Most consider the duties of the off-grid medic to be solely the treatment of injuries and infections. These can occur suddenly and are referred to as “acute” problems. However, more often, group members will have long-standing medical issues we call “chronic” conditions. These can be just as or more dangerous if left untreated. The medic must always have a plan of action to deal with some of these very common disorders.
One of the most common chronic medical conditions the medic will see in hard times is high blood pressure (also known as “hypertension”). Stress associated with activities of daily survival can raise blood pressure in the short term and may worsen chronic conditions. Lack of blood pressure medications may cause complications in people who were previously under good control.
The “blood pressure” is a measure of blood flow pushing against the walls of the arteries in your body. In older people and the obese, those walls become less elastic, and more force is necessary to maintain your circulation. This additional stress can lead, over time, to heart attack, heart failure, or stroke. Millions of adults in the U.S. have hypertension, which often lacks any signs or symptoms. Hence, it has been referred to as a “silent killer.”
A blood pressure is measured as “systolic” and “diastolic” pressures. Systolic refers to the blood pressure when the heart beats and diastolic refers to the blood pressure when the heart is at rest. Blood pressure readings are written as systolic over diastolic: for example: (systolic pressure) 120 over 80 (diastolic pressure). You’ll see it written like this: 120/80.
Until 2017, a person was not considered hypertensive unless their blood pressure was 140/90 or higher. Since then, the American Heart Association standard has become stricter, with 130/80 now being considered borderline hypertension. As a result, more than 40% of the U.S. population are now in the elevated range or worse.
Blood pressure may be designated as:
Normal: A systolic of less than 120 and diastolic of less than 80 (less than 120/80).
Elevated: A systolic of 120-129 and diastolic of less than 80 (less than 130/80).
Stage 1 hypertension: A systolic of 130-139 and diastolic between 80-89 (less than 140/90).
Stage 2 hypertension: A systolic of 140 or higher and diastolic 90 or higher.
Hypertensive Crisis A systolic of 180 or higher than diastolic of 120 or higher.
It’s important to know that these numbers should be used only as a guide. A single blood pressure measurement higher than normal is not necessarily an indication of a problem. Multiple (at least three) readings over several days or weeks should be taken before making a diagnosis of hypertension. Any consistent series of high blood pressure readings are a concern, but those above 160/100 are associated with a higher frequency of complications.
BLOOD PRESSURE CUFFS
The group medic should have, as part of his equipment, an inexpensive pressure monitor called a “sphygmomanometer,” or blood pressure cuff, and a stethoscope for listening.
First, place the cuff around the upper arm. You should be able to fit two fingertips under the top edge but not beneath the cuff. If you can wedge your full fingers under the cuff, loosen it and pull it tighter before closing it again
Squeezing the attached bulb several times, fill the cuff with air until the gauge registers around 180-200. Place your stethoscope over an area with a pulse (usually the inside of the crook of the arm). Slowly loosen the valve until the gauge readings slowly drop, while listening for the pulse using your stethoscope.
When you first hear the pulse, the number noted is the systolic pressure. As the air deflates from the sphygmomanometer, the pulse will reach the point where it fades away. When it’s no longer audible is the diastolic pressure. As blood pressures tend to vary at different times of the day and under different circumstances, you would be looking for at least three elevated pressures in a row sitting or standing (spaced a few days or weeks apart) before confirming the diagnosis of hypertension.
Persistent hypertension can lead to stroke, heart attack, heart failure, and kidney failure. Commonly seen symptoms that are red flags include:
- Foot and leg swelling
- Blurred vision
- Irregular heart rhythms
High blood pressure is not only a disease of the obese and elderly: Pregnancy-induced hypertension (also called “pre-eclampsia”) is a serious late pregnancy condition that may lead to seizures (“eclampsia”) and blood clotting abnormalities. It is most commonly seen in the latter stages of a first late-term pregnancy.
TREATMENT AND PREVENTION
The first step to controlling elevated blood pressures is to return to a normal weight for your height and age. Most people who are overweight find that their pressures decrease (often back to normal) when they lose weight. Even a loss of ten pounds may have a beneficial effect.
Physical exercise and dietary control are the best ways to get there. Restricting sodium is important when it comes to decreasing pressures. Excessive salt intake appears to decrease the natural elasticity of arteries. The sodium in salt is in just about everything you eat, so stop adding salt to food; humans get enough in their diet. If you’re living off your long-shelf-life food supplies, you’re getting even more.
From a survival standpoint, limited food intake during a drawn-out disaster may actually have a beneficial effect on the blood pressures of previously obese people.
Alcohol, nicotine, and perhaps, caffeine are substances also known to raise blood pressures; avoidance of these may help. If blood pressures are particularly high, lying the patient on their side (many prefer the left) has a tendency to lower readings, at least temporarily.
THE DASH DIET
The National Institute of Health recommends the DASH (Dietary Approaches to Stop Hypertension) diet. A major feature of the plan, as you can imagine, is limiting intake of sodium. It generally encourages the consumption of (unsalted) nuts, whole grains, fish, poultry, fruits and vegetables while lowering the consumption of red meats, sweets, and sugar.
The DASH diet is also a reasonable diet for healthy people. Rich in protein, potassium, calcium, and magnesium, studies have found that the DASH diet can reduce high blood pressure within two weeks in certain cases. These are the daily guidelines of the DASH diet:
- 7 to 8 servings of grains
- 4 to 5 servings of vegetables
- 4 to 5 servings of fruit
- 2 to 3 servings of low-fat or non-fat dairy
- 2 or less servings of meat, fish, or poultry
- 2 to 3 servings of fats and oils
- 4 to 5 servings per week of nuts, seeds, and dry beans
- Less than 5 servings a week of sweets
Typical serving Sizes
-1/2 cup cooked rice or pasta
-1 slice bread
-1 cup raw vegetables or fruit
-1/2 cup cooked vegetables or fruit
-8 oz. of milk
-1 teaspoon olive oil
Optimize your results on this diet by implementing the following tips:
- Choose foods that are low in saturated and total fat, such as lean meat, poultry, and fish.
- Eat plenty of fruits and vegetables; aim for eight to ten servings each day.
- Include two to three servings of low-fat or fat-free dairy foods each day.
- Choose whole-grain foods, such as 100 percent whole-wheat or whole-grain bread, cereal, and pasta.
- Eat nuts, seeds, and dried beans — four to five servings per week (one serving equals 1/3 cup or 1.5 ounces nuts, 1 tablespoons or 1⁄2-ounce seeds, or 1⁄2 cup cooked dried beans).
- Go easy on added fats. Choose soft margarine, low-fat mayonnaise, light salad dressing, and unsaturated vegetable oils (such as olive, soybean, canola, or safflower).
- Cut back on sweets and sugary beverages (or better, eliminate them).
The above is good advice about nutrition in almost every circumstance, whether you are dealing with high blood pressure or not.
A number of medications are available for the control of high blood pressure: ACE inhibitors, alpha blockers, angiotensin II receptor antagonists, beta blockers, calcium channel blockers, diuretics, and others.
All of these drugs will be scarce in times of trouble, leading some to consider asking sympathetic physicians for higher doses of specific medications than what is needed. The strategy is to break them in half and store some. This request may be considered unethical to many medical professionals.
Natural remedies may, eventually, be all you have when the medicines run out. Any herb that has a sedative effect may also lower pressures. Valerian, passionflower, and lemon balm are some examples. Garlic and cayenne pepper are also thought to have a modest lowering effect.
Antioxidants like Vitamin C 500mg daily and up to three grams of fish oil per day may prevent free radicals from damaging artery walls. Coenzyme Q10 100mg daily (200 mg for smokers and those on cholesterol-lowering meds) has shown promise in some studies as well.
Don’t forget natural relaxation techniques. Meditation, Yoga, and mild massage with aromatherapy will help relax your patient. Take their blood pressure after a session and see what effect it has. You might be surprised at the results in high-stress austere scenarios.
Any avenue you can find that help blood pressures remain within normal range will keep the people under your care healthier. Diet, mild natural sedatives, relaxation techniques, and conventional medications are all tools in the medical woodshed. Consider each one with an open mind.
Joe Alton MD
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