UNDERSTANDING HYPERTENSION

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1 UNDERSTANDING HYPERTENSION THE ROLE CHWS AND INSTRUCTORS CAN PLAY IN HYPERTENSION WELLNESS AND PREVENTION Presented by: Texas AHEC East Coastal Region CHW Training Organization Approved by the Texas Department of State Health Services This project is funded in part by State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health, CDC-RFA-DP , Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, through Texas Department of State Health Services.

2 LEARNING OBJECTIVES (CHWS) 1. WHAT IS HYPERTENSION AND HOW IS IT DETERMINED? 2. WHAT ARE THE CAUSES AND RISK FACTORS FOR HYPERTENSION? 3. WHAT ARE THE CONSEQUENCES OF NOT TREATING HYPERTENSION? 4. HOW CAN HYPERTENSION BE TREATED OR PREVENTED?

3 TEACHING OBJECTIVES (INSTRUCTORS) TEACH CHWS TO DEVELOP OBJECTIVES WHEN PRESENTING HYPERTENSION IN THEIR COMMUNITIES. TEACH CHWS TERMINOLOGY AND BLOOD PRESSURE READING STEPS THAT EMPHASIZE A MORE THOROUGH KNOWLEDGE BASE AND A HANDS-ON APPROACH. CONDUCT HYPERTENSION RESEARCH AND TEACH CHWS TO IMPLEMENT HYPERTENSION ACTIVITIES WITH ADVOCACY AND CULTURAL COMPETENCY COMPONENTS IN THEIR OWN COMMUNITY. DEMONSTRATE STRESS-RELIEVING EXERCISES CHWS CAN TAKE BACK AND SHARE IN THEIR COMMUNITIES. PROVIDE CHWS WITH EFFECTIVE TEACHING TECHNIQUES FOR HYPERTENSION EDUCATION.

4 HYPERTENSION SELF-ASSESSMENT 1. WHICH OF THE FOLLOWING AFFECTS BLOOD PRESSURE? a) HOW HARD THE HEART PUMPS b) HOW NARROW OR WIDE THE BLOOD VESSELS ARE c) BLOOD VOLUME d) ALL OF THE ABOVE 2. WHERE IS THE BLOOD PRESSURE HIGHEST? a) ARTERIES b) CAPILLARIES c) VEINS

5 HYPERTENSION SELF-ASSESSMENT 3. WHAT IS THE SYSTOLIC BLOOD PRESSURE? a) ARTERIAL BLOOD PRESSURE WHEN THE HEART IS ACTIVELY PUMPING BLOOD b) ARTERIAL BLOOD PRESSURE WHEN THE HEART IS IN BETWEEN BEATS c) AVERAGE SUSTAINED CAPILLARY BLOOD PRESSURE OVER ONE MINUTE d) AVERAGE BLOOD PRESSURE WITHIN THE BRAIN 4. WHAT CATEGORY DOES THE BLOOD PRESSURE 145/82 FALL IN? a) NORMAL b) PREHYPERTENSION c) STAGE 1 HYPERTENSION d) STAGE 2 HYPERTENSION

6 HYPERTENSION SELF-ASSESSMENT 5. WHICH OF THE FOLLOWING IS NOT A RISK FACTOR FOR ESSENTIAL HYPERTENSION? A. FAMILY HISTORY OF HYPERTENSION B. OBESITY C. CIGARETTE SMOKING D. EXCESSIVE ALCOHOL USE E. PHYSICAL INACTIVITY F. DEHYDRATION

7 SELF ASSESSMENT ANSWERS 1. D- ALL OF THE ABOVE 2. A- ARTERIES 3. A- ARTERIAL BLOOD PRESSURE WHEN THE HEART IS ACTIVELY PUMPING BLOOD 4. C- STAGE 1 HYPERTENSION 5. F- DEHYDRATION

8 WHAT IS HIGH BLOOD PRESSURE? BLOOD PRESSURE IS THE FORCE OF BLOOD PUSHING AGAINST THE WALLS OF THE ARTERIES AS THE HEART PUMPS BLOOD. IF THIS PRESSURE RISES AND STAYS HIGH OVER TIME IT CAN DAMAGE THE BODY IN MANY WAYS. BLOOD PRESSURE IS MEASURED AS SYSTOLIC AND DIASTOLIC PRESSURES. "SYSTOLIC" REFERS TO BLOOD PRESSURE WHEN THE HEART BEATS WHILE PUMPING BLOOD. "DIASTOLIC" REFERS TO BLOOD PRESSURE WHEN THE HEART IS AT REST BETWEEN BEATS. YOU MOST OFTEN WILL SEE BLOOD PRESSURE NUMBERS WRITTEN WITH THE SYSTOLIC NUMBER ABOVE OR BEFORE THE DIASTOLIC NUMBER, SUCH AS 120/80 MMHG. (THE MMHG IS MILLIMETERS OF MERCURY THE UNITS USED TO MEASURE BLOOD PRESSURE.)

9 HYPERTENSION OTHER NAMES FOR HBP WHEN HBP HAS NO KNOWN CAUSE, IT MIGHT BE CALLED ESSENTIAL HYPERTENSION, PRIMARY HYPERTENSION, OR IDIOPATHIC HYPERTENSION. WHEN ANOTHER CONDITION CAUSES HBP, IT'S SOMETIMES CALLED SECONDARY HYPERTENSION. ISOLATED SYSTOLIC HYPERTENSION (ISH) IS WHEN ONLY THE SYSTOLIC PRESSURE IS HIGH MANY OLDER ADULTS HAVE THIS CONDITION. ISH CAN CAUSE AS MUCH HARM AS HBP IN WHICH BOTH NUMBERS ARE TOO HIGH

10 CATEGORIES FOR BLOOD PRESSURE IN ADULTS The table below shows normal blood pressure ranges for adults. It also shows which numbers put you at greater risk for health problems. Category Systolic (top number) Diastolic (bottom number) Normal Less than 120 And Less than 80 Prehypertension Or High blood pressure Stage Or Stage2 160 or higher Or 100 or higher

11 HYPERTENSION BASICS BLOOD PRESSURE DOESN'T STAY THE SAME ALL THE TIME. IT LOWERS AS YOU SLEEP AND RISES WHEN YOU WAKE UP. BLOOD PRESSURE ALSO RISES WHEN YOU'RE EXCITED, NERVOUS, OR ACTIVE AND TENDS TO RISE WITH AGE. IF YOUR NUMBERS STAY ABOVE NORMAL MOST OF THE TIME, YOU'RE AT RISK FOR HEALTH PROBLEMS. IF YOU'RE BEING TREATED FOR HBP AND HAVE REPEAT READINGS IN THE NORMAL RANGE, YOUR BLOOD PRESSURE IS UNDER CONTROL. HOWEVER, YOU STILL HAVE THE CONDITION. YOUR SYSTOLIC AND DIASTOLIC NUMBERS MAY NOT BE IN THE SAME BLOOD PRESSURE CATEGORY. THE MORE SEVERE CATEGORY IS THE ONE YOU'RE IN. FOR EXAMPLE, IF YOUR SYSTOLIC NUMBER IS 160 AND YOUR DIASTOLIC NUMBER IS 80, YOU HAVE STAGE 2 HBP. IF YOUR SYSTOLIC NUMBER IS 120 AND YOUR DIASTOLIC NUMBER IS 95, YOU HAVE STAGE 1 HBP.

12 LEARNING ACTIVITY (CHWS)

13 TERMINOLOGY (INSTRUCTORS) SPHYGMOMANOMETER: AN INSTRUMENT FOR MEASURING BLOOD PRESSURE, TYPICALLY CONSISTING OF AN INFLATABLE RUBBER CUFF THAT IS APPLIED TO THE ARM AND CONNECTED TO A COLUMN OF MERCURY NEXT TO A GRADUATED SCALE, ENABLING THE DETERMINATION OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE BY INCREASING AND GRADUALLY RELEASING THE PRESSURE IN THE CUFF. KOROTKOFF SOUNDS: ARTERIAL SOUNDS HEARD THROUGH A STETHOSCOPE APPLIED TO THE BRACHIAL ARTERY DISTAL TO THE CUFF OF A SPHYGMOMANOMETER THAT CHANGE WITH VARYING CUFF PRESSURE AND THAT ARE USED TO DETERMINE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE.

14 LEARNING ACTIVITY (INSTRUCTORS)

15 SYMPTOMS AND MYTHS OF HYPERTENSION ONE OF THE MOST DANGEROUS ASPECTS OF HYPERTENSION IS THAT IT IS ASYMPTOMATIC. MEANING PEOPLE MAY NOT KNOW THAT THEY HAVE IT. NEARLY ONE-THIRD OF PEOPLE WHO HAVE HIGH BLOOD PRESSURE DON'T KNOW IT. BE AWARE OF COMMON SYMPTOMATIC MYTHS OR MISCONCEPTIONS. THEY INCLUDE: HEADACHES NOSEBLEEDS BLOOD SPOTS IN THE EYE FACIAL FLUSHING DIZZINESS

16 CAUSE VS RISK FACTOR WHEN TALKING TO CLIENTS IT S IMPORTANT TO BE ABLE TO EXPLAIN THE DIFFERENCE BETWEEN CAUSE AND RISK FACTOR. CAUSE IS DEFINED AS A CAUSE THAT DIRECTLY OR WITH NO INTERVENING AGENCY PRODUCES AN EFFECT. EXAMPLE, HIV IS THE CAUSE, AIDS IS THE EFFECT; RISK FACTOR IS DEFINED AS SOMETHING THAT INCREASES YOUR CHANCES OF GETTING A DISEASE. SOMETIMES, THIS RISK COMES FROM SOMETHING YOU DO.

17 CAUSES OF HYPERTENSION PRIMARY (ESSENTIAL) HYPERTENSION FOR MOST ADULTS, THERE'S NO IDENTIFIABLE CAUSE OF HIGH BLOOD PRESSURE. THIS TYPE OF HIGH BLOOD PRESSURE, CALLED ESSENTIAL HYPERTENSION OR PRIMARY HYPERTENSION, TENDS TO DEVELOP GRADUALLY OVER MANY YEARS.

18 CAUSES OF HYPERTENSION SECONDARY HYPERTENSION SOME PEOPLE HAVE HIGH BLOOD PRESSURE CAUSED BY AN UNDERLYING CONDITION. THIS TYPE OF HIGH BLOOD PRESSURE, CALLED SECONDARY HYPERTENSION, TENDS TO APPEAR SUDDENLY AND CAUSE HIGHER BLOOD PRESSURE THAN DOES PRIMARY HYPERTENSION. VARIOUS CONDITIONS AND MEDICATIONS CAN LEAD TO SECONDARY HYPERTENSION, INCLUDING: KIDNEY PROBLEMS ADRENAL GLAND TUMORS CERTAIN DEFECTS IN BLOOD VESSELS YOU'RE BORN WITH (CONGENITAL) CERTAIN MEDICATIONS, SUCH AS BIRTH CONTROL PILLS, COLD REMEDIES, DECONGESTANTS, OVER-THE-COUNTER PAIN RELIEVERS AND SOME PRESCRIPTION DRUGS ILLEGAL DRUGS, SUCH AS COCAINE AND AMPHETAMINES

19 CONTROLLABLE RISK FACTORS OVERWEIGHT / OBESITY NOT BEING PHYSICALLY ACTIVE. USING TOBACCO TOO MUCH SALT (SODIUM) IN YOUR DIET TOO LITTLE POTASSIUM IN YOUR DIET EXCESSIVE USE OF ALCOHOL STRESS

20 RISKS THAT CANNOT BE CONTROLLED AGE. THE RISK OF HIGH BLOOD PRESSURE INCREASES AS YOU AGE. THROUGH EARLY MIDDLE AGE, HIGH BLOOD PRESSURE IS MORE COMMON IN MEN. WOMEN ARE MORE LIKELY TO DEVELOP HIGH BLOOD PRESSURE AFTER MENOPAUSE. RACE. HIGH BLOOD PRESSURE IS PARTICULARLY COMMON AMONG AFRICAN-AMERICANS, OFTEN DEVELOPING AT AN EARLIER AGE THAN IT DOES IN OTHER RACES. SERIOUS COMPLICATIONS, SUCH AS STROKE AND HEART ATTACK, ALSO ARE MORE COMMON AMONG AFRICAN- AMERICANS. FAMILY HISTORY. HIGH BLOOD PRESSURE TENDS TO RUN IN FAMILIES. CERTAIN CHRONIC CONDITIONS. CERTAIN CHRONIC CONDITIONS ALSO MAY INCREASE YOUR RISK OF HIGH BLOOD PRESSURE, INCLUDING HIGH CHOLESTEROL, DIABETES, KIDNEY DISEASE AND SLEEP APNEA.

21 IMPROVING CULTURAL COMPETENCY USING HYPERTENSION TEACHING (INSTRUCTORS) HAVE STUDENTS RESEARCH HYPERTENSION TRENDS IN THEIR LOCAL COMMUNITY (ONLINE, LOCAL HEALTH DEPARTMENTS, ETC). HAVE THEM FIND ANSWERS TO THE FOLLOWING QUESTIONS: ARE THERE DIFFERENCES IN HYPERTENSION RATES AMONG GEOGRAPHICAL AREAS IN THEIR COMMUNITY? ARE THERE DIFFERENCES IN HYPERTENSION RATES ALONG ETHNIC, RACIAL, OR CULTURAL LINES IN THEIR COMMUNITY? WHAT KIND OF ACCESS TO SCREENINGS, PREVENTION PROGRAMS, AND TREATMENTS DO MEMBERS OF THE COMMUNITY HAVE? IS ACCESS EASIER OR MORE DIFFICULT FOR CERTAIN POPULATIONS IN THEIR COMMUNITY?

22 TREATMENT GOALS (AS DETERMINED BY YOUR DOCTOR) YOUR BLOOD PRESSURE TREATMENT GOAL DEPENDS ON HOW HEALTHY YOU ARE. BLOOD PRESSURE TREATMENT GOALS 140/90 MM HG OR LOWER IF YOU ARE A HEALTHY ADULT 130/80 MM HG OR LOWER IF YOU HAVE CHRONIC KIDNEY DISEASE, DIABETES OR CORONARY ARTERY DISEASE OR ARE AT HIGH RISK OF CORONARY ARTERY DISEASE 120/80 MM HG OR LOWER IF YOUR HEART ISN'T PUMPING AS WELL AS IT SHOULD (LEFT VENTRICULAR DYSFUNCTION OR HEART FAILURE) OR YOU HAVE SEVERE CHRONIC KIDNEY DISEASE

23 TREATMENT HIGH BLOOD PRESSURE (HBP) IS TREATED WITH LIFESTYLE CHANGES AND MEDICINES. MOST PEOPLE WHO HAVE HBP WILL NEED LIFELONG TREATMENT. STICKING TO A TREATMENT PLAN IS IMPORTANT.

24 LIFESTYLE CHANGES HEALTHY LIFESTYLE HABITS CAN HELP YOU CONTROL HBP. THESE HABITS INCLUDE: FOLLOWING A HEALTHY DIET BEING PHYSICALLY ACTIVE MAINTAINING A HEALTHY WEIGHT QUITTING SMOKING MANAGING YOUR STRESS AND LEARNING TO COPE WITH STRESS

25 DIETARY APPROACHES TO STOP HYPERTENSION (DASH) EATING PLAN SCIENTISTS SUPPORTED BY THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI) CONDUCTED TWO KEY STUDIES. THEIR FINDINGS SHOWED THAT BLOOD PRESSURES WERE REDUCED WITH AN EATING PLAN THAT IS: LOW IN SATURATED FAT, CHOLESTEROL, AND TOTAL FAT EMPHASIZES FRUITS, VEGETABLES, AND FAT-FREE OR LOW-FAT MILK AND MILK PRODUCTS. INCLUDES WHOLE GRAIN PRODUCTS, FISH, POULTRY, AND NUTS. IT IS REDUCED IN LEAN RED MEAT, SWEETS, ADDED SUGARS, AND SUGAR- CONTAINING BEVERAGES RICH IN POTASSIUM MAGNESIUM, AND CALCIUM, AS WELL AS PROTEIN AND FIBER.

26

27 PHYSICAL ACTIVITY ROUTINE PHYSICAL ACTIVITY CAN LOWER HBP AND REDUCE THE RISK FOR OTHER HEALTH PROBLEMS. PEOPLE GAIN HEALTH BENEFITS FROM AS LITTLE AS 60 MINUTES OF MODERATE-INTENSITY AEROBIC ACTIVITY PER WEEK. THE MORE ACTIVE, THE MORE BENEFIT. ALWAYS ADVISE CLIENTS TO TALK WITH THEIR DOCTOR BEFORE STARTING A NEW EXERCISE PLAN. QUESTIONS TO ASK MIGHT INCLUDE: HOW MUCH AND WHAT KINDS OF PHYSICAL ACTIVITY ARE SAFE? ARE THERE ANY RESTRICTION DUE TO MY PAST HEART DIAGNOSIS?

28

29 HEALTHY WEIGHT LOSING EVEN 5 POUNDS (2.3 KILOGRAMS) CAN LOWER YOUR BLOOD PRESSURE. 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.

30 BMI CHART

31 SMOKING CESSATION PEOPLE WHO SMOKE ARE UP TO SIX TIMES MORE LIKELY TO SUFFER A HEART ATTACK THAN NONSMOKERS, AND THE RISK INCREASES WITH THE NUMBER OF CIGARETTES SMOKED EACH DAY. SMOKERS ARE LIKELY TO SUFFER A HEART ATTACK OR OTHER MAJOR HEART PROBLEM AT LEAST 10 YEARS SOONER THAN NONSMOKERS. TOBACCO INJURES BLOOD VESSEL WALLS AND SPEEDS UP THE PROCESS OF HARDENING OF THE ARTERIES.

32 STRESS MANAGEMENT

33 THE BODY S STRESS RESPONSE STRESS IS A RISK FACTOR WHEN YOU PERCEIVE A THREAT, YOUR NERVOUS SYSTEM RESPONDS BY RELEASING A FLOOD OF STRESS HORMONES, INCLUDING ADRENALINE AND CORTISOL. THESE HORMONES ROUSE THE BODY FOR EMERGENCY ACTION. YOUR HEART POUNDS FASTER, MUSCLES TIGHTEN, BLOOD PRESSURE RISES, BREATH QUICKENS, AND YOUR SENSES BECOME SHARPER. THESE PHYSICAL CHANGES INCREASE YOUR STRENGTH AND STAMINA, SPEED YOUR REACTION TIME, AND ENHANCE YOUR FOCUS PREPARING YOU TO EITHER FIGHT OR FLEE FROM THE DANGER AT HAND.

34 SIGNS OF STRESS IRRITABILITY - FRUSTRATION OVERREACTING TO MINOR DISTURBANCES LOSING YOUR TEMPER MORE FREQUENTLY FEELING JUMPY OR EXHAUSTED ALL THE TIME DIFFICULTY CONCENTRATING OR FOCUSING WORRYING ABOUT INSIGNIFICANT THINGS

35 STRESS SELF-ASSESSMENT: THE HOLMES-RAHE LIFE STRESS INVENTORY

36 HOLMES-RAHE LIFE STRESS INVENTORY 150 POINTS OR LESS LOW SUSCEPTIBILITY TO STRESS- RELATED HEALTH PROBLEMS POINTS IMPLIES ABOUT A 50% CHANCE TO DEVELOP STRESS-RELATED HEALTH PROBLEMS IN THE NEXT TWO YEARS 300+ POINTS RAISES THE CHANCE TO ABOUT 80%, ACCORDING TO THE HOLMES-RAHE PREDICTION MODEL

37 UNHEALTHY WAYS TO DEAL WITH STRESS SMOKING DRINKING TOO MUCH OVEREATING OR UNDEREATING ZONING OUT FOR HOURS IN FRONT OF THE TV OR COMPUTER WITHDRAWING FROM FRIENDS, FAMILY, AND ACTIVITIES USING PILLS OR DRUGS TO RELAX SLEEPING TOO MUCH PROCRASTINATING FILLING UP EVERY MINUTE OF THE DAY TO AVOID FACING PROBLEMS TAKING OUT YOUR STRESS ON OTHERS (LASHING OUT, ANGRY OUTBURSTS, PHYSICAL VIOLENCE)

38 STRESS MANAGEMENT STRATEGY # 1 AVOID THE STRESSOR SAY NO WHEN YOUR PLATE IS FULL AVOID PEOPLE WHO STRESS YOU OUT AVOID HOT-TOPIC ISSUES PARE DOWN YOUR TO-DO LIST CONTROL YOUR ENVIRONMENT

39 STRESS MANAGEMENT STRATEGY #2 ALTER THE SITUATION PLAN AHEAD SO YOU DON T OVEREXTEND YOURSELF. EXPRESS YOUR FEELINGS RATHER THAN BOTTLE THEM UP. BE MORE ASSERTIVE ABOUT YOUR TIME.

40 STRESS MANAGEMENT STRATEGY #3 ADAPT TO THE STRESSOR LEARN TO ENJOY TRAFFIC JAMS LOOK AT THE BIG PICTURE ADJUST YOUR STANDARDS REFLECT ON THE POSITIVE THINGS IN YOUR LIFE

41 STRESS MANAGEMENT STRATEGY #4 ACCEPT THE THINGS YOU CANNOT CHANGE DON T TRY TO CONTROL THE UNCONTROLLABLE LOOK FOR THE UPSIDE LEARN TO FORGIVE SHARE YOUR FEELINGS

42 STRESS MANAGEMENT #5 MAKE TIME FOR FUN AND RELAXATION! GO FOR A WALK. SPEND TIME IN NATURE. CALL A GOOD FRIEND. SWEAT OUT TENSION WITH A GOOD WORKOUT. WRITE IN YOUR JOURNAL. TAKE A LONG BATH. LIGHT SCENTED CANDLES. SAVOR A WARM CUP OF COFFEE OR TEA. PLAY WITH A PET. WORK IN YOUR GARDEN. GET A MASSAGE. CURL UP WITH A GOOD BOOK. LISTEN TO MUSIC. WATCH A COMEDY.

43 PRACTICE WHAT YOU PREACH! (INSTRUCTORS) RESERVE SOME CLASS TIME TO DO SOME STRESS- RELIEVING EXERCISES: GO FOR A WALK AROUND THE BUILDING. SIT AND BE FIT! (STRETCH BANDS, EXERCISE BALLS, ETC.) ALLOW 10 MINUTES TO WRITE IN A JOURNAL. GUIDED MEDITATION. BACKGROUND MUSIC DURING BREAKS OR RECESS. HAVE CLASS OUTSIDE ONE DAY!

44 DRUGS AND MEDICATION WHEN BLOOD PRESSURE IS 140 OR HIGHER FOR YOUR SYSTOLIC PRESSURE (TOP NUMBER) OR 90 OR HIGHER FOR YOUR DIASTOLIC PRESSURE (BOTTOM NUMBER), HEALTHCARE PROVIDERS WILL LIKELY PRESCRIBE MEDICATION IN ADDITION TO LIFESTYLE MODIFICATIONS. MORE THAN ONE TYPE OF PRESCRIPTION MEDICATION TO KEEP YOUR BLOOD PRESSURE AT A HEALTHY LEVEL. BLOOD PRESSURE MEDICINES WORK IN DIFFERENT WAYS TO LOWER BLOOD PRESSURE. SOME REMOVE EXTRA FLUID AND SALT FROM THE BODY TO LOWER BLOOD PRESSURE. OTHERS SLOW DOWN THE HEARTBEAT OR RELAX AND WIDEN BLOOD VESSELS.

45 BROAD CATEGORIES OF MEDICATION FOR CLIENTS DIURETICS - SOMETIMES CALLED "WATER PILLS" BECAUSE THEY WORK IN THE KIDNEY AND FLUSH EXCESS WATER AND SODIUM FROM THE BODY. BETA-BLOCKERS - BETA-BLOCKERS REDUCE NERVE IMPULSES TO THE HEART AND BLOOD VESSELS. THIS MAKES THE HEART BEAT SLOWER AND WITH LESS FORCE. BLOOD PRESSURE DROPS AND THE HEART WORKS LESS HARD. ACE INHIBITORS - ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS PREVENT THE FORMATION OF A HORMONE CALLED ANGIOTENSIN II, WHICH NORMALLY CAUSES BLOOD VESSELS TO NARROW. THE ACE INHIBITORS CAUSE THE VESSELS TO RELAX AND BLOOD PRESSURE GOES DOWN. ANGIOTENSIN ANTAGONISTS - ANGIOTENSIN ANTAGONISTS SHIELD BLOOD VESSELS FROM ANGIOTENSIN II. AS A RESULT, THE VESSELS BECOME WIDER AND BLOOD PRESSURE GOES DOWN.

46 BROAD CATEGORIES OF MEDICATION FOR CLIENTS CALCIUM CHANNEL BLOCKERS (CCBS) - CCBS KEEP CALCIUM FROM ENTERING THE MUSCLE CELLS OF THE HEART AND BLOOD VESSELS. THIS CAUSES THE BLOOD VESSELS TO RELAX AND PRESSURE GOES DOWN. ALPHA-BLOCKERS - REDUCE NERVE IMPULSES TO BLOOD VESSELS, WHICH ALLOWS BLOOD TO PASS MORE EASILY, CAUSING THE BLOOD PRESSURE TO GO DOWN. ALPHA-BETA-BLOCKERS - WORK THE SAME WAY AS ALPHA-BLOCKERS BUT ALSO SLOW THE HEARTBEAT, AS BETA-BLOCKERS DO. AS A RESULT, LESS BLOOD IS PUMPED THROUGH THE VESSELS AND THE BLOOD PRESSURE GOES DOWN. NERVOUS SYSTEM INHIBITORS - RELAX BLOOD VESSELS BY CONTROLLING NERVE IMPULSES. THIS CAUSES THE BLOOD VESSELS TO BECOME WIDER AND THE BLOOD PRESSURE TO GO DOWN. VASODILATORS - DIRECTLY OPEN BLOOD VESSELS BY RELAXING THE MUSCLE IN THE VESSEL WALLS, CAUSING THE BLOOD PRESSURE TO GO DOWN.

47 HYPERTENSION AND WOMEN THREE OUT OF FOUR WOMEN WITH HIGH BLOOD PRESSURE KNOW THEY HAVE IT. FEWER THAN ONE IN THREE ARE CONTROLLING THEIR BLOOD PRESSURE. ALL WOMEN SHOULD TAKE STEPS TO CONTROL THEIR BLOOD PRESSURE CERTAIN CONDITIONS CAN INCREASE BLOOD PRESSURE IN WOMEN. PREGNANCY ORAL CONTRACEPTIVES HORMONE REPLACEMENT THERAPY

48 ESSENTIAL COPING AND SUPPORT HIGH BLOOD PRESSURE ISN'T A PROBLEM THAT YOU CAN TREAT AND THEN IGNORE. IT'S A CONDITION YOU NEED TO MANAGE FOR THE REST OF YOUR LIFE. TO KEEP YOUR BLOOD PRESSURE UNDER CONTROL: TAKE YOUR MEDICATIONS PROPERLY. IF SIDE EFFECTS OR COSTS POSE PROBLEMS, DON'T STOP TAKING YOUR MEDICATIONS. ASK YOUR DOCTOR ABOUT OTHER OPTIONS. SCHEDULE REGULAR DOCTOR VISITS. IT TAKES A TEAM EFFORT TO TREAT HIGH BLOOD PRESSURE SUCCESSFULLY. YOUR DOCTOR CAN'T DO IT ALONE, AND NEITHER CAN YOU. WORK WITH YOUR DOCTOR TO BRING YOUR BLOOD PRESSURE TO A SAFE LEVEL AND KEEP IT THERE. ADOPT HEALTHY HABITS. EAT HEALTHY FOODS, LOSE EXCESS WEIGHT AND GET REGULAR PHYSICAL ACTIVITY. LIMIT ALCOHOL. IF YOU SMOKE, QUIT. MANAGE STRESS. SAY NO TO EXTRA TASKS, RELEASE NEGATIVE THOUGHTS, MAINTAIN GOOD RELATIONSHIPS, AND REMAIN PATIENT AND OPTIMISTIC. STICKING TO LIFESTYLE CHANGES CAN BE DIFFICULT ESPECIALLY IF YOU DON'T SEE OR FEEL ANY SYMPTOMS OF HIGH BLOOD PRESSURE.

49 TEACHING HYPERTENSION (INSTRUCTORS) THE BLOOD PRESSURE MONITOR EXERCISE IS A GREAT HANDS- ON ACTIVITY THAT WILL TEACH CHWS HOW TO EFFECTIVELY DO A BLOOD PRESSURE SCREENING. PARTICULARLY EFFECTIVE WITH TACTILE / KINISTHETIC LEARNERS. VISUAL LEARNERS WILL BENEFIT FROM THE MULTIPLE RESOURCES AVAILABE AT HAVE STUDENTS RESEARCH AND DEVELOP A RESOURCE LIBRARY CONTAINING LOCAL AGENCIES, HEALTH DEPARTMENTS, ETC. THAT PROVIDE MEDICAL AND SOCIAL SUPPORT FOR AT-RISK CLIENTS.

50 RESOURCES THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (PRIMARY SOURCE) YOUR GUIDE TO LOWERING BLOOD PRESSURE (DASH) HIGH BLOOD PRESSURE CONTROL BMI CALCULATOR MENU PLANNER

51 RESOURCES 10 YEAR CVD RISK CALCULATOR RTYPE=PUB SMOKING CESSATION ATORS/CALCULATORS/APP/SMOKING-COST- CALCULATOR.ASPX DASH EATING PLAN HE/FACTS_ABOUT_THE_DASH_EATING_PLAN.PDF

52 PRE- AND POST-TESTING

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