What should the nurse do if the patient’s blood pressure is not within normal limits?

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Blood pressure is the pressure of blood on the walls of your arteries as your heart pumps blood around your body. Blood pressure does not stay the same all the time. It changes to meet your body’s needs and it is normal for your blood pressure to go up and down throughout the day. It is affected by various factors, including body position, breathing, emotional state, exercise and sleep.
If blood pressure remains high over a long period of time, it can lead to a heart attack, stroke, heart failure or kidney disease.

The medical name for high blood pressure is hypertension. The medical name for low blood pressure is hypotension.

What blood pressure numbers mean

Blood pressure is recorded as two numbers, such as 120/80. The larger number is the pressure in the arteries as the heart pumps out blood during each beat. This is called the systolic blood pressure.
The lower number is the pressure as the heart relaxes before the next beat. This is called the diastolic blood pressure. Both are measured in units called millimetres of mercury (mmHg).

Measuring blood pressure

It is best to measure blood pressure when you are relaxed and sitting. Blood pressure is usually measured with an inflatable pressure cuff that wraps around your upper arm. This cuff is part of a machine called a sphygmomanometer.

Your blood pressure changes to meet your body’s needs. If a reading is high, your doctor may measure your blood pressure again on several separate occasions before diagnosing high blood pressure.

Your doctor may recommend that you have your blood pressure recorded at home with a monitoring device. This is also known as 24-hour ambulatory blood pressure monitoring and it involves measuring your blood pressure at regular intervals (usually every 20-30 minutes), while you do your usual activities including sleeping. Your doctor will organise this service if required.

If you are considering buying a blood pressure device to use at home, it is best to speak to your doctor to see if this is needed. If so, then buy a device that measures blood pressure accurately. See this list of devices that have been approved by the British and Irish Hypertension Society.

Diagnosing high blood pressure

What is considered a healthy blood pressure varies from person to person. Your doctor will explain what your ideal blood pressure is based on a range of factors, including your overall health.
The following numbers should only be used as a guide:

High blood pressure usually does not have any symptoms. You can have high blood pressure and feel perfectly well. The only way to find out if your blood pressure is high is to have it checked regularly by your doctor.

Low blood pressure can be a problem if it has a negative impact on your body or affects the way you feel. Low blood pressure can make people feel dizzy or faint. See you doctor if you think you have low blood pressure.

Get regular blood pressure checks

Get your blood pressure checked every two years if your blood pressure is in the healthy range and:

Your doctor can also check your blood pressure during routine visits.

You should have your blood pressure checked more frequently (such as every 12 months or as directed by your doctor) if:

• your blood pressure is ‘high–normal’ (or higher – for example 140/95), or
• you have other risk factors for cardiovascular disease, such as a personal or family history of high blood pressure, stroke or heart attack.

You can also have your blood pressure checked as part of a Heart Health Check. A Heart Health Check is a 20-minute check up with your doctor (GP) which is subsidised by Medicare. You are eligible for a Heart Health Check if you:

• have not had a heart attack or stroke, and
• you are 45 years of age or over (or 30 years of age or over for Aboriginal and/or Torres Strait Islander Peoples).

As part of a Heart Health check, your doctor will:

• ask you about your medical and family history of heart disease
• ask you about your lifestyle, including your diet, physical activity, and if you smoke or drink alcohol
• check your blood pressure, cholesterol and blood sugar levels.

Your doctor will then use this information to calculate your risk of having a heart attack or stroke over the next five years. Your doctor will then discuss how you can lower your risk.

High blood pressure and your overall risk

If your blood pressure remains high, it can lead to serious conditions like a heart attack, heart failure, stroke or kidney disease. Your risk will depend on any other modifiable or non-modifiable risk factors you might have.

Modifiable risk factors are factors that you can change. Non-modifiable risk factors are factors you can’t change.

Heart attack and stroke risk factors that you can change include:

There are also some health conditions that increase risk:

Risk factors you can’t change include:

• your age
• whether you were born male or female (your sex)
• being post-menopausal
• having a premature family history of heart disease. This means that if one or more of your immediate family members (such as a parent or sibling) has had a heart attack or stroke before the age of 65, it’s important to mention this to your doctor.

Aboriginal and/or Torres Strait Islander Peoples and people from some ethnic backgrounds (South Asian, Middle Eastern, Māori or Pacific Islander) are also at increased risk.

Managing your blood pressure

Your doctor will support you to make changes to manage your blood pressure:

Your doctor may also recommend you take medicines to manage your blood pressure. Even if you need to take medicines, it’s still important for make healthy changes too.

Tobacco smoking and blood pressure

Tobacco smoking is a major risk factor for heart disease and can increase blood pressure. Stopping smoking is one of the best things you can do to help manage your blood pressure. Every cigarette that you don’t smoke is doing you good.

The most effective way to stop smoking is with a combination of:

• support from Quitline (Tel. 13 78 48)
• stop-smoking medicines such as nicotine replacement therapy.

There is also evidence that e-cigarettes can increase heart rate and blood pressure, which may increase the risk of heart disease. If you are ready to quit smoking or thinking about quitting smoking, talk to your doctor about ways to help you give up smoking. You can also call the Quitline (Tel. 13 78 48)

Heart-healthy eating and blood pressure

The Heart Foundation recommends people follow a heart-healthy eating pattern. Heart-healthy eating is important for managing blood pressure and reducing the risk of heart disease .

• Eat plenty of vegetables, fruit and wholegrains.
• Include a variety of healthy protein-rich foods, especially fish and seafood, legumes (such as beans and lentils), nuts and seeds. Eggs and poultry can also be enjoyed as part of a heart-healthy eating pattern. If you eat red meat, choose lean cuts and limit to one to three times per week.
• Choose unflavoured milk, yoghurt and cheese . If you have heart disease or high cholesterol, choose reduced fat varieties.
• Include healthy fats and oils . Choose nuts, seeds, avocados, olives and their oils for cooking.
• Add herbs and spices to flavour foods, instead of adding salt .

This way of eating is naturally low in unhealthy fats, salt and added sugar. It’s rich in wholegrains, fibre, antioxidants and healthy fats.

Check out the Heart Foundation website for a range of resources to help you follow a heart-healthy eating pattern.

For individualised nutrition advice, you can also speak to an Accredited Practising Dietitian .

Salt intake and blood pressure

Salt is a mineral made up of sodium and chloride. It’s the sodium in salt that is bad for your health. When looking at food labels on groceries, it is the sodium that is listed.

Reducing the amount of salt (sodium) you eat can help to manage your blood pressure. The Heart Foundation recommends five grams of salt (about a teaspoon) as a daily maximum.

In addition to following a heart-healthy eating pattern, follow these top tips to reduce your salt intake:

• Look out for hidden salt. Many packaged and processed foods (such as pizzas, pastries, biscuits and take away foods) are high in salt. You can’t see the salt in these foods, so you don’t know how much salt you are having. These foods aren’t part of a heart-healthy eating pattern.
• Get into the habit of checking food labels. Choose low-salt food (less than 120mg sodium per 100g) where possible. Another simple alternative is to look for labels with ‘low salt’, ‘salt reduced’ or ‘no added salt’.
• Avoid adding salt to cooking or at the table. Flavour meals with herbs and spices instead.
• Cook at home when you can. Take away food and food prepared outside the home are often high in salt. Preparing and cooking your own meals is a great way to stay in control of how much salt is added.

Physical activity and blood pressure

Being physically active is a great way to manage your blood pressure and reduce your risk of heart disease.

All types of physical activity count. Walking, cycling, swimming and yoga are all great for your health. It’s important to do activities you enjoy as you are more likely to keep active if you are having fun. It is recommended that you:

• do 30 minutes or more of moderate-intensity physical activity five or more days per week. If you like, you can break this up into smaller bouts, such as three 10-minute walks
• include muscle-strengthening activities on at least two days each week.

Walking for heart health

Walking is a great activity for heart health and managing blood pressure. Getting involved with a Heart Foundation Walking group is a fun and social way to be active. You can also register for a free Personal Walking Plan. Visit Heart Foundation Walking for more information .

Alcohol and blood pressure

Alcohol isn’t a necessary or recommended part of a heart-healthy eating pattern. Drinking alcohol can increase blood pressure and the risk of heart disease.

If you don’t drink alcohol, don’t start. If you do drink alcohol, the Heart Foundation recommends following the National Health and Medical Research Council’s (NHMRC) recommended levels of alcohol consumption:

• Healthy men and women should drink no more than 10 standard drinks per week and no more than four standard drinks on any one day.
• Children and young people under 18 years of age should not drink alcohol.
• To reduce the risk of harm to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby.
• For people with heart disease and related conditions or risk factors, the evidence is not strong enough to recommend a safe amount of alcohol consumption for heart health.
• For some people, the safest option is to not drink alcohol at all.

Speak to your doctor for advice and support to cut down on alcohol.

Medicines for high blood pressure

Medicines are available to lower and manage high blood pressure. Your doctor may call them ‘antihypertensives’, (which basically means ‘anti’ – against and ‘hypertensive’ – high blood pressure).

Medicines for high blood pressure can include:

• ACE inhibitors
• Angiotensin receptor blockers
• Beta blockers
• Calcium channel blockers
• Thiazide diuretics.

These medicines help maintain a healthy blood pressure to improve the flow of oxygen and blood around the body. Some help the heart to pump more easily and efficiently.

Taking blood pressure medicines

Once you start to take medicines to manage your blood pressure, you may need to take them for the rest of your life. However, the dose of these medicines may change over time. If your doctor recommends you take blood pressure medicines, it’s still important to make healthy choices when it comes to your diet and physical activity.

If you need to take medicines, your doctor will advise you on the correct type and dose. Two or more different medicines are often needed to manage blood pressure.

Make sure you take your medicines regularly. Some things that may help you remember to take them include:

• building them into your daily routine by taking them at the same time each day
• keeping them somewhere that will remind you – such as next to your alarm, or with your coffee or tea
• marking the time on your calendar
• asking a family member or friend to remind you
• always carrying a list of your medicines with you, including their doses and when to take them
• entering a daily alarm in your mobile phone or downloading an app to remind you.

Take any blood pressure medicine exactly as prescribed. Don’t stop or change your medicine unless your doctor advises you to.

Where to get help