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Session 4- Help Your Heart: Control Your High Blood Pressure

Manual Contents

Session 4
Help Your Heart: Control Your High Blood Pressure

Page Contents

Objectives

By the end of this session, group members will learn:

  • What blood pressure is
  • That it is best to have a blood pressure below 120/80 mmHg (millimeters of mercury)
  • That blood pressure between 120/80 and 139/89 mmHg is prehypertension
  • That a blood pressure of 140/90 mmHg or greater is high
  • What a stroke is and what the warning signs are
  • That eating less salt and sodium can lower the risk of developing high blood pressure
  • That they can take steps to lower the amount of salt and sodium in their diet

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Materials and Supplies

To conduct this session, you will need:

  • “Your Heart, Your Life” manual and picture cards
  • Blackboard and chalk or several large pieces of paper, a marker, and tape
  • Measuring spoons (1 teaspoon)
  • Small amount of salt
  • Colored plate or plastic test tube
  • Doña Fela’s Seasoning Mixture. Prepare enough to give a small sample to each group member in a plastic bag or cup.
  • (Optional) The “They’ll Learn To Like Him” and “An Unsettling Surprise: Prevent High Blood Pressuretelenovelas.
    Note: The telenovela is available in Spanish only.
  • (Optional) VCR or DVD and TV monitor
  • (Optional) Note: Arrange for a health professional to come to the session to take blood pressure readings.

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Handouts

Give these handouts to each group member during this session:

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Introducing the Session

  1. Welcome
  2. Review of Last Week's Session
  3. About This Session
  1. Welcome
    • Welcome group members to the session.
  2. Review of Last Week's Session
    • Say:
      Last week, we talked about why you should be physically active. What do you remember about the benefits of being physically active?
      Note: Allow about 3 minutes for group members to answer. Write responses on the blackboard or on a large piece of paper taped to the wall.
    • Add the following benefits if they are not mentioned.
      Physical activity:
      • Strengthens your heart and lungs.
      • Builds and maintains healthy bones, muscles, and joints.
      • Helps you feel better about yourself.
      • Helps you control your weight.
      • Helps you lower your high blood pressure.
      • Helps you control your blood cholesterol.
      • Helps you sleep better.
      • Helps you reduce stress and feelings of depression and anxiety.
      • Helps you have more energy.
      • Helps lower your chances of developing diabetes (high blood sugar), heart disease, and some cancers.
    • Say:
      At the end of our last session, everyone made a pledge to be more active.
      Note: Share with the group what you did and what barriers you faced.
    • Ask:
      Would any of you like to share with the group what you did? What problems did you face (such as not having time or not getting family support)? How did you solve them?
      Note: Allow about 5 minutes for responses.
  3. About This Session
    • Say:
      Today’s session is about blood pressure and the steps you can take to lower your blood pressure or keep it from rising.

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Conducting the Session

  1. The Facts Don't Lie
  2. (Optional) “An Unsettling Surprise: Prevent High Blood Pressure” Telenovela or Fotonovela
  3. Facts About Blood Pressure and Stroke
  4. Lowering High Blood Pressure
  5. (Optional) “They'll Learn To Like Him” Telenovela
  6. Salt and Sodium–How Much Do We Need?
  7. Food Label Activity–Sodium
  8. Shake the Salt and Sodium Habit
  9. Easy on the Alcohol
  10. Manage Your High Blood Pressure With Medicine
  11. Turkey Meatloaf Recipe
  1. The Facts Don’t Lie
    • Say:
      • More than 65 million people (one in three) in the United States have high blood pressure, which is also called hypertension. Nearly a third of these people don’t know they have high blood pressure.
      • Another 59 million Americans have prehypertension, which means they are at risk for developing high blood pressure.
      • Nearly one in five Latinos has high blood pressure.
      • Only one in five Mexican Americans with high blood pressure have their blood pressure under control.
  2. (Optional) “An Unsettling Surprise” Telenovela or Fotonovela
  3. Facts About Blood Pressure and Stroke
    • Show picture card 4.1.
    • Say:
      Blood pressure is the force of blood against the walls of your arteries. Blood pressure is needed to move the blood through your body.
    • Show picture card 4.2.
    • Say:
      Blood pressure is recorded as two numbers––the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats).
    • Say:
      The measurement is written one above the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mmHg is expressed verbally as “120 over 80.”
    • Say:
      It is important to keep track of your blood pressure numbers. Write down your numbers every time you have your blood pressure checked.
    • Ask:
      Do you know your blood pressure numbers?
      Note: Allow about 2 minutes for responses.
      Note: Copy this chart on the blackboard or on a large piece of paper taped to the wall.
      Your Blood Pressure Numbers
      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.
    • Say:
      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.
    • Show picture card 4.3.
    • Say:
      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.
    • Say:
      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.
    • Say:
      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, and high blood cholesterol.
    • Ask:
      Do you know anyone who has had a stroke?
      Note: Allow a few minutes for group members to answer.
    • Give group members the “Know the Stroke Signs. Act Quickly.” handout.
    • Show picture card 4.4.
    • Say:
      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 .
    • Say:
      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
    • Say:
      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.
    • Say:
      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.
    • Show picture card 4.5.
    • Say:
      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.
    • Give group members:
    • Say:
      Ask for your numbers each time you have your blood pressure checked. Keep a record of each reading on the wallet card.
  4. Lowering High Blood Pressure
    • Ask group members to raise their hands if someone in their families has high blood pressure.
    • Say:
      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.
    • Say:
      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.
    • Ask:
      Which steps could you and your family take to prevent or lower high blood pressure?
      Note: Allow 3 minutes for group members to respond.
  5. (Optional) “They’ll Learn To Like Him” Telenovela
    • Say:
      Let’s see what the Ramírez family has to say about eating less salt and sodium.
    • Show the “They’ll Learn To Like Him” telenovela.
  6. Salt and Sodium—How Much Do We Need?
    Note: For this activity, you will need a ¼ 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.
    • Say:
      Eating less salt and sodium can help you prevent or lower high blood pressure. You probably 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.
    • Say:
      Now let's look at how much sodium we really need. The body only needs about 500 milligrams (mg) of sodium each day. That's about ¼ teaspoon of salt.
      Note:
      Use the measuring spoon to show ¼ teaspoon of salt.
    • Say:
      Most people are eating much more than 500 milligrams of sodium every day.
    • Say:
      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.
    • Say:
      Most people in the United States eat about 4,000 to 6,000 milligrams of sodium each day, or about 2 ½ teaspoons.
      Note: Now show 2 ½ teaspoons of salt.
    • Say:
      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.
    • Say:
      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 regular canned soups, canned vegetables, frozen dinners, salty chips, and meats high in sodium such as hotdogs.
      • 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.
  7. Food Label Activity—Sodium
    • Show picture card 4.7.
    • Say:
      The food 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 food label to choose foods that are lower in sodium.
    • Give group members the “Read the Food Label for Sodium!” handout.
    • Say:
      The food label lists the serving size and number of servings in the container. It also gives the amount of calories, sodium, saturated fat, trans fat, cholesterol, and sugar 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.
    • Say:
      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.
    • Say:
      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 Food Label for Sodium!” handout.
    • Point again to picture card 4.7.
    • Say:
      The Percent Daily Value for sodium in a packaged noodle soup is circled on the food label.
    • Say:
      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.
    • Say:
      Look at the bottom of the handout. Look at the Percent Daily Value for low-sodium soup and for packaged noodle soup. Which soup is lower in sodium?
    • Say:
      Low-sodium soup is lower in sodium. One serving of low-sodium soup has only 9 percent of the Daily Value for sodium. One serving of packaged noodle soup has 34 percent of the Daily Value for sodium. The oriental soup has four times more sodium than low-sodium soup.
    • Say:
      You can also think of the Percent Daily Value like a budget. For example, you have a daily budget of $100 for all of your sodium needs for 1 day. If, from that daily budget, you spend $34 (Percent Daily Value) on the packaged noodle soup, that serving has cost you almost a third of your daily budget. That’s not too bad if it is for a whole meal, but it is for one food item. You now have only $66 left. You could easily go over your sodium budget for that day if the sodium content of the rest of your foods is also “expensive.”

      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.

    • Say:
      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.
    • Say:
      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 “Mariano’s Food Choices” handout. Read or ask a volunteer to read the story below.

      Mariano's Food Choices

      Mariano's blood pressure was slightly higher the last time he visited his doctor. The doctor told Mariano to cut back on the amount of sodium he eats. Use the food labels to help his wife Virginia choose foods that will help Mariano follow his doctor's advice.

    • Say:
      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 Virginia choose tomato juice or orange juice? Orange juice
      Should she serve corn tortillas or flour tortillas? Corn tortillas
      Is there less sodium in canned chicken or roasted chicken? Roasted chicken
      To cut back on sodium, should Mariano eat thin pretzels or baked tortilla chips? Baked tortilla chips
  8. Shake the Salt and Sodium Habit
    Note: Prepare Doña Fela’s Seasoning Mixture before the session.
    • Give group members the “Sodium in Foods” handout.
    • Ask:
      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.
    • Say:
      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: 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.
    • Say:
      Here is a sample of Doña Fela’s secret recipe from the bottom of the “Keep Your Heart in Mind” handout. Fill an empty saltshaker with the seasoning mixture, and put it on your table. Tell your family to try this instead of salt.
    • Give each group member a sample of Doña Fela’s seasoning mixture.
    • Ask:
      Why is it hard for you to cut back on salt and sodium?
      Note: Write their responses on the blackboard or on a large piece of paper taped to the wall. Then write down some possible solutions. See the “Examples” box for some problems and solutions.
      Examples
      Problems You May Encounter Solutions
      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.
  9. Easy on the Alcohol
    • Say:
      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 don’t 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.
    • Ask:
      What do you think counts as one drink?
      Note: Allow a few minutes for group members to respond.
    • Say:
      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)
  10. Manage Your Blood Pressure With Medicine
    • Say:
      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.
    • Ask:
      Do any of you take medicine for high blood pressure?
    • Ask:
      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, or supplements 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.

    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.
  11. Turkey Meatloaf Recipe

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Review of Today's Key Points

Say:
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 needed 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 don't 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 a 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 food 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 happens when blood suddenly stops going to the brain. This can happen for different reasons. One example is that a blood vessel bursts. Another way 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.

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Weekly Pledge

  • Say:
    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. This will be your pledge for the week.
  • Say:
    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 food labels the next time I go to the store to help me choose canned soups that are lower in sodium, or I will prepare homemade soup 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.
  • Say:
    Write your pledge on the back of the “Keep Your Heart in Mind: Eat Less Salt and Sodium” handout. Keep this handout in a special place so you can review your pledge and keep your goals in mind.
    Note: Allow 5 minutes for group members to think of a pledge and write it down.
  • Say:
    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.
  • (Optional) Say:
    Keeping a personal value in mind can help you make changes in your everyday life to prevent and control high blood pressure. Remember that a personal value is a quality that you consider important.
  • Today's value is openness. Being open means you are willing to consider making changes to improve your health, such as cutting back on foods high in salt and sodium.
  • Ask:
    How can you enlist the quality of openness, or another value, to help you keep your pledge?
    Note: Allow 3 minutes for group members to share their thoughts.
  • Say:
    We will talk about how you did with your pledge at the next session. Remember to keep working on your pledge to be more physically active.

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Blood Pressure Check

(Optional – Try to get a health professional to come to your session.)

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Closing

  • Say:
    Thank you for coming today. What did you think of today's session?
    Note: Wait to see if group members have a response.
  • Say:
    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: Think about today's session. What worked and what didn't work? Have you decided to make any changes in your own life based on what was covered in today's session?

Go to Session 3

Go to Session 5


Information on this page is taken from the English print version of “Your Heart, Your Life, 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

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