Know your Numbers: Blood Pressure

1. Know your Numbers:Blood Pressure Presented by Health Net of California

2. Disclaimer • The information provided in this presentation is intended solely for the general information of the audience. It is not medical advice and shall not replace consultation with your physician or other qualified health provider. If you have any health related questions or problems, please seek the advice of your physician or other qualified health provider.

3. Course Overview • High Blood Pressure - Overview • Definition • Causes • Risk Factors • Monitoring Blood Pressure • Physician’s Office • Self Monitoring • Reducing Your Risk for High Blood Pressure • Maintaining a Healthy Weight • Quitting Tobacco Use • Being Physically Active • Eating Well • Managing Your Stress • Reducing Salt in Your Diet • Moderate Alcohol Consumption • Oral Contraception – Knowing Your Risk • Health Net Decision PowerSM Healthy Discounts • Healthnet.com Wellness Services • Resources

4. What is Blood Pressure? • Blood pressure is the force of blood against the walls of arteries. • Blood pressure is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). • Normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic.

5. What is High Blood Pressure? • Blood pressure rises and falls during the day. When blood pressure stays elevated over time, it is called high blood pressure or hypertension. • Known as the “silent killer” usually no symptoms. • It increases the risk of heart disease and stroke, which are the first- and third-leading causes of death among Americans. • High blood pressure also can result in other conditions, such as: • congestive heart failure • kidney disease • blindness

6. Categories for Blood Pressure Levels in Adults*(in mmHg, millimeters of mercury) * For adults 18 and older who: • Are not on medicine for high blood pressure • Are not having a short-term serious illness • Do not have other conditions such as diabetes and kidney disease Note: When systolic and diastolic blood pressures fall into different categories, the higher category is used to classify blood pressure level. For example, 160/80 would be stage 2 high blood pressure.

7. High Blood Pressure - Facts • High blood pressure increases your chance (or risk) for getting heart disease and/or kidney disease, and for having a stroke. It is especially dangerous because it often has no warning signs or symptoms. • Regardless of race, age, or gender, anyone can develop high blood pressure. • It is estimated that 1 in every 3 adults in the United States has high blood pressure. You can have it for years without knowing it. During this time, though, it can damage the heart, blood vessels, kidneys, and other parts of your body. • Once high blood pressure develops, it usually lasts a lifetime. • Blood pressure tends to rise with age. Following a healthy lifestyle helps some people delay or prevent this rise in blood pressure.

8. Effects of High Blood Pressure on Your Body Brain High blood pressure is the most important risk factor for stroke. Very high pressure can cause a break in a weakened blood vessel, which then bleeds in the brain. This can cause a stroke. If a blood clot blocks one of the narrowed arteries, it can also cause a stroke. Eyes High blood pressure can eventually cause blood vessels in the eye to burst or bleed. Vision may become blurred or otherwise impaired and can result in blindness. Arteries As people get older, arteries throughout the body "harden," especially those in the heart, brain, and kidneys. High blood pressure is associated with these "stiffer" arteries. This, in turn, causes the heart and kidneys to work harder.

9. Effects of High Blood Pressure on Your Body Kidneys The kidneys act as filters to rid the body of wastes. Over time, high blood pressure can narrow and thicken the blood vessels of the kidneys. The kidneys filter less fluid, and waste builds up in the blood. The kidneys may fail altogether. When this happens, medical treatment (dialysis) or a kidney transplant may be needed. Heart High blood pressure is a major risk factor for heart attack. The arteries bring oxygen-carrying blood to the heart muscle. If the heart cannot get enough oxygen, chest pain, also known as "angina," can occur. If the flow of blood is blocked, a heart attack results. High blood pressure is the number one risk factor for congestive heart failure (CHF). CHF is a serious condition in which the heart is unable to pump enough blood to supply the body's needs.

10. Monitoring Your Blood Pressure If you don't know your blood pressure, have it checked at your doctor's office, at a health clinic, etc. How it's checked 1. A soft arm cuff is wrapped around the upper arm. A hand bulb pumps air into the cuff, gently squeezing the arm and temporarily interrupting the flow of blood. The pressure gauge reaches a peak. 2. Then the cuff is slowly deflated, letting blood flow again. As the cuff deflates and the pressure gauge gradually decreases, the return of the blood flow through the main artery in your arm can be heard using a stethoscope. 3. The reading on the pressure gauge when the pulse is first heard is your systolic pressure (the peak pressure as the heart contracts). 4. The reading when the pulse can first no longer be heard is your diastolic pressure (the lowest pressure as the heart relaxes between beats).

11. Self Monitoring Your Blood Pressure • If your blood pressure is high, you can monitor your own blood pressure at home with an inexpensive blood pressure cuff and gauge, available at most drug stores and medical supply outlets. • Many newer blood pressure testers (electronic sphygmomanometers) are easy to use and have digital readouts. They do not require using a stethoscope or other difficult steps. • Check your blood pressure gauge for accuracy every six months by comparing its readings with those of the professional gauge in your doctor's office. • If you have difficulty with your home blood pressure testing equipment, get instruction from a healthcare professional.

12. Making Blood Pressure Readings More Reliable • Be seated, feet flat on the floor (do not cross your legs), with your arms bared, supported and at heart level. • Do not smoke or drink caffeinated beverages 30 minutes before testing. • Go to the bathroom prior to the reading. A full bladder can change your blood pressure reading. • Sit quietly for five minutes before starting measurement and remember - do not talk during the measurement. • Make sure the measurement cuff fits comfortably around your arm. • Take two or more readings, at least two minutes apart, and average the results. • Make sure your measurement cuff has been checked for accuracy.

13. Modifiable Risks for High Blood Pressure You can't do a thing about some of the factors that contribute to the development of high blood pressure: age, sex, race and family history just can't be changed. Luckily, though, there are several risk factors that you can influence strongly, helping to get your blood pressure under control or keeping it in control: • Weight - Being overweight is a major factor in having high blood pressure. Losing excess weight is the most important step you can take in lowering high blood pressure. • Smoking - Each time you smoke a cigarette, your blood pressure rises. Nicotine causes a narrowing in small blood vessels, making blood flow more difficult. Smoking increases your risk of coronary heart disease. • Activity - A lack of activity results in poor cardiovascular health. Exercise strengthens your heart, lungs, and muscles, relieves stress, and helps lower blood pressure. • Eating - A diet high in fat and cholesterol increases the risk for high blood pressure.

14. Modifiable Risks for High Blood Pressure(continued) • Stress - Emotional stress, frustration, and feelings of futility contribute to high blood pressure. Physical tension caused by anger, especially holding anger in, can contribute to increased blood pressure. • Salt - Some people are highly sensitive to sodium (mostly eaten as sodium chloride, salt). Sodium sensitivity can lead to an increase in body fluids, increasing pressure in your blood vessels. Most people consume much more sodium than they need. Recent findings suggest that potassium may be protective in blood pressure management. Bananas and other fruit are good sources of potassium. • Alcohol - Regular drinking, especially heavy drinking, can dramatically increase your blood pressure. • Oral contraceptives - Birth control pills can contribute to increased blood pressure in some women, especially if they also smoke.

15. Tips for Changing Modifiable Risks • Maintaining a Healthy Weight • Quitting Tobacco Use • Being Physically Active • Eating Well • Managing Your Stress • Reducing Salt in Your Diet • Moderate Alcohol Consumption • Oral Contraception – Knowing Your Risk

16. Maintaining a Healthy Weight • There is no magic formula for weight loss. • Eat fewer calories than you burn. • Just how many calories you burn daily depends on factors such as your body size and how physically active you are. • If you have to lose weight, it's important to do so slowly. • Aim for losing no more than 1 to 2 pounds a week. • One pound equals 3,500 calories. So, to lose 1 pound a week, you need to eat 500 calories a day less or burn 500 calories a day more than you usually do. • Try starting with a weight loss of 10 percent of your current body weight over 6 months. This is the healthiest way to lose weight — and importantly — it offers the best chance of long term success.

17. Tobacco Use - Quit Smoking While smoking doesn’t cause high blood pressure, it can temporarily raise blood pressure, and it DOES increase the risk of heart and blood vessel diseases. • Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. • Once you quit, your risk of having a heart attack is reduced after the first year. • The increased risk for stroke associated with smoking begins to reverse when an individual stops smoking. About 10 to 15 years later, the risk for stroke approaches that of a person who never smoked.

18. Pick a day Mark it on your calendar Some individuals smoke up until their quit date, some quit cold turkey Prepare for your quit day Tell friends/family/support network Get rid of ALL cigarettes and ashtrays in your home/car/work Additional strategies to help you along when you do have an urge to smoke: Drink water. Distract yourself: Do something else. Deep breathing:When you were smoking, you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air. Delay: If you feel that you are about to light up, delay. Tell yourself you must wait at least 10 minutes. Often this simple trick will allow you to move beyond the strong urge to smoke. Quit Smoking: How to get started

19. Being Physically Active – Why? • Exercise reduces the level of stress hormones in the body - results in slower heart rate, relaxed blood vessels, lowered blood pressure • Exercise strengthens muscles (your heart is a muscle) and bones • Weight loss – added exercise burns calories • Helps with mood – exercise releases endorphins (a chemical that calms your mood)

20. Exercise – How Much? 2008 Physical Activity Guidelines for Americans*: Do both aerobic and muscle strengthening activities Aerobic Activities: • If you choose aerobic activities at a moderate level, do at least 2 hours and 30 minutes a week • If you choose vigorous activities, do at least 1 hour and 15 minutes a week • Slowly build up the amount of time you do physical activities, do at least 10 minutes at a time • You can combine moderate and vigorous activities Muscle Strengthening Activities: • Do these at least 2 days a week *For more information, visit www.healthfinder.gov

21. Exercise – What? Vigorous Aerobic Activities: • Aerobic dance • Biking faster than 10 miles per hour • Fast dancing • Heavy gardening (digging, hoeing) • Hiking uphill • Jumping rope • Martial arts • Race walking, jogging or running • Sports with a lot of running (basketball, soccer, hockey) • Tennis (singles) • Swimming fast or swimming laps Moderate Aerobic Activities: • Biking on level ground or with few hills • Canoeing • General gardening (raking, trimming shrubs) • Sports where you catch and throw (baseball, softball, volleyball) • Tennis (doubles) • Using your manual wheelchair • Using hand cyclers (ergometers) • Walking briskly • Water aerobics Source: 2008 Physical Activity Guidelines for Americans

22. Eating to Lower Blood Pressure The DASH eating plan significantly lowered blood pressure in the recent Dietary Approaches to Stop Hypertension (DASH) study, and it may also help prevent and control high blood pressure. DASH stands for “Dietary Approaches to Stop Hypertension.”

23. The DASH Eating Plan • Food and medicine • The DASH eating plan can lower blood pressure. • If you are taking medication for high blood pressure, don't stop taking your medication just because you are starting the diet. • Instead, advise your healthcare provider of your lifestyle changes, so your medication regimen can be monitored accordingly. Source: National Heart, Lung, and Blood Institute

24. Managing Your Stress – Why? • Stress is the internal and external response to a stressful situation. • Stress can make blood pressure go up for a while, and it has been thought to contribute to high blood pressure. But the long-term effects of stress are as yet unclear. • Stress management techniques do not seem to prevent high blood pressure. However, such techniques may have other benefits, such as making you feel better or helping you to control over-eating.

25. Managing Your Stress – Tips Learning how to manage stress, relax and cope with problems can improve your emotional and physical health. • Physical activity helps some people cope with stress. • Other people listen to music, or focus on something calm or peaceful to reduce stress. • Some people learn and practice yoga, tai chi, or meditation. • Other stress reducing activities include: • Reading a book • Talking to a friend • Taking a bubble bath • Engaging in a hobby • What do you do to reduce your stress?

26. Reducing Salt in Your Diet • Current dietary guidelines recommend that adults in general should consume no more than 2,300 mg of sodium per day. However, if you are in the following population groups, you should  consume no more than 1,500 mg per day. • You are 40 years of age or older. • You are African American. • You have high blood pressure.

27. Reducing Salt in Your Diet Using less sodium is key at keeping blood pressure at a healthy level. Tips: • Buy fresh, plain frozen or canned “with no salt added” vegetables. • Use fresh poultry, fish and lean meat, rather than canned or processed types. • Use herbs, spices, and salt-free seasoning blends in cooking and at the table. • Cook pasta, rice and hot cereal without salt. • Choose convenience foods that are low in sodium. • Rinse canned foods, such as tuna, to remove some sodium. • When available, buy low-sodium or reduced-sodium or no-salt added versions of foods.

28. Moderate Alcohol Consumption Drinking too much alcohol can raise blood pressure. It also can harm the liver, brain, and heart. Alcoholic drinks also contain calories, which matter if you are trying to lose weight. If you drink alcoholic beverages, have only a moderate amount — one drink a day for women; two drinks a day for men. What counts as a drink? 12 ounces of beer (regular or light, 150 calories), or 5 ounces of wine (100 calories), or 1 ounces of 80-proof whiskey (100 calories).

29. Oral Contraception Use – Knowing the Risk • Women taking oral contraceptives experience a small but detectable increase in both systolic and diastolic blood pressure, usually in the normal range. Talk to your doctor about a possible rise in blood pressure and what you can do about it. • Women age 35 and older who smoke cigarettes are at even greater risk for heart disease and stroke and are encouraged to quit smoking. If they are unable to quit smoking, they should talk to their doctor about using other forms of contraception.

30. Controlling High Blood Pressure with Medication If you have high blood pressure, the lifestyle habits discussed may not lower your blood pressure enough. Even if you need medications, you still need to make the lifestyle changes. Doing so will help your drugs work better and may reduce how much of them you need. • When you start a drug, work with your doctor to get the right drug and dose level for you. If you have side effects, tell your doctor so the drugs can be adjusted. • It is important to take your drugs as prescribed. That can prevent a heart attack, stroke, and congestive heart failure. • Be sure to tell your doctor about any over-the-counter drugs you’re taking and ask whether they may make it harder for you to bring your blood pressure under control. • Use notes and other reminders to help you remember to take your medications.

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32. Health Net Resources • Online Resources- www.healthnet.com • Health Risk Questionnaire • Personal Health Record • Wellness Programs • Smoking Cessation • Health Improvement Center • Blood Pressure • Telephonic Wellness Programs: • Smoking Cessation • Weight Management

33. Resources • NHLBI (National Heart, Lung and Blood Institute, NIH): ‘High Blood Pressure: Treat It for Life’ • American Heart Association: ‘High Blood Pressure, Why It Is Bad’ • NINDS (National Institute of Neurological Disorders and Stroke, NIH): ‘Stroke’ • WebMD: High Blood Pressure

34. Resources Your Guide To Lowering Blood Pressure Follow step-by-step instructions on how to achieve and maintain a lower blood pressure through lifestyle and, if prescribed, medication. It’s filled with practical advice about how to find your target weight, use herbs and spices to reduce sodium intake, and even how to remember to take your blood pressure medication. The bright, colorful design and upbeat language motivates as it educates hypertensive and pre-hypertensive patients to take control of their cardiovascular health. 20-page guide available on line atwww.nhlbi.nih.gov

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