Monitoring your blood pressure at home
- High blood pressure often is referred to as the "silent killer," because it usually has no obvious symptoms &
most people can't tell if their blood pressure is high unless it's measured.
- Home blood pressure monitors make it easy for people to measure their blood pressure
at home. If you're concerned that you might have high blood pressure, or if your family has a history of high blood pressure, you may want to consider getting a home blood pressure monitor.
- The Seventh Joint
National Committee (JNC 7) on Prevention, Detection, Evaluation & Treatment of High Blood Pressure recommends that healthy
adults with normal blood pressure (119/79 mm Hg or below)
should have their blood pressure checked at least every 1 to 2 years. This can be done during
any routine medical visit. 1
- Adults who are prehypertensive
(120–139 &/or 80–89 mm Hg) should have their blood pressure checked as often as recommended by their doctor, or at least annually. This can be done during
any routine medical visit.
- Adults with other risk factors
for heart or blood vessel disease or evidence of disease caused by high blood pressure need
to have their blood pressure checked more often.
source: Yahoo Health
How do I take my blood pressure?
- use tobacco products
- use medications known to raise blood pressure (such as certain nasal decongestant sprays)
- or exercise (for at least 30 minutes)
before taking your blood pressure.
taking your blood pressure if you are nervous or upset. Rest at least 15 minutes before
taking a reading.
When you first obtain a blood pressure device, check its accuracy by comparing readings from it with readings obtained by a doctor or nurse taken
in the doctor's office. Ask your doctor or nurse to observe your technique to make sure that you're using the device correctly.
It's a good idea to have your device checked every year.
and position of the blood pressure cuff can greatly affect the accuracy of blood
pressure readings. If the cuff is too small or too large, the measurements will be inaccurate. As
a general rule, the inflatable part of the cuff needs to be at least as long as the widest measurement around your
upper arm. Hospital and medical supply stores generally carry a variety of cuff sizes.
your blood pressure while you're seated in a comfortable, relaxed position. Try not to move
or talk while you're measuring your blood pressure.
that the blood pressure readings may be 10 to 20 mm Hg different between your right arm and
your left arm. For this reason, you may want to use the same arm for every reading.
Blood pressure readings also
vary throughout the day. They usually are highest in the morning after you wake up and move around, decrease throughout the
day and are lowest in the evening.
instructions for using blood pressure monitors vary depending upon the specific device
you choose. Here are the basic principles.
blood pressure monitors: Sit with your arm slightly
bent and resting comfortably on a table so that your upper arm is on the same level as your heart.
Expose your upper arm by rolling up your sleeve but not so tightly as to constrict blood flow. If you're
unable to roll up your sleeve, remove your arm from the sleeve or take off your shirt.
Wrap the blood pressure cuff snugly around your upper arm so that the lower edge of the cuff is about
1 in. (2.54 cm) above the bend of your elbow.
See an illustration of blood pressure cuff placement.
artery, the brachial artery, is located slightly above the inside of your elbow. You can check its location
by feeling for a pulse in the artery with the fingers of your other hand.
using a stethoscope, place the earpieces in your ears and the bell of the stethoscope over the artery, just
below the cuff. The stethoscope should not rub on the cuff or your clothing, since this may cause noises that can make your
pulse hard to hear.
using a cuff with a built-in stethoscope bell, be sure the part of the cuff with the stethoscope is positioned
just over the artery. The accuracy of a blood pressure recording depends on the correct positioning of the stethoscope over
the artery. You may want to have another person who can use a stethoscope properly help you take your blood pressure.
the valve on the rubber inflating bulb. Squeeze the bulb rapidly with your opposite hand to inflate the cuff
until the dial or column of mercury reads about 30 mm Hg higher than your usual systolic
pressure. (If you don't know
your usual pressure, inflate the cuff to 210 mm Hg.) The pressure in the cuff will stop all blood flow within
the artery temporarily.
the pressure valve just slightly by twisting or pressing the valve on the bulb. The pressure should fall gradually
at about 2 to 3 mm Hg per second.
pressure devices have a valve that automatically controls the fall at this rate. As you watch the pressure slowly
fall, note the level on the dial or mercury tube at which you first start to hear a pulsing or tapping sound through the stethoscope.
is caused by the blood starting to move through the closed artery. This is your systolic
letting the air out slowly. The sounds will become muffled and finally will disappear. Note the pressure when
the sounds completely disappear. Record this as your diastolic blood pressure.
Finally, let out all the remaining air to relieve the pressure on your arm.
Electronic blood pressure monitors: For electronic models, press the on/off button on the electronic monitor
and wait until the ready-to-measure "heart" symbol appears next to zero in the display window.
Then press the start button. The cuff will inflate automatically to approximately 180 mm Hg (unless the monitor determines that you require a higher value). It then begins to deflate automatically
and the numbers on the screen will begin to drop. When the measurement is complete, the heart symbol stops flashing and your
blood pressure and pulse readings are displayed alternately.
All blood pressure monitors: Repeat the same procedure 2 more times, for a total of 3 readings. Wait 5
to 10 minutes between recordings while the blood flows unimpeded in your arm.
Record your systolic and diastolic pressures, the date and time, which arm you used (left
or right) and your position (sitting, standing, lying).
Once you become accustomed to taking your own blood pressure, you probably will need to take it only once or twice.
Inspect your blood pressure cuff frequently to see whether the rubber tubing, bulb, valves and cuff are in good
condition. Even a small hole or crack in the tubing can lead to inaccurate results.
feel some discomfort when the blood pressure cuff inflates, squeezing your arm.
have poor hearing or eyesight or limited manual dexterity, you may not be able to use a manual blood pressure
monitor well enough to get accurate results. For people with these limitations, an electronic arm or wrist-cuff model is a
How much weight do you need to lose to lower blood pressure?
MODEST WEIGHT LOSS AND BLOOD PRESSURE CONTROL;
The January 2, 2001 issue
of the Annals of Internal Medicine includes a very important article on the effects of weight loss on those with diastolic
blood pressures in the upper part of the normal range (being in the upper part of the normal
range is a risk factor for heart attacks and strokes); a high blood pressure, that is above the normal range,
is an even greater risk factor.
The investigators studied
595 men and women who were 10% to 65% above ideal weight (a little overweight to a
lot overweight), average age 43 years, with an average systolic pressure of 127 millimeters of mercury
(a little bit above what is desirable) and an average diastolic pressure
of 86 millimeters of mercury (in the upper part of the normal range).
The participants received
a lot of counseling to achieve weight loss. They were compared with 596 controls who were not given any weight reduction counseling.
The results, in part, show
the problems involved in weight reduction and keeping the weight off. At 6 months, on average, the diet group lost almost
10 pounds. At 18 months, the group was attending fewer counseling sessions and the weight loss was an average 4.5 pounds.
By 3 years, they were, on
average, back to their original weights, but still differed from the control group who had, on average, gained 4 pounds.
At 6 months, when the weight loss was greatest, the diastolic blood pressure fell, on average, 2.7 millimeters of mercury
(that does not sound like a lot, but it really is quite significant).
Those who lost the most weight
(almost 20 pounds) dropped their diastolic blood pressure by 7 millimeters
of mercury and their systolic pressures by 5 millimeters of mercury (in both cases,
very significant drops). Those who managed to keep the weight off during the 3-year period maintained their
lower blood pressures.
The authors concluded "significant
long-term reductions in blood pressure and reduced risk for hypertension can be achieved with even modest weight loss".
Commentary: This is a very
good study. It agrees with many other studies. Moderate weight loss can be very helpful not only for those with elevated blood
pressures, but also for those with blood pressures in the upper part of the normal range who are at some increased risk of
heart attack and stroke, and also at increased risk of becoming hypertensive with resulting further increase in risk of heart
attack and stroke.
But there is a warning in
this report. Even this motivated group given extensive counseling had trouble with weight management. As a group, they showed
decreasing interest in the counseling and weight loss over the 3 years, and did not maintain either the weight loss or blood
pressure reduction. Only 13% lost 10 pounds or more, and then kept it off for the 3-year study period.
source site: click here
Behavioral Counseling in Primary Care to Promote a Healthy Diet
Summary of Recommendations
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence
is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected patients in primary care settings.
The USPSTF found
fair evidence that brief, low to medium-intensity behavioral dietary counseling in the primary care setting can produce small
to medium changes in average daily intake of core components of an overall healthy diet (especially saturated fat and fruit and vegetables) in unselected patients (see “Scientific Evidence” for discussion of patient populations
and intensity of interventions).
strength of this evidence, however, is limited by:
addition, there is limited evidence to assess possible harms (see “Clinical Considerations”).
As a result, the USPSTF concluded that there is insufficient evidence to determine the significance and magnitude of the benefit
of routine counseling to promote a healthy diet in adults.
community-based studies have evaluated measures to reduce dietary fat intake in children, no controlled trials of routine
behavioral dietary counseling for children or adolescents in the primary care setting were identified.
The USPSTF recommends
intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular
and diet-related chronic disease.
can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.
found good evidence that medium to high-intensity counseling interventions can produce medium to large changes in average
daily intake of core components of a healthy diet (including saturated fat, fiber, fruit, and vegetables) among adult patients at increased risk for diet-related chronic disease.
Intensive counseling interventions that have been examined in controlled trials among at-risk
adult patients have combined nutrition education with behavioral dietary counseling provided by a nutritionist, dietitian,
or specially trained primary care clinician (e.g.; physician, nurse, or nurse practitioner).
The USPSTF concluded that such counseling is likely to improve important health outcomes and that
benefits outweigh potential harms. No controlled trials of intensive counseling in children or adolescents that measured diet
• Several brief dietary assessment questionnaires
have been validated for use in the primary care setting.5,6 These instruments can identify dietary counseling needs, guide interventions, and monitor changes in patients’
However, these instruments are susceptible to the bias
of the respondent. Therefore, when used to evaluate the efficacy of counseling, efforts to verify
self-reported information are recommended since patients receiving dietary interventions may be more likely to report positive
changes in dietary behavior than control patients.7-10
• Effective interventions combine nutrition
education with behaviorally-oriented counseling to help patients acquire
the skills, motivation, and support needed to alter their daily eating patterns and food preparation practices.
Examples of behaviorally-oriented
counseling interventions include:
training to overcome common barriers to selecting
a healthy diet,
helping patients to set their own goals,
arranging for intra-treatment social support.
In general, these
interventions can be described with reference to the 5-A behavioral counseling framework11:
Advise to change dietary practices,
Agree on individual diet change goals,
Assist to change dietary practices or address motivational barriers,
Arrange regular follow-up and support or refer to more intensive behavioral nutritional counseling (e.g.; medical nutrition therapy) if needed.
• Two approaches
appear promising for the general population of adult patients in primary care settings:
(1) medium-intensity face-to-face dietary counseling
(2 to 3 group or individual sessions) delivered by a dietitian or nutritionist
or by a specially trained primary care physician or nurse practitioner, and
(2) lower-intensity interventions that involve 5
minutes or less of primary care provider counseling supplemented by patient self-help materials, telephone counseling, or
other interactive health communications.
However, more research
is needed to assess the long-term efficacy of these treatments and the balance of benefits and harms.
• The largest
effect of dietary counseling in asymptomatic adults has been observed with more intensive interventions (multiple sessions lasting 30 minutes or longer) among patients with hyperlipidemia or hypertension,
and among others at increased risk for diet-related chronic disease.
include individual or group counseling delivered by nutritionists, dietitians, or specially trained primary care practitioners
or health educators in the primary care setting or in other clinical settings by referral.
of these interventions have enrolled selected patients, many of whom had known diet-related risk factors such as hyperlipidemia
or hypertension. Similar approaches may be effective with unselected adult patients, but
adherence to dietary advice may be lower, and health benefits smaller, than in patients who have been told they are at higher
risk for diet-related chronic disease.12
systems supports (prompts, reminders, and counseling algorithms) have been
found to significantly improve the delivery of appropriate dietary counseling by primary care clinicians.13-15
• Possible harms
of dietary counseling have not been well defined or measured. Some have raised concerns that if patients focus only on reducing
total fat intake without attention to reducing caloric intake, an increase in carbohydrate intake (e.g.;
reduced-fat or low-fat food products) may lead to weight gain, elevated triglyceride levels, or insulin resistance.
Nationally, obesity rates
have increased despite declining fat consumption, but studies did not consistently examine effects of counseling on outcomes
such as caloric intake and weight.
• Little is
known about effective dietary counseling for children or adolescents in the primary care setting. Most studies of nutritional
interventions for children and adolescents have focused on non-clinical settings (such
as schools) or have used physiologic outcomes such as cholesterol or weight rather than more comprehensive
measures of a healthy diet.3,4
Epidemiology and Clinical Consequences
Consuming a healthy
diet is associated with lower risks for chronic disease morbidity and mortality. 4 of the 10 leading causes of death - coronary heart disease, some types of cancer, stroke, and type 2 diabetes - are associated with unhealthy diets.2
between dietary patterns and health outcomes have been examined in a wide range of observational studies and randomized trials with patients at risk
for diet-related chronic disease. The majority of studies show that people consuming diets that are low in fat, saturated fat, trans-fatty acids, and cholesterol and high in fruits, vegetables, and whole grain products containing fiber have lower rates of morbidity and mortality from coronary heart disease, and possibly several forms of cancer.
In addition, one
needs to balance calories with physical activity to maintain a healthy weight. The Dietary Guidelines for Americans16 recommend 3 to 5 daily servings of vegetables and vegetable juices, 2 to 4 daily
servings of fruits and fruit juices, and 6 to 11 daily servings of grain products, depending on caloric needs.
In addition, they
recommend a diet that contains less than 10% of calories from saturated fat, no more than 30% of calories from total fat, and limited consumption
of trans-fatty acids.
well-established benefits of consuming a healthy diet, more than 80% of Americans of all ages eat fewer than the recommended number of daily servings of fruit, vegetables, and grain products and more than the recommended proportions of daily calories from saturated fat and total
28% of people aged 2 years and older consumed at least 2 daily servings of fruit, 49% consumed at least 3 daily servings of vegetables, 51% consumed at least 6 daily servings of grain products, 36% consumed
less than 10% of daily calories from saturated fat, and 33% consumed 30% or less of daily calories from total fat.17
counseling practices of primary care clinicians indicate limited attention to diet modification. In a 1999-2000 survey of
U.S. adults, 33% of respondents reported past-year physician advice to eat more fruits and vegetables, and 29% reported similar advice to reduce dietary fat.18
another recent survey, 25% of adult patients from four community-based group family medicine clinics indicated that their
physicians had advised them to limit or reduce the amount of fat in their diets.19
Effectiveness of Dietary Counseling
The ideal evidence to support behavioral dietary counseling would link counseling
directly to improved health outcomes in randomized controlled clinical trials. In the absence of such evidence, the clinical
logic behind counseling is based on a chain of critical assumptions:
(1) the clinician must be able to assess whether a patient is consuming a healthy diet,
(2) critical components of counseling must be routinely replicable,
(3) counseling must lead to sustained improvements in diet, and
(4) the health benefits of these changes in diet must be established and known to exceed the potential harms of intervention.
conducted for the USPSTF identified 21 fair to good quality randomized controlled clinical trials of dietary counseling among
patients without existing diet related chronic disease (e.g.; coronary heart disease or cancer).
Trials had to include follow-up of at least 3 months after intervention for at least 50% of the
enrolled subjects and include measures of dietary intake.
Studies that assessed only physiologic measures (e.g.; lipid levels, weight, or body mass index [BMI]) were not included.
Additional details of
the inclusion and exclusion criteria, and methods for
assessing quality of studies, are described elsewhere.2,20
Most of these trials
focused exclusively on dietary counseling, though some targeted
diet as part of a broader risk-factor modification program that
also addressed smoking and sedentary lifestyle.21-24 Most studies
targeted reductions in total fat or saturated fat
studies targeted increased fruit and vegetable intake 8,9,12,21,25-27,32,34,35 and
7 targeted increased intake of fiber and whole grains.7,13,22,26,27,32,36
studies (n=11) focused on a single nutrient,
although 10 focused on changes in 2 or more
Studies were classified
by intensity of the interventions evaluated, based on the
number and length of counseling sessions, the magnitude
and intensity of educational materials provided, and the
use of supplemental interventions such as support group sessions or cooking classes.
Low-intensity interventions involved 1 contact lasting less than 30 minutes. High-intensity interventions involved more than 6 contacts lasting more than 30 minutes. Medium-intensity
interventions fell between low and high-intensity.
Effects of counseling
were classified as “large,” “medium,”
or “small” for each component of diet measured.2 With reference to these specific, defined categories,
the USPSTF concluded that large effects sustained
over time were likely to produce important health benefits
(reductions in morbidity and mortality).37-41
the large attributable risk associated with
these dietary components, it is possible that medium or
even small changes in diet would yield important health
benefits across a large population.
However, to date,
there is little direct evidence about the effect of small
and medium dietary changes on the future risk for coronary heart disease, making it difficult to determine with certainty whether
such changes will translate into changes in the incidence
of chronic disease. Better data about these linkages are
Assessing Dietary Behaviors in Primary Care Patients
A number of brief,
validated dietary assessment instruments can identify dietary
counseling needs, guide intervention, and monitor change
among adult patients in primary care and other clinical
settings. Most of these instruments can be self administered,
are easily scored, have fewer than 40 items, and take 10 minutes or less to administer.
instruments are susceptible to bias (i.e.; patients report healthier diets than they actually consume); some studies indicate that underreporting of
caloric intake is common, especially among obese patients.10 When used to evaluate counseling efficacy, efforts to verify self-reported information are recommended. 7-10,13,24,42
children aged 9 years and older, food frequency
questionnaires administered directly to children can provide
a reasonably accurate picture of usual dietary patterns, with correlations with criterion measures ranging from 0.46 to 0.79.6 No
brief valid dietary screening instruments
were identified for children below the age of 9 years. The
optimal interval for screening adults or children is not
Effectiveness of Routine Counseling in Primary Care
The USPSTF found
9 fair to good quality randomized controlled trials of behavioral
dietary counseling in unselected populations in primary
care settings. The majority of these interventions focused on change in more than one nutrient (i.e.; fat/saturated fat, fruit/vegetables, and/or
of these trials combined basic nutrition education
with behaviorally-oriented counseling to help patients acquire
the skills, motivation, or support needed to alter their
daily eating patterns and food selection and preparation practices. Duration of interventions lasted from 1 week to 1 year.
No controlled trials
with children or adolescents were identified. The 9 studies varied in the amount of face-to-face counseling involved. Two studies of medium-intensity interventions evaluated multiple face-to-face sessions of
behavioral dietary counseling provided in the primary care
setting by a dietitian or nutritionist, or by a primary
care physician or nurse practitioner who had received brief
training in dietary counseling.32,36
interventions involved 2 to 3 group or individual
sessions lasting 30 minutes, with follow-up visits at 1
and 3 months. Baron et al reported an 84% patient recruitment
/ participation rate.36
Seven studies involved little or no face-to-face
counseling and placed greater emphasis on patient self-help materials, manuals, and varied forms of interactive health communication.
Two were studies
of low-intensity interventions that combined brief (<5 minutes) face-to-face counseling sessions with a primary care physician or nurse with self-help materials.7,13
others were studies of low intensity interventions
that relied either on mailed self-help materials25,34 or on health behavior change messages
delivered via an automated computer-based voice
et al25 found significantly greater
benefits from tailored than non-tailored self help materials; Lutz et al34 did not. The remaining 2 were medium-intensity interventions that combined a computer-generated personalized letter and motivational
phone call(s) from a trained health educator with a series
of self-help mailings and newsletters.9,26
recruitment and participation in
this second group of studies ranged from 16%34 to 80%,25 with most in the 40% to 70% range.
These studies in
unselected populations produced mostly small (n=9) and medium
(n=8) as opposed to large (n=3) improvements in self reported
dietary behaviors, most of which were statistically significant. Most studies followed patients for 6 months or less post-intervention; 4 followed patients for as long as 12 months.9,13,32,36
Only 2 of them
assessed impacts on intermediate biological endpoints (e.g.; serum cholesterol, weight, or BMI), of which none reported significant treatment effects.13,36 No studies examined adverse treatment effects.
The USPSTF also
reviewed 2 additional studies that enrolled predominantly
healthy pre-menopausal women, a large proportion of whom were overweight or obese. These studies employed high-intensity interventions involving multiple dietitian-led individual12 or group33 counseling sessions.
extended over a 6-month period and aimed at increasing fruit and vegetable intake12; the other extended over a 5-year period and focused on dietary fat reduction.
Both trials reported large treatment effects in self-reported
dietary behavior at 6-month post-intervention follow-up, and both reported
favorable changes in biological risk factors or markers.
in these studies were highly selected and motivated volunteers.
The USPSTF concluded that results could not be generalized to more representative primary care populations.
Effectiveness of Intensive Counseling in Patients at Risk for Chronic Disease
The USPSTF found
10 fair to good quality randomized controlled trials that
tested whether medium to high-intensity interventions delivered
in primary care or other clinical settings led to improved dietary outcomes among adults who were identified as being at increased risk for diet-related chronic disease.8,14,15,21-24,28-31,35
For 2 of these
trials, 2 research reports for each were reviewed.
14,15,28,29 No controlled trials with children or adolescents
at risk for chronic disease were identified that reported
involved a two-step assessment:
screening to identify a patient’s risk status
using chart audit/clinical exam/laboratory testing to screen for hyperlipidemia, hypertension,
family history of heart disease or breast cancer, overweight, obesity, smoking status, and sedentary lifestyle,
followed by assessment of dietary practices using a variety of dietary assessment tools and protocols
(e.g.; food frequency
questionnaires, 3-4 day food records, and brief dietary assessment instruments).
was included as a risk factor in most of these studies.
Four trials addressed diet along with physical activity and/or smoking.21-24 Most
of the trials tested multi-session group or individual counseling
that combined nutrition education with behaviorally-oriented
Most studies focused
on reducing saturated fat and/or total fat intake; 2 of
these studies also targeted fiber or fruit and vegetable
intake,21,22 and one focused on increasing fruit and vegetable
Most studies also
reported intermediate health outcomes, such as serum lipid
levels, blood pressure, weight, and/or BMI. Follow-up in most studies
(n=6) was 12 months or longer, some as long as 4 to 6 years.21-24,28-30
Six of the trials
took place outside of primary care settings, where counseling
was provided by an experienced nutritionist, dietitian,
and/or health educator in 8 to 20 sessions over a period
ranging from 4 months to 5 to 6 years.8,21,23,28,29,31,35
Four trials took place within primary care settings,14,15,22,24,30 where counseling was provided by specially trained primary care physicians or nurses (training ranging from 60 minutes to 3 days)
in 3 to 6 special sessions supplemented by follow-up phone
calls and/or newsletters, and follow-up at routine visits
over a period of 4 to 18 months.
In two primary
care based studies,14,15,30 behavioral dietary counseling
for patients with hyperlipidemia was supplemented, if needed, with lipid-lowering medication and/or referral to outside counseling by a dietitian. Ockene et al15 found that implementing office-level systems supports
(prompts, reminders, and counseling algorithms) significantly improved primary care provider adherence to the comprehensive dietary counseling.
In summary, interventions
for patients at risk for chronic disease resulted in dietary behavior changes that were small (n=3),14,15,21,22 medium (n=6),8,21,22,24,30,35
and large (n=4),8,23,28,31 most of which were statistically
significant. The magnitude and duration of these changes were greater with higher intensity interventions than with interventions of lower intensity.
More than 1/2 of
these studies found that self-reported dietary changes were accompanied by significant improvements in serum lipids,
weight, or BMI.8,21,22,28-30 These findings help corroborate
patients’ self-reported dietary changes and confirm the overall health benefits of the observed
changes in diet.
Medium to high-intensity
behavioral interventions appear to produce consistent, sustained, and clinically important changes in dietary intake of total fat, saturated fat, fruit and vegetables, and fiber. However, these trials were generally
either conducted with patients with known risk factors for
diet-related chronic disease, or performed in special clinics with highly selected patients and specially trained providers.
The most effective
interventions generally combined education, behaviorally-oriented
counseling, and patient reinforcement and follow-up. More intensive interventions, and those of longer duration, are associated with larger magnitude of benefit and more sustained changes in diet.
Available studies do not, however, allow firm conclusions about the essential or most effective elements of these multi-component interventions, their relative effect
on specific dietary constituents (e.g.; fat, fruits and vegetables,
or fiber), or the relative efficacy of targeting
single or multiple dietary risks or addressing diet in the context of broader lifestyle interventions.
is stronger for counseling patients who are at increased
risk for chronic disease, such as those with hyperlipidemia,
than for the general population of patients, it is not possible to disentangle the effects of patient risk status from the effects of intervention intensity.
Adherence to these
intensive interventions and the dietary changes they require may be dependent on patients’ heightened
perceived risk and motivation for change. Existing trials of routine dietary interventions in unselected primary care populations have generally produced
only small to medium changes in self reported diet.
comparisons cannot be made, results from medium-intensity,
routine face-to-face counseling from:
to those achieved through less intensive, minimal-contact
interventions to supplement brief primary care provider
The consistently positive effects of such interventions on diet in unselected patient populations establish these interventions
as highly promising as part of routine7 preventive care for patients at average risk for chronic disease.
The USPSTF concluded,
however, that existing studies do not provide sufficient
evidence to recommend these interventions for widespread
use due to a number of limitations such as modest overall patient recruitment/participation rates, reliance on self-reported outcome measures, relatively short follow-up periods, uncertainty about the health
effects of small and medium changes in diet, and the lack of evidence about possible adverse effects of counseling.
Two studies suggest
high intensity interventions can be effective in selected
patients at average risk, but the applicability of these findings and the feasibility of these interventions in primary care settings are uncertain.12,33
Recommendations of Others
for the general population have been issued by the U.S.
Department of Agriculture (USDA)16 and the Department of Health and Human Services; specific dietary objectives for the nation are outlined in Healthy
People 2010.17 Guidelines from the American Heart Association (AHA) and the American
Cancer Society (ACS)
address diets that will lower the risk for heart disease and cancer, respectively.43,44
guidelines generally agree in recommending
a diet that includes a variety of:
to maintain a healthy weight.
A variety of groups
have recommended nutritional counseling or dietary advice
for patients at average risk for chronic disease, including
the American College of Preventive Medicine (ACPM), American Academy of
Family Physicians (AAFP), American Academy
of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG).45-48
recommendations are based primarily on the
benefits of a healthy diet rather than on evaluations of the efficacy of counseling.
The Canadian Task
Force on Preventive Health Care (CTFPHC)
concluded in 1994 that there was fair evidence to provide
general dietary advice to all patients, based on a limited
number of trials of counseling.49
on nutritional counseling for patients at risk (e.g.; those who have hypertension or hyperlipidemia) have been issued by the American Dietetic Association (ADA) and two panels
sponsored by the National Institutes of Health (NIH) National Heart,
Lung, and Blood Institute.
The ADA recommends
that primary care providers screen for nutrition-related
illnesses, prescribe diets, provide preliminary counseling on specific nutritional
needs, follow up with patients, and refer patients to appropriate dietetic professionals when necessary.50
Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure
recommends that dietary assessments be included as part
of routine medical history and that physicians counsel patients
on lifestyle modifications for the prevention and treatment of high blood pressure (lose weight if overweight, limit alcohol intake, reduce sodium intake, reduce saturated fat and cholesterol intake).51
The National Cholesterol
Education Program recommends that individuals with elevated
levels of low density lipo-protein limit their intake of
fats, particularly saturated fats, and cholesterol and increase dietary fiber.52
source site: click here (all references listed at the source site)
Why should I monitor my blood pressure
Home blood pressure
monitoring provides a measurement of a person's blood pressure at different times and in
different environments, such as at home and at work, throughout the day.
It may be done to:
- Help establish the diagnosis of high
- Monitor the effects of medication taken to lower blood pressure.
- Help people with high blood pressure
to see the effects of medications or lifestyle changes on their blood pressure. Home monitoring can help people feel more involved in and more
in control of their own health care.
- Help diagnose low blood pressure
that may be caused by irregular heart rhythms (arrhythmias), certain medications,
or other medical conditions.
- Monitor the blood pressure
of people who are taking medications, such as monoamine oxidase inhibitors (MAOIs), that can cause episodes of high pressure.
Blood pressure normally fluctuates
from day to day and even from minute to minute depending upon:
- emotional and physical state
Home blood pressure
monitoring is most effective when the person also records his or her daily activities, such as the time when medication is
taken or when a stressful event occurs, in a diary. This can help explain an unusual blood pressure reading and help a
doctor adjust medication dosages accurately.
experience a significant rise in blood pressure only when they're in a doctor's office.
This is called "white-coat hypertension" and probably is caused by anxiety about the doctor visit.
blood pressure at home, these people can often find out whether their blood pressure readings generally are lower when they aren't in the doctor's office.
cases, ambulatory blood pressure monitoring (ABPM) also may be done to help diagnose white-coat hypertension.
source: Yahoo Health
The Silent Killer - A Cautionary Tale
By Michael Wooller
It’s often referred to as the “silent killer” and it’s only by some form of divine intervention
that it didn’t kill me.
I’m talking about high blood pressure.
According to recent estimates, nearly
one in three adults in the industrial nations is likely to have high blood pressure, but because there are no symptoms, nearly
one-third of these people don't know they have it. In fact, many people have high blood pressure for years without knowing
it. The only way to tell if you have high blood pressure is to have your blood pressure checked.
blood pressure can lead to stroke, heart attack, heart failure or kidney failure. Hence high blood pressure is often called
the "silent killer."
As I got into my forties I very occasionally chanced to get my blood pressure checked. It was
usually on the high side. I would usually say things like “well I have ‘white coat syndrome’ so of course
it is high. It’s always high when taken by a doctor”. And in fact if I had it taken at the local chemist it was
usually a bit lower, so I wasn’t worried. Besides I didn’t want to be taking tablets for the rest of my life!
didn’t go to the doctor very often. I was healthy and never had the need. I didn’t smoke, only drank now and then.
However, on the rare occasions that I did visit the doctor, he would point out that I may be healthy but I certainly wasn’t
Anyway this particular doctor was so concerned about me that after I left the district he sent me a prescription for
blood pressure tablets!
I took them for a while, but I couldn’t see the point. OK, so my blood pressure may be a
bit high, but I felt fine. There was nothing wrong with me. I had no symptoms. Hardly ever went to see a GP.
I drove home from work. I had been working a late shift so I got home around midnight. Had a glass of wine, checked my emails,
as you do…………
it was just awareness. The beautiful smiling face of my wife, brightly coloured in a sea of gray. It seems we had been talking
for a while, though I don’t know what I had said. Penny’s voice is full of love and joy and encouragement.
have no context to put it in so I just accept it in the now. There is only now. I have no past. The future is not contemplated.
I see my daughter’s face and hear words of love, joy and encouragement. I am doing exceptionally well. With regards
to what, I wonder? I gradually become aware of the ICU bed and the tubes and the wires and the oxygen mask. And it is all
so normal. I’ve always been like this.
I had suffered an aortic dissection. It had been caused by years of
high blood pressure. The main blood vessel serving my vital organs had split and was blocking the blood supply and my aortic
valve was damaged. But by some miracle I was alive.
The fact that I am writing this piece is one of a series of miracles.
fact that my youngest daughter was visiting us, sleeping on the lounge but not asleep and heard me fall is a miracle. The
fact that I made alive to the hospital was a miracle as well as a testament to the skills of the paramedics who kept me alive.
The fact that I survived the eight hour operation is another miracle and a testament to the skills of the surgeons and medical
staff. The fact that I was found in time, survived the journey to the hospital, the operation and had no brain or organ damage
is another miracle. I am very lucky. Most are not.
I am now on four different blood pressure tablets and will be for
the rest of my life. However long that is!
Because my vascular system is weakened and damaged, I have to make sure
that I average a blood pressure of less than 120/70 and I get yelled at if I pick my grandchildren up because that sort of
muscular activity increases blood pressure.
But then, at least I am still here to be yelled at!
As you get older,
keeping blood pressure in check is fundamental if you want a long and happy life.
I now have my own blood pressure meter
and keep a constant check on it.
The moral is, take your blood pressure seriously. Buy yourself a meter, talk to your
doctor, be proactive. It’s your life.
Prevention is simple. The results of ignorance often can only be rectified
by divine intervention.
What is your blood pressure now?