Liz Rhodes, RNECU Student Nurse

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PROBLEM Uncontrolled blood pressures related to

medications, poor diet, and decreased physical activity

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GOALTo motivate a change in behavior patterns

and activities to control blood pressure for stroke prevention

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OBJECTIVESList four modifiable risk factors for strokesState the importance of controlling blood pressure.List different types of foods which are healthy and

not healthy.Verbalize the importance of a healthy lifestyle to

prevent a strokeInterpret BP results after participation in blood

pressure screening and document results if follow-up required

Complete the stroke risk factor form from using obtained knowledge of program

 Be aware that there are others available for assistance

Desire a more positive healthy life styleIdentify reasons for not taking medications 

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BLOOD PRESSUREHow can I tell if I have high blood

pressure?High blood pressure usually has no symptoms. Many people have high blood pressure for years

without knowing it. It's called the "silent killer."

Hypertension is the medical term for high blood pressure. It doesn't refer to being tense, nervous or

hyperactive. You can still have high blood pressure even if you are

a calm, relaxed person.

http://www.americanheart.org/presenter.jhtml?identifier=4473 5

Why is Blood Pressure Management Important?

There is a progressive increase in the risk of: stroke

Elevated BP one of the most common reasons Elevated BP places unnecessary stress on blood

vesselsCoronary (heart) disease (Kaplan & Rose, 2008).

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Factors related to High Blood Pressure

A family history of high blood pressureAge - The incidence of high blood

pressure rises in men after age 35 and in women after age 45

Gender - Men are more likely to have high blood pressure than women

Race - Approximately 33 percent of African-Americans have high blood pressure, compared to 25 percent of Caucasians

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Potential Reasons For Not Taking Medications

Poor eye sight Impairs ability to read prescription and understand labeling

on bottleLimited hearing

Critical communication from health care provider is diminished

Limited mobility Decreased mobility and dexterity can limit a person's ability to

have prescriptions filled to open and close childproof containers

Memory Loss Problem with recalling prescription instructions from

healthcare provider

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Potential Reasons For Not Taking Medications

Economic Condition Limited incomeIncrease in prescription costs

Depression Social and Health Beliefs

beliefs can be based on: misconceptions faulty information cultural conditioning

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Blood Pressure GuidelinesCategory Systolic BP (mm Hg) Diastolic BP (mm Hg) Treatment recommendations

Normal Less than 120 Less than 80 Lifestyle changes encouraged

Prehypertension 120–139 80–89Lifestyle changes necessaryDrugs for compelling indications*

Stage 1 hypertension 140–159 90–99

Lifestyle changes necessaryThiazide diuretic for most peopleMay also consider other blood pressure drugs alone or in combinationDrugs for compelling indications*

Stage 2 hypertension 160 or higher 100 or higherLifestyle changes necessaryTwo or more blood pressure drugs for most peopleDrugs for compelling indications*

*Compelling indications: diabetes, chronic kidney disease, previous heart attack, congestive heart failure, previous stroke, high cardiac risk

Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example, 150/85 mm Hg is classified as stage 1 hypertension, not prehypertension.

Source: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, December 2003.

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Why is Blood Pressure ManagementFor Stroke Prevention Important?Strokes

Leading Cause of Disability in the U.S.3rd Leading Cause of Death in the U.S.

N.C. lies in the Stroke BeltThe Stroke Belt has the highest morbidity

and mortality from Stroke in the U.S.The Buckle of the Belt includes NC, SC and

Georgia

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TYPES OF STROKESHemorrhagic Stroke

Blood vessels in the brain ruptureIschemic Stroke

Blood clots or fatty deposits block vessels that supply the brain with blood.

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Modifiable Risk Factors of StrokesHigh cholesterolHypertension (high

blood pressure)ExerciseDietTobacco

Doubles stroke risk Increases blood

pressureObesity

Alcohol 4 oz. wine or

equivalent may be protective

DiabetesCardiac Disease

Atrial FibrillationTIA/Prior stroke

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PREVENTIONEating a well balanced dietExerciseCompliance with medicationsManagement of:

Diabetes HTN Heart disease

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STROKE RISK AWARENESS SURVEY Check all that applies to you. ***If you check two or more, please see a

healthcare professional and determine what you can do to lower your risk. AGE ____ You are a man over 45 or a woman over 55 years old. FAMILY HISTORY ____ Your father or brother had a heart attack before age 55 or your mother or

sister had one before age 65. MEDICAL HISTORY ____ You have coronary artery disease, or you have had a heart attack. ____You have had a stroke. ____You have an abnormal heartbeat. Tobacco SMOKE ____ You smoke, or live or work with people who smoke every day. Total CHOLESTEROL and HDL cholesterol ____ Your total cholesterol level is 240 mg/dL or higher. ____ Your HDL (“good”) cholesterol level is less than 40 mg/dL if

you’re a man or less than 50 mg/dL if you’re a woman. ____ You don’t know your total cholesterol or HDL levels.

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Risk assess cont.BLOOD PRESSURE ____ Your blood pressure is 140/90 mm Hg or higher, or you’ve been

told that your blood pressure is too high. ____ You don’t know what your blood pressure is. PHYSICAL INACTIVITY ____ You don’t accumulate at least 30 minutes of physical activity on

most days of the week. Excess BODY WEIGHT ____You are 20 pounds or more overweight. DIABETES ____ You have diabetes or take medicine to control your blood sugar.

American Heart Association. (2008). Personal risk assessment form. Accessed on September 12, 2008 at http://www.strokeassociation.org/presenter.jhtml?identifier=3034972

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Stroke is a Medical Emergency

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ABCs of Preventing Heart Disease, Stroke and Heart Attack

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http://www.strokeassociation.org/presenter.jhtml?identifier=3034972

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Heart-Healthy Cooking TipsEat less cholesterol, salt and saturated and trans

fats. Eating less saturated fat and trans fat helps to

lower blood cholesterol levels. Eating fewer calories will help you lose weight,

especially when you also enjoy regular physical activity.

Eating less salt and more potassium helps control blood pressure in most people.

Focusing your diet on foods such as fat-free and low-fat dairy fruits, vegetables and whole-grain, high-fiber foods is essential to good health.

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Here are some tips to help make your meals healthful:

FryingSteam, stir-fry, broil, or bake foods in olive oil or

canola instead of deep-frying in bacon grease or shortening.

SaltUse lemon juice, vinegar, garlic, hot red pepper flakes,

and onions or other low-salt spices instead of salt.Use little or no salt when you cook, spaghetti, noodles,

hot cereal or rice. 

Salad DressingUse low-fat, low-calorie or fat-free salad dressings.

 

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TIPS continuedButter

Use soft tub margarine instead of butter, or use other spreads that are lower in trans fat, cholesterol, and saturated fat such as a stick of margarine.

Eggs Limit egg yolks to three or four per week, or eat egg whites

instead. 

Meat Buy fresh lean cuts of meat and trim the fat before cooking. Eat chicken, turkey, and very lean pork or beef. Remove the skin from poultry before cooking except when

roasting a whole chicken. Roast, broil, or bake meats instead of frying them.

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TIPS continuedOils

Use olive, canola, corn, or safflower oil in cooking.

Use calorie-free, fat-free cooking spray to provide a non-stick surface for grills, bake ware, and wok-ware.

FatLimit saturated calories to less than 7 percent of

your total calories and trans-fat calories to less than 1 percent of your total calories.

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AREA DIETICIANSRenee L KemskeMPH RD LDNOrange County Health Dept2501 Homestead RdChapel Hill, NC 27514Phone: (919) 968-2022 x309Email: rkemske@co.orange.nc.usAreas of Practice:

Individual Counseling, Group Counseling, Programs/Workshops, Cardiovascular/Hypertension, Diabetes, General Nutrition/Wellness,

Gerontology, Weight Control

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AREA DIETICIANSAnne-Marie ScottUNC Wellness CenterHealth Education Dept100 Sprunt StChapel Hill, NC 27517Phone: (919) 843-2163Email: a_scott@uncg.eduAreas of Practice: Individual Counseling, Group Counseling, Programs/Workshops Cardiovascular/Hypertension, General Nutrition/Wellness, Gerontology,

Weight Control

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AREA DIETICIANSElizabeth A WattRD LDNThe Wellness Center at MeadowMont100 Sprunt StChapel Hill, NC 27517-7811Phone: 919-843-2163Email: ewatt@unch.unc.eduAreas of Practice:

Individual Counseling, Group Counseling, Programs/Workshops, Cardiovascular/Hypertension, General Nutrition/Wellness, Weight

Control

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AREA DIETICIANSKara M MitchellMS RD LDDuke Center for Living1300 Morreene RdDurham, NC 27710Phone: (919) 660-6818Email: mitch068@mc.duke.eduAreas of Practice: Individual Counseling, Group Counseling, Programs/Workshops Cardiovascular/Hypertension, Diabetes, General Nutrition/Wellness,

Vegetarian, Weight Control

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FITNESS CENTERSCarolina Fitness

503-C West Main StCarrboro, NC 27510

phone (919) 960-9910

O2 FitnessView Website300 Market Street, #110 (Southern Village),

Chapel Hill, NC 27516 phone (919) 942-6002

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FITNESS CENTERSThe Wellness Center at Meadowmont

View Website100 Sprunt St

Chapel Hill, NC 27517 phone (919) 966-5500

 World-Renowned Residential Program-- Duke

University Diet and Fitness Center 1-800-235-3853 http://www.dukehealth.org/Services/DietAndFit

ness/About/index/DFC%20Brochure%20Inside.pdf

Check with your physician be for starting any physical fitness program

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Prescription DrugsWALMART/SAM'S CLUB

$4 Prescription Drug Program Heart Health & Blood Pressure Medications

Target $4 Prescription Drug Program

UNC Hospital Program for free medications. An application needs to be filled out and submitted.

It does go by income.

**(Check with your physician for generic medication prescription for area programs)

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Things to RememberHelp decrease your risk for a stroke or

recurring stroke by:Maintaining a healthy dietExercise Program

Check with your physician before startingControl your blood pressure

Monitoring/keep tract of results Medications Medical follow-up

**If you think you are having a stroke, call 911 immediately! (See the following signs & symptoms)

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Signs & Symptoms of StrokesSudden numbness or weaknessSudden confusion, trouble speaking or understanding

Sudden trouble seeingSudden trouble walking, dizziness, or loss of balance or coordination

Sudden, severe headache32

Thank You

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Resources American Heart Association [AHA]. (2008). Diet and Nutrition. Site accessed on September 29, 2008 at

http://americanheart.org/presenter.jhtml?identifier=1200010

American Heart Association. (2008). Personal risk assessment form. Accessed on September 12, 2008 at http://www.strokeassociation.org/presenter.jhtml?identifier=3034972

 American Heart Association [AHA], (2008). Stroke risk factors. Site accessed on September 29, 2008 at http://www.americanheart.org/presenter.jhtml?identifier=9217

  American Heart Association [AHA]/American Stroke Association [ASA]. (2007). Let’s talk about lifestyle changes to prevent

stroke. Site accessed on September 29, 2008 at http://www.strokeassociation.org/downloadable/stroke/1219770019473Lifestyle%20Chgs%20to%20Prevent%20Stroke.pdf

  American Stroke Association [ASA]. (2008). Converging risk factors. Site accessed on September 29, 2008 at

http://www.strokeassociation.org/presenter.jhtml?identifier=3027394

American Stroke Association [ASA]. (nd). Stroke risk awareness survey. Site accessed on September 29, 2008 at http://www.strokeassociation.org/downloadable/stroke/1130509929967PTES%20Risk%20Assessment%20Card.pdf

Dufresne, J. & Greene, V. (1990). Medication regimens: Causes of non-compliance. Department of Health and Human Services: Offices of Inspector General. Accessed on October 6, 2008 at http://www.oig.hhs.gov/oei/reports/oei-04-89-89121.pdf

Every Day Health Network. (2008). Stroke center: Blood pressure guidelines Accessed on October 27, 2008 at http://www.everydayhealth.com/publicsite/index.aspx?puid=1c66ebdb-25c5-4042-bd9b-051cb3f9e623&xid=gslp&s_kwcid=blood%20pressure|2525548814&gclid=CMyQ8Z6rzZYCFQS7sgodBWgGzQ

Kaplan, N. &Rose B. (2008). What is goal blood pressure in treatment of hypertension? Retrieved on October 19, 2008 from Up to date at UNC -Chapel Hill.

Sebastian, J. G. in M. Stanhope & J. Lancaster (2008). The nurse leader in the community. Public health nursing: Population-centered health care in the community. (7th ed.). St. Louis, MO: Mosby.

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