers.

• Walk the dog.

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Learn to relax There are ways to relax and take a break from the stress in your life. Before you try to relax: 1. Find a quiet place where you will not be bothered.

2. Get comfortable.

Sit or lie so your muscles can relax.

Then do some relaxation exercises. Try one or all of these to help you learn to relax and manage your stress: • deep breathing • fixed images • muscle tightening/relaxing

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Deep breathing exercises This gets more oxygen into your lungs and helps your muscles relax. To do this exercise: • Sit up straight or stand.

• Let your hands lie comfortably by your side.

• Take a long, deep breath through your nose, and hold it for a moment.

• Purse your lips (like you’re going to whistle) to control your speed.

Then breathe out slowly through your mouth.

Repeat this 10 times or until you are relaxed. Try to make each time you breathe in or out last 5 to 10 seconds.

Shortness of breath can be a sign that you are under stress. Use this technique to change that pattern. It will slow down your breathing and help you relax all over.

You can get some relief from this technique even though you may not be comfortable and in a quiet place. Try it when your house is full of people and noise.

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Fixed image exercises • Create a quiet, peaceful scene in your mind.

Pretend you are at the ocean, in the mountains or any place that is special for you. Use pictures or music if it helps. Block out all other thoughts except for this one calm image.

• Focus on your quiet scene for 5 to 10 minutes.

Don’t let yourself get distracted.

• Breathe deeply. Let your body relax as your mind takes you to this peaceful place.

Your worries and problems will seem to just slip away.

Your muscles will relax, and you can handle the things that were causing you to be stressed.

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Muscle by muscle relaxing • Clench (tense) your fists as hard as you can and hold them clenched for 5 to 10 seconds.

• Then relax them. Notice the feelings when they are clenched and as the tension leaves your hands.

• Repeat this 5 times. Concentrate on feeling the tension leaving your hands.

Now repeat this tense-and-relax action for these muscle groups until you get that same relaxed feeling: • head, neck and jaw • shoulders and back • arms, hands and feet • stomach muscles • buttocks and legs • feet and toes If you get distracted, go back a few steps and try again. You may need to try this exercise a few times before you can finish.

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Follow-up care

a

a You now know what treatment of high blood pressure includes: • eating right

• keeping a healthy weight

• taking medicines exactly as your doctor or nurse tells you

Blood pressure chart

Date

Time

Pressure Systolic Pressure Diastolic (bottom number) (top number)

Comments

• exercising on a regular basis • not smoking or using other tobacco products • controlling stress

As you bring your blood pressure down, you must stay in touch with your doctor and/or nurse. You are partners.

Your doctor and/or nurse need to know your progress so he or she can change your treatment when needed.

Ask your nurse for a blood pressure chart.* Take your blood pressure often, and keep a record to take to your doctor.

Ask questions about your treatment and condition.

Write your questions and the answers you get here:

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* p. 41

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Facts about taking your own blood pressure When taking your blood pressure (BP) at home, you should know that: • BP is often much lower when you are asleep.

It goes up as soon as you wake up and become more active.

• Talking, walking or eating can make BP go up.

• Sudden stress or pain can cause BP to rise in a few seconds.

• Exercising hard or getting excited can raise BP. • BP increases when you are uneasy or fearful (like when you go to the doctor).

Smoking and drinking caffeine within 30 minutes of taking your blood pressure can affect your readings. Take your blood pressure at about the same time each day and in the same surroundings. Do not take your BP after an activity. Sit and rest with your back supported and your feet flat on the floor for 5-10 minutes before taking it.

Go to the bathroom before you take your blood pressure. A full bladder can change your BP reading.

Continued on next page.

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taking your own blood pressure

page 2

The most popular type of device today is a digital blood pressure device.

Your blood pressure is easy to read as the numbers flash on a small screen. Some BP machines also have a paper printout that gives you your blood pressure reading.

Important tips on digital blood pressure devices: 1. Check your digital BP device with your doctor or nurse to make sure it is accurate.

2. All digital BP equipment comes with instructions.

Read them carefully before starting to take your blood pressure.

3. Store the BP device at room temperature.

Extreme heat or cold can cause it to give wrong readings.

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How to take your blood pressure Read through these steps one or more times before starting.

1. Sit in a quiet place near a table where you can place your arm and equipment comfortably.

2. Wrap the blood pressure cuff around your bare arm (not over your clothes) an inch above the elbow.

Make sure the tubing is on the inside of your elbow.

The cuff should fit snugly but with enough room so that one finger can be slipped under the cuff. Wrap the cuff evenly. cuff

cuff 1 inch above elbow

snug, but room for a finger under cuff

3. Rest your elbow and lower arm on a flat surface so that the upper arm is level with the heart. Stay still.

upper arm level with heart

Continued on next page.

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how to take your blood pressure

page 2

4. Turn the power on.

5. Squeeze the rubber bulb and inflate the cuff.* Inflate the cuff about 30–40 mmHg above the estimated systolic pressure. (This is the level of blood pressure that causes the radial pulse to disappear when the cuff is pumped up.) If you don’t know your estimated systolic pressure, ask your doctor or nurse. cuff radial pulse

read blood pressure numbers here rubber bulb

6. After you stop inflating, the automatic exhaust mechanism will slowly reduce the cuff pressure.

The machine will display your systolic and diastolic pressures on the screen.

7. Press the exhaust button to release all of the air from the cuff.

8. Record your blood pressure numbers.

exhaust button

rubber bulb

9. Turn power off. * Many cuffs don’t have a rubber bulb and inflate by themselves with the push of a button.

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Keep these in mind when taking your blood pressure • Taking your blood pressure over clothes or rolling a shirt or jacket up over the upper arm, can cause false or high readings.

• Many machines offer only one cuff size.

But cuffs must be large enough to get a true reading. Measure the distance around the middle of your upper arm.

If it is more than about 13 inches, you will most likely need a large rather than a standard size cuff. Ask your nurse where to get a large cuff.

• The height at which your arm is resting can affect the blood pressure reading. Keep the arm with the blood pressure cuff at about heart level. Do this by propping the arm up on a table, sofa edge, etc.

• Your blood pressure equipment should be stored with care. Before storing, remove the batteries, and make sure tubing is not twisted. Store your equipment away from heat and dust. Check rubber tubing for cracks or leaks.

• Have your blood pressure device checked to be sure it is accurate. Do this when you buy it and at least once a year after that. You can check it at your doctor’s office or at a nearby fire station that provides this service.

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Blood pressure chart

Date

Time

Systolic Pressure Diastolic Pressure (top number) (bottom number)

Comments

Based on the kind of medicine you take, your doctor might make changes to your diet. Be sure to follow them.

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Resources American Heart Association

(800)AHA-USA1 (242-8721)

National Center 7272 Greenville Avenue Dallas, TX 75231 www.americanheart.org

National Heart, Lung and Blood Institute

(301) 592-8573

Information Center PO Box 30105 Bethesda, MD 20824-0105 www.nhlbi.nih.gov

American Medical Association

(800) 621-8335

515 North State Street Chicago, IL 60610 www.ama-assn.org

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