Home Health Care

The National Health and Nutrition Examination Survey (NHANES) states that 76 million adult Americans, or approximately 29% of the adult population of the United States, have hypertension. Cardiovascular disease is the primary cause of deaths in the United States. In 2008, the number of deaths due to cardiovascular disease was greater than the number of deaths caused by cancer, accidents, and Alzheimer disease combined.

High blood pressure (HBP) is correlated with an increased risk of heart failure, stroke, and chronic kidney disease. However, HBP does not have to be "high" to lead to these issues; even prehypertension can put one at risk for heart failure, stroke, or chronic kidney disease. People with pre-hypertension are more likely to develop sustained hypertension over the next 5-10 years.

There are two aspects to blood pressure (BP): systolic and diastolic values.

- Normal BP is systolic BP (SBP) <120 mm Hg and diastolic BP (DBP) <80 mm Hg or 120/80.

- Hypertension is defined as SBP ≥140 mm Hg or DPB ≥90 mm Hg or ≥140/90.

- Pre-hypertension is defined as untreated SBP 120 to 139 mm Hg or untreated DBP 80 to 89 mm Hg.

- Stage 1 hypertension is SBP 140 to 159 mm Hg and/or DBP 90 to 99 mm Hg.

- Stage 2 Hypertension is SBP ≥160 mm Hg and/or DBP ≥100 mm Hg.

The presence and staging of HBP should be based on 2 or more BP readings during clinical office visits.

Age and lifestyle factors strongly influence the likelihood of one having HBP. Lifestyle modifications are essential to BP. Lifestyle modifications include weight control, exercise, dietary sodium restriction, moderation of excessive alcohol, and a sensible diet, such as the DASH diet. Visit Mayo Clinic for a great article on the DASH diet.

The ease of home BP measurement has grown with the introduction of small, easily and reliably operated automatic monitoring devices. Home BP devices are convenient and inexpensive methods of getting involved with your own care. However, unless devices are properly maintained and used, they may produce unreliable results.

BP should be taken while sitting in a chair with feet on the floor and your arm comfortable supported at heart level. Caffeine, exercise, and smoking should be avoided for at least 30 minutes prior to taking your BP. You can track your BP by keeping a log and recording your values daily (the good & the bad!).

If you do find at home that you have HBP and visit a clinic for follow up, the physician may prescribe ambulatory monitoring for 24 hours. Ambulatory BP monitoring provides many BP measurements over a period of time, usually 24 hours, which can give a better picture of your BP status.

Once diagnosed with hypertension, the physician will recommend lifestyle modifications (such as diet and exercise), cessation of smoking, and may prescribe a daily anti-hypertensive to lower your BP. It is important to follow these guidelines and take the medication as prescribed at the same time each day to effectively lower your BP. Your physician may also arrange for a follow-up appointment in two months to monitor the effectiveness of your prescribed regimens.

The target goal for an individual with elevated BP is <140/90 mm Hg, except for individuals with diabetes mellitus or chronic kidney disease, for whom a target of <130/80 mm Hg is recommended.

It is important to remember that you can manage your BP and change does not happen overnight. By adhering to the dietary guidelines, exercise regimen, and medication schedule you can control your blood pressure!

If you prefer a visual demonstration on how to monitor your BP, please view http://nurseswithheart.com/home-health-care/nurses-with-heart-whats-up-with-my-blood-pressure.