and CONTROL High Blood Pressure CM-09-10

Transcription

1 Eating to STOP and CONTROL High Blood Pressure CM Developed by Joyce M. Woodson, M.S., R.D., Area Specialist Jacqueline Black, B.S., Program Officer Millicent Braxton-Calhoun, M.S., Program Officer Copyright 2009, University of Nevada Cooperative Extension. All rights reserved. No part of this publication may be reproduced, modified, published, transmitted, used, displayed, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopy, recording or otherwise without the prior written permission of the publisher and authoring agency. The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States.

2 EATING TO STOP AND CONTROL HIGH BLOOD PRESSURE Introduction Research documents that despite the progress that has been made in the improvement in overall health of the nation, minorities are experiencing continuing disparities in the burden of illness. Racial and ethnic minorities suffer a disproportionately high incidence of chronic disease. Data show that overall, while one in three Americans has hypertension; two in five African Americans have hypertension. The effects of hypertension are more frequent and severe in African Americans. This population develops hypertension at an earlier age than whites. Hypertension is a leading risk factor for stroke. Nevada, unfortunately, parallels the rest of the nation with heart disease as the No. 1 cause of death in the state; uncontrolled hypertension is a risk factor for heart disease. A Community Health Survey (2001) conducted in Clark County, Nevada, through predominately African American churches, has shown that 40 percent of respondents reported to be hypertensive and 60 percent reported hypertension in their family history. Controllable risk factors for hypertension include excessive weight; physical inactivity; high-fat, high-sodium food choices; and food-preparation methods. All of these risk factors are found in the lifestyle behaviors of Americans. Many who are diagnosed and treated for hypertension do not follow the medical recommendations. The Dietary Approaches to Stop Hypertension (DASH) has been found to be most effective in lowering blood pressure in hypertensive and non hypertensive

3 subjects. Additional research was done to show the effects of limiting sodium when using DASH. DASH-Sodium included a reduction of the use of salt and sodium in addition to the increase in fruits, vegetables and low-fat dairy products as in the original DASH. Sixty percent of the participants in the DASH research and 57 percent of the participants in the DASH-Sodium research were African Americans. This curriculum uses DASH-Sodium to modify food choices and food- preparation methods. The goal of the curriculum is to give participants skills and knowledge to prevent and control hypertension. EVALUATION The Stages of Change Model (a transtheoretical model) is our choice for evaluation. The Stages of Change Model looks at readiness to change a health behavior. The stages are: Precontemplation (no intention of changing within the next 6 months) Contemplation (intent to change) Preparation (planning to change within the next month) Action (changing behavior) Maintaining (continuing changed behavior for 6 months) To assess participants change as a result of this program, users may want to consider administering pre and post tests. In addition, we have found it helpful to re-administer the test as a post-post-test several months after conclusion to assess movement along the stages and maintenance. The goal of the curriculum is to assist participants to acquire the skills and knowledge necessary to utilize the DASH eating plan.

4 One possible instrument may be the Eating Style Questionnaire (ESQ) developed by Margaret K. Hargeaves and other researchers at Meharry Medical College. The ESQ was found to be useful in working with African American women. The ESQ can be modified to assess use of low-fat milk products, and the intake of fruits, vegetables and fiber as recommended by the DASH diet. This curriculum is designed to be used with any population. Included in the curriculum is one Fact Sheet that is specific to African Americans; if the participants are not predominantly African American, this Fact Sheet will not be used. The curriculum is designed to be taught by nonprofessional lay or community persons (instructors) trained by nutrition or health educators. The overview section of each lesson is background for the instructor. Although the lay or community instructor will be trained to teach the curriculum, this overview will serve as a refresher on each topic.

5 LESSON 1 WHAT IS HIGH BLOOD PRESSURE

6 LESSON 1 PREVENTION AND CONTROL OVERVIEW: Hypertension, or high blood pressure, is often called the silent killer, because usually, as this silent killer advances, it has no symptoms. It is a serious condition which lasts a lifetime once it occurs. By taking the right action and developing a healthy lifestyle, hypertension can be controlled or prevented. WHAT IS HYPERTENSION OR HIGH BLOOD PRESSURE? Blood pressure is the force of blood against the walls of arteries. Blood pressure will rise and fall throughout the day. When the pressure stays elevated over time, it s called high blood pressure. The medical term for high blood pressure is hypertension. High blood pressure is dangerous because after exposure to high blood pressure over a period of time, small blood vessels can become narrower and therefore the heart must pump harder to push blood throughout the body. This can result in weakening of the heart muscle, decreasing the heart s ability to function efficiently. Hardening of the arteries causes the flow of oxygen-rich blood to be slowed or blocked. It increases the risk of heart disease and stroke, the first and third-leading causes of death among Americans. High blood pressure also can result in other conditions, such as congestive heart failure, kidney disease and blindness. High blood pressure affects about 73.6 million, or one in three American adults. Some people are more likely to develop it than others. It is especially common among African Americans, who tend to develop it earlier and more often than 1-1

7 whites. African Americans suffer from a higher mortality rate than their white counterparts (15.8 percent white males to 52.1 per cent black nonhispanic males and 15.1 percent white females to 40.3 percent black nonhispanic females). Many Americans tend to develop high blood pressure as they get older, but hypertension is not a part of normal or healthy aging. Nevertheless, about 50 percent of all Americans ages 60 and older have high blood pressure. Others at high risk of developing hypertension are people who are overweight, people with a family history of high blood pressure and those with a high, normal blood pressure. High blood pressure also is more common in the southeastern United States. This part of the country is often referred to as the stroke belt. HOW IS BLOOD PRESSURE CHECKED? Blood pressure is measured using a blood pressure cuff on the upper arm. Blood pressure usually is measured in millimeters of mercury (mm Hg) and recorded as two numbers systolic pressure (as the heart beats) over diastolic pressure (as the heart relaxes between beats) for example: 120/80 mm Hg. Both numbers are important, although for some Americans systolic blood pressure is especially important. A systolic blood pressure of less than 120 and a diastolic blood pressure of less than 80 mm Hg is considered healthy. A blood pressure reading between 120/80 mm Hg and 139/89 mm Hg is prehypertension. Prehypertension means that you don t have high blood pressure at present; however, you may develop high blood pressure in the future. Adopting healthy lifestyle changes will decrease your risk for developing hypertension. 1-2

8 CAN HIGH BLOOD PRESSURE BE PREVENTED OR CONTROLLED? High blood pressure can be prevented. If someone has high blood pressure, it can be controlled. The following steps are suggested: Maintain a healthy weight. Be physically active. Follow a healthy eating plan which includes foods lower in salt and sodium. If you drink alcoholic beverages, do so in moderation. If you have high blood pressure and are prescribed medication, take it as directed. If you smoke, get help to stop. Learn how to manage stress. Maintain a healthy weight. Overweight increases your risk of developing high blood pressure. In fact, blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure. Weight loss has the biggest effect in those who are overweight and already have hypertension. If you need to lose weight, it s important to do so slowly. Lose no more than onehalf to two pounds a week. Begin with a goal of losing 10 percent of your current weight. This is the healthiest way to lose weight and, importantly, it offers the best chance of long-term success. There s no magic formula for weight loss. You have to eat fewer calories than you use in daily activities. Just how many calories you burn daily depends on factors such as your body size and how physically active you are. 1-3

9 Be physically active. Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It also helps to reduce your risk of heart disease. It doesn t take a lot of effort to become physically active. All you need to do is 30 minutes of moderate-level physical activity on most, and preferably all, days of the week. Examples of moderate-level activity are brisk walking, bicycling, raking leaves and gardening. You can divide the 30 minutes into shorter periods of at least 10 minutes each. For instance: use stairs instead of an elevator; get off the bus one or two stops early; or park your car at the far end of the lot at work. If you already engage in 30 minutes a day, you can get added benefits by doing more. Do a moderate-level activity for longer periods each day or engage in a more vigorous activity. For example, build a 30-minute exercise period up to 60 minutes or four 15-minute periods per day. Most people don t need to see a doctor before they start a moderate level of physical activity. You should check with a doctor first, however, if you have heart trouble or have had a heart attack; if you are over age 50 and are not used to doing a moderate level activity; if you have a family history of heart disease at an early age; or if you have any other serious health problems. Follow a healthy eating plan. One aspect of a healthy eating plan is to choose foods low in sodium, saturated fat, cholesterol and total fat. Also important is low-fat dairy foods and increased intake of fruits, vegetables and whole-grain breads and cereals. Include nuts, seeds and cooked dried beans three times weekly. If red meat is used with beans, use moderately. Baked or broiled fish, seafood and poultry are good choices. 1-4

10 Drink alcoholic beverages in moderation. Research strongly suggests a relationship between alcohol intake and blood pressure. Consuming high levels of alcohol has been found to increase the risk of high blood pressure. Moderation in use of alcohol is always advisable. Moderation would be one drink daily for women and no more than two for men. Twelve ounces of beer, 5 ounces of wine and 1 ½ ounces of distilled spirits count as a drink. 1-5

11 LESSON 1: Teaching Guide PREVENTION AND CONTROL OBJECTIVES: After completing this lesson the participant will be able to: 1. Explain the normal levels for blood pressure. 2. List the uncontrollable and controllable risk factors for high blood pressure. 3. Identify steps to take to lower their risk for high blood pressure. 4. State the medical name for high blood pressure. KEY POINTS TO COVER WHEN TEACHING THE LESSON: 1. African Americans have a high incidence of hypertension. 2. High blood pressure can be controlled and prevented. 3. Physical inactivity and unhealthy food choices are risk factors that are controllable. MATERIALS AND SUPPLES NEEDED: 1. Attendance sheet 2. Name tags 3. UNCE promotional items 4. Copies of pretest and consent form 5. Participant handouts: Copies of Scenario High Blood Pressure in Blacks Blood Pressure Levels in Adults BMI-What does it Mean? Copies of PowerPoint slides Sample Walking Plan One Day Food Record 1-6

12 6. Wall Covering for PowerPoint Projection 7. Printout of PowerPoint handouts 8. Blood pressure record cards 9. Projector 10. PowerPoint presentation BEFORE TEACHING THE LESSON: 1. Review procedure for administrating the pretest. 2. Review the lesson overview and teaching guide. 3. Review overheads. 4. Gather all materials and supplies. 5. Check with the facility/site, at intervals, one week, two days and the day before, to be sure there is no problem with schedule. WARM UP: 1. Ask participants to sign in, complete nametags, pick up notebooks and promotional items as they arrive. 2. The pretest is to be administered at the beginning of this lesson. Please review the procedure. The instructor or volunteer may administer the test. 3. As the lesson begins, ask each person to introduce themselves and what they hope to learn from the workshop. If expectations are beyond the scope of the workshop, suggest possible resource information. 4. Distribute the scenario and read the scenario for Lesson 1 to the group. Have participants read and respond to the scenario. Divide participants into groups to discuss the questions. After 5 minutes, each group will select a speaker to share their group s responses to the questions. 1-7

13 PROCEDURES FOR TEACHING THE LESSON: 1. Show title PowerPoint #1 repeating the title of the workshop. 2. Show PowerPoint #2 repeat the title saying, In this lesson we will learn about blood pressure levels and the risk factors for high blood pressure. 3. Show PowerPoint #3 and repeat the objectives of the lesson. 4. Show PowerPoint #4 and explain that the medical term for high blood pressure is hypertension. Share the following information. o It affects about 73.6 million or 1 in 3 adult Americans. o High blood pressure is more common in the southeastern United States. o African Americans have long suffered a disproportionately high incidence of high blood pressure. This ethnic group tends to develop it at an earlier age and more often than white Americans. o In 2006, University of Nevada Cooperative Extension conducted a community health survey through 15 churches in Clark County Nevada (n=1,370). The incidence of high blood pressure was 40 percent, which was the same as national data at that time. In the same survey, 62 percent of respondents reported having a family history of hypertension. o Hypertension, the medical name for high blood pressure, is often called the silent killer because it has no symptoms. 5. Ask the question, 1-8

14 What is blood pressure? Wait for a response. 6. Show PowerPoint #5, repeating the definition of blood pressure. Explain that; Blood pressure rises and falls throughout the day. But when the pressure stays elevated over time, it s called high blood pressure. Explain that blood pressure is measured with a blood pressure cuff, as shown in the slide. This is a painless procedure. 7. Explain that blood pressure increases as we get older. Approximately 60 percent of people ages 60 and older have high blood pressure. However, high blood pressure is not a natural part of healthy aging. 8. Show PowerPoint #6 stating the information regarding systolic and diastolic pressure. 9. Show PowerPoint #7 asking the participants to turn to the handout Blood Pressure Levels for Adults. Go through the information given, explaining that the levels are for people 18 years and older and state the source, National High Blood Pressure Education Program. We should know our blood pressure numbers. Participate in blood pressure screenings at your church, during medical annual checkups and in the community. If you have hypertension and your doctor has prescribed medication, it is important that you follow recommendations in taking your medication. 1-9

15 Pass out blood pressure record cards. Ask the question; How many of you know your blood pressure reading or numbers? Tell them to write your numbers on the card. You should keep this card and each time your blood pressure is taken the numbers should be recorded. 10. Show PowerPoint #8, reading the definition of risk factors. 11. Show PowerPoint #9, stating that: There are some risk factors beyond our control. State these risk factors. 12. Show PowerPoint # 10, stating: "The good news is that there are risk factors that we can control. State those listed on the PowerPoint. High levels of alcohol have been found to increase the risk of high blood pressure. At all times alcoholic beverages should be used in moderation. This means no more than one drink per day for women and no more than two for men. 13. Show PowerPoint #11 and state that: Hypertension can lead to more serious health conditions. State those listed. 14. Tell the participants: 1-10

16 One of the risk factors we can control is physical inactivity. 15. Show PowerPoint #12, discuss the information given. 16. Show PowerPoint #13., then #14, discussing the suggestions given for moderate exercise. Tell the participants: You should get your doctor s okay before beginning any exercise if you are over 50 years of age, have not exercised in a long time or have a health problem; also remember to pace yourself. Ask that they look at the handout, A Sample Walking Program. Review parts of this handout. 17. Show PowerPoint # 15 and ask participants to turn to the handout Body Mass Index (BMI). Increasing physical activity is important, as important as controlling weight and food selections. Notice at the bottom of the page, weight is measured with underwear but no shoes. Find your height and move across to your body weight. Check your BMI, if your BMI is more than 25, you have some changes to consider. Review information on BMI chart. 18. Show PowerPoint # 16 explaining the points covered on the slide. 1-11

17 This concludes this first lesson on Eating to Stop and Control High Blood Pressure. Over the next week think of steps you may take to lower your blood pressure. 19. Show PowerPoint # 17 and review the main points covered by Lesson Tell participants: In the following lessons we will learn the key points regarding: reading food labels finding salt and sodium in foods using herbs and spices the importance of dairy products Dietary Approaches to Stop Hypertension (DASH) eating plan 21. Show PowerPoint # 18. Next week our lesson will be Why DASH? We will learn about an eating plan to stop and control high blood pressure. Please complete the one day food record and bring it to class next week. Write everything that you eat and drink for one entire day including amount and food preparation method. Please choose a typical day. 1-12

18 Lesson I Scenario Mrs. Linda Williams is a 55-year-old female. Mrs. Williams and her husband Thomas have been married for 25 years. They have four children, a teenage daughter and three adult sons. Their daughter Toni and one son Harry live at home with their parents. Mrs. Williams works part-time as a receptionist for a local dentist, Mr. Williams is in building maintenance with the school district, Harry was recently hired in security at a local hotel/casino and Toni is volunteering for the summer at the nearby Boys and Girls Club. During a recent medical checkup, the doctor expressed concern about Mrs. Williams blood pressure. He said that she needed to lower her blood pressure. Mrs. Williams enjoys cooking for her family, especially on holidays. Mr. and Mrs. Williams maintain a practice of eating dinner out on Saturdays and going to brunch after church on Sundays. Both have gained weight over the past five years. Instructor: Divide participants into groups to discuss questions below. 1. What can Mrs. William do to lower her blood pressure? 2. How would lowering her blood pressure protect her health? 3. What are some problems or difficulties that might get in the way of controlling her blood pressure? 4. What suggestions do you have to help her overcome those problems or difficulties? A group speaker will share responses to questions. The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States. Revised 11/09

19 1 Eating to Stop and Control HIGH BLOOD PRESSURE

20 2 LESSON 1 PREVENTION AND CONTROL

21 OBJECTIVES: 3 After completing this lesson the participant will be able to: 1. Explain the normal levels for blood pressure. 2. List the uncontrollable and controllable risk factors for high blood pressure. 3. Identify steps to take to lower their risk for high h blood pressure. 4. State the medical name for high blood State t e ed ca a e o g b ood pressure.

22 4 HIGH BLOOD PRESSURE IS ALSO KNOWN AS HYPERTENSION

23 5 Blood Pressure is the force of blood against artery walls.

24 SYSTOLIC PRESSURE 6 (as the heart beats) DIASTOLIC PRESSURE (as the heart relaxes between beats)

25 Blood Pressure Levels for Adults * 7 Category Systolic Diastolic Result (mmhg) (mmhg) Normal less than and less than Good for you! Prehypertension or Your blood pressure could be a problem. Make changes in what you eat and drink, be physically active, and lose extra weight. If you also have diabetes, see your doctor. Hypertension 140 or higher or 90 or higher You have high blood pressure. Ask your doctor or nurse how to control it. * For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness. Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NIH Publication No , National High Blood Pressure Education Program, May If systolic and diastolic pressures fall into different categories, overall status is the higher category. Millimeters of mercury.

26 8 RISK FACTORS Conditions or behaviors that increase your likelihood of developing a disease. The more you have, the higher the risk.

27 9 RISK FACTORS BEYOND YOUR CONTROL AGE FAMILY HISTORY RACE OR ETHNICITY

28 10 RISK FACTORS UNDER YOUR CONTROL OVERWEIGHT PHYSICAL INACTIVITY OVERUSE OF ALCOHOL UNHEALTHY FOOD CHOICES STRESS SMOKING

29 11 HYPERTENSION High Blood Pressure can lead to: Stroke Blindness Kidney Failure Heart Attacks Coronary Artery Disease

30 GET UP AND MOVE! Check with your doctor Start slowly Wear comfortable shoes and socks Warm up and cool down Drink Di plenty of water Have fun 12

31 13 MODERATE LEVEL OF ACTIVITY Here s a good place to start. Moderate activities such as walking and climbing stairs for 10 minutes, three times a day, can improve your health.

32 MODERATE ACTIVITIES 14 WALKING GARDENING DANCING VACUUMING RAKING LEAVES CLIMBING STAIRS BOWLING BICYCLING WATER AEROBICS SWIMMING LAPS

33 B ODY M ASS I NDEX (BMI) 15 Here is a chart for men and women that gives BMI for various heights and weights. * To use the chart, find your height in the left-hand column labeled Height. Move across to your body weight. The number at the top of the column is the BMI for your height and weight. BMI HEIGHT (FEET AND INCHES) BODY WEIGHT (POUNDS) * Weight is measured with underwear but no shoes. * For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness. Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NIH Publication No , National High Blood Pressure Education Program, May 2003.

34 16 What Does Your BMI Mean? Category BMI Result Normal weight Good for you! Try not to gain weight. Overweight Do not gain any weight, especially if your waist measurement is high. You need to lose weight if you have two or more risk factors for heart disease. Obese 30 or greater You need to lose weight. Lose weight slowly - about ½ pound to 2 pounds a week. See your doctor or a registered dietitian if you need help. Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report; NIH Publication No , National Heart, Lung, and Blood Institute, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, June 1998.

35 Review 17 Normal Blood Pressure Less than 120 systolic Less than 80 diastolic Risk Factors Under Your Control Overweight Unhealthy Food Choices Stress Smoking Physical y Inactivity Overuse of Alcohol High Blood Pressure Can Lead To Coronary Artery Disease Heart Attacks Stroke Kidney Failure Blindness Get Up And Move

36 Next Week 18 Why y DASH Dietary Approaches to Stop Hypertension Using DASH 20 Years Ago Today Serving Sizes and Choices 1. Please complete the one day food record and bring it to class next week. 2. Write everything that you eat and drink for one entire day including amount and food preparation method. 3. Please choose a typical day. National Heart Lung Blood Institute Portion Distortion Interactive Quiz

37 Joyce M. Woodson, MS, RD, Area Nutrition Specialist Millicent Braxton-Calhoun, MS, Program Officer Kristen Bourque, BS, Dietetic Intern High Blood Pressure/Hypertension What is blood pressure and why blood pressure numbers are important? Blood pressure is the force of the blood against the artery walls. If blood pressure is elevated over time it can lead to high blood pressure also referred to as hypertension. Hypertension is dangerous because it makes the heart work too hard and contributes to hardening of the arteries. High blood pressure puts you at risk for stroke, heart disease, heart failure and kidney failure. FS Reprinted with permission from National Library of Medicine. Blood Pressure Numbers to Know: (In mm Hg) 1. Culter J A, Sorlie P D, Wolz M, Thom T, Fields L E, Roccella E J, Trends in Hypertension Prevalance, Awareness, Treatment and Control in United States adults between and , United States Department of Health and Human Services National Heart, Lung, and Blood Institute, National Institute of Health Saunders E African Americans and Hypertension, Maryland Heart Center blood_pressure.htm 3. What about African Americans and High Blood Pressure? American Heart Association presenter.jhtml?idetifier= Who Can Develop High Blood Pressure? U. S. Department of Health and Human Services National Heart Lung and Blood Institute, National Institute of Health 5. Hypertension and African Americans, St. John Health Normal (less than) 120/80 mm Hg Prehypertensive /80-89 Hypertensive 140/90 or higher Prehypertension is an increased risk for hypertension. What do these numbers mean? 120/80 - The first number (120), also referred to as systolic, represents the pressure when the heart is beating. The second number (80), referred to as diastolic, represents the pressure when the heart is resting between beats. The systolic pressure is always stated first and the diastolic pressure second. Example: 120/80 (120 over 80); systolic = 120, diastolic = 80 The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States. Copyright 2008, University of Nevada Cooperative Extension. Did You Know About 72 million people in the United States age 20 and older have high blood pressure. Of those people with high blood pressure, 71.8 percent were aware of their condition. Black people are more likely to suffer from high blood pressure than the general population.

38 What Are the Risk Factors? Controllable Risk Factors How Can I Improve or Prevent High Blood Pressure? Obesity People with a body mass index (BMI) of 30.0 or higher are more likely to develop high blood pressure. Eating too much salt A high sodium intake increases blood pressure in some people. Drinking too much alcohol Heavy and regular use of alcohol can increase blood pressure dramatically. Lack of physical activity An inactive lifestyle makes it easier to become overweight and increases the chance of high blood pressure. Stress This is often mentioned as a risk factor, but stress levels are hard to measure, and responses to stress vary from person to person. Decrease Sodium/Salt Intake. Less sodium helps lower blood pressure in most people. Herbs and spices give food flavor and avoid the risk of high sodium intake. DASH. Follow the eating plan of Dietary Approaches to Stop Hypertension. Eat for Heart Health. Consume a diet rich in high fiber products such as fruits, vegetables and whole grains. Get Regular Physical Activity. Getting regular physical activity with approval from your doctor will help reduce blood pressure and improve overall heart health. Lose Weight if You re Overweight. Talk to your doctor to see if this is an option. Losing weight will reduce the strain on your heart. Often, weight loss will cause your blood pressure to drop. Manage Stress. Trying to relax throughout the day can help improve blood pressure. Stop Smoking. Smoking is another risk factor for heart disease and stroke. Avoid Excessive Alcohol. Some studies say that drinking more than 3 to 4 ounces of 80-proof alcohol per day will raise blood pressure. Limit your alcohol consumption to no more than 1 2 drinks a day. Uncontrollable Risk Factors Race Black people develop high blood pressure more often than whites people and it tends to occur earlier and to be more severe. Black women are at greater risk compared to black men and other racial groups. Heredity If your parents, or other close blood relatives, have high blood pressure, you're more likely to develop it. Age In general, the older you get, the greater your chance of developing high blood pressure. It occurs most often in people over age 35. Men seem to develop it most often between ages 35 and 55. Women are more likely to develop it after menopause.

39 Blood Pressure Levels for Adults * Category Normal Systolic (mmhg) less than 120 and Diastolic (mmhg) less than 80 Result Good for you! Prehypertension or Your blood pressure could be a problem. Make changes in what you eat and drink, be physically active, and lose extra weight. If you also have diabetes, see your doctor. Hypertension 140 or higher or 90 or higher You have high blood pressure. Ask your doctor or nurse how to control it. * For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness. Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NIH Publication No , National High Blood Pressure Education Program, May If systolic and diastolic pressures fall into different categories, overall status is the higher category. Millimeters of mercury.

40 B ODY M ASS I NDEX (BMI) Here is a chart for men and women that gives BMI for various heights and weights. * To use the chart, find your height in the left-hand column labeled Height. Move across to your body weight. The number at the top of the column is the BMI for your height and weight. BMI HEIGHT (FEET AND INCHES) BODY WEIGHT (POUNDS) * Weight is measured with underwear but no shoes. * For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness. Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NIH Publication No , National High Blood Pressure Education Program, May 2003.

41 What Does Your BMI Mean? Category Normal weight Overweight Obese BMI or greater Result Good for you! Try not to gain weight. Do not gain any weight, especially if your waist measurement is high. You need to lose weight if you have two or more risk factors for heart disease. You need to lose weight. Lose weight slowly - about ½ pound to 2 pounds a week. See your doctor or a registered dietitian if you need help. Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report; NIH Publication No , National Heart, Lung, and Blood Institute, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, June 1998.

42 A SAMPLE WALKING PROGRAM Week 1 Session A Session B Session C Warm Up Walk slowly 5 minutes Repeat Repeat Target Zone Exercising Cool Down Total Time Walk briskly 5 minutes Walk slowly 5 minutes 15 minutes Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 AND BEYONd Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk slowly 5 minutes Walk briskly 7 minutes Walk briskly 9 minutes Walk briskly 11 minutes Walk briskly 13 minutes Walk briskly 15 minutes Walk briskly 18 minutes Walk briskly 20 minutes Walk briskly 23 minutes Walk briskly 26 minutes Walk briskly 28 minutes Walk briskly 30 minutes Walk slowly 5 minutes 17 minutes Walk slowly 5 minutes 19 minutes Walk slowly 5 minutes 21 minutes Walk slowly 5 minutes 23 minutes Walk slowly 5 minutes 25 minutes Walk slowly 5 minutes 28 minutes Walk slowly 5 minutes 30 minutes Walk slowly 5 minutes 33 minutes Walk slowly 5 minutes 36 minutes Walk slowly 5 minutes 38 minutes Walk slowly 5 minutes 40 minutes National Heart, Lung and Blood Institute. Distributed by University of Nevada Cooperative Extension

43 LESSON 2 WHY DASH?

44 LESSON 2 Why DASH? OVERVIEW: Researchers have not been able to find the exact cause of high blood pressure. However, it is known that lifestyle and dietary habits can affect blood pressure. Lifestyle and dietary modifications have been shown to prevent or delay the expected rise in blood pressure in susceptible people and help others to control their blood pressure. Some of these lifestyle modifications include: dietary habits, foods low in salt and sodium, increased physical activity and moderate alcohol consumption. Two studies have shown that diet affects the development of hypertension or high blood pressure. The first was called DASH, for Dietary Approaches to Stop Hypertension. Scientists tested nutrients in foods and found that blood pressure levels were reduced with an eating plan that is low in saturated fat, cholesterol, total fat, and that emphasizes fruit, vegetables, low-fat dairy foods and whole grains. In the first study, three groups of adult volunteers ate one of three diets for eight weeks. The diets of the different groups were as follows: 1. A diet low in fruits, vegetables and dairy products with the same amount of fat as in the average American diet called the control diet. 2. A diet rich in fruits and vegetables called the fruits and vegetables diet. 3. A diet rich in fruits and vegetables, low-fat dairy products with reduced saturated and total fat called the combination diet. 2-1

45 At the end of the eight weeks, the researchers compared the changes in blood pressures of each group. The researchers found that after only eight weeks, the people in the third group, who ate the combination diet, had lowered their blood pressure more than the other groups. In fact, these changes were most significant among people with high blood pressure. These decreases in blood pressure were similar to the effects of medications! Included in this study were 459 adults, with 27 percent having hypertension. Approximately 50 percent were women and 60 percent were African Americans. The second study called DASH-Sodium focused on the effect of reduced sodium intake on participants following the DASH diet or eating a typical American diet. DASH-Sodium involved 412 participants; 41 percent had high blood pressure, 57 percent were women and about 57 percent were African Americans. Participants were assigned, randomly, to follow one of the two eating plans. They were followed for one month on the assigned plan and at each of three sodium levels. The sodium levels were 3,300 milligrams per day (the amount consumed by many Americans), 2,300 milligrams (considered an intermediate intake) and 1,500 milligrams per day (a lower intake). It is recommended that sodium not exceed 2,300 milligrams per day. The results from this study showed that reducing dietary sodium lowered blood pressure for both the DASH and the typical American diet plan. At each sodium level, blood pressure was lower on the DASH diet than on the other eating plan. The biggest blood pressure reductions were for the DASH diet at the sodium intake of 1,500 milligrams per day. Those with hypertension saw the biggest reductions, but those without hypertension also had large decreases. Research has shown that a diet rich in potassium may help to reduce elevated or high blood pressure. It is important that potassium come from food sources not supplements. Potassium is found in many fruits and vegetables, some milk 2-2

46 products and fish. Calcium, important in contraction of the heart muscle, plays a role in the success of DASH, as does magnesium, which controls the relaxation of the heart muscle as blood is pumped out. As with potassium it is important to get these nutrients from food sources. The DASH research was sponsored by the National Heart, Lung, and Blood Institute. Research studies were conducted at Brigham and Women s Hospital, Boston, MA; Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Durham, NC; Johns Hopkins Medical Institutions, Baltimore, MD; and Pennington Biomedical Research center, Baton Rouge, LA. Blood pressure medication can cause side effects and is also expensive. However, some people may be able to prevent or decrease their high blood pressure through food choices, thus reducing the need for medications. It is important to note that an individual should never stop taking blood pressure medication or change your dosage without consulting their physician first. 2-3

47 LESSON 2: Teaching Guide Why DASH? OBJECTIVES After completing this lesson, the participants will be able to: 1. List three DASH recommendations that can help lower blood pressure. 2. Explain appropriate serving sizes of foods. KEY POINTS TO COVER WHEN TEACHING THE LESSON 1. The DASH Eating Plan has been shown to successfully lower blood pressure. 2. Lowering sodium intake is an important part of this eating plan. 3. Fruits, vegetables, low-fat dairy products and whole grain foods are emphasized in the DASH Eating Plan. MATERIALS AND SUPPLIES NEEDED: 1. Attendance sheet 2. Name tags 3. PowerPoint presentation 4. Projector 5. Wax food models (NASCO) and deck of cards 6. Wall covering for PowerPoint Projection 7. Plain sheets of paper 8. Participant handouts: Copies of PowerPoint slides DASH Eating Plans, 1600 and 2000 calories 2-4

48 Servings Sizes and Choices, 1600 and 2000 calories DASH Eating Plan Guide Sample of a food label (to be brought in for next lesson) BEFORE TEACHING THE LESSON: 1. Review lesson overview, DASH Eating Plans and teaching guide. 2. Gather all necessary materials and supplies. WARM UP: 1. Have participants pick up name tags and sign attendance sheets. 2. Ask if there are questions about the last lesson. 3. Ask if any one used any of the information from the last lesson. 4. Collect One Day Food Record sheets. PROCEDURES FOR TEACHING THE LESSON: 1. Show the PowerPoint #1, the title of the workshop. 2. Show the PowerPoint #2 Tell the group: During this hour we will review the recommendations for DASH, D-A-S-H, Dietary Approaches to Stop Hypertension. We will look at food groups, daily servings, serving sizes and note the examples of foods in the different food groups. Research has proven that an eating plan emphasizing using low fat dairy products, fruits, vegetables, whole grains and limited sodium does decrease blood pressures levels in persons with high blood pressure and those who do not have high blood pressure. This eating plan was found to be particularly effective with African Americans. 2-5

49 3. Show PowerPoint #3 and repeat the objectives of the lesson. 4. Show the PowerPoint #4 and discuss the information regarding importance of key nutrients in DASH. 5. Show the PowerPoint #5 and pass out copies of the DASH Eating Plan handouts asking participants to insert them in their notebooks. Let s review the recommendations that resulted from the DASH study. You have a sheet for 2,000 calories and one for 1,600 calories. In this discussion we will refer to the 2,000-calorie plan. If you are overweight and wish to lose weight you may want to use the 1,600 calorie plan. Regardless of the plan you find best for you, it is important to make changes slowly. Do not try to make all of the changes at once. The number of changes you find you need to make will be determined by your current eating habits. This lesson and the next four lessons will help you to follow DASH. Please look at the DASH Eating Plan and Serving Sizes and Choices. 6. Using the PowerPoint # 6 and the participant s handout, review all of the information given for grains. Remember the added notes at the bottom of the participant handout. Share food models with the group to understand serving sizes. Continue with a discussion of the vegetable group, using food model to show serving sizes. Ask if there are questions regarding the grains or vegetable groups. 7. Using the PowerPoint # 7 and the participant s handout, review all of the information given for the fruit group. Share food models with the group to understand serving sizes. Continue with a discussion of the fat-free or low-fat milk and milk products, using food models to show serving sizes. Ask if there are questions regarding the fruits or milk and milk products. Tell the group 2-6

50 that additional information on milk will be shared in the lesson on Lactose Intolerance. 8. Using the PowerPoint # 8 and the participant s handout, review all of the information given for lean meats, poultry and fish. It is important to share the information about eggs given in the note on the participant s handout. Share food models with the group to understand serving sizes, show a deck of cards to represent 3 ounces of meat. Continue with a discussion of nuts, seeds and legumes, using food models to show serving sizes. Ask if there are questions regarding these two groups. 9. Using the PowerPoint # 9 and the participant s handout, review all of the information given for fats and oils. It is important to share the information about fats and oils given in the note on the participant s handout. Share food models with the group to understand serving sizes. Continue with a discussion of sweets and added sugars, using food models to show serving sizes. Ask if there are questions regarding these two groups. Emphasize that sweets and added sugars are not included on the 1,600 calorie eating plan. 10. Show PowerPoint #10 and review lesson. This concludes the lesson Why DASH. Limiting salt and sodium is a very important part of DASH. High blood pressure is decreased more as sodium intake decreases, per the DASH recommendations. 11. Show PowerPoint #11 Next week we will practice writing menus using DASH- Sodium Eating Plan. Please continue to review the DASH Eating Plan during the week. 2-7

51 Eating to Stop and Control HIGH BLOOD PRESSURE

52 LESSON 2 Why DASH

53 OBJECTIVES After completing this lesson, the participants will be able to: 1. List 3 DASH recommendations that can help lower blood pressure. 2. Explain appropriate serving sizes of foods.

54 Key Nutrients Potassium keeps a normal water balance between cells and body, needed for contraction of muscles. Magnesium maintains i i normal muscle and nerve function, regular heart rhythm, and for more than 300 chemical reactions in the body. Calcium blood pressure regulation and works in conjunction with potassium and magnesium. Protein needed for chemical reactions and as foundation for building proteins in the body. Fiber decreases risk for heart disease and type 2 diabetes.

55 Dietary Approaches to Stop Hypertension Some pictures courtesy of the National Dairy Council,

56 THE DASH EATING PLAN FOOD GROUP SERVINGS PER DAY 1,600 SERVINGS PER DAY 2,000 Grains & grain products WHAT IS A SERVING? 1 slice bread 1 oz. dry cereal* ½ cup cooked rice, pasta or cereal EXAMPLES cornbread bagel English muffin pita bread grits oatmeal unsalted pretzels crackers popcorn brown rice whole wheat bread whole grain cereals IMPORTANCE Major source of: energy fiber Vegetables cup raw mustard greens tomatoes Rich sources of: leafy kale potatoes potassium vegetable carrots green peas magnesium ½ cup cooked lima beans squash fiber vegetable 4 oz. vegetable juice broccoli turnip greens collards spinach green beans artichokes sweet potatoes cabbage Brussel sprouts *Equals ½ - 1 ¼ cup depending on cereal type. Check the product s Nutrition Facts panel.

57 THE DASH EATING PLAN FOOD GROUP SERVINGS SERVINGS PER DAY PER DAY 1,600 2,000 Fruits WHAT IS A SERVING? 4 oz. fruit juice 1 medium fruit 1/4 cup dried fruit 1/2 cup fresh, frozen or EXAMPLES apples apricots bananas dates grapes oranges grapefruit mangos melon peaches pineapple prunes raisins strawberries tangerines watermelon canned fruit cherries orange juice grapefruit juice IMPORTANCE Important sources: potassium magnesium fiber Lowfat or Fat Free Dairy Foods oz. milk fat free (skim milk) Major sources 1 cup yogurt low fat milk of: 1 1/2 oz. fat free buttermilk calcium cheese low fat buttermilk protein fat free regular or frozen yogurt low fat regular or frozen yogurt fat free cheese low fat cheese

58 THE DASH EATING PLAN FOOD GROUP SERVINGS SERVINGS PER DAY PER DAY 1,600 2,000 WHAT IS A SERVING? EXAMPLES IMPORTANCE Meats, poultry and fish or less 3 oz. cooked meats, poultry or fish select only lean trim away visible fats remove skin from poultry instead of frying, try one of these broil roast bake poach boil Rich sources of: protein magnesium Nuts, seeds 3 per week and dry beans 4-5 per week 1/3 cup or 1 1/2 oz. nuts 2 Tbsp. or 1/2 oz. seeds 1/2 cup cooked dry beans or peas almonds filberts sunflower seeds lentils black-eyed peas split peas hazelnuts walnuts kidney beans peas black beans Rich sources of: energy magnesium potassium protein fiber

59 THE DASH EATING PLAN FOOD GROUP Fats and Oils SERVINGS PER DAY 1,600 SERVINGS PER DAY 2,000 WHAT IS A SERVING? EXAMPLES IMPORTANCE tsp. soft soft margarine DASH has 27 margarine lowfat mayonnaise percent of 1 Tbsp. lowfat light salad dressing calories as fat, mayonnaise vegetable oil (such as olive, including fat in 2 Tbsp. light corn, canola or safflower) or added to salad dressing 1 tsp. vegetable oil foods Sweets 0 5 or less per week 1 Tbsp. sugar 1 Tbsp. jelly or jam 1/2 oz. jelly beans 8 oz. lemonade maple syrup sugar jelly jam fruit flavored gelatin jelly beans hard candy fruit punch sorbet ices Sweets should be low in fat The amount of fat in salad dressings changes based upon the fat content. One tablespoon of regular salad dressing equals one serving, 1 Tbsp. of lowfat dressing equals ½ serving, 1 Tbsp. of fat free dressing equals 0 servings.

60 Review Research has proven that an eating plan using: low fat dairy products grains vegetables fruits limited sodium does decrease blood pressures levels in persons with high blood pressure and those who do not have high blood pressure.

61 Next Week Practice writing menus using DASH Sodium Eating Plan Please continue to review the DASH Eating Plan during the week.

62 DASH 2,000 Calorie Eating Plan Food Group Daily Servings Serving Sizes Examples and Notes Significance of Each Food Group to the DASH Eating Pattern Grains* slice bread 1 oz dry cereal** ½ cup cooked rice, pasta, or cereal Whole wheat bread and rolls, whole wheat pasta, English muffin, pita bread, bagel, cereals, grits, oatmeal, brown rice, unsalted pretzels and popcorn Major sources of energy and fiber Vegetables cup raw leafy vegetable ½ cup cut-up raw or cooked vegetable ½ cup vegetable juice Broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes Rich sources of potassium, magnesium, and fiber Fruits medium fruit ¼cup dried fruit ½ cup fresh, frozen, or canned fruit ½ cup fruit juice Apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, raisins, strawberries, tangerines Important sources of potassium, magnesium, and fiber Fat-free or lowfat milk and milk products cup milk or yogurt 1½ oz cheese Fat-free (skim) or low-fat (1%) milk or buttermilk, fat-free, low-fat, or reducedfat cheese, fat-free or low-fat regular or frozen yogurt Major sources of calcium and protein Lean meats, poultry, and fish ounce servings 3 oz cooked meats, poultry, or fish 1 egg*** Select only lean meat; trim away visible fats; broil, roast, bake or poach; remove skin from poultry (bottom round roast, top sirloin, white meat of chicken and turkey) Rich sources of protein and magnesium Nuts, seeds, and legumes 4-5 per week ⅓ cup or 1 ½ oz nuts 2 Tbsp peanut butter 2 Tbsp or ½ oz seeds ½ cup cooked legumes (dry beans and peas) Almonds, hazelnuts, mixed nuts, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentils, split peas Rich sources of energy, magnesium, protein, and fiber Fats and oils**** tsp soft margarine 1 tsp vegetable oil 1 Tbsp mayonnaise 2 Tbsp salad dressing Soft margarine, vegetable oil (such as canola, corn, olive, or safflower), lowfat mayonnaise, light salad dressing The DASH study had 27 percent of calories as fat, including fat in or added to foods Sweets and added sugars 5 or less per week 1 Tbsp sugar 1 Tbsp jelly or jam ½ cup sorbet, gelatin 1 cup lemonade Fruit-flavored gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugar Sweets should be low in fat * Whole grains are recommended for most grain servings as a good source of fiber and nutrients. ** Serving sizes vary between ½ cup and 1¼ cups, depending on cereal type. Check the product's Nutrition Facts label. *** Since eggs are high in cholesterol, limit egg yolk intake to no more than four per week; two egg whites have the same protein content as 1 oz of meat. **** Fat content changes serving amount for fats and oils. For example, 1 Tbsp of regular salad dressing equals one serving; 1 Tbsp of a low-fat dressing equals one-half serving; 1 Tbsp of a fat-free dressing equals zero servings. An EEO/AA institution Reviewed 11/09