Heart Health: Lowering Blood Pressure without Medications


By: Shanrae’l Vinel, MPH, Pharm D Candidate Class of 2016

Supervised By: By Pamela Wiltfang, Pharm.D., M.P.H., B.A., CHES, NuCara Pharmacist

About 1 in 3 Americans have hypertension (high blood pressure). Only about half of all people with high blood pressure have their condition under control. If left untreated, high blood pressure can lead to other health problems such as stroke, heart failure and kidney disease. A normal blood pressure is less than 120/80mmHg. People have high blood pressure when either their systolic blood pressure (the top number) or their diastolic blood pressure (bottom number) is above normal. Prehypertension is a stage when you are at risk for having high blood pressure. People who have high blood pressure may not be able to feel that their blood pressure is high. It is important to remember that high blood pressures can cause damage to your heart, blood vessels and kidneys even if you feel well. If a person can lower their blood pressure to normal just by making lifestyle changes, then they may not need medications.

  Systolic Blood Pressure

(Top Number)

Diastolic Blood Pressure

(Bottom Number)

Normal Less than 120 mmHg Less than 80 mmHg
Prehypertension 120 to 139 mmHg 80 to 89 mmHg
Hypertension Greater than 140 mmHg Greater than 90 mmHg

Risk Factors for High Blood Pressure

There are some things that can put you at risk for having high blood pressure.

  • Family History of High Blood Pressure
  • Race
  • Age
  • Other Chronic Conditions (Examples include diabetes and kidney disease)
  • Prehypertension
  • Unhealthy Diet
  • Physical Inactivity
  • Obesity
  • Tobacco Use
  • Too Much Caffeine
  • Too Much Alcohol

How to Lower Blood Pressure

People who have been diagnosed with prehypertension or hypertension can lower their blood pressure with a combination of medications and lifestyle changes. Lifestyle changes include: exercise, weight loss, improving your diet, and reducing your caffeine and alcohol consumption. The table shows how much each of these changes can lower your blood pressure.

Activity Blood Pressure Lowering
Weight Loss 5 – 20 mmHg
Exercise 4 – 9 mmHg
Sodium Reduction 2 – 8 mmHg
Improving Diet 8 – 14 mmHg
Reducing Caffeine Intake 5 – 10 mmHg
Reducing Alcohol Intake 2 – 4 mmHg
Smoking Cessation 5 – 20 mmHg


Adding 150 minutes of cardio exercise per week can help reduce blood pressure. The exercise can be divided into 30 minute intervals throughout the week. Cardio exercise includes activities such as walking, running, swimming, biking and dancing.


Your diet can be improved by gradually adding fruits and vegetables, eating more lean meats and eating lower fat dairy products. An example of a healthy diet is the DASH (Dietary Approaches to Stop Hypertension) diet:

Food Type Recommended Number of Servings Examples
Vegetable 4 to 5 Carrots, squash, cucumber, and lettuce
Fruit 4 to 5 Bananas, tomatoes, avocados, dates, tomatoes, raisins, cantaloupe, and oranges
Dairy 2 to 3 Low fat or fat free milk, yogurt, and cheese
Grains 7 to 8 Whole grain bread
Meat 2 or fewer Lean beef, poultry or seafood
Other proteins 4 to 5 Nuts, seeds, or beans
Fats 2 to 3 Fats and oils
Sugars 5 or fewer Pastries, candies, other sweets

Sodium Reduction

Sodium can raise blood pressure by forcing your body to retain water. This makes your heart and kidneys work harder and can make blood pressure medications less effective. Limit sodium intake to 2,300 milligrams or less. You can do this by reading food labels to figure out the sodium content of what you are eating, eating fewer processed foods and not adding salt to your food. It may be easier to ease into a reduced sodium diet gradually so that you can get used to your food tasting different.

Weight Loss

Improving diet and exercise can lead to weight loss. A healthy rate of weight loss is 1 to 2 pounds per week, which can be achieved by burning or cutting out 3500 calories per week. Large waist circumference has also been associated with heart disease. To reduce their risk, men should limit their waist circumference to less than 40 inches and women should limit their waist circumference to less than 35 inches.


Drinking caffeine containing beverages can cause spikes in blood pressure of 5 to 10 mmHg. Try to limit your caffeine consumption to 200 milligrams per day, which is about two 12oz brewed cups of coffee. To determine how much caffeine is in your beverages please read food labels on caffeine containing beverages such as soda or coffee. Some other sources of caffeine include flavored water, chocolate, tea, and ice cream.


Drinking too much alcohol can raise blood pressure and make medications less effective. Excess alcohol can also cause weigh gain, which can raise blood pressure. Men should limit themselves to 1 to 2 drinks per day. Women should limit themselves to one drink per day. One drink equals 12 ounces of beer, five ounces of wine or 1.5 ounces of 80-proof liquor.


Each time you smoke you cause dramatic spikes in your blood pressure (up to 20mmHg), which can stress your heart and other organs. Quitting smoking can reduce your risk of heart disease, lung disease, and cancer.

Please contact your doctor or pharmacist if you are interested in discussing these lifestyle changes.



Bad Habits Your Heart Hates

by: NuCara Intern, Lindsey GarnerDrake University, PharmD/MBA Candidate 2016


Heart shaped by hands

  1. Smoking

Smoking is a habit for some, but an addiction for others. It is the #1 preventable cause of death and illness in the United States. We know it can cause narrowing of blood vessels leading to your heart, which, coupled with the carbon monoxide in your blood stream, means decreased oxygen flow to your heart. You can end up with chest pain, heart attack, arrhythmias, or death. Aside from the thousands of unhealthy chemicals found in cigarettes, the nicotine in tobacco products causes a rise in blood pressure. See our post here for more information on how to quit.1

2. Putting off going to the doctor

Just because you didn’t have any health problems when you were 25, doesn’t mean you don’t have any now as a 40 year old. Many people don’t realize that over the course of 10-15 years their body has changed to develop high cholesterol, high triglycerides, or high blood pressure. Even though you don’t feel these things, you still need to see a doctor regularly to get them assessed! It’s time to make your yearly physical a priority.

3. Sleeping too much or not enough

Having an irregular sleep pattern is definitely an annoyance for some and inevitable for others (especially those with demanding jobs, kids, or sleep conditions), but not having a steady sleep routine can put undue pressure on your heart. The stress hormone Cortisol is regulated by your sleep schedule. If your sleep schedule is abnormal, your Cortisol level could remain unnecessarily high throughout the day and night.

  1. Drinking too much Alcohol

Drinking excessive alcohol puts additional calories and triglycerides into your body. Extra calories and higher triglycerides (sugary fats in the blood) can lead to obesity, high blood pressure, or diabetes. Binge drinking can cause arrhythmias (heart beats that are out of normal rhythm), which can lead to stroke. What’s considered excessive? For women the American Heart Association recommends no more than one drink per day, and men are allowed to have 2. One drink is one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits.2

5. Ignoring your Belly Fat

Developing a “belly” with age isn’t supposed to be normal! The more fat you store in your midsection, the higher your risk for cardiovascular disease. Ask your doctor to assess your risk based on waist circumference and visceral fat (the fat between your midsection organs). Men who have a waist circumference greater than 40 inches and women with a waist circumference of greater than 35 inches are at higher risk of developing diabetes, hypertension, breast or colorectal cancer, and heart disease.

  1. Ignoring your High Blood Pressure

High blood pressure can be due to stress, eating a poor diet (especially one high in salt), lack of exercise, lack of sleep, excessive weight, drinking too much alcohol, smoking, and advancing age. Any of these sound familiar? Nearly everyone has at least one risk factor for high blood pressure, yet many people don’t remember the last time they got it checked. High blood pressure, while not usually a painful or bothersome diagnosis, can lead to damage in your heart. The longer you let it go unattended, the worse it will get. The good news is that there’s almost always a way to treat it without turning to medication. While medications do an excellent job of improving cardiac outcomes, changing your diet, exercising more, and getting more sleep can all lower your blood pressure.3

  1. Ignoring your Depression or Anxiety

Even though depression, anxiety, and mental health in general is getting much more help and attention than in years past, there are still many people who don’t think they “qualify” for help. Whether it’s due to cultural, familial, or personal ideas, acknowledging depression or anxiety is still stigmatized in some areas. Unfortunately, people with depression frequently have more biomarkers in their system that indicate a higher risk for cardiovascular events and coronary artery disease. While we’re still trying to figure out if depression comes first or follows a coronary event, the fact remains that the two together mean worse outcomes for the patient. That being said, don’t think that you aren’t important enough for treatment. Depression and anxiety can manifest in different ways for different people. Make sure to seek treatment! Your primary care provider or a specialized doctor can both be helpful.

  1. Pretending you don’t have time for exercise

We’re all guilty of this one — whether it’s pretending not to hear your alarm go off in the morning, or insisting that your day was just too long to put in an extra 30 minutes to go work out. As much as we try to convince ourselves that we can’t make time, a 30 minute walk, jog, or run is only 4% of your day! Like it or not, this is the one thing that you absolutely cannot continue to ignore. The more excuses you make, the harder it is to start. So, give yourself a kick start and make it happen!

  1. Acting like your dietary choices “aren’t that bad”

Yes they are, and you know it. If you’re eating more than 50% of foods that come from boxes, cans, or packaged on a shelf, then chances are that you’re eating an unnecessary amount of extra sugar, fat, and salt. The extra sugar can lead to insulin resistance, the extra fat can cause increases in triglycerides, and the salt can cause water retention that leads to high blood pressure. A majority of your food choices should come from complex carbohydrates (fruits, vegetables, legumes, and some whole grains), lean means (including fish), and healthy fats (olive oil, avocados, nuts and seeds). Everything you eat either helps or hurts your body, so consider that next time you stop for some fast food eats. Try keeping a food journal for a week, then tell me if your choices “aren’t that bad.” Bonus points can go to anyone who actually eats the recommended daily value of fiber (25 grams).

  1. Living on caffeine and energy drinks

Energy drinks are packed with caffeine, guarana, and sugar. Drinking even one energy drink can cause a modest spike in blood pressure. Drinking more than one per day is sure to elevate blood pressure, and put you at risk for heart beat irregularities. Drinking more than one per day on a regular basis is going to put your heart in toxic conditions. If you have a familial history of heart disease or arrhythmias, you’re at an even higher risk. Feeling any of the following after drinking one energy drink is a reason to go see a doctor, immediately: racing heart, skipping or jumping heartbeat, feeling jittery or anxious, or extended dizzy spells.

New Year’s Resolution: Healthy Eating/Living


A healthy lifestyle is one that includes healthy eating, regular physical activity, and balancing the number of calories you consume with the number of calories your body uses. According to the Dietary Guidelines for Americans 2010, a healthy eating plan:

  • Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk products
  • Includes lean meats, poultry, fish, beans, eggs, and nuts
  • Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars
  • Stays within your daily calorie needs

Focus on foods you CAN eat instead of foods you CAN’T eat!

  • Fresh, Frozen, or Canned Fruits ― don’t think just apples or bananas. All fresh, frozen, or canned fruits are great choices. One caution about canned fruits is that they may contain added sugars or syrups. Be sure and choose canned varieties of fruit packed in water or in their own juice.
  • Fresh, Frozen, or Canned Vegetables ― try something new. You may find that you love grilled vegetables or steamed vegetables with an herb you haven’t tried like rosemary. When trying canned vegetables, look for vegetables without added salt, butter, or cream sauces. Commit to going to the produce department and trying a new vegetable each week.
  • Calcium-rich foods ― you may automatically think of a glass of low-fat or fat-free milk when someone says “eat more dairy products.” But what about low-fat and fat-free yogurts without added sugars? These come in a wide variety of flavors and can be a great dessert substitute for those with a sweet tooth.
  • A new twist on an old favorite ― if your favorite recipe calls for frying fish or breaded chicken, try healthier variations using baking or grilling. Maybe even try a recipe that uses dry beans in place of higher-fat meats. Ask around or search the internet and magazines for recipes with fewer calories ― you might be surprised to find you have a new favorite dish!

Some general tips for comfort foods:

  • It’s all about balancing comfort foods you love with healthier foods and physical activity
  • Eat them less often
  • Eat smaller amounts
  • Try a lower-calorie version. Use lower-calorie ingredients or prepare food differently.

For more ideas on how to cut back on calories, see Eat More Weigh Less(http://www.cdc.gov/healthyweight/healthy_eating/energy_density.html).

Physical Activity

Regular physical activity is important for good health, and it’s especially important if you’re trying to lose weight or to maintain a healthy weight. It also helps to-

  • Reduce high blood pressure.
  • Reduce risk for type 2 diabetes, heart attack, stroke, and several forms of cancer.
  • Reduce arthritis pain and associated disability.
  • Reduce risk for osteoporosis and falls.
  • Reduce symptoms of depression and anxiety.

To maintain your weight: Work your way up to 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent mix of the two each week.

Moderate: While performing the physical activity, if your breathing and heart rate is noticeably faster but you can still carry on a conversation — it’s probably moderately intense. Examples include—

Moderate Physical Activity Approximate Calories/30 Minutes

for a 154 lb Person

Hiking 185
Light gardening/yard work 165
Dancing 165
Golf (walking and carrying clubs) 165
Bicycling (<10 mph) 145
Walking (3.5 mph) 140
Stretching 90

Vigorous: Your heart rate is increased substantially and you are breathing too hard and fast to have a conversation, it’s probably vigorously intense. Examples include—

Vigorous Physical Activity Approximate Calories/30 Minutes

for a 154 lb Person

Running/jogging (5 mph) 295
Bicycling (>10 mph) 295
Swimming (slow freestyle laps) 255
Aerobics 240
Walking (4.5 mph) 230
Weight lifting (vigorous effort) 220
Basketball (vigorous) 220


To lose weight and keep it off: You will need a high amount of physical activity unless you also adjust your diet and reduce the amount of calories you’re eating and drinking. Getting to and staying at a healthy weight requires both regular physical activity and a healthy eating plan.


New Year’s Resolution: I want to stop smoking

By Pamela Wiltfang, Pharm.D., M.P.H., B.A., CHES, NuCara Pharmacist

More people in the United States are addicted to nicotine, a drug found naturally in tobacco, than to any other drug. Research suggests that nicotine may be as addictive as heroin, cocaine, or alcohol. Tobacco use can lead to tobacco/nicotine dependence and serious health problems. Quitting smoking greatly reduces the risk of developing smoking-related diseases. Tobacco/nicotine dependence is a condition that often requires repeated treatments, but there are helpful treatments and resources for quitting.

Health Benefits of Quitting

Tobacco smoke contains a deadly mix of more than 7,000 chemicals; hundreds are harmful, and about 70 can cause cancer. Smoking increases the risk for serious health problems, many diseases, and death. Stopping smoking now can lead to the following health benefits:
• Lower risk for lung cancer and many other types of cancer.
• Reduced risk for heart disease, stroke, and peripheral vascular disease (narrowing of the blood vessels outside your heart).
• Reduced heart disease risk within 1 to 2 years of quitting.
• Reduced respiratory symptoms, such as coughing, wheezing, and shortness of breath.
• Reduced risk of developing some lung diseases (such as chronic obstructive pulmonary disease, also known as COPD, one of the leading causes of death in the United States).
• Reduced risk for infertility in women of childbearing age. Women who stop smoking during pregnancy also reduce their risk of having a low birth weight baby.

Ways to Help You Quit

Counseling and medication are both effective for treating tobacco dependence, and using them together is more effective than using either one alone.

• Brief help by a doctor (such as when a doctor takes 10 minutes or less to give a patient advice and assistance about quitting)
• Individual, group, or telephone counseling
• Behavioral therapies (such as training in problem solving)
• Treatments with more person-to-person contact and more intensity (such as more or longer counseling sessions)
• Programs to deliver treatments using mobile phones. For examples of apps that can be downloaded on your mobile phone, follow the link below:
Android: https://play.google.com/store/apps/details?id=com.portablepixels.smokefree Apple:https://itunes.apple.com/us/app/iquit-stop-smoking-counter/id317768836?mt=8
• Nicotine replacement products:
o Over-the-counter (nicotine patch, gum, lozenge)
o Prescription (nicotine patch, inhaler, nasal spray)
• Prescription non-nicotine medications: bupropion SR (Zyban®), varenicline tartrate (Chantix®)

Helpful Resources

Quitline Services
Call 1-800-QUIT-NOW (1-800-784-8669) if you want help quitting. This is a free telephone support service that can help people who want to stop smoking or using tobacco. Callers are routed to their state quitlines, which offer several types of quit information and services. These may include:
• Free support, advice, and counseling from experienced quitline coaches
• A personalized quit plan
• Practical information on how to quit, including ways to cope with nicotine withdrawal
• The latest information about stop-smoking medications
• Free or discounted medications (available for at least some callers in most states)
• Referrals to other resources
• Mailed self-help materials
Online Help
• For information on quitting, go to the Quit Smoking Resources(http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/resources/index.htm) page on CDC’s Smoking & Tobacco Use Web site.
• Read inspiring stories about former smokers and their reasons for quitting at CDC’s Tips From Former Smokers(http://www.cdc.gov/tobacco/campaign/tips/) Web site.



Deon Clabby, Home Assessment Specialist at NuCara Home Medical, has earned the Assistive Technology Professional (ATP) certification by the Rehabilitation Engineering and Assistive Technology Society of North America, (RESNA). An assistive technology professional analyzes the needs of individuals with disabilities, assists in the selection of the appropriate equipment and trains the consumer on how to properly use the specific equipment. The Assistive Technology Professional (ATP) certification recognizes those who have reached an internationally accepted standard of knowledge in assistive technology and who demonstrate a commitment to provide only the highest ethical standards of practice.

To become certified, one has to establish eligibility (through work and education), and then successfully pass a rigorous exam that tests competency in the field of assistive technology. The exam covers main principles of assistive technology including psychology and sociology; human anatomy, physiology, kinesiology and biomechanics; basic etiologies and pathologies; learning and teaching; assessment procedures; service delivery systems and funding for assistive technology; design and product development; product knowledge of assistive technology devices; integration of person, technology and the environment and professional conduct.

Clabby has been with NuCara Home Medical for 3 1/2 years and works out of the NuCara location on Ansborough Avenue in Waterloo, Iowa.

There are almost 4,000 rehabilitation engineers, occupational therapists, physical therapists, speech and language pathologists, suppliers, educators and other professionals who have successfully received their certification.


RESNA, the Rehabilitation Engineering & Assistive Technology Society of North America, is the premier professional organization dedicated to promoting the health and well-being of people with disabilities through increasing access to technology solutions.

For more information on the ATP certification, visit www.resna.org.

NuCara in Pleasant Hill Adds New Natural Product Line

By: Julia Johnson, MHA, CPhT

Your NuCara Pharmacy in Pleasant Hill has a special integrative approach to healthcare and carries several natural products designed to help each person reach their maximum health potential. The pharmacy’s newest addition of natural products is the renowned Young Living brand of essential oils. The popularity of essential oils is rapidly growing due to their ability to act as natural medicine without any side effects. The medicinal benefits derive from the oils’ antioxidant, antimicrobial, and anti-inflammatory properties.

Essential oils (EOs) are concentrated liquids containing volatile aroma compounds from plants and have been used medicinally for thousands of years. Although EOs have declined in evidence-based medicine, they are reemerging as the popularity of aromatherapy and natural medicine increases. Aromatherapy is a form of alternative medicine intended to support overall health and wellbeing through the aroma of EOs. Aromatherapy goes beyond appealing smells by offering some of the following health benefits:
• Relaxation and stress relief
• Mood enhancement
• Relief of minor discomforts
• Boosting the immune and respiratory systems

In addition to their aromatic uses, essential oils can be used topically and in some cases internally. Not all EOs can be ingested, so it is important to read their labels carefully.
Listed below are a few common essential oils and some of their uses:
• Lavender: Known for its calming properties, wound healing, insect bites and reduces inflammation.
• Peppermint: Provides natural boost of energy, improves mental alertness, relieves/reduces migraines, alleviates symptoms of congestion and aids in digestion.
• Lemon: Has antiviral properties, great for cleaning, uplifting, and detoxing.
• Frankincense: Strengthens immune system and soothes inflamed skin conditions.

The Young Living essential oils are 100% pure, therapeutic-grade oils. Young Living is confident with their purity and authenticity claims due to their patented Seed to Seal process. This five-step process applies the most rigorous quality controls possible to ensure consumers are receiving essential oils the way nature intended.

Overall, essential oils can be a great natural, complementary health treatment in a variety of situations. However, due to a lack of scientific evidence, EOs should not replace traditional medical treatments recommended by your doctor. It is suggested to do research and talk with qualified individuals before using EOs.

For more information and ideas on how to use essential oils, visit Young Living’s official blog: https://www.youngliving.com/blog/
1. http://seedtoseal.com/en/seedtoseal
2. https://www.youngliving.com/en_US/discover/guide/about

NuCara Continues to Lead the Way in Telepharmacy

Brett Barker, Director of Operations at NuCara says, ” “We also are using Telepharm for respiratory therapy. Let’s say we have a patient that’s an hour away and an issue about his therapy comes up. With Telepharm we can take the respiratory therapist right into his living room on his iPad.”

Find out more information about innovative ways NuCara is using Telepharmacy here…