|Level||First number (mmHg)||Second number (mmHg)||Results|
|Normal||Below 120||Below 80||Good for you!|
|Prehypertension||120-139||80-89||Keep an eye on your blood pressure. It is time to make changes in your eating and physical activity habits. Visit the doctor if you have diabetes.|
|High blood pressure||140 or greater||90 or greater||Ask your doctor or nurse how to control it.|
A normal blood pressure is less than 120/80 mmHg. Blood pressure of 120/80 to 139/89 mmHg is prehypertension. This means that you don’t have high blood pressure yet, but are likely to develop it in the future, unless you make changes in your health habits. Blood pressure is high when it is 140/90 mmHg or greater.
If you have high blood pressure, or hypertension, it means your heart has to pump harder than it should to get blood to all parts of your body. High blood pressure raises your chances of having a stroke, heart attack, or kidney problems or becoming blind.
High blood pressure is known as the “silent killer” because it often has no symptoms. Most people who have it don’t feel sick until they have a stroke, heart attack, or some other problem caused by high blood pressure.
High blood pressure is a major risk factor for stroke. Other risk factors that increase your chances of having a stroke include heart disease, smoking, diabetes, high blood cholesterol, and overweight/obesity.
Do you know anyone who has had a stroke?
Note: Allow a few minutes for group members to answer.
A stroke is also called a brain attack. A stroke happens when blood suddenly stops going to the brain and brain cells die. A stroke is very serious and can lead to disability and death.
The warning signs of a stroke happen suddenly. A person may have one or more warning signs. The warning signs of a stroke include:
- Numbness of the face, arm, or leg (especially on one side of the body)
- Confusion, trouble talking, and difficulty understanding others
- Trouble seeing in one or both eyes
- Trouble walking, dizziness, and loss of balance or coordination
- Severe headache
Ministrokes–or transient ischemic attacks (TIAs)–have the same symptoms as a stroke, but they do not last as long and usually do not cause brain damage. A ministroke is a warning that a stroke may happen in the future.
Ministrokes may last a few seconds or an entire day and then go away. These signs should not be ignored. As with a heart attack, act immediately if you or someone you know has stroke symptoms. Calling 9–1–1 right away will help prevent serious problems.
Measuring blood pressure is easy and does not hurt. The best way to find out if you have high blood pressure is to have it checked at least once a year. Check it more often if you already have high blood pressure.
- A list of places (such as clinics and hospitals) to get blood pressure checked
- The “My Healthy Heart Wallet Card” handout
Ask for your numbers each time you have your blood pressure checked. Keep a record of each reading on the wallet card.
- Ask group members to raise their hands if someone in their families has high blood pressure.
If a member of your family has high blood pressure, you are at greater risk for getting it, too. Even if you do not have high blood pressure now, you are still at greater risk if a family member has it.
The good news is that you can take steps now to lower your blood pressure or keep it from rising. Let’s find out how.
- Give each group member the “Take Steps–Healthy Habits To Lower High Blood Pressure!” handout.
- Read aloud the steps to lower high blood pressure or keep it from rising.
Which steps could you and your family take to prevent or lower high blood pressure?
Note: Allow 3 minutes for group members to respond.
- Note: For this activity, you will need a 1/4 teaspoon measuring spoon, a 1 teaspoon measuring spoon, and some salt. Use a colored plate or a plastic test tube to show the sodium levels.
Even though salt is commonly seen as a symbol of good luck, eating less salt and sodium can help you prevent or lower high blood pressure. You know what salt is, but you may wonder what sodium is. Sodium is a part of salt. It is also part of mixtures used to flavor and preserve foods.
Now let’s look at how much sodium we really need. The body needs only about 500 milligrams of sodium each day. That is about ¼ teaspoon of salt.
Note:Use the measuring spoon to show ¼ teaspoon of salt.
Most people are eating much more than 500 milligrams of sodium every day.
You should cut back the amount of sodium you get from all foods and beverages to less than 2,300 milligrams of sodium — or about 1 teaspoon of salt — per day.
Note: Now show 1 teaspoon of salt.
Most people in the United States eat about 4,000 to 6,000 milligrams of sodium each day.
Note: Now show 2 ½ teaspoons of salt.
This is about 8 to 12 times more sodium than the body needs. Eating this much salt and sodium may lead to high blood pressure.
- Show picture card 4.6.
Let’s talk about what foods are high in sodium.
- Most of the sodium that we eat comes from packaged foods, and from restaurants and fast foods. Examples of packaged foods are:
- Sauces and seasonings, such as soy sauce, patis (fish sauce), tuyo (salty dried fish), and alamang (salted shrimp paste)
- Regular canned soups and vegetables
- Frozen dinners
- Salty chips
- Canned meat, such as pork and sausages, and fish and seafood, such as salmon, squid, and sardines
- Meats high in sodium, such as hotdogs and bacon
- When you eat out, most of the food will be high in sodium. If you have high blood pressure, you should eat out less often.
- Sodium also comes from salt added during cooking or at the table.
- Most of the sodium that we eat comes from packaged foods, and from restaurants and fast foods. Examples of packaged foods are:
- Give group members the “Role Play: Lola’s Family Works Together To Control High Blood Pressure” handout.
Note: If you choose, ask four volunteers to act out the role play. As the trainer, you can read the introduction. After reading the role play, allow 3 to 5 minutes for open discussion.
The family helped Ric learn that he has to make some changes to lower his high blood pressure and lower his risk of a stroke.
- What are some of the lessons we learned from this role play?
- Is there any part of the play that you can use in your own life?
- Give the following responses if they are not said:
Jose teaches Ric that:
- High blood pressure often does not have symptoms and is called the “silent killer.”
- Changing his diet and level of physical activity can help Ric control or lower his high blood pressure and reduce his risk of a stroke.
- Jose’s friends made the right decision by calling 911 right away when he showed signs of a stroke.
One way Lola has learned to control her high blood pressure is by reading the Nutrition Facts label on food products.
- Show picture card 4.7.
The Nutrition Facts label found on packaged foods is one of the best tools we have for choosing foods for a healthy diet. In this session, we will learn how to use the Nutrition Facts label to choose foods that are lower in sodium.
- Give group members the “Read the Food Label for Sodium!” handout.
The Nutrition Facts label lists the serving size and number of servings in the container. It also gives the amount of calories, sodium, saturated fat, trans fat, and cholesterol in one serving of the food. We will talk about calories, saturated fat, trans fat, and cholesterol in the next two sessions. Today, we will concentrate on sodium.
- Point to where the Percent Daily Value is located on the food label.
The Percent Daily Value helps you compare products. It tells you if a food is high or low in various nutrients. Remember–it is easy to take in more than 2,300 milligrams of sodium. Choose foods with a lower Percent Daily Value for sodium. A Percent Daily Value of 5 or less is low, and a Percent Daily Value of 20 or more is high. Once you get into the habit of looking at food labels, it will be easy.
More Asian grocery stores are now carrying products with Nutrition Facts labels, making it easier to choose foods, sauces, and seasonings that are lower in sodium.
Let’s take a close look at the Nutrition Facts on an actual label to find the amount of sodium. Let’s go back to the “Read the Nutrition Facts Label for Sodium!” handout.
- Point again to picture card 4.7.
The Percent Daily Value for sodium in frozen peas and carrots is circled on the Nutrition Facts label.
The sodium content of the same food can vary, depending on how it is packaged or what brand it is. Compare food labels to choose foods that are lower in sodium.
Look at the bottom of the handout. Look at the Percent Daily Value for frozen peas and carrots and for canned peas and carrots. Which peas and carrots are lower in sodium?
Frozen peas and carrots are lower in sodium. One serving of frozen peas and carrots has only 5 percent of the Daily Value for sodium. One serving of canned peas and carrots has 15 percent of the Daily Value for sodium. In other words, the canned peas and carrots have three times more sodium than frozen peas and carrots. Rinsing the canned peas and carrots in cold water can help reduce the sodium content.
More Information: Potassium, Calcium, and Magnesium
The latest research shows that foods rich in potassium are important in protecting against high blood pressure. Foods rich in calcium and magnesium may help, too. Eat foods that are a good source of these nutrients:
- Potassium: bananas, plantains, tomatoes, potatoes, oranges, prunes, spinach, and dry beans
- Calcium: low-fat milk; low-fat, reduced-sodium cheese; low-fat yogurt; calcium-fortified orange juice; leafy greens; and fresh or rinsed canned fish
- Magnesium: whole-grain breads and cereals, beans, nuts, seeds, okra, and spinach
More Information: The DASH Eating Plan To Lower Your Blood Pressure
One eating plan that can lower blood pressure is Dietary Approaches to Stop Hypertension (DASH). By using the DASH plan, you can lower blood pressure by eating:
- Lots of fruits and vegetables
- Fat-free or low-fat milk products
- Whole-grain products
- Fish, poultry, and lean meats
- Nuts, seeds, and dry beans
The DASH eating plan also includes:
- Less salt and sodium
- Small amounts of fats and oils
- Small amounts of sweets and beverages that are high in added sugar
People with high blood pressure will get extra benefits from following the DASH eating plan and eating foods low in salt and sodium. This combination also is heart healthy for people who don't have high blood pressure.
Choosing and preparing foods that are lower in salt and sodium may help prevent or lower high blood pressure. Eating more fruits and vegetables, whole-grain breads and cereals, and fat-free or low-fat milk products also may help lower blood pressure.
Let’s try an activity that will help us choose foods that are low in salt and sodium. First, I am going to describe a situation that may apply to you or to a member of your family. Then, using Nutrition Facts labels, we are going to learn how to choose lower-sodium foods.
Let’s try an activity that will help us choose foods that are low in salt and sodium. First, I am going to describe a situation that may apply to you or to a member of your family. Then, using food labels, we are going to learn how to choose lower-sodium foods.
- Give each group member the “Ric’s Food Choices” handout. Read or ask a volunteer to read the story below.
Ric's Food Choices
Ric's blood pressure was slightly higher the last time he visited his doctor. The doctor told him to cut back on the amount of sodium he eats. Use the Nutrition Facts labels to help him choose foods that will help him follow his doctor's advice.
Let’s go over some questions. Use the food labels to choose the food that is lower in sodium.
- Ask these questions. Give the correct answer after group members guess.
Food Label Questions and Answers
Questions Correct Answers When buying juice, should Ric choose tomato juice or pineapple juice? Pineapple juice Should Ric buy soy sauce or light soy sauce? Light soy sauce Should Ric eat unsalted dry roasted peanuts or beef jerky? Dry roasted peanuts, unsalted Should Ric eat regular canned pork or chicken siopao? Chicken Siopao Should Ric snack pork rinds or low-sodium crackers? Low-sodium crackers
- Give group members the “Sodium in Foods” handout.
Does anyone see a food on the right side of the page that you eat often?
- Ask the person to name a lower-sodium food on the left side that he or she could eat instead.
Let’s now review some practical tips that will help you cut back on salt and sodium.
- Give each group member a copy of the “Keep Your Heart in Mind: Lola’s Tips To Eat Less Salt and Sodium” handout. Review the tips on how to cut back on salt and sodium when you are shopping, cooking, and eating.
Here is Lola’s favorite tip to control high blood pressure. Gradually decrease the sodium in your diet, and cook with seasonings and sauces that are low in sodium.
Why is it hard for you to cut back on salt and sodium?
Note: Allow 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall. Then write down some possible solutions. See the “Salt Solutions Examples” box for some problems and solutions.
Problems You May Encounter Solutions Using fewer traditional sauces or seasonings is difficult. When preparing foods, use a smaller amount of the sauces and seasonings that are high in sodium. Replace some with light versions, such as light soy sauce, which has less sodium. The food has no flavor. Use herbs or spices to add flavor to foods. See the “Use Herbs and Spices Instead of Salt” handout. Family members will get upset. Cut back on salt slowly. Use less salt each time you cook, so family members can get used to the taste. Adding salt is a habit that is hard to break. Give yourself time to get used to using less salt. Choose brands that are lower in salt. Take the saltshaker off the table.
Drinking too much alcohol can raise your blood pressure. It can also harm the liver, brain, and heart. Alcoholic drinks also contain calories. The extra calories can make it hard to control your weight.
If you do not drink alcohol, don’t start. If you drink alcohol, drink only a moderate amount. That means:
- Men should have no more than two drinks a day.
- Women should have no more than one drink a day.
- Pregnant women should not drink any alcohol.
What do you think counts as one drink?
Note: Allow a few minutes for group members to respond.
One drink is:
- 12 ounces of beer (regular–150 calories; light–100 calories)
- 5 ounces of wine (100 calories)
- 1 ½ ounces of liquor (100 calories)
Note: The general term “medicine” refers to Western medicine.
If you have high blood pressure, making the lifestyle changes we just discussed may not be enough to lower your blood pressure. Medications are available to lower blood pressure. They work in different ways.
- Give group members the “Tips for Taking Medicine for High Blood Pressure” handout.
Do any of you take medicine for high blood pressure?
- Read aloud the “Tips for Taking Medicine for High Blood Pressure” handout.
If you are taking medication for high blood pressure, what are some things you can do to help your medicines work better?
Note: Allow a few minutes for group members to respond.
- Add the following suggestions if they are not mentioned:
- Ask your doctor the name of your medicine and how to take it.
- Take your medicine the way the doctor tells you.
- Tell your doctor the names of all other medicines, home remedies, herbs, supplements, or any traditional Asian medicine you take.
- Tell your doctor if the medicine makes you feel strange or sick.
- Refill your prescription before you run out of medicine.
- Have your blood pressure checked to see if the medicine is working for you.
- Keep taking the medicine as your doctor tells you, even if your blood pressure is okay.
Some people use traditional medicine or home remedies instead of or in addition to Western medicine. Tell your doctor if you are using traditional Asian medicine or home remedies. The doctor needs to know if you are taking anything that does not work well with your prescribed medicine(s).
More Information: Medicine for High Blood Pressure
- Many people with high blood pressure may take more than one medicine to keep their blood pressure low.
- Some medicines can cause side effects or reactions. If this happens, talk to your doctor.
- Eating more fruits and vegetables, cutting back on salt and sodium, losing weight, and being physically active can help your medicines work better.
- Give group members the “Use Herbs and Spices Instead of Salt” handout. Ask them to use some of the herbs and spices in place of salt when they cook this week.
- Give group members the “Fish Cardillo Recipe” handout. Ask them to prepare it during the coming week. Tell them that using this recipe will give them a chance to practice some of the ideas from the session.
Review of Today's Key Points
Let’s review what we learned today.
- What is blood pressure?
Blood pressure is the force of blood against the walls of your arteries. Blood pressure is necessary to move blood through your body.
- What is a normal blood pressure?
A normal blood pressure is below 120/80 mmHg.
- What is prehypertension?
Blood pressure of 120/80 to 139/89 mmHg is prehypertension. This means that you do not have high blood pressure yet, but you’re likely to develop it in the future unless you make changes in your health habits.
- What is high blood pressure?
High blood pressure is 140/90 mmHg or greater. Have your blood pressure checked. If it is 140/90 mmHg or greater, see your doctor.
- Why is high blood pressure dangerous?
High blood pressure can lead to heart attack, stroke, kidney problems, eye problems, and death.
- What can you do to help make your blood pressure medicine work better?
Eat more fruits and vegetables, cut back on salt and sodium, lose weight, and be more physically active. Take your medicine as your doctor tells you. Talk to your doctor about side effects.
- Why should you cut back on salt and sodium in your food?
You should cut back on salt and sodium to help prevent or lower high blood pressure.
- What are some ways to cut back on salt and sodium?
Use herbs and spices to season foods. Be careful! Some seasonings such as garlic salt and onion salt are high in sodium. Check the Nutrition Facts label to choose foods lower in sodium. Eat more fruits and vegetables for snacks instead of salty snacks such as nuts, pretzels, or chips.
- How can drinking alcohol affect your blood pressure?
Drinking too much alcohol can raise blood pressure.
- What is a stroke?
A stroke occurs when blood suddenly stops going to the brain. This can happen for different reasons. One reason is that a blood vessel bursts. Another is that a clot blocks the arteries. Either way, the result is the same: blood stops going to the brain, and brain cells die. Both types of stroke are very serious and can lead to disability and death.
- What is another name for a stroke?
A stroke is also called a brain attack.
Lola's Life Lessons: A Time To Reflect
In the last session, Lola Idad reminded us that setting goals and not giving up can help us make the necessary lifestyle changes. Perseverance must be combined with an awareness of your actions. It requires you to look at your habits and to plan for the future.
You have learned a lot today about how to prevent and control high blood pressure. You also learned how to cut back on salt and sodium. Now let’s think about how you can practice what you have learned. Please think of one change you can make in your everyday life.
Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:
- I will get my blood pressure checked within the next month.
- I will read Nutrition Facts labels the next time I go to the store to help me choose canned vegetables that are lower in sodium, or I will prepare fresh or frozen vegetables without adding salt.
- I will rinse canned foods with water before I cook or eat them, starting tomorrow.
- I will take the saltshaker off the table, starting tomorrow.
- Give each group member the “Lola’s Life Lessons: Session 4” handout.
- Ask a volunteer to read the handout.
Please take a few moments to reflect on Lola’s advice and how it applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your feelings about this week’s session. Please write down your thoughts. Remember, this is for you and no one else.
- Give each group member 2 to 3 minutes to write down some thoughts.
Pledge for Life!
- Give each group member the “Pledge for Life! Session 4” handout (page 141).
Take the pledge for life with Lola Idad. Lola and her family have taken the pledge to practice heart healthy eating daily. Take the step toward healthy eating and lowering your blood pressure. Pledge to do one thing on this list during the coming week. Now, let’s start by sharing our goals with each other.
Would anyone like to share his or her pledge with the group?
Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.
We will talk about how you did with your pledges at the next session. Remember to keep working on your pledges to be more physically active.
Blood Pressure Check
(Optional – Try to get a health professional to come to your session.)
- Tell group members that a health professional will now check everyone’s blood pressure.
- Ask group members to write their blood pressure numbers on the “My Healthy Heart Wallet Card” handout.
Thank you for coming today. What did you think of today’s session?
Note: Wait to see if group members respond.
I am looking forward to seeing you at the next session. The next session will be about how to prevent and control high blood cholesterol.
- Note for Educator: Think about today’s session. What worked and what didn’t work? Have you decided to make any changes in your own lifestyle based on what was covered in today’s session to control or prevent high blood pressure?
Information on this page is taken from the English print version of “Healthy Heart, Healthy Family: A Community Health Worker's Manual.” U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, NIH Publication No. 08-3674, Originally Printed 1999, Revised May 2008.
Last Updated March 2012