What is Hypertension
How is Hypertension Diagnosed?
Based on 3 high blood pressure readings taken on separate occasions.
Systolic 130 or more
OR
Diastolic 80 or more
What is the impact of High Blood Pressure?
Can lead to multi-systems harms
Complications include stroke, heart attack, heart failure, vision loss, kidney disease, sexual dysfunction
Use the water hose metaphor to explain blood pressure.
Water hose Metaphor: the tap is the heart controlling rate, pressure and flow of water going through the hose, if the hose is stiff the tab or heart has to pump harder to allow the flow. The hose is like the blood vessels, over time the hose gets wear and tear and becomes stiff and less flexible which makes it more prone to damage. The water coming out of the hose is like the blood in the vessels, the flow and pressure is critical for proper functioning
What does the DASH acronym stand for and what is it used for?
Dietary Approach to Stop Hypertension
The DASH diet is an eating plan to help manage BP, it is a balanced diet that is flexible and requires no special foods.
What is the daily recommendation of sodium (mg)? What is the recommendation for someone with uncontrolled BP?
Sodium should be limited to 2300mg/day, and if they have uncontrolled BP, they should limit the sodium intake to 1500mg/day.
Explain the difference between Systolic and Diastolic
Systolic blood pressure is the force on artery walls when heart beats. Top number
Diastolic blood pressure is the force on artery walls when heart muscle rests between beats. Bottom number
Other than blood pressure what else should be managed in a person that has hypertension to reduce their risk of heart disease and stroke.
Cholesterol
Weight
And applicable their Diabetes
What are 5 most common medication classes used to treat high blood pressure?
Beta Blocker
ACE Inhibitors
ARBs
Calcium Channel Blockers
Diuretics
What alternatives could your patient use to season their food other than salt?
Alternative choices include: herbs, spices such as onion and garlic powder, red and black pepper, oregano, dill, basil, cilantro, cinnamon, spices and dressings by Mrs DASH.
What is Sodium and how does it relate to blood pressure?
Sodium is basically salt which is a mineral that can cause high BP.
Explain what you know about high blood pressure symptoms
Most times Hypertension has no obvious symptoms that will give you an indication that something is wrong.
You can have high blood pressure for years without knowing it, and that's why its called the "silent killer".
If the blood pressure is very high for a while or rises rapidly it can cause tiredness, confusion, vision changes, trouble sleeping, nosebleeds, flushed skin, palpitations, and too much sweating.
Explain the acronym used to help remember and recognize stroke symptoms.
Face dropping
Arm weakness
Speech difficulties
Time to call
Your patient is on Lisinopril (ACE-I), her doctor recently added Metoprolol (beta blocker). Explain why she is on 2 medications and how each one works.
Your PCP started you on another medication because your blood pressure is uncontrolled and you need more help to improve your BP.
Every medication works on different areas of the body to help lower the BP.
Lisinopril helps lower the BP by widening the arteries.
Metoprolol helps lower the BP by decreasing the heart rate.
What is the difference between healthy fats and unhealthy fats?
Healthy fats: are unsaturated fats that help decrease the LDL levels, help increase HDL, prevent plaque build up in the arteries and decrease the risk for stroke and heart attack.
Unhealthy fats: are the saturated fats, that increase the LDL cholesterol, and increase the risk for stroke and heart attack.
How does sodium increase BP?
Salt increases blood pressure by increasing blood volume, it causes increase thirst, increased fluid intake and in return increased blood volume which increases the blood pressure.
What are the risk factors that can lead to high blood pressure.
Modifiable Risk Factors: lack of physical activity, high sodium diets, overweight/obesity, too much alcohol, sleep apnea, high cholesterol, diabetes, smoking, stress
Other Risk Factors: family history, age, gender, race preexisting medical conditions like kidney disease
What are 5 common warning signs of a heart attack?
Pain or discomfort in chest
Lightheadedness, nausea, or vomiting
Jaw, neck or back pain
Discomfort or pain in arm or shoulder
Shortness of breath
Explain what the BP treatment goal should be for someone with Hypertension.
BP readings less than 130/80
Some recommend a more aggressive target of 120/80 if patients have comorbidities such as diabetes
What foods are encouraged in the DASH eating plan? What are the minerals these foods are rich in?
The DASH diet encourages fresh whole foods such as fruits, vegetables, whole grains, fat free dairy, lean meats such as fish and poultry, beans, nuts and seeds, and vegetable oils
Potassium, Calcium, Magnesium
What foods are high in sodium?
Foods to avoid include: table salt and hidden sodium sources such as processed foods including cheese and meats, canned and packaged foods, condiments, fast foods, pickled foods, dressings, MSG, chips and salty snacks.
Explain what hypertension is.
The force of blood against artery walls is higher than it should be.
The heart has to pump harder than normal.
A heart that has to work harder than normal for a long time gets larger and weaker.
What are the 3 lab values in a lipid profile that are important to monitor, explain what they are and normal ranges of each.
LDL: should be <100 or <70 if a person has diabetes or CAD. LDL is the bad cholesterol that increases plaque build up in the arteries which can lead to a stroke/heart attack.
HDL: should be >50 for women and >40 for men. HDL is the good cholesterol that decreases the plaque build up in the arteries and reduces the risk for stroke and heart attack.
Triglycerides: should be <150. TG are fats in the body that indicate an unhealthy diet composed of saturated fats and sugars.
Explain to your patient how to take their blood pressure at home
Avoid smoking, eating, caffeine, and exercise for 30 minutes prior to taking
Sit calmly for at least 5 minutes
Sit back in your chair with both feet on the floor
Before taking your BP make sure the cuff size is appropriate, too large will give a false low and too small will give a false high reading.
Roll up your sleeve above your upper arm then place the bottom of the cuff above the bend of the elbow. Wrap it against your bare skin and not clothes.
If the BP is too high especially >180/120 wait 5 minutes and take a second reading.
Take 2 readings : one in the morning before taking your medications and the second one in the evening before bedtime.
Keep a BP log with the time of day you took the BP and what the reading was, if it was high jot down what you ate or if you had a stressful event
What foods does the DASH eating plan limit?
The DASH discourages foods such as fatty meats, full dairy fats, sugary beverages, sweets, and sodium intake.
Give examples of healthy fats and unhealthy fats?
Examples of healthy fats: unsaturated fats: mono and polyunsaturated fats such as avocado, canola oil, olive oil, nuts, walnuts, sunflower seeds, omega 3 fatty acids like fish, tofu, flaxseed.
Examples of Unhealthy fats: saturated fats: lard, butter, margarine, cream and cream cheese, plant based (only coconut and palm oil), and cholesterol containing foods including red meats, egg yolks, processed meats and high fat dairy. Trans fats including margarine, shortening, and processed baked goods.