Hypertension Training Guide

Everything You Need to Know About High Blood Pressure

TABLE OF CONTENTS

1. What is High Blood Pressure (Hypertension)?

    • Blood Pressure Categories Chart

    • Risk Factors (Controllable / Uncontrollable)

2. What Are the Consequences of High Blood Pressure?

    • Stroke, Heart Failure, Kidney Disease, and More

3. How Can I Improve My Blood Pressure?

    • Lifestyle Changes Chart

    • Why Should I Restrict Sodium?

    • High Blood Pressure Medications and Side Effects

4. African Americans and High Blood Pressure

5. How Do I Measure My Blood Pressure Correctly?

6. Resources and Reference Links

1. What is High Blood Pressure (Hypertension)?

Blood pressure is the force exerted by circulating blood against the walls of the blood vessels. It is measured in millimeters of mercury (mm Hg) and is written as two numbers (e.g., 112/78 mm Hg). High blood pressure usually has no symptoms; therefore, it is called the ‘silent killer.’ Nearly half of the American population over the age of 20 has high blood pressure, yet many are unaware of it.

Basic Definitions

• Systolic pressure (top number): The pressure in your blood vessels when your heart beats.
• Diastolic pressure (bottom number): The pressure in your blood vessels between heartbeats.
• Normal blood pressure: A value below 120/80 mm Hg.

Why is High Blood Pressure Dangerous? Left untreated, high blood pressure damages the heart, brain, kidneys, and eyes. It significantly increases the risk of heart attack, stroke, and kidney failure.

Blood Pressure Categories

Risk Factors

Controllable Factors:

• Smoking and secondhand smoke exposure
• Diabetes
• Obesity or being overweight
• High cholesterol
• Unhealthy diet (diet high in sodium, low in potassium, and excessive alcohol)
• Physical inactivity

Uncontrollable Factors:

• Family history of high blood pressure
• Race / ethnicity
• Advanced age
• Gender (higher risk in men)
• Chronic kidney disease
• Obstructive sleep apnea

Important Note: Socioeconomic status and psychosocial stress are also risk factors for hypertension. This situation can negatively affect access to basic life needs, medication use, access to healthcare professionals, and the capacity to adopt healthy lifestyle changes.

2. What Are the Consequences of High Blood Pressure?

High blood pressure is the first stone that paves the way for devastating health problems, much like a ‘domino effect’. If left uncontrolled, it can lead to a heart attack, stroke, heart failure, or kidney failure.

Affected Organ Systems

How Does High Blood Pressure Increase Stroke Risk? High blood pressure is one of the most important risk factors for stroke. Over time, it increases the workload of the heart and damages your blood vessels. People with high blood pressure are much more likely to have a stroke compared to people with normal blood pressure.

• Ischemic Stroke (87%) Caused by narrowed or blocked blood vessels that cut off blood flow to the brain and kill brain cells. High blood pressure damages the inner lining of the blood vessels, paving the way for this blockage.
• Hemorrhagic Stroke (13%) Occurs when a blood vessel in or near the brain ruptures. Chronic high blood pressure or age-related blood vessel damage is the main cause of this type of stroke.

How Can I Control High Blood Pressure? Even if you have previously had a stroke or heart attack, keeping your blood pressure under control can prevent a new event:

• Do not smoke; avoid exposure to secondhand smoke.
• Maintain a healthy weight.
• Eat a diet rich in fruits and vegetables, and low in sodium and saturated/trans fats.
• Get at least 150 minutes of moderate-intensity physical activity per week.
• Alcohol causes your blood pressure to rise.
• Take all medications exactly as prescribed.
• Know what your blood pressure should be and try to maintain that value.
• Do not skip your regular follow-up appointments.

3. How Can I Improve My Blood Pressure?

By treating high blood pressure, you can significantly reduce the risk of stroke, heart attack, heart failure, and kidney failure. Each of the lifestyle changes below reduces blood pressure by a certain amount:

Effect of Lifestyle Changes on Blood Pressure

SBP = Systolic Blood Pressure | BMI = Body Mass Index

Weight Loss To lose weight, you must burn more calories than you consume every day. Consult your healthcare professional for a healthy eating and physical activity plan. Losing at least 5% of your body weight will help lower your blood pressure.

Why Should I Restrict Sodium? Excess sodium in the blood pulls water into the blood vessels, increasing the amount of blood inside them; this leads to an increase in blood pressure. In some people, it can cause high blood pressure or make it even higher.

Daily Sodium Goals and Practical Tips

• Daily goal: 1,500 mg or less. Even a 1,000 mg reduction improves heart health.
• Ways to Reduce Sodium:
  • Read nutrition labels; products containing 140 mg or less of sodium are considered low sodium.
  • Avoid ready-made, packaged, and processed foods.
  • Do not use salt when cooking or at the table; prefer herbs and salt-free spices instead.
  • When eating out, ask for your food to be prepared without salt.
  • The ‘Salty 6’: bread, pizza, sandwiches, cold cuts, soup, burritos — the 6 foods containing the most salt.
  • Watch out for ‘hidden sodium’ sources like cheese, canned vegetables, frozen meals, and fast food.

Alcohol Alcohol can raise blood pressure. If you have difficulty cutting back on alcohol, ask your doctor for information about support groups.

Physical Activity Regular physical activity helps lower blood pressure, control weight, and reduce stress. Aim for at least 150 minutes of moderate-intensity or 75 minutes of high-intensity aerobic exercise per week. Start with activities you enjoy, such as brisk walking or cycling (Consult your family doctor before starting exercises, and adjust the durations according to their recommendations).

About High Blood Pressure Medications Depending on your risk level and blood pressure readings, one or more medications may be necessary. Your doctor may implement a trial process to find the most suitable combination for you.

Common Side Effects

• Weakness, fatigue, or sleepiness
• Cough
• Muscle cramps
• Headache, dizziness
• Erectile dysfunction
• Sleep problems
• Constipation or diarrhea
• Feeling thirsty, skin rash

Important Reminder:

• Take your medications exactly as prescribed; do not stop taking them without your doctor’s approval.
• Medication use usually continues for life even after your blood pressure returns to normal.
• If you experience side effects, do not stop taking the medication yourself — call your doctor.

How Do I Remember to Take My Medication?

• Take your medication at the same time every day.
• Combine taking your medication with a daily habit, like brushing your teeth.
• Use a weekly pillbox with separate compartments for each day.
• Ask family members or friends for reminders.
• Set a reminder on your smartphone or keep a medication calendar.

4. African Americans and High Blood Pressure

African Americans in the US have a higher rate of hypertension compared to other racial and ethnic groups. High blood pressure can be more severe in this group, and some medications may be less effective in these individuals. High blood pressure usually has no symptoms; therefore, it gets the name ‘silent killer’.

Special Dietary Recommendations:

• Aim for 1,500 mg or less of sodium per day (even a 1,000 mg reduction is beneficial).
• Consume 3,500–5,000 mg of potassium per day (bananas, potatoes, beans, spinach).
• Alcohol consumption can increase your blood pressure.
• Do at least 150 minutes of moderate-intensity aerobic exercise per week (Always consult your doctor before exercising).

Caution in Medication Treatment:

• Thiazide-type diuretics and/or calcium channel blockers may be more effective alone or in combination in African Americans.
• Your doctor may implement a trial process to find the most suitable combination for you.
• Continue medication treatment along with lifestyle changes.

Conditions Uncontrolled Hypertension Can Lead To:

• Heart attack and heart failure
• Stroke
• Kidney disease and kidney failure
• Erectile dysfunction
• Vision loss

5. How Do I Measure My Blood Pressure Correctly?

Preparation before and during the measurement is of great importance to get accurate results. Follow the steps below:

BEFORE MEASUREMENT:

• Do not smoke, exercise, consume caffeine, or drink alcohol 30 minutes before the measurement.
• Sit in a chair for at least 5 minutes with your left arm resting comfortably at heart level.
• Relax; sit upright, keep your feet flat on the floor, and have your back supported.
• Do not talk during the measurement.

DURING MEASUREMENT:

• Take at least 2 readings at least 1 minute apart; measure in the morning before taking medication and in the evening before dinner. Record all results.
• Use a properly calibrated and validated device. Check the cuff size.
• Place the bottom edge of the cuff just above the bend of the elbow.

⚠ HYPERTENSIVE CRISIS — EMERGENCY If your blood pressure is over 180/120 mm Hg, wait a few minutes and measure again. If it is still high, IMMEDIATELY CALL YOUR DOCTOR OR GO TO THE EMERGENCY ROOM.

6. Resources and Reference Links

Useful Websites and Videos

References

1. American Heart Association (AHA) (2021). Blood pressure fact sheets. heart.org
2. AHA (2021). Getting active to control high blood pressure. heart.org
3. AHA (2022). Recipes. recipes.heart.org
4. American Medical Association (2022). 7-step quick guide to measuring home blood pressure. ama-assn.org
5. CDC (2017). Tips for taking blood pressure medicines as directed [Video]. YouTube.
6. NHLBI (2020). Easy ways to add exercise to your life [Video]. YouTube.
7. NHLBI (2019). 3 Delicious Heart-Healthy Recipes [Video]. YouTube.
8. NHLBI (2022). Delicious healthy eating recipes for heart health. healthyeating.nhlbi.nih.gov
9. USDA (n.d.). Budget-friendly healthy eating. myplateprod.azureedge.us
10. USDA (2022). MyPlate. myplate.gov

This document is based on American Heart Association (AHA) resources. Please consult your healthcare professional for medical decisions.