My doctor told me something about blood pressure guidelines, what are they?

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1 The Expert s Guide to Lowering Blood Pressure My doctor told me something about blood pressure guidelines, what are they? Every year a group of Canadian blood pressure experts get together and publish recommendations for doctors to follow when treating blood pressure. This publication is known as clinical practice guidelines or guidelines for short. In the guidelines these specialists list: How to properly measure and diagnose high blood pressure What readings your blood pressure should be What changes you can make in your lifestyle to lower blood pressure What medications are the best for treating high blood pressure Shouldn t my doctor know the best way to treat my high blood pressure? Think of blood pressure guidelines is a way for every Canadian to be treated by the best blood pressure specialists in the country The best way to control blood pressure and lower your risk of a heart attack and stroke is always changing. Your doctor is an expert at treating many different health conditions. The blood pressure guidelines don t replace the great advice and individual care you get from your doctor. The blood pressure guidelines are designed to keep your doctor up-to-date with all the latest and greatest blood pressure information. They keep your doctor informed of the best way to treat your blood pressure and keeping you as healthy as possible. Can I look at see the high blood pressure guidelines? The high blood pressure (hypertension) guidelines are very technically but every person can see and read them. These guidelines are available at At this website the blood pressure specialists also have some information for the general public.

2 Why do these experts care about high blood pressure? Having high blood pressure puts you at a much higher risk of premature death. By lowering your blood pressure we can lower your risk of death and many other medical conditions. Some of these conditions include: Stroke Heart attack Congestive heart failure Kidney damage Erectile dysfunction Memory loss (dementia) I have high blood pressure; does this mean that I am going to have a heart attack or stroke? Nobody can tell you if you are going to have a heart attack or stroke. What we can tell you is that every person with high blood pressure is at a higher risk of heart problems. But high blood pressure is just one thing that puts you at higher risk. Experts recommend that doctors check every patient for other things that can also increase the risk of heart disease. Some of these include: Your age Your sex Your cholesterol level Your family history of heart disease Your waist size and your weight If you have diabetes If you are a smoker

3 The more of these things you have the higher your risk of a heart attack or stroke. Your doctor and the blood pressure experts recommend that you try to control as many of these risk factors as possible. Some key tips are: Keep your blood pressure and cholesterol under control Try to keep a healthy weight by eating properly and exercising regularly If you are a smoker, talk to your doctor or pharmacist about how you can become a non-smoker My uncle has had high blood pressure for years and has not had a problem. Why should I care about mine? Having high blood pressure only increases the risk of heart problems. By treating high blood pressure we lower your risk of a heart attack and stroke. The best way to describe the risk of high blood pressure is to think of it like two different people crossing the street. Amy crosses a busy street every day at the street light, waits for the cars to stop and is always watching for problems Jim decides to jaywalk across the same busy street and does not even bother to look before he steps off the curb. We can all agree that Amy has a much lower risk than Jim of having a problem. Although Jim may be able to get across the street most days safely, the odds are is that he will eventually run into a problem. Jim is just like a person with poorly controlled blood pressure. They may not have a heart attack or stroke today or even in the next few years but the odds are they will eventually run into a problem.

4 Do the experts think that all people should have the same blood pressure readings? Experts agree that all people need to have a blood pressure lower than 140/90 or 140 over 90. What this means is that: AND Your top number or systolic blood pressure should be lower than 140 Your bottom number (diastolic blood pressure) should be lower than 90 In people with diabetes and chronic kidney disease, the experts recommend a blood pressure lower than 130/80. I just checked my blood pressure in the machine at the local pharmacy and it is 145/93. Does this mean that I have high blood pressure? Having one blood pressure reading that is a bit above 140/90 does not mean that you have high blood pressure. Blood pressure experts recommend to doctors (with a few rare exceptions) to check the blood pressure at least 2 to 3 more times on different days before diagnosing someone with high blood pressure. If you have a high blood pressure reading, Canadian blood pressure specialists recommend you do the following: If you have a reading that is just a bit above 140/90 you should recheck it a few more times over a few days to see if it stays high. If it stays high and is not going down you should talk to your doctor. If your reading is very high (higher than 180/110) you should see your doctor. If your reading is extremely high (higher than 200/120) you should see your doctor or emergency department immediately

5 How often do experts recommend that I should have my blood pressure checked? People with high blood pressure have no warning signs or symptoms. For this reason many of the people that have high blood pressure don t even know it. Canadian blood pressure experts recommend that every Canadian should have their blood pressure checked at least once every two years by a health care provider. It should be checked more often if you are found to have high blood pressure. Why is my blood pressure so much higher at the doctor s office? White coat high blood pressure is a condition where your blood pressure is high at the doctor s office but normal otherwise. Having white coat high blood pressure is NOT true high blood pressure and it does not require treatment. This is one of the main reasons that experts recommend that your doctor takes several blood pressure readings over a few days before diagnosing you with high blood pressure. If your doctor suspects you have white coat high blood pressure, he may ask you to wear a 24 hour monitor that checks your blood pressure throughout the day. What do the blood pressure experts think about testing my blood pressure at home? Canadian blood pressure experts think that home blood pressure monitoring is a very good idea for most people with high blood pressure. A home blood pressure monitor helps to check your blood pressure when you are relaxed. These experts recommend that your doctor can even use your home blood pressure monitor readings to help diagnose high blood pressure. Are there anything different between the readings at the doctor s office and the ones that I take at home? Canadian blood pressure experts have a little bit different targets for blood pressure when taken on a monitor at home. On a home blood pressure monitor, any reading above 135/85 is considered high

6 There are so many blood pressure monitors on the market, which one do I choose? With so many blood pressure monitors available, you may want to know which one you should use. Blood pressure experts have done all the work for you. Here are some When choosing a monitor make sure you pick one with the right cuff size for your arm. People with small or large arms may need a different cuff than the one that comes with the monitor Only buy a blood pressure tested for accuracy by the Canadian Hypertension Society How do the experts recommend that I test my blood pressure at home? Canadian blood pressure experts recommend the following Best Life Tips when you test your blood pressure: Wait at least 2 hours after a big meal and at least 30 minutes after drinking coffee or smoking 1. If either your bladder or bowel is full, empty them before taking your reading 2. Sit and relax for at least 5 minutes in a quite comfortable place with no distractions 3. Put the cuff around your bare arm according to the manufacturer s instructions 4. Sit in a chair that supports your back and with a table that can support your arm so that it keeps the cuff at heart level. 5. Keep both feet flat on the floor. Do not cross your legs 6. Take your blood pressure in the morning before breakfast and taking any blood pressure medications and before going to bed at night 7. Take at least two blood pressure readings at a time and record both of them with the date and time. 8. Have your machine checked every year by bringing it to your doctor office to make sure it matches your doctor s readings.

7 Do Canadian blood pressure experts recommend that all people with high blood pressure take medication? Blood pressure experts recommend lifestyle changes to be one of the most important treatments for high blood pressure. These changes can not only have a major impact on high blood pressure but can also help to lower your risk of a heart attack or stroke. If you don t lower your blood pressure enough with the lifestyle changes, experts recommend that doctors add medication to your good lifestyle to lower your risk of a heart attack or stroke. What do the blood pressure experts recommend for a healthy lifestyle? A healthy lifestyle is all about eating the right foods and getting a bit of physical activity on most days of the week. Table 1 has a list of good lifestyle changes from the guidelines and the impact these changes can have on your blood pressure. Table 1. Canadian Blood Pressure Experts Lifestyle Recommendations Lifestyle change Recommendation Effect on blood pressure Weight loss Try to maintain a healthy weight. Pay special attention to your waist size because extra stomach fat really increases your risk of heart disease For every 10 pounds of weight loss your blood pressure will drop by: 7.2 mmhg off the top number 5.9 mmhg off the bottom number

8 Healthy diet Choose a diet high in fresh fruits, vegetables, dietary fibre, non-animal protein (e.g. soy) and low-fat dairy products. It should be low in saturated fat and cholesterol. This diet can have a major impact on blood pressure and can drop it by: 11.4 mmhg off the top number 5.5 mmhg off the bottom number Being physically active minutes of moderate exercise on 4 to 7 days per week It can lower drop your blood pressure by: 4.9 mmhg off the top number 3.7 mmhg off the bottom number Moderate alcohol intake Limit your alcohol to a maximum of 2 drinks per day Men should have less than 14 drinks per week and women should have less than 9 drinks per week It can lower drop your blood pressure by: 3.9 mmhg off the top number 2.4 mmhg off the bottom number

9 Lowering your stress Relaxation techniques It can lower drop your blood pressure by: 6.1 mmhg off the top number 4.3 mmhg off the bottom number My doctor keeps talking about salt restriction; does it really make a difference? One thing that blood pressure specialists have focussed on is the amount of salt or sodium in our diet. They now feel that high blood pressure can be treated and prevented by a healthy lifestyle and lowering the amount of salt in our diets. Table 2 lists some quick facts on the impact of salt on our health. Table 2 Some quick facts on the impact of sodium on our health If all Canadians lowered their average sodium intake from 3500 to 1700 mg we would have: 1 million fewer people with high blood pressure 5 million fewer doctor s visits each year for high blood pressure It would save our healthcare system between $ million per year because of lower drug costs, fewer doctor s visits and lab costs There would be a 13% drop in heart disease The total healthcare savings would be over $1.3 billion/year 1 in 3 Canadians with high blood pressure would have normal blood pressure if they just lowered the amount of salt in their diet

10 How much salt do the experts recommend that I eat each day? Canadian blood pressure experts have recommended the following limits for the amount of salt (sodium) we eat each day. The older we become the lower the amount of sodium we should eat in our diets. For people aged years they should eat less than 1500 mg of sodium per day For people aged years they should eat less than 1300 mg of sodium per day For people aged 71 and over they should eat less than 1200 mg of sodium per day Experts recommend that we all follow these salt restrictions to TREAT and PREVENT high blood pressure. I don t add any salt to my food so I should be ok, right? Did you know that over 80% of our salt (sodium) intake comes from eating processed foods or restaurants? Only 10% of our average intake is added at the dinner table or through cooking. How do I lower the salt that I eat? Lowering the amount of salt you eat is easier than ever. All food producers must put the sodium content of their food on the nutrition facts label. Take a look at the label and it should list the sodium amount of the food. Table 3 lists some Best Life Tips to lowering the amount of salt in your diet. Canadian blood pressure and stroke specialists have a great site that talks about the salt in our diet. It is called sodium101.ca.

11 Table 3 Tips to lower the amount of salt (sodium) that you eat in your diet. Try to buy fresh foods (fruits, vegetables, meats) as they are low in sodium Read your nutrition facts labels. Many times you will be able to pick a lower sodium comparable product Foods that tend to be high in sodium are: o Pickled foods o Sauces o Processed meats o Convenience foods (for example TV dinner foods) o Soups Do not put a salt shaker on the table when eating a meal Watch your portion sizes. For example a bottle of vegetable juice may say that it has 100 mg of sodium for a 250 ml serving size, but it comes in a 710 ml bottle. If you drink the whole drink you will be consuming 284 mg of sodium instead of just 100 mg. Try to cook your meals from scratch because you can control the amount of salt you add Be careful when cooking with broth, stock or sauces as they tend to be high in salt Use fresh or frozen vegetables if possible When eating at a restaurant consult the nutritional information or ask the waiter about low-salt options When eating out some foods that tend to be high in sodium are: o Hamburgers o Hotdogs o Pizza o Sandwiches o Subs

12 If I lower the amount of salt in my diet, what does it do to my blood pressure? Blood pressure experts have found that if you lower your sodium intake to fewer than 1800 mg per day: Your top number (systolic blood pressure) will drop by 5.1 mmhg Your bottom number (diastolic blood pressure) will drop by 2.7 mmhg Is there an easier way to watch the amount of salt I eat in my diet? Stroke and blood pressure experts have developed a quick system for helping you choose foods that are low in sodium. They give foods a red, yellow or green colour based on how much sodium they have. This system can be found at sodium101.ca and is listed in table 4. Table 4 The sodium 101 method to lowering the sodium in your diet. Too Much Foods with 400 mg or more of sodium per serving Watch out Foods with mg of sodium per serving Go Ahead Foods with mg of sodium per serving

13 I have improved my diet and I started exercising regularly but my doctor says I am still high; do I really have to take medication? Blood pressure experts feel that if you are not reaching your target blood pressure, your doctor should start you on a medication to lower your blood pressure. Remember most people with high blood pressure don t feel any symptoms, but if your blood pressure high it places you at high risk of a heart attack or stroke. There are so many blood pressure medications out there how does my doctor choose which one is right for me? Blood pressure experts recommend that your doctor chose a blood pressure medication based on any of your medical conditions. If you have high blood pressure without any other medical conditions then experts feel there are many different medications yourdoctor can use to lower your blood pressure. In people with certain medical conditions, experts are very specific in the drugs they recommend. For example: In people with kidney problems they recommend certain blood pressure medications such as ACE inhibitors or ARBs In people with serious heart disease they common recommend ACE inhibitors, ARBs or a class of drugs called beta blockers. For more information on the specific drugs, please read the high blood pressure module. My doctor says that he needs to add another medication to control my blood pressure, why is the one medication not working? Blood pressure experts know that about two-thirds of all people with high blood pressure will need at LEAST 2 drugs to control their blood pressure. Close to a half of all people will need to take at LEAST 3 drugs to control their blood pressure. They also recommend that doctors use lower doses of different blood pressure drugs because it may work better and have fewer side effects.

14 With so many people needing at least two medications to control their blood pressure, many pills are now made with two blood pressure drugs in a single pill. This is a good choice for most people because it means taking at least one fewer pill and can help to make it easier to take their medication. Do I have to take a different blood pressure medication because I have diabetes? Most people with diabetes are at a high risk of having heart problems. This is why blood pressure experts recommend a lower blood pressure target of 130/80 mmhg for people with diabetes. To reach these blood pressure targets, most people with diabetes and high blood pressure will need several blood pressure medications. Many people with diabetes will also develop problems with their kidneys. There are certain blood pressure medications that can not only lower blood pressure but also help to protect the kidneys. These medications are called ACE inhibitors or ARBs. For this reason both blood pressure and diabetes experts recommend these medications as the best choice for people with diabetes and signs of kidney problems. Do I have to take a blood pressure pill every day? Unfortunately we don t have a cure for high blood pressure. The medications that we have lower blood pressure but you have to take them every day. Some people will stop their medications or only take them every now and then. This is not a good idea because any time the blood pressure is high, the person is at a much higher risk of a heart attack or stroke. To get the most out of your medications and to have a lower risk of a heart attack and stroke it is very important that you take your blood pressure pill(s) every day.

15 I take so many medications; do I really have to take two different blood pressure pills? Some people with high blood pressure also take other medications every day. Adding a few blood pressure pills can makes things even more complicated and confusing. The good news is that for most people there are many things that can be done to make this easier. Here are some questions that you can ask your doctor or pharmacist to make taking your medications easier: Ask if there is anything that can be done to make your pill schedule any easier. Ask if any of your medications can be taken at the same time. It is easier to take 5 medications once a day instead of taking 1 medication 5 times per day. Ask if any of the medications can be replaced by combination pills. Many pills will have 2 different medications in one pill. Some pills will have two different blood pressure medications and there is even a combination that has both a blood pressure medication and a cholesterol drug Ask about special packaging. Sometimes a simple pillbox can help. Some pharmacies also help to blister package your medication to make things much easier for you.