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Understanding Blood Pressure @LWNurses #LearnWithNurses Michaela Nuttall RGN MSc Founder, Learn With Nurses Director, Smart Health Solutions Clinical Advisor for CVD Prevention, Public Health England Associate in Nursing, C3 Collaborating for Health Chair, Health Care Committee HEART UK Member, Nurses Working Party and Guidelines & Information Working Party, British and Irish Hypertension Society Trustee, PoTS UK @ thisismichaelaUsing Medall.orgClosed FB group & PageUnderstanding blood pressure Across the world THE No. 1 • contributing risk factor for global death is raised blood pressure – causing strokes, heart attacks and other cardiovascular complications 10 MILLION+ • lives are lost each year needlessly due to raised blood pressure ONLY HALF • of people with high blood pressure, know itWhy high blood pressure matters 6What is Blood Pressure? Heart Arteries Arterioles (Cardiac (Blood (Peripheral output) pressure) resistance) • Systolic (the top number) • Diastolic (the bottom number) 120/70mmHgAfterload??? …is the pressure that the heart must work against to eject blood during systole (ventricular contraction)????? The Circulatory SystemWe weren’t designed to live this long….How is BP maintained…. (easy peasy) Baroreceptors • Help the body to adjust to being upright • Keeping us functioning • Stops gravity from pulling fluid into our legs • Keeps us consciousAutonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Increase cardiac output CO =Stroke volume x Heart rate Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Produce Aldosterone. Hormone helps to maintain the body’s salt and water levels Copyright ©2001 BMJ Publishing Group Ltd. Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd. Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd. Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd. Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd.http://high-blood-pressure-symptoms.com/page/2https://www.nice.org.uk/guidance/ng136https://www.nice.org.uk/guidance/ng136 Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd. Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd.https://www.nice.org.uk/guidance/ng136 Reduce the amount of calcium entering cells of the heart and arterial walls. - less strong contractions. Reduces afterload. Myocardial oxygen demand decreases. https://www.nice.org.uk/guidance/ng136 Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd.https://www.nice.org.uk/guidance/ng136 Autonomic nervous system Produce renin Copyright ©2001 BMJ Publishing Group Ltd.Lifestyle and effects on Blood Pressure Modifications Recommendation Approximate SBP Reduction Reduce weight Maintain normal body weight 3-20 mm Hg (BMI of 18.5-24.9 kg/m ) Adopt DASH diet Rich in fruit, vegetables and low-fat 8-14 mm Hg dairy; reduced saturated and total fat content Reduce dietary <100 mmol (2.4g)/day 2-8 mm Hg sodium Increase physical Aerobic activity >30 min/day most days of the week 4-9 mmHg activity Moderate alcohol Men: < 2 drinks/day 2-4 mm Hg consumption Women: < 1 drink/day Chobanian AV et al., JAMA 2003; 289: 2560-2572. Blumenthal JA et al., Arch Intern Med. 2000; 160: 1947-1958 In summary • Think dinosaurs and dinner ladies • What worked to keep us upright and conscious is now working against us (mostly because we are not living as we were designed to be used)