How to measure and manage blood pressure

written by DR SUHAIL AHMED

If diabetes rules the charts of non infectious diseases leading to chronic health issues, high blood pressure aka hypertension is not too far behind. Combined, both hypertension and diabetes are major causes of long term morbidity and mortality currently.

A close look at the latest statistics paints a gloomy picture for sure.

Nearly 63% of total deaths in India are due to noncommunicable diseases, of which 27% are attributed to cardiovascular disease which affects 45% people in the 40-69 age group. Raised blood pressure is among the most important risk factors for cardiovascular diseases. Moreover, it remains poorly controlled due to low awareness about hypertension, lack of appropriate care through primary care and poor follow up.

About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.

What's the definition of blood pressure?

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. -Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 2015.)

How and why blood pressure is measured?

Your blood pressure is recorded as two numbers:

  • Systolic blood pressure (the first/upper number) – indicates how much pressure your blood is exerting against your artery walls when the heart beats.
  • Diastolic blood pressure (the second/ lower number) – indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

You might have a blood pressure test as a part of a routine doctor's appointment or as a screening for high blood pressure (hypertension).

It's important to measure blood pressure more than once because it fluctuates over the course of the day. It can also change due to things like physical exertion, stress, pain, or extreme heat or cold. But this kind of increase in blood pressure is only temporary and it soon returns to normal.


Why is it important to measure blood pressure correctly?

An accurate blood pressure reading gives a clearer picture of your risk for heart disease and stroke.
A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health.
A reading that says your blood pressure is higher than it actually is may lead to treatment you don’t need.

Preparation:

No special preparations are usually needed for a blood pressure test. But the following steps may help your doctor get the most accurate measurement:

  1. Do not smoke, exercise or drink caffeinated beverages for 30 minutes to an hour before the test- may lead to an increase in your heart rate and blood pressure.
  2. Consider wearing a short-sleeved shirt so that the blood pressure cuff can be placed more easily around your arm.
  3. Relax in a chair for at least five minutes before the test.
  4. Tell your doctor about the medications you take. Some drugs may affect your blood pressure.

Procedure: how to use the sphygmomanometer aka BP apparatus

  • The blood pressure cuff is wrapped around the top part of your arm. The bottom of the cuff is just above your elbow. It's important that the cuff fits. Readings can vary if the cuff is too big or too small.
  • Manual blood pressure measurement -
  • the nurse or technician places a stethoscope over the major artery in your upper arm (brachial artery) to listen to blood flow. The cuff is inflated with a small hand pump.
  • As the cuff inflates, it squeezes your arm. Blood flow through the artery stops for a moment.
  • The nurse or technician opens a valve on the hand pump to slowly release the air in the cuff and restore blood flow. He or she continues to listen to blood flow and pulse and records your blood pressure.
  • Digital measurement : automatically inflates and measures your pulse. In this case, a stethoscope is not needed.
  • It takes about one minute to get a blood pressure measurement.


What are a few causes of High Blood Pressure?

High blood pressure has many risk factors, including:

  1. Age : The risk of high blood pressure increases as you age.
  2. Race : Studies point towards certain genetic factors that may lead to hypertension in people of African and Asian origin. Also its noticed that the onset is a decade earlier in these groups as compared to Caucasians
  3. Family history : High blood pressure tends to run in families.
  4. Being overweight or obese : direct and a major causative factor.
  5. Lack of physical activity : not only is the cardiac capacity diminished, this also increases the risk of being overweight.
  6. Using tobacco : Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
  7. Too much salt (sodium) in your diet : Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  8. Too little potassium in your diet : Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don't get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.
  9. Drinking too much alcohol : Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
  10. Stress : High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
  11. Certain chronic conditions : Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.
  12. Sometimes pregnancy can get complicated due to high blood pressure as well, known as Pregnancy Induced Hypertension (PIH). Timely diagnosis and  treatment prevents complications and ensures healthy outcome of the pregnancy.


Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.

A few ways to reduce BP without medicines :

  1. Diet - A diet with a high intake of vegetables, fruits, and whole grains is recommended.  Other recommendations include consuming low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, and nuts; and limiting intake of sweets, sugar-sweetened beverages, and red meat. This dietary pattern should be adapted to appropriate calorie requirements, personal and cultural food preferences, and nutritional therapy for other medical conditions, including diabetes mellitus. One way to achieve this is by following plans such as the Dietary Approaches to Stop Hypertension (DASH) diet
  2. Sodium Intake - There is strong and consistent evidence that reducing sodium intake reduces blood pressure. Adults who would benefit from lowering blood pressure should be advised to limit their sodium intake to no more than 2,400 mg per day (about 1 teaspoon of table salt). Further reduction of sodium intake to 1,500 mg per day is desirable because it is associated with an even greater reduction in blood pressure. The average blood pressure reduction in patients consuming a sodium-restricted diet of 2,400 mg per day is 2/1 mm Hg, or 7/3 mm Hg for those restricting sodium to 1,500 mg per day. Reducing baseline sodium intake by at least 1,000 mg per day will lower blood pressure even if the desired daily sodium intake is not yet achieved.
  3. Physical Activity and Weight Loss - aerobic physical activity three or four times per week for an average of 40 minutes per session to lower blood pressure.  Most health benefits occur with at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking
  4. Smoking Cessation
  5. Alcohol Consumption - alcohol consumption should be limited to two drinks per day (30 mL of ethanol) for most men and one drink per day for women and lighter-weight men.
  6. Stress management - Meditation, Yoga, adequate sleep, family bonding etc.

Yes, this article is one of the many we find online. Similar advice will be given at other places too. Lets follow the advice for once and make a difference, shall we?

Here is a link of video explaining in easy terms the steps to measure blood pressure at home  

Thank you Dr Suhail for the well researched and wonderful write up.

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