hands on health |
High Blood Pressure Questionnaire |
Name ..................................................... Date ..................
Dietary and Lifestyle Factors |
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Answers Yes = about four times a week Sometimes = not more than once a week No = less than once per week |
Score 2 points for each Yes answer Score 1 point for each Sometimes answer Score 0 points for each No answer |
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Table A |
Answer |
Score |
1 |
Do you eat refined (white) flour products? |
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2 |
Do you include sugar (any type) in your diet or eat sweets? |
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3 |
Do you drink coffee, tea, chocolate or cola drinks? |
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4 |
Do you drink alcohol other than the equivalent of 1½ glasses of wine or a pint of beer daily? |
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5 |
Do you eat foods containing any chemical additives (colouring, flavouring) etc? |
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6 |
Do you skip meals? |
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7 |
Do you pick at food between meals/ |
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8 |
Do you eat more than 175g (6oz) of animal protein daily? |
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9 |
Do you eat convenience, ready-made foods such as instant mashed potato, TV dinners or tinned foods? |
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10 |
Do you add salt to your food/ |
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11 |
Do you eat fried or highly seasoned and spiced foods? |
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12 |
Do you eat fatty meats, smoked or preserved foods? |
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Total Score Table A top questionaire |
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Table B |
Answer |
Score |
1 |
Do you eat fresh fruit? |
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2 |
Do you eat salad? |
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3 |
Do you insist on fresh vegetables (not frozen or canned) only? |
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4 |
Do you use herbs or garlic for flavouring food? |
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5 |
Do you ensure adequate fibre in your diet? |
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6 |
Do you eat whole cereal products (such as brown rice and wholemeal bread)? |
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7 |
Do you drink bottled or filtered water rather than chlorinated tap water? |
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8 |
Do you take a multivitamin or multimineral supplement or a vitamin C tablet? |
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9 |
Do you eat non-animal proteins such as seeds, nuts pulses? |
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10 |
Do you eat breakfast? |
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11 |
Do you eat natural yoghurt? |
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12 |
Do you believe that what you eat affects your health in a major way for good or ill? |
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Total Score table B |
Deduct Score table B from table A |
Ideal total is a minus number, or zero |
If score is above 6 there is a great need for attention to your diet |
Deficiencies
Table C |
Yes |
No |
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1 |
Are your nails ridged? |
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2 |
Do your nails break easily? |
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3 |
Do you have white flecks on your nails? |
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4 |
Do your gums bleed when you clean your teeth? |
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5 |
Do you get frequent mouth ulcers? |
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6 |
Do you have stretch marks in your skin? |
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7 |
Do you get cracks in the corner of your mouth? |
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8 |
Does strong light irritate you? |
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9 |
Are your eyes, mouth or nose dry? |
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10 |
Have you lost your sense of taste or smell |
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11 |
Does your skin scale or flake? |
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12 |
Do you have strong body odour? |
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13 |
Do your feet smell strongly? |
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14 |
Do you bruise easily? |
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15 |
Do you have difficulty recalling your dreams on waking? |
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Yes answers in Table C indicate vitamin and mineral deficiencies |
Lifestyle
Table D |
Answer Yes/No |
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1 |
Do you work more than 5 ½ days per week? |
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2 |
Do you work more than 10 hours on a work day? |
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3 |
Do you take less than half an hour for each main meal/ |
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4 |
Do you eat quickly and nor chew thoroughly? |
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5 |
Do you smoke? |
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6 |
Do you get less than seven hours sleep daily? |
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Answers to table D should be No for normal blood pressure top questionaire
Table E |
Answer Yes/No |
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1 |
Do you regularly listen to relaxing music? |
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2 |
Do you practice daily relaxation or meditation? |
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3 |
Do you take 30 minutes exercise at least three times weekly? |
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4 |
Do you have a creative hobby (gardening, painting, needlework, music etc? |
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5 |
Do you play non-competitive sport or activity such as walking, swimming, cycling or attend a yoga or exercise class? |
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6 |
Do you have a regular massage or osteopathic attention, or practice yoga or Tai chi at home? |
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7 |
Do you spend at least half an hour outdoors in daylight each day? |
Answers to table E should be Yes for normal blood pressure top questionaire
Hypertension tendency
Table F |
Yes |
No |
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1 |
Were you raised or do you live in a city environment? |
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2 |
Were you not breastfed as a baby |
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3 |
Are you showing any signs of premature ageing (early gray hair, early wrinkling etc.)? |
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4 |
Have you been overweight, other than for brief periods (more than 15 per cent above ideal weight)? |
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5 |
Have you a history of following a strict low-calorie diet/ |
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6 |
Is there a family history of blood pressure, heart disease or diabetes? |
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7 |
Have you been on the Pill for more than a two-year period? |
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8 |
Do you eat meat daily? |
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9 |
Do you add salt to your food at table or like salty cooked food? |
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10 |
Are you competitive, work to deadlines, easily irritated and/or ambitious? |
Age |
Number YES answers |
Tendency |
Number YES answers |
Tendency |
Number |
Tendency |
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Under 50 |
Less than five |
Low |
Five |
Moderate |
More than five |
High |
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50 - 60 |
Less than four |
Low |
Four |
Moderate |
More than four |
High |
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Over 60 |
Less than three |
Low |
Three |
Moderate |
More than three |
High |
The insights that the series of questions can give help focus attention on the factors which are within your control. The majority of harmful influences that can mitigate towards high blood pressure and cardiac problems lie within your control.
Personality type
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Table G |
YES |
No |
1 |
Are you impatient, handling delay badly? |
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2 |
Do you walk, move., eat, speak quickly? |
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3 |
Do you consider yourself restless? |
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4 |
Do you feel anxious when not occupied with work? |
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5 |
Are you easily angered by people or events? |
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6 |
Do you work quickly rather than methodically? |
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7 |
Do you often find yourself doing more than one thing at a time? |
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8 |
Do you consider yourself forceful, dominant personality? |
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9 |
Are you competitive, wanting to win? |
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10 |
Do you seek promotion and advancement, either socially or at work? |
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11 |
Do you crave peer and/or public recognition? |
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12 |
Do you set yourself and/or work to deadlines? |
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13 |
Are you time-conscious, always punctual? |
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14 |
Do you have any nervous ticks? |
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15 |
Do you commonly find your fists clenched or your hands moving, perhaps touching your face or smoothing your hair? |
If you have answered Yes to seven or more of these questions, you are undoubtedly a Type A personality.
Type A personalties are much more prone to cardio-vascular illness and hypertension than a Type B personality.
Many Type A people learn to mimic and adopt Type B traits after their first coronary!
Type B Traits