Well Aware Health Improvement Program HYPERTENSION High Blood Pressure

1. Well Aware Health Improvement Program HYPERTENSIONHigh Blood Pressure OMC Wellness Center Click here to continue

2. Authors of information: • Cindy Floyd MSN, FNP-BC Director of Wellness and Well Aware Health Coach • Marla Rabalais RD Registered dietician • Don Lusk RPH, Pharm D. OMC Pharmacist

3. Well Aware Benefit PlanReview of Goals • Purpose and Mission of the Well Aware Program: • To empower Oconee Medical Center employees and their families to reach their best state of health. • How will this program benefit the employees, their spouse and OMC? • Health Coaches will be available to assist you in decreasing risk factors and improving lifestyle choices which will lead to better health. • Better health leads to the following: • Improves your outlook on life • Increases your energy level • Increases employee productivity • Decreases absenteeism • Decreases your personal medical cost • Saves OMC money allowing cost savings to be reinvested into additional benefits for all employees

4. Compliance with the 2012 Risk Management Focus: Hypertension • Complete Hypertension Assessment • Complete online educational session and post test • Drop-in blood pressure check in the Wellness Center during the month of March • 1:1 Health Coach visits based on level of control and severity but not mandatory unless warranted

5. Hypertension Management Part 1 What is hypertension How it affects the body Measurement of blood pressure Risk and complications General overview of treatment to lower blood pressure

6. Hypertension • What is it? • A dangerous condition where blood pressure is persistently higher than normal • It is mainly due to clogs or blockages in arteries requiring the heart to pump harder to get blood flowing throughout the body • Causes damage in the walls of the arteries over time and ultimately can damage the heart • Your heart beats about 100,000 times a day; if you have hypertension, damage can be done with each beat

7. Blood Pressure Measurements • There are two measurements when determining blood pressure: Systolic/Diastolic • Systolic – top number • The pressure exerted on the arteries when the heart beats/pumps • Diastolic – bottom number The pressure exerted in between beats (when the heart is at rest)

8. Blood Pressure Measurements • Stage 2 Hypertension: More than 160/100 • Stage 1 Hypertension: 140-159/90-99 • Pre-hypertension: 120-139/80-89 • Normal: less than 120/80

9. Diagnosis Hypertension • One reading cannot diagnose hypertension • Need 2 or more readings by your doctor or other health professional, 2 minutes apart for 2 or more visits • Verify in the other arm

10. The Correct Way to Measure BP • Best time to check: late AM or early afternoon • Best not to check in early AM as will be higher than later times due to high Cortisol levels in blood stream. • Do not test during time of increased pain or stress • Measure at least 30 minutes after last meal, caffeine or nicotine. • Bladder should be empty • Should rest at least 5 minutes (sitting) prior to test

11. The Correct Way to Measure BP • Should be sitting in a chair with a back rest while testing • Cuff should be at level of heart, so place arm on a table. Do not hold arm out mid-air for test or rest in lap. • Relax arm and shoulder muscle while testing • Use instrument that is routinely calibrated for accuracy. • Finger measurements have been found to be inaccurate. • Use correct cuff size • Take your personal cuff in to physician’s office so comparison testing can be done.

12. Record keeping • Purchase a home measurement cuff • Blood pressure machines available at: OMC Ambulatory Pharmacy Tony Chapman – Pharmacist Phone: (864) 885-7654 • See handout for more information • Always record your measurements with date and time. • Take record with you to physician’s office so trends can be seen from readings.

13. Hypertension Risk • High blood pressure is called the “silent killer” because it contributes to deadly health conditions (heart disease) and there are NO symptoms • Of those with hypertension, 1 out of 3 do not even know they have it! • Therefore, to avoid health problems, awareness and early intervention are essential!

14. Complications of Hypertension • Coronary Artery Disease • Atherosclerosis –plaque deposits narrow diameter

15. Complications of Hypertension • Arteriosclerois – hardening of the arteries • Aneurysm – ballooning out in wall of vessel • Hemorrhagic Stroke – blood vessel rupture in part of brain • Ischemic Stroke – lack of oxygen to part of brain

16. Complications of Hypertension • Heart Failure • Dementia • Kidney failure • Impotence • Vision loss • Stroke

17. Treating Hypertension • Lowering blood pressure can greatly reduce risk for serious health problems • Small changes in lifestyle can lower blood pressure: • Dietary management • Weight Loss (even a small amount – 10%) • Smoking Cessation • Regular physical activity • Limit alcohol intake • Increase fruits, vegetables and whole grains • Stress Management • Medication

18. Smoking Increases BP • 7 seconds after the first puff, nicotine reaches the brain signaling the release of epinephrine (adrenaline). • Epinephrine narrows blood vessels forcing the heart to beat harder under higher pressure. • After 2 cigarettes the systolic and diastolic BP increases about 10 mm Hg and keeps it there for at least 30 minutes. • Chain smoking keeps the BP higher over longer periods of time. • Smoking and high blood pressure combined increases your risk for a heart attack, heart failure and stroke.

19. Smoking Cessation classes • American Cancer Society’s “Freshstart” program offered here at OMC Wellness Center. • Classes consist of 3 (1 hour) sessions • Free to anyone, but must register by calling the Wellness Center at 885-7684 • Offered quarterly.

20. Learning Check Do most individuals have symptoms that alert them that they may have hypertension? YES NO

21. Learning Check Hypertension can cause which of the following conditions? Heart Failure Vision Loss Kidney Failure Stroke ALL OF THE ABOVE Dementia

22. Learning Check Normal blood pressure is below… 100/90 130/90 120/80 150/100

23. Learning Check To diagnose hypertension, you should have your blood pressure taken on more than one visit to your doctor with two readings each visit, at least 2 minutes apart. TRUE FALSE

24. Learning Check The best time to take blood pressure is earlymorning and late afternoon. TRUE FALSE

25. Learning Check To get the most accurate blood pressure reading you should do which of the following: Have your arm hanging straight down Lay down Drink a cup of coffee Empty your bladder

26. Learning Check Blood pressure can be lowered by lifestyle changes such as which of the following. Eating more fruits, vegetables, & whole grains Losing Weight Not smoking & limiting alcohol intake Regular exercise All of the above

27. Learning Check After 2 cigarettes the systolic and diastolic BP increases about 10 mm Hg and keeps it there for at least 30 minutes. T/F TRUE FALSE

28. Hypertension Management • Part 2 • Dietary Management—DASH DIET • Sodium Reduction • Caffeine Reduction • Food restrictions with Medications

29. DASH Diet DASH = Dietary Approaches to Stop Hypertension • The diet is lower in sodium and higher in potassium, calcium, magnesium and fiber.  • Evidence indicates that the DASH diet creates a synergy between nutrients that helps lower blood pressure, potentially as much as one prescription medication.

30. DASH Diet • Dash has been called a “Diet for all Diseases” because the benefits of DASH extend beyond hypertension to a decreased risk of developing certain cancers, diabetes and osteoporosis. • Dash can benefit everyone! Making a few simple changes, one step at a time, can lead you down a path of good health. 

31. DASH Diet recommendations Fruits • Daily Goal: 2-2 1/2 cups • Examples of a ½ cup portion include: • 1 medium fresh fruit, 16 grapes, ½ cup fresh, canned or frozen, ¼ cup dried, or 4 oz 100% juice • If you don't eat fruit now or have only juice at breakfast, add a serving to your meals or have it as a snack.

32. DASH Diet recommendations Vegetables • Daily Goal: 2-2 1/2 cups • Examples of a ½ cup portion include: • 1 cup leafy greens, ½ cup raw, canned* or frozen, or 4 oz 100% juice • * when purchasing canned foods choose “low sodium” option • If you now eat one or two vegetables a day, add a serving at lunch and another at dinner.

33. DASH Diet recommendations Fat-free or Lowfat Milk and Dairy • Daily Goal: 2-3 cups • Examples of a 1 cup portion include: • 8 oz milk, 8 oz yogurt • Gradually increase dairy products to three servings per day. • For example, drink milk with lunch or dinner, instead of soda, alcohol, or sugar-sweetened tea. Choose low-fat (1 percent) or fat free (skim) dairy products to reduce total fat intake.

34. DASH Diet recommendations Whole Grains • Daily Goal: 6-8 ounces • Examples of a 1 oz portion: • 1 oz slice of bread, ½ cup cooked rice or pasta, ½ - 1 ¼ cup dry cereal* • * Always check the nutrition fact label on cereal before buying.

35. DASH Diet recommendations Lean Meat, Fish, Poultry • Daily Goal: 6 ounces or less • Note: a 3 oz portion roughly equals the size of a deck of cards • Treat meat as one part of the whole meal, instead of the focus.

36. DASH Diet recommendations Nuts, Seeds, and Legumes • Daily Goal: 4-5 portions per week • Examples of a portion: • 1/3 cup or 1 ½ oz. nuts, 2 Tbsp peanut butter, ½ oz. seeds, ½ cup cooked dry beans, peas or lentils. • Note: These portions can count as a 2 oz. portion of lean meat, fish, or poultry. • Include two or more vegetarian-style (meatless) meals each week.

37. DASH Diet recommendations Oils and Fats • Use sparingly • Examples of a 1 teaspoon portion: • 1 tsp soft margarine, 1 Tbsp low-fat mayo, 2 Tbsp low-fat salad dressing or 1 tsp. olive oil or canola oil • Use only half the butter, margarine, or salad dressing you do now • Try low-fat or fat free condiments, such as fat free salad dressings

38. DASH Diet recommendations Added Sugar • Use sparingly • Examples of one serving: • 1 Tbsp. sugar, 1 Tbsp jelly or jam, ½ cup sorbet and ices or 1 cup lemonade, 1 cup sweet tea

39. DASH Diet recommendations Alcohol • One drink is equivalent to: • 12 oz beer, 5 oz wine, 1.5 oz spirits • Men: 2 or less drinks per day • Women: 1 or less drinks per day

40. DASH Diet recommendations Sodium • 1 teaspoon of salt = 2,300 mg of sodium • Dietary sodium comes primarily in the form of salt or sodium-chloride.  • Sodium is found naturally in some foods. However, it is the sodium from added salt, especially in many processed foods, restaurant meals, and shaken on that really adds up.

41. Sodium (“Salt”) Intake • The average American gets about 3,400 mg of sodium a day — twice what is recommended.

42. Recommended Sodium Intake • Age 51 years or older: < 1500 mg/day • African American : < 1500 mg/day • If have Hypertension: < 1500 mg/day • If have Hypertension & Kidney Disease: < 1500 mg/day • Everyone else: < 2300 mg/day

43. Lowering Sodium • To lower sodium, be aware of sodium content in foods : • 1 teaspoon table salt: 2300mg • 1 teaspoon of sea salt: 2250mg • 1 packet of salt, single serving: 400mg • 1 oz cheddar cheese: 170 mg • 1 dill pickle 2.5 oz : 900 mg • 1 average Lean Cuisine: 700 mg • 1 cup tomato sauce: 1200 mg • 2 slices of a pepperoni & cheese pizza: 1770 mg • ½ cup chicken noodle soup: 890 mg • 1 instant noodle lunch: 1,240 mg

44. Caffeine Increases BP • Caffeine increases blood pressure by: • Narrowing blood vessels. This “vasoconstriction” or narrowing is a result of caffeine blocking the hormone adenosine release. Adenosine helps keep the vessels widened. • Raising heart rate. Caffeine causes the adrenal glands to release more cortisol and adrenaline which both increase heart rate.

45. Limit Caffeine • Found in coffee, tea, soft drinks and chocolate • Limit to about 200 mg /day • Amount of Caffeine in: • Coffee , ¾ cup or 6 oz = 103 mg • Tea, ¾ cup or 6 oz = 100 mg • Soft Drink, 12 oz = 70 mg • 1 chocolate bar, 1 ½ oz = 10 mg • 2 to 3 cups of coffee has been shown to raise systolic BP 14 mm Hg and diastolic BP 13 mm Hg • It is also advised to avoid caffeine right before activities that naturally increase BP, such as exercise or hard physical labor.

46. Food/Drinks that interfere with medications • If on a Calcium Channel Blocker avoid • Grapefruit and grapefruit juice • Seville (sour) oranges • Natural Licorice often added to chewing tobacco and some cough drops • It increases BP by making your kidneys retain sodium and fluid • High doses of calcium can interfere with some BP medications

47. Learning Check For men, the DASH diet recommends limiting alcohol intake to 4 or less drinks per day. T/F TRUE FALSE

48. Learning Check Following the DASH Diet (Dietary Approaches to Stopping Hypertension), can also help lower your risk for developing diabetes, certain cancers, and osteoporosis. TRUE FALSE

49. Hypertension Management • Part 3 • Medication Management • Physician driven • Classifications • Actions • Dosing regimens • Side effects • Monitoring (liver and renal function) recommendations • Guidelines for adding medications • OTC and other medications that increase BP • Taking medications correctly • Financial support

50. Classifications of Hypertension Medications • There are several different types of medicines the physician may prescribe to help control high blood pressure. • Each type works differently (different sites in the circulatory system, different mechanisms, etc.). • Sometimes, multiple medications from different classes may be needed for appropriate blood pressure control. The physician and you will make these decisions.