19-18
Points to cover when teaching about blood pressure:
• Before health workers begin to measure blood pressure, be
sure they know how to use a stethoscope. Have them listen
to each other’s heartbeats to become familiar with the
sound of the pulse.
• Caution each health worker against using either the stethoscope or pressure cuff
as ‘magic medicine’ to make people think he has special powers or knowledge.
Use these instruments as tools, and only when necessary—never for show or
prestige.
• Measure blood pressure when the person is ‘at rest’. Recent exercise (running,
walking, or working), anger, worry, fear, or nervousness can make pressure rise
and give a falsely high reading. In a doctor’s office the most common problem is
nervousness, especially if the patient is a woman and the doctor is a man. Ask
the health workers why they think this is so. Discuss with them what can be done
to make the person as comfortable and relaxed as possible before taking their
blood pressure.
• Always take a person’s blood pressure 2 or 3 times to be sure your readings are
about the same.
• Normal blood pressure for an adult at rest is usually around
120/80, but this varies a lot. Anything from 100/60 to 140/90
can be considered normal. Older people usually have somewhat
higher blood pressure than young people.
• Of the two readings, top (systolic) and bottom (diastolic), it is
usually the bottom number that tells us more about a person’s health. For example,
if a person’s blood pressure is 140/85, there is not much need for concern. But if
it is 135/110, he has seriously high blood pressure and
should lose weight (if fat) or get treatment. It is generally
TOO HIGH
agreed that a bottom number (BN) of over 100 or a top number
of over 160 means the blood pressure is high enough to require
attention (diet and perhaps medicine).
• Advise health workers that they usually do not have to worry
when a person regularly has low blood pressure. In fact, blood
pressure on the low side of normal, 90/60 to 110/70, means a
person is likely to live long and is less likely to suffer from heart
trouble or stroke. Many normal, healthy village people, especially in Latin America,
have blood pressure as low as 90/60.
• A sudden or marked drop in blood pressure is a danger sign
(blood loss, shock), especially if it falls below 60/40. Health
workers should watch for any sudden drop in the blood pressure
of persons who are losing blood or at risk of shock. However, some
drop in pressure may happen normally when a woman relaxes after
giving birth or a person calms down after an accident. Always
look for other signs of shock besides a drop in blood pressure.
(See the test for shock on p. 16-9.)
TOO LOW
Note: References to blood pressure in Where There Is No Doctor are: Shock, p. 70 and 77 (also
see Index); Fat People, p. 126; Heart Trouble, p. 325; High Blood Pressure, p. 125 and 326; Stroke, p.
327; Pregnancy, p. 249, 251, and 253; Pre-eclampsia, p. 249; Childbirth (blood loss), p. 265; and Birth
Control Pills, p. 289.