1. UNIT TWO LESSON 5: Blood Pressure

2. Objectives At the end of the lesson, participants should be able to: 1. Describe the relationship between diabetes and high blood pressure 2. Explain blood pressure 3. Know their blood pressure numbers 4. Describe ways to control blood pressure 5. Describe feelings and experiences of living with diabetes 6. Identify ways to modify everyday recipes to fit into the diabetes meal plan

3. L-esson

4. What Should You Be Aware Of? Two out of three adults with diabetes also have high blood pressure or hypertension High blood pressure has no symptoms, so it may be difficult to tell if your blood pressure is high If you have diabetes, you should have your blood pressure checked each time you visit your doctor or at least two to four times a year

5. Diabetes and Blood Pressure A person with diabetes and high blood pressure also called hypertension is: two to four times more likely to develop heart disease or have a stroke more likely to have diabetes complications: kidney disease eye problems and blindness nerve problems

6. What Is Blood Pressure? Blood pressure is the force of blood inside the arteries It is needed to move blood from the heart to other parts of the body

7. What Is High Blood Pressure? High blood pressure is a condition where the force at which blood flows through the blood vessels is above normal It is also known as hypertension

8. Understanding Terms and Numbers The top number is called the systolic (sis-TOL-ik) pressure This measures the pressure inside the artery as the heart beats and pumps blood to the blood vessels The bottom number is called the diastolic (di-a- STOL-ik) pressure This measures the pressure between beats when the heart is resting There are two numbers in a blood pressure reading: Both of these numbers are recorded as millimeters of mercury (mmHg)

9. What Is Considered High Blood Pressure? A blood pressure reading of 130 over 80 (130/80) mmHg is considered high blood pressure Keeping blood pressure below 130/80 mmHg lowers a person’s risk of developing diabetes complications

10. Ways to Control Blood Pressure 1. Reduce the amount of sodium you eat 2. Follow a healthy meal plan 3. Maintain a healthy weight 4. Take part in physical activity 5. Limit alcohol 6. Stop smoking 7. Take all prescribed medications

11. High Sodium Foods The following foods are high in sodium. You should limit these foods in your diet: Salted snacks Canned, pre-breaded, pre-fried fish Cured or preserved meats (luncheon meats, sausage, hotdogs, corned beef) Canned foods

12. High Sodium Foods Cheeses and buttermilk Seasoned salts Convenience and processed foods Condiments: ketchup, mayonnaise, soy sauce, and salad dressings

13. Reducing Sodium in the Diet Reduce the amount of salt in the diet Eat less than 1,500 mg of sodium each day Less than ¾ of a teaspoon of salt daily Many Americans eat 2,900 to 4,300 mg (1¼ to 2 teaspoons salt) of sodium daily

14. Reducing Sodium in the Diet Use herbs and spices to flavor food instead of salt Limit the amount of salt in cooking Add little salt at the table Cut back on condiments such as mustard, relish, ketchup, soy sauce and barbecue sauce

15. Ways to Cut Back on Sodium Choose fresh fruits and vegetables and foods that are not processed

16. Read Food Labels for Sodium Content Use the Percent (%) Daily Value information on the label to see the percent of the daily requirement you are getting “Low-sodium” foods: contain less than 140 mg of sodium in each serving provide 5% or less of the Daily Value for sodium “High-sodium” foods: contain 20% or more of the Daily Value of sodium

17. Follow a Healthy Meal Plan High blood pressure can be reduced by following the Dietary Approaches to Stop Hypertension (DASH) eating plan Lowers LDL “bad” cholesterol Reduces a person’s risk for heart disease

18. The DASH eating plan is high in: Fruit Vegetables Whole grains Fat-free or low-fat milk or milk products These foods provide nutrients such as potassium, calcium, magnesium, fiber, and protein that tend to lower blood pressure Follow a Healthy Meal Plan

19. The DASH plan is low in: Sodium Saturated fat Cholesterol Total fat Red meats Added sugars and sweets Beverages that contain sugar

20. Breakfast 1 slice whole-wheat toast 2 tablespoons peanut butter 1 medium apple 1 cup fat-free milk DASH Sample Menu

21. Lunch Tossed salad 4 cups of tossed lettuce leaves 2 ounces grilled chicken breast 1 cup sliced fruit (pear, pineapple or berries) ¼ cup almonds or walnuts 2 tablespoons non-fat dressing 6 reduced-sodium wheat crackers 1 cup sugar-free iced tea

22. DASH Sample Menus Dinner 3 ounces grilled salmon 1/3 cup brown rice or whole-wheat pasta ½ cup steamed broccoli and carrots ½ cup tossed salad with reduced-fat dressing 1 whole wheat roll with 1 teaspoon margarine (no trans fat) 1 cup fat-free milk

23. Maintain a Healthy Weight Blood pressure rises as body weight increases Losing weight is an effective means of reducing blood pressure

24. Take Part in Physical Activity Regular exercise can lower systolic blood pressure by 2-10 mmHg Check with your doctor before you begin exercising 30 minutes of physical activity five or more days per week is recommended

25. Limit Alcohol Drinking too much alcohol can raise your blood pressure and add calories without adding nutrients Alcohol should always be taken in moderation No more than 1 drink per day for women No more than 2 drinks per day for men 1 drink is counted as: 12 ounces of regular beer 5 ounces of wine 1 ½ ounces of 80-proof distilled spirits

26. Stop Smoking Smoking injures the walls of the arteries and causes them to harden Smoking is bad for everyone but even more for a person with high blood pressure

27. Take All Prescribed Medications Not everyone takes the same kind of blood pressure medicine Many individuals take more than one type of medication It is important that you take medication as prescribed by your doctor

28. E-mpowerment Diabetes Education Series: Blood Pressure

29. Diabetes Education Series How would you describe your experiences and feelings living with diabetes and high blood pressure. What was most difficult for you? What are ways that you could overcome some of these difficulties? What can you learn from this person’s experience?

30. A-ction Did you accomplish the goal you set last week? Set a goal to help you control your blood pressure.

31. R-eal-Life Problem Solving Virginia’s Story

33. Questions about Virginia’s Story What is Virginia’s problem? Why is this a problem for Virginia? What are things Virginia needs to do to solve this problem? (List as many suggestions as possible.) What might be the best way to solve this problem at this point? Why?

34. Questions about Virginia’s Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Virginia’s story

35. N-utrition Menu Tuna Salad with Whole Grain Bread Zucchini Spice Cake Healthier Cream Cheese Frosting

36. See you next week! Topic: Cholesterol There is nothing better than the encouragement of a good friend. - Katharine Butler Hathaway

37. Date: References: Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist Author: Ingrid Adams, Ph.D., Assistant Professor, Nutrition and Food Science, University of Kentucky Other Contributors