Dr. Bones & Nurse Amy wrote an excellent post on blood pressure and we publish part of it here for your review, with their permission of course!
One of the most common chronic medical conditions that we will see, in good times or bad, is high blood pressure. Looking back recently at all the articles on [my] blog, I surprised myself when I realized that I hadn’t written about this condition, also known as hypertension, even though I have a touch of it myself. So, here is a primer on high blood pressure, its diagnosis, and treatment:
The blood pressure is the measure of the blood flow pushing against the walls of the arteries in your body. Without this flow of blood, oxygen would never get to all the organs of the body. If this pressure, however, is elevated over time, it can cause long-term damage. Many millions of adults in the U.S. have this condition, which is often asymptomatic (no signs or symptoms). Because of this, it has been referred to as a “silent killer”. Blood pressure tends to rise with increasing age and weight.
The group medic should have, as part of his equipment, a stethoscope for listening and a pressure monitor called a “sphygmomanometer” (blood pressure cuff). This is relatively inexpensive and will allow you to keep an eye on the blood pressures of the members of the community. To use it, place the cuff around the upper arm and fill it up with air, using the attached bulb. Place your stethoscope over an area with a pulse (commonly the inside of the crook of the arm – see figure above) and listen while looking on the gauge on the cuff. Some new compact blood pressure units are shaped like wristbands and no longer require a stethoscope.
When you take a blood pressure, you are listening for the pulse to register on your stethoscope as a rhythmic thumping sound. A blood pressure is measured as systolic and diastolic pressures. “Systolic” refers to blood pressure when the heart beats and “Diastolic” refers to blood pressure when the heart is at rest. Therefore, blood pressure is written down as systolic over diastolic: for example: (systolic pressure) 120 over 80 (diastolic pressure).
Wherever the gauge is when you first hear the pulse is the “systolic” pressure. As the air deflates from the sphygmomanometer, the pulse will fade away. When it first appears to fade is the “diastolic” pressure. You should be concerned with numbers that are above 140/90 in the supine or sitting position. As blood pressures tend to vary at different times of the day and under different circumstances, you would be looking for at least 3 elevated pressures in a row before making the diagnosis of high blood pressure (hypertension). Readings above 160/100 are associated with higher frequency of complications. Persistent hypertension can lead to stroke, heart attack, heart failure and chronic kidney failure. Commonly seen symptoms include headaches, blurred vision, or nausea and vomiting.
Sometimes, elevated pressures can cause a blood vessel in the brain to have an “accident”. Strokes (also known as “cerebrovascular accidents” or CVAs) are bleeding episodes or clots in the brain that occur as a high pressure event, and can cause paralysis. Suspect this condition if your patient has suddenly found themselves unable to control the extremities on one side of their body, or is unable to speak and cannot move one side of their face. They will usually complain of a severe headache as well.
The first step to controlling elevated blood pressures is to return to a normal weight for your height and age. Most people who are obese find that their pressures decrease (often back to normal) when they lose weight. Physical exercise and dietary control are the best way to get there. Dietary restriction of Sodium (salt) is an important factor when it comes to decreasing pressures. Alcohol, Nicotine, and perhaps Caffeine are also known to raise blood pressures, so abstention from these substances is an additional strategy.
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