1. Change your lifestyle and set up your own priorities, with health occupying the top position.
2. Decrease the psychic stress * reduce the excessive number of activities, avoid the time shortage, always have atime reserve, even in keeping the trivial deadlines (e.g., departure of a public bus). Do not perform more activities simultaneously, finish the task before starting another one. Increase the support of people who are close to you; feel the support of relatives, friends, colleagues.
3. Increase relaxing activities * introduce regular strolls, passive rest, and asufficient quantity of sleep, warm spa and whirlpool, autorelaxing and yogism techniques, non-competitive sports, non-stressful hobby.
4. Enrich your weekly schedule with the minimum of 3 x 40 minutes of aerobic activities (fast walk, jogging, swimming, cycling, cross-country skiing) reaching 50-70% of the maximum pulse rate. If you suffer from aconcomitant cardiovascular or other disease, follow the recommendations of the specialist.
5. Do not smoke.
6. Gradually decrease the content of salt in meals and substitute it by natural plant spices. Avoid food and beverages with ahigh content of salt (smoked meats, tinned and instant meals, some mineral waters).
7. Prefer meals with high content of fibres and vitamins (5 pieces or 500 g of fruits daily, raw or stewed vegetables, whole-grain bakery products). Substitute whole milk and dairy products with low-fat ones (cheese with the content of fat in the solid ingredients lower than 30 %), reduce the intake of animal fats (butter, egg-yolk, red meat and products made of it). Increase the intake of fresh fish and fish products. The meals should be stewed, not fried. If you are overweight, reduce the intake of calories and increase the output of energy.
8. In case of high alcohol consumption, decrease adaily alcohol intake to the maximum of 0.2-0.3 l of wine, 0.3-0.5 l of beer, or 0.04 l of liquors.
9. These changes should be introduced gradually, not simultaneously. Akey to the success is to focus on 1 or 2 changes. If you reach them and keep them up, then you can concentrate on other changes.
10. Measure your blood pressure regularly at the same time in mornings and evenings, and calculate the mean values. The aim is to reach the mean values lower than or equal to 135/85 mmHg. Use calibrated aneroid, the accuracy of which was verified by comparison with astandard mercury sphygmomanometer (in electronic manometers prefer those with the accuracy verified according to BHS or AAMI protocols).

    Stefan Farsk@, M.D., Ph.D.
    Assistant Professor
    Slovak League against Hypertension
    House of Heart, Zelena3
    03608 Martin, Slovakia
    email farsky@za.psg.sk
    

    SLOVAKOFARMA

Principles of measuring blood pressure

Standardised way of measuring blood pressure

• The patient sits back, his upper limb is put down on the underlayment at the level of heart, manometer is also placed at the level of heart.
• The patient should rest for the minimum of 5 minutes prior to examination, smoking and consumption of beverages with the content of caffeine should be avoided 30 minutes before examination.
• Examination should be repeated after 2 minutes, possibly more times, if the difference between the values is higher than 5 mmHg * the mean is calculated from resulting values.
• Measuring is possible also in the standing position * in elderly patients and diabetics.

Technical requirements:
Suitable size of the cuff

• inflated part must embrace at least 80 % of the upper arm
  (in circumference of the upper arm > 41 cm, width of the cuff being 18 cm)

Mercury sphygmomanometer or calibrated aneroid, possibly electronic manometer (in Europe validated according to British Hypertension Society or AAMI, possibly other relevant standards). Digital gaugers are inaccurate.

In auscultatory technique

• phase 1 * the beat can first be heard * means asystolic pressure
  
• phase 2 * the beat disappears * means adiastolic pressure

Characteristics of measuring blood pressure at home:

Normal values are somewhat lower than in standard measuring * 135/85 mmHg and below. Mean value calculated from many measurements is crucial for evaluation of normal values. It is recommended to measure blood pressure 3 times before breakfast and 3 times before bedtime. In-depth instruction of patients is aprerequisite to the success.