Focus on… Self-Management
A normal blood pressure [BP] is 120/80 such as you would have in your 30’s.
This matters because …
BP is a silent killer; you can’t tell from how you feel whether your BP is normal or dangerously sky-high. Raised BP is part of the metabolic syndrome [insulin resistance + raised BP + abnormal cholesterol pattern + prediabetic change] associated with mid-abdominal weight gain and major cause of cardiovascular risk [heart attack and stroke].
BP increases ‘due to age’ are really due to weight increase, stress, reduced exercise and various inflammatory processes damaging normal control mechanisms.
The expert view is that tightly controlled BP, even in over 60 year olds, is beneficial and medically desirable. In the ACCORD-BP study of high risk type 2 diabetics with BP, intense control lowered the death rate from cardiovascular events from 8.8/1000 every year to 5.8/1000 every year and lowered non-fatal events significantly too.
This is critically important for the other main ‘killer’ condition ie dementia. The SPRINT-MIND study found reduced risk of cognitive impairment in older adults with intensive blood-pressure-lowering targets (systolic BP < 120 vs. <140 mm Hg) . The risk of side effects was small [1-3%, and manageable by treatment changes] and there was no risk of reduced cerebral blood flow – in fact a small increase was seen .A study reported at the American Heart Association last week confirmed these concepts. The ESPRIT trial included 11,255 Chinese adults (average age, 64 years; 41% women. Deaths from cardiovascular events were 5/1000/year in the ‘standard treatment group and 3/1000/year with intensive BP reduction. There are four trials that have looked at systolic targets of less than 120 mm Hg vs less than 140 mm Hg (SPRINT, ACCORD BP, RESPECT, and now ESPRIT), and when analyzed properly, they all show a similar benefit for cardiovascular outcomes with the lower 120 target.
What good looks like …
So a BP of 120/80 or lower is ideal [the systolic or top figure is the one to work on]; between this and 129/80 is the prehypertension stage so lifestyle changes could lower your blood pressure, sufficiently.
A BP of between 130/80 to 139/89 is stage 1 hypertension and if lifestyle changes haven’t normalised It, you should take medication. Especially, if you are at risk of heart disease for other reasons.
At 140/80 to 179/119 you have stage 2 hypertension and may need more than one medication to lower your blood pressure At 180/120 it’s a medical emergency and you need urgent help.
However how the BP is measured makes a big difference
Where are you on this?
Best to have a blood pressure monitor at home [upper arm is best – Boots do several inexpensive ones]. Check BP one day every month [diarise it] early morning [30 minutes after rising], noon and teatime, write it down.
Important: BP varies throughout the day.
It is typically higher in the morning, so a clearer picture comes from the 3 x daily routine: always use the same arm.
To get an accurate reading use a monitor with an arm cuff rather than one which wraps round the wrist. The cuff needs to be the right size - a small cuff is intended for an upper arm circumference of less than 23cm, a medium cuff for a circumference of 23-33cm
and a large cuff for an upper arm circumference of between 33 and 50cm
Do take your blood pressure before a coffee or a meal as both can temporarily raise your blood pressure. Don’t take your blood pressure within 30 minutes of smoking, exercising or drinking alcohol for the same reason. In a warm room, place your monitor and arm on a table so that your arm is supported with your elbow at the level of your heart.
Roll your sleeve up so that the cuff is on your bare skin
Position your cuff correctly – you will often see a mark on the cuff which should be positioned over the artery at the crease of your elbow on your inner arm
Relax for 5 minutes in this position before you take your blood pressure
Keep your fleet flat on the floor and Don’t talk or move your fingers while you are using the monitor.
Take 3 measurements and write down the lowest.
What people tell me is difficult/ stops them succeeding
It is just a matter of getting in the habit.
What should you do now?
Get started and encourage your partner to participate.
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