blood pressure canada – brief hypertension action tools ... · brief hypertension action tools...

BRIEFHYPERTENSIONACTION TOOLS – INSTRUCTIONS

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BRIEF HYPERTENSION ACTIONTOOLS – INSTRUCTIONS

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The Brief Hypertension Action Tool isintended to be used by a health careprofessional to inform and engage apatient with hypertension to becomemore active in their care. The flexible tool involves 3 actions thatcan be done in one session or inseparate sessions.

Action Tool #1 explains high bloodpressure and persuades patients tobecome more engaged.

Action Tool #2 informs patientsabout self management of lifestyle.

Action Tool #3 assists patients inproper home measurement of bloodpressure and provides basic information about blood pressuremedications.

The health professional begins byproviding a brief overview of the 3 Action Tools and then the patientselects the one they would like tostart with. Presentation of all 3 toolsin a single session may be too time-consuming for most health care professionals and overwhelming formost patients; thus, the Action Toolswill be presented in separate sessions for most patients.

Once you are used to using thetools, on average, Action Tool #1takes approximately 4 minutes,Action Tool #2 takes approximately10 minutes and Action Tool #3 takesapproximately 7 minutes to complete.

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ACTION TOOL 1

This tool educates patients about bloodpressure and how to keep accurate records.

Begin by briefly describing what bloodpressure is and explaining the health problems caused by hypertension. Formost patients define hypertension as systolic BP >140 mmHg or diastolic BP >90mmHg. For those with diabetes or chronickidney disease, define hypertension as systolic BP >130mmHg or diastolic BP>80mmHg.

Next, fill in the blanks on the Action Toolwith the patient:

1) Document the patient’s actual blood pressure and the date on page 1.

2) Document the “target” office blood pressure on page 1 (<140/90 mmHg for most patients; <130/80 mmHg for those with diabetes or chronic kidney disease).

3) Document the healthy target homeblood pressure on page 1 if the patient is measuring blood pressure at home (<135/85 mmHg, for most patients). Targets for those with diabetes and chronic kidney disease have not been firmly established. Some experts think that <125/75 mmHg is reasonable (10 mmHg lower than the target for those without diabetes or chronic kidneydisease).

4) Document healthy target blood pressures for your patients and plan for follow-up to have their blood pressure rechecked (Table 1).

A template produced by the Cardiovascular Health Awareness and Management Program (CHAMP) is on the next page. If patients have cardiovascular disease, diabetes or chronic kidney disease or are at high risk, you will want them to take action at lower targets than those indicated in thegeneric template.

5) Ask patients to recheck high blood pressure readings at home and to take action only if the readings are consistently elevated. For patients who are at low risk several readings over several days are usually safe. For patients with cardiovascular disease whoare at more immediate risk shorten the period of observation. In particular if patients have cardiovascular symptoms and high pressures several readings in a single setting may be enough to requestthem to seek assistance.

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Recommendation:*

Home (or public) readings

Most people

SBP 135-179

DBP 85 -109

SBP 180-199

DBP 110-119

SBP Over 200

DBP Over 120

SBP 130-179

DBP 85 -109

SBP 180-199

DBP 110-119

SBP Over 200

DBP Over 120

Patient to recheck to make sure thereading is correct.

If the patient still gets a high reading,encourage them to call to explain thesituation and make an appointment.

Check that the patient has taken theirblood pressure medication as prescribed.

Patient to recheck to make sure thereading is correct.

If the patients still gets a high reading,encourage them to call to explain thesituation and make an appointment as soon as possible.

Patient to recheck immediately tomake sure the reading is correct.

If the readings remain high, the patientis advised to go to urgent care, emergency dept. or call 911.

The patient should not drive.

For patients with diabetes or kidney

(renal) disease

TEMPLATE: Blood Pressure Alert Ranges.

* If the patient is uncertain about the accuracy of their home BP readings, encourage themto bring their device to the next appointment and review technique with them. If anxiety isa recurrent cause of high readings the patient may be unsuited for home measurement.

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This tool motivates patients to change theirlifestyle.

Begin by having the patient select one (ormore) of the five lifestyle issues. Ideally thisshould be the lifestyle that they are mostwilling to change. For some patients it willbe overwhelming to tackle more than onelifestyle change at the same time. Once thepatient has selected a lifestyle changereview the goals.

Next, have the patient document what theyare doing now, what they are willing tochange, the barriers they must confront inorder to change, and their plan to overcome these barriers. Patients can useadditional pages to record extra details.

Finally, both the patient and health careprofessional sign the table to make a contract. For many patients it is most efficient to review the table at the initial visitand have them fill in the details at home.The plan is then reviewed and signed at thenext visit. The completed form is given topatients to help them understand and usethe table.

Patients who are comfortable with the internet can be directed to www.heartandstroke.ca\bp. This site has a sophisticated interactive program that is an

excellent alternative to the paper-based tool.

ACTION TOOL 2

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This tool trains patients to accurately measure and record their blood pressure athome, provides some information on medicines, and reinforces the need foradherence. There is a section for notes,questions for patients to ask and internetresources for those who want to learn more.

1) Begin by determining whether the patient is suited to home measurement of blood pressure. Patients with very obese arms, arrhythmias, and those withmental or physical limitations are not good candidates.

2) Advise patients to buy a validated machine. The presence of the logo indicates that the device meets an established standard for accuracy, that test results have been published in a peer reviewed journal, and that the validation data has been assessed by a committee of the Canadian Hypertension Society.

3) Recommend a semi-automated or fully-automated device. Fully-automated devices are more expensive but easier to use.

4) Measure and record the patient’s mid-arm circumference (see Figure 1 on page 7 of the Action Tool). This will help them purchase a device with the appropriate cuff size. Many pharmacies have cardboard templates that measure arm circumference and indicate the appropriate cuff size.

5) Using the diagram on page 7, review the proper technique for measurement of blood pressure at home.

6) Document the target home blood pressure on page 8 (<135/85 mmHg, for most patients). Targets for those withdiabetes and chronic kidney disease have not been firmly established. Someexperts think that <125/75 mmHg is reasonable (10 mmHg lower than the target for those without diabetes or chronic kidney disease).

7) Show the patient how to record their blood pressure in the log book (on page 9).

8) Tell patients to consistently measure their blood pressure in the left or right arm. Advise individuals with a blood pressure difference between arms to usethe arm with the higher blood pressure.

9) Advise patients to record their pulse if it is above 100 or less than 60 bpm.

ACTION TOOL 3

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BRIEFHYPERTENSIONACTION TOOLS

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WHAT IS BLOOD PRESSURE?Blood pressure is the force that myblood exerts on the walls of myblood vessels.

Blood pressure varies throughout theday but if it is usually above ahealthy range, it is called high bloodpressure or “hypertension”.

There are two blood pressure measurements:• Systolic blood pressure occurs

when my heart beats and pumps blood through my vessels.

• Diastolic blood pressure occurs when my heart relaxes and refills with blood, between beats.

• If my blood pressure is “135 on 85” the first, higher number is mysystolic pressure and the second,lower number is my diastolic pressure.

It is important to know my bloodpressure numbers and to know if Ihave hypertension.

WHY SHOULD I BE CONCERNED ABOUT MYBLOOD PRESSURE?If I have high blood pressure I maynot feel sick, but high blood pressure damages blood vessels andcan be very dangerous.

If my blood pressure is not well controlled, I have an increased riskof:• Stroke• Heart attack• Heart failure• Dementia• Kidney (renal) disease• Eye problems (retinopathy)• Sexual dysfunction

High blood pressure is common, butmany people do not know that theyhave hypertension. I will know mynumbers and know whether I have hypertension. I can check my bloodpressure with a home blood pressuremonitor or have my health providercheck my blood pressure.Controlling my blood pressure willhelp me stay healthy and decreasemy risk of stroke, heart disease, kidney disease and other problems.

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ACTION TOOL 1

My OFFICE blood pressure is ____ /____ mm Hg. (Date : ____ / ____ / ____ )

My target (“healthy”) OFFICE blood pressure is <____ /____ mm Hg

My target (“healthy”) HOME blood pressure is <____ /____ mm Hg

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If I monitor my blood pressure I can use this chart to decide when to talk with a health careprovider about my blood pressure.

TABLE 1: Patient blood pressure appointment chart

NOTE: If my systolic blood pressure follow-up date differs from my diastolic blood pressure follow-up date, I will use the earlier date.

Make an appointment with a healthcare provider to check my bloodpressure and review my blood

pressure goals:

If my blood pressure is

Systolic BP(mmHg)

less than 125

125-129

130-139

130 -139

140-159

160-179

180-199

200 or more

less than 75

75-79

80-84

85-89

90-99

100-109

110-119

120 or more

Within ________________________

Within ________________________

Within ________________________

Within ________________________

Within ________________________

Within ________________________

Within ________________________

Within ________________________

Diastolic BP(mmHg)


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WHAT CAN I DO ABOUTHIGH BLOOD PRESSURE?Blood pressure can be controlled.

If I do not have hypertension thereare things I can do to keep my bloodpressure within the healthy range.

If I do have hypertension there arethings I can do to lower my bloodpressure and reduce my risk ofstroke, heart failure, kidney diseaseand other problems.

To prevent hypertension or bettermanage my blood pressure I can:

• Get regular physical activity

• Eat a healthy diet

• Lose weight or maintain a healthyweight

• Avoid excess alcohol

• Stop smoking and avoid places where other people smoke

Use chart on page 4 (Table 2) to helpchange my lifestyle and improve myblood pressure. Changing mylifestyle may be as effective as takingblood pressure medication to lowermy blood pressure.

For more information on things I cando to prevent hypertension, I canvisit www.hypertension.ca orwww.heartandstroke.ca/bp or ask forinformation at my local health carefacility.

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TABLE 2: Select one or more lifestyle plans to improve blood pressure*My priorities are 1______________, 2 ______________, 3______________, 4______________,5______________. Use additional pages to record extra details.

*Changing a single lifestyle can reduce blood pressure as much as a medication1 Patient and health care professional’s initials.

Mypriorities(rank inorder)

Lifestyle factors that

can improve

my blood pressure

My goal How am Idoing?= poor

=excellent

What can

Ichange?

What barriersprevent me from

changing?

What can I do

to overcome

thesebarriers?

Initials1

h physical activity

i my waist line

Drink alcohol in moderation

Stop smoking

i calories

i saturatedfats

h fruit & vegetables

hwholegrains

Switch to low fat dairy

products

i salt or sodium

Changesto mydiet

1 2 3 4 5

30-60 minutes of moderate activity

most days of the week.

To maintain a healthy weight.

Lose weight if overweight.

7-10 servings

a day

Avoid saturated or

trans fats

Avoid foods with added sodium

Choose foods with the least

added sodium

Part of the dailydiet


Men: < 102 cmWomen: < 88 cm

≤ 2 drinks per dayWomen: ≤ 9 drinks

/weekMen: ≤ 14 drinks

/week

Smoke free

5

1

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5


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TABLE 3: An example of a form that has been filled in.You can provide more information.

Not trying

Not losingweight

Trying

4

2

1

3

5

Don’t want to

Don’t wantto

Not working

I’m a lightdrinker

Thinkingabout quitting

I’ll work onmy diet

Nothing

Ask my doctor for

help

My friendssmoke

See if friendswill stop with

me

Always rushed;often eat out

Don’t want to

Don’t want to

Don’t want to

Don’t want to I’ll thinkabout it

See diet; I’llthink about

physical activity

Don’t wantto

Not sure how

Not surehow

Read foodlabels; look

for more information

Go to www.

hypertension.ca for more

info

Often eat at restaurants,

I like fats

Ask for fruits & vegetables;

reduce slowly

Stop drinking

pop

Try to eatmore

Always in a rush,often eat out,

don’t like manyveggies

Snack on fruit atwork, bring

lunch & snack towork, eat moreveggies I like

Pop machine is next to my

office & I get thirsty

Bring water

bottle to work

Think about it

No timeTake stairs,park further

from bus

1 - 2

Mypriorities(rank inorder)

Lifestyle factors that

can improve

my blood pressure

My goal How am Idoing?= poor

=excellent

What can

Ichange?

What barriersprevent me from

changing?

What can I do

to overcome

thesebarriers?

Initials1

h physical activity

i my waist line

Drink alcohol in moderation

Stop smoking

i calories

i saturatedfats

h fruit & vegetables

hwholegrains

Switch to low fat dairy

products

i salt or sodium

Changesto mydiet

30-60 minutes of moderate activity

most days of the week.

To maintain a healthy weight.

Lose weight if overweight.

7-10 servings

a day

Avoid saturated or

trans fats

Avoid foods with added sodium

Choose foods with the least

added sodium



Men: < 102 cmWomen: < 88 cm

≤ 2 drinks per dayWomen: ≤ 9 drinks

/weekMen: ≤ 14 drinks

/week

Smoke free

5

1


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HOW TO BECOME A PARTNER IN THE MANAGEMENT OF MYBLOOD PRESSURE?Ask my health care provider if Ishould measure my blood pressure at home.Some very anxious individuals orthose with disabilities may haveproblems measuring their bloodpressure.

Why should I measure my bloodpressure at home?Measuring my blood pressure athome helps my health care providerand I to understand how well controlled my blood pressure is on aday-to-day basis. It also shows howlifestyle changes and medicationshelp to control my blood pressure.

My health care provider may ask meto measure and record my bloodpressure twice a day for at least oneweek before each appointment.This shows how well my blood pressure is controlled during mydaily routine.

What type of blood pressure monitor should I buy?There are many blood pressure monitors for sale in Canada.

I will ask my health care providerwhich blood pressure monitor isright for me.

To ensure I buy an accurate monitor, I will look for this logo.

A basic model costs approximately$100. A device with more featuresmay suit me best but may be moreexpensive. Home blood pressuremonitors are either semi-automaticor automatic. I must squeeze a bulbto pump up the pressure when usinga semi-automatic device.

Automatic monitors are easier touse, but tend to be more expensivethan semi-automatic monitors.

Blood pressure cuffs come in different sizes. It is very importantthat the cuff fits my arm properly.The wrong cuff size will give meincorrect readings. It is important tomeasure arm circumference to buythe right cuff. Take the measurement midway between theshoulder and elbow (see Figure 1page 7). I will ask my pharmacist tohelp me choose the right size cuff.

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My arm circumference is ____________cm/in

FIGURE 1: Choosing the Right Cuff Size for Blood Pressure Measurement

Mid Arm point

Mid Arm circumference

FIGURE 2: Measuring Blood Pressure The Right Way

Seated with back support

Comfortable with no distractions or talking

Arm supported at heart level

Feet flat on the floor


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HOW DO I MEASURE MY BLOOD PRESSURE WITH A HOME MONITOR?

I will…• Follow the directions that come with the

device.

• Only measure and record my blood pressure if I have time to do it correctly.

• Rest and relax for 5 minutes in a quiet comfortable place with no distractions before measuring my blood pressure.

• Not talk or watch TV while resting or measuring my blood pressure.

• Wait for at least two hours after a big meal and for at least half an hour after drinking coffee or smoking.

• Empty my bladder or bowels if I am uncomfortable before taking a reading.

• Put the cuff on a bare arm.

• Not measure blood pressure when I am uncomfortable, cold, anxious, stressed or in pain.

• Sit in a chair that supports my back and beside a table that can support my arm.If required put a pillow or towel under my arm so that it rests at heart level. I will not cross my legs (see Figure 2 on page 7).

• Measure blood pressure in the morning before taking medications and eating, and in the evening before going to bed,bathing or taking medications.

• Take at least two readings and record them with the date and time.

A diagnosis of high blood pressure (hypertension) may be based upon:• Blood pressure readings taken at the

health care provider’s office;

• Blood pressure readings taken at home with a personal blood pressure monitor;

• Blood pressure readings taken with an ambulatory blood pressure monitor (a device worn for 24 hours that takes measurements automatically at regular intervals during the day and night).

If I am diagnosed with high blood pressure I should:

1) Talk with my health care provider. Learn what my blood pressure should be and what my numbers are now.

2) Learn how to monitor my blood pressure at home.

3) Keep a record of my blood pressure andshow it to my health care provider at each appointment (as outlined in Table 4).

4) Make healthy lifestyle changes.

5) Take my medications (if any are prescribed) as instructed by my health care provider and keep a current list of my medications with me including the name, dose and how often I take them. Report any side effects I may experience. Show this record to my health care provider at each appointment.

Every year, I will have the accuracy of my home monitor checked by ahealth care professional as well as check the instructions for measuring blood pressure to make sure I am still measuring

my blood pressure properly

My target (“healthy”) HOME blood pressure is <____/____ mm Hg


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TABLE 4: My Blood Pressure Log*(please copy this page if additional measurements are required) My target (“healthy”) HOME blood pressure is <____/____ mm Hg

I measure my blood pressure in my Right / Left arm (circle one)

Date AM PM

1st BPReading

2nd BPReading

AverageBP

1st BPReading

2nd BPReading

AverageBP

MedicationTaken?Yes/No

Notes**

* If my blood pressure reading says 158/88, 158 is my systolic blood pressure and 88 is mydiastolic blood pressure.** If my heart rate/pulse is less than 60 or greater than 100 beats per minute this can berecorded in the notes section above.

Measure blood pressure in the morning before medications and eating, and in theevening before going to bed, bathing or taking medications.

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There are many different medications forhigh blood pressure. Most of thembelong to six basic “classes” that work indifferent ways to lower blood pressure;

• Diuretics lower blood pressure by reducing the amount of salt and water inthe body.

• Beta-blockers slow the heart rate.

• ACE (angiotensin converting enzyme) inhibitors prevent the formation of substances (“hormones”) that increase blood pressure.

• Renin inhibitors prevent the formation ofthe same hormones as ACE inhibitors but in a different way.

• ARBs (angiotensin receptor blockers) block the effects of hormones that increase blood pressure.

• CCBs (calcium channel blockers) relax blood vessels.

I may require two or more drugs to controlmy blood pressure.

To keep my blood pressure in the healthyrange and to reduce the risk of heart disease, stroke, kidney disease or eye problems, I should take my medication asinstructed.

I should talk with my health care provider if Iam unsure how to take my medication orhave any other questions.

I should not stop taking my medicationwithout first talking to a health care providerunless I have a severe reaction.

If I have trouble remembering to take my medication, I can:

• Develop a routine (e.g., take them at thesame time each day). If I find it easier totake a medication at a certain time of day (e.g., with my breakfast), ask my health care provider for a drug that best fits my routine.

• Ask my health provider if I can switch to a medication that is taken only once a day.

• Ask my health care provider if my blood pressure medications may be available in a single tablet.

• Purchase a pill dispenser from my pharmacy and fill it with my weekly supply. Some pharmacies can “blister pack” my pills to make it easier to stay organized.

• Mark my calendar or blood pressure log after taking my medication.

• Mark my calendar to remind me when my prescription runs out. When the date arrives I can check to see if I have pills left over. I should ask for a refill or new prescription before it runs out.

• Keep a current list with me that includes the name, dose and how often I take each medication. Show it to my health care providers every time I see them.

• Keep a supply of my medications at work in case I forget to take them at home.

• Measure my own blood pressure to helpme remember to take my medication.

• Ask my health care provider for help.

BLOOD PRESSURE MEDICATION

More information on blood pressure medications can be obtained atwww.hypertension.ca or www.heartandstroke.ca


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Pharmacy:

Nurse:

Doctor:

Emergency:

NOTES:

IMPORTANT NUMBERS


QUESTIONS FOR MY HEALTHCARE PROVIDER

QU

ESTIO

NS

Q1. Should I measure myblood pressure at home?ANSWER:

Q2. What is my arm circumference? (So I can buy the right size cuff)

ANSWER: ________ (cm)

Q3. Does my home bloodpressure monitor need to bechecked to make sure itworks properly?ANSWER:

Q4. How often does myhome blood pressure monitorneed to be checked to makesure it works properly?ANSWER:

Q5. Should I take two readings each time I measuremy blood pressure at home?ANSWER:

Q6. Is there a difference inblood pressure between myleft and right arm? Whicharm should I use to measuremy blood pressure?ANSWER:

Q7. How often should Imeasure my blood pressureand what should I record?ANSWER:

Q8. What should I do if myblood pressure is very high?ANSWER:

OTHER QUESTIONS?

OTHER QUESTIONS?

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www.hypertension.ca

www.heartandstroke.ca/bp

www.nhlbi.nih.gov/hbp/prevent/

h_eating/h_eating.htm

www.hc-sc.gc.ca/fn-an/foodguide-

aliment/index_e.html

www.healthtoolsonline.com/h

alth-fit.html

www.diabetes.ca

www.heartandstroke.ca

www.phac-aspc.gc.ca/pau-uap/paguide/

www.hc-sc.gc.ca/hl-vs/pubs/

tobac-tabac/orq-svr/index_e.html

General information on prevention and

treatment of Hypertension

Create a personalized action plan for healthy living

The DASH diet and healthy eating to improve blood

pressure control

Canada’s official guide to healthy eating and lifestyle choices.

Personalize your own good guide!

Learn about your risk factors using different tools to calculate

your personal factors

Information on hypertension for

people with diabetes

Controlling your blood pressure can reduce

your chance of developing heart disease or having a stroke

Information on healthy activities

Information and resources to helpstop smoking

2008 PublicHypertension

Recommendations

On-line, personalized

blood pressure plan

DASH diet

Canada’s FoodGuide

On-line health and fitness

calculators

Diabetes &Hypertension

Heart Disease &Stroke

Canada’s PhysicalActivity Guide

Smoking

RESOURCES

RE

SOU

RC

ES13

Resource Description Source


BLOOD PRESSURE CANADA GRATEFULLY ACKNOWLEDGES THE SUPPORT AND PARTNERSHIP OF THE FOLLOWING ORGANIZATIONS:


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