BLOOD

PRESSUR
E
 BLOOD
PRESSURE
Dr shabeel pn
 DEFINITION
Blood pressure is defined
as the lateral pressure exerted by
flowing blood on the walls of the
arteries.
 TYPES OF BLOOD
PRESSURE
Depending on the NATURE OF BLOOD
VESSEL –
 Arterial B.P
 Venous B.P
 Capillary B.P
 BLOOD PRESSURE IS
DETERMINED BY:
Force with which heart pumps the
blood

Resistance offered by the vessels

B.P = C.O x P.R
CARDIAC CYCLE
Systole
- .3sec

Diastole
- .5sec

Total - .8 sec
 ARTERIAL BLOOD
PRESSURE
TYPE NORMAL RANGE
Systolic BP 110-130mmHg
Diastolic BP 60-80mmHg
Pulse pressure 40mmHg
Mean arterial 93-100mmHg
pressure
MEASUREMENT OF BP
DIRECT METHOD

INDIRECT METHOD

Palpatory method
Auscultatory method
DIRECT METHOD
INDIRECT
METHOD
INSTRUMENTS
SPHYGMOMANOMET
ER
 ANEROID
BAROMETER
 AUTOMATIC
INFLATION CUP
PROCEDURE
 KOROTKOFF’S
SOUNDS
PHASE NATURE OF DURATION
SOUND
I Tapping 10 mmHg
sound
II Murmer 20 mmHg
III Gong sound 5 mmHg
IV Muffled Rest
V Dissappears
PALPATORY
METHOD
 BASIS OF KOROTKOFF’S
SOUND
Sounds are heard due to turbulence
Cuff pressure > Systolic. P Lumen is
occluded No sounds are heard.
Cuff pressure <just below> systolic .P
Blood flow at height of systole
Tapping sound
Cuff pressure < diastolic.P
Streamline flow No sounds.
AUSCULTATORY GAP

A gap present after

tapping sound
 Seen in hypertensive patients.
VARIATIONS
PHYSIOLOGICAL
PATHOLOGICAL
 PHYSIOLOGICAL
 AGE: in B.P
Old age Lipid deposition in lamina
propria Loss of windkessel effect
 SEX:
Males > Females upto menopause.
After menopause Equal.
Plasma cholesterol
Estrogen
Vasodialator NO [ERF]
 MEAL:
B.P After a meal Due
to in blood volume

 SLEEP:
Less due to general
vasodialatation.
7 EMOTIONS:
Rage, anxiety, panic e.t.c
production of adrenaline

B.P
7. Exercise

Moderate exercise
Systolic B.P upto
20-30 mmHg.
Diastolic B.P unaltered.

Severe exercise
Systolic B.P upto
40-50 mmHg
Diastolic B.P
8.Gravity

Above heart level

B.P
Below heart level
B.P

Magnitude of
gravitational
effect

.77mmHg/cm.
 PATHOLOGICAL
1.Hypertension
Persistent increase in systemic arterial
B.P is known as hypertension.
According to JNC VII
 Normal - 120/80 mmHg.
 Pre hypertension – 120-139/80-90mmHg
 Stage I Hypertension-140-159/90-99
mmHg
 Stage II Hypertension->/160/100mmHg
 Benign

Primary

Hypertension Malignant
Secondary
-Atherosclerosis
-Pheochromocytoma
-Cushing syndrome
-Glomerulonephritis
-Gestational
-Drug induced
White coat hypertension
COMPLICATIONS OF
HYPERTENSION
Renal failure
LVH
MI
Cerebral
haemorrhage
Retinal
haemorrhage
 COMPLICATIONS OF
UNCONTROLLED HYPERTENTION
DURING SURGERY

Reflects cardiac status

Anaesthetic risk of the patient.

Excessive bleeding from operation site

Blood loss.
 PRE-OPERATIVE
INVESTIGATION
Chest x-ray
ECG
USG of kidney
Ophthalmic evaluation for retinal
haemorrhage
RFT
 MANAGEMENT OF
HYPERTENSION
Non drug therapy Drug therapy
Stop smoking Beta blockers
Control obesity Calcium channel
Regular exercise blockers
Decrease salt intake Vasodialators
Diuretics
ACE inhibitors
VMC depressors
DIETARY APPROACH TO
STOP HYPERTENSION.
During surgical procedures:
B.P should be monitored and
controlled before,during and after
treatment.

Antihypertensives should be
continued.

LA solution without adrenaline or

bupivacaine should be given.
 HYPOTENSION
Fall in B.P below normal range is known as
hypotension.
TYPES
Primary/Essential hypotension.
Secondary hypotension.
-MI
-Hypoactivity of pituitary gland
-Hypoactivity of adrenal gland
-Tuberculosis
Orthostatic hypotension
 TREATMENT OF
HYPOTENSION
Correct the underlying etiology.

 Orthostatic hypotension Change

to supine position with head below the
heart level & leg raised.
REGULATON OF
ARTERIAL
B.P
RAPIDLY ACTING
INTERMEDIATE ACTING
LONG TERM ACTING
 RAPIDLY ACTING
MECHANISM
Baroreceptor reflex
Chemoreceptor reflex
CNS ischeamic response
 BARORECEPTOR REFLEX
carotid body & aortic arch
B.P impulse to tractus solitarius

supress VMC&stimulate CIC

vasodialatation rate and

force of
contraction

PR CO
LOCATION OF
BARORECEPTORS
 CHEMORECEPTOR REFLEX
CAROTID SINUS $ AORTIC BODY

B.P tissue ischeamia

Po2 and Pco2 in chemoreceptors

stimulation of VMC

B.P
 INTERMEDITE ACTING
CAPILLARY FLUID SHIFT MECHANISM

STRESS RELAXATION

REVERSE STRESS RELAXATION

CAPILLARY FLUID
SHIFT MECHANISM
 STRESS RELAXATION
MECHANISM
 B.P in blood storage organs
vasodialatation B.P .

REVERSE STRESS
RELAXATION

B.P vasoconstriction perfusion .

LONGTERM REGULATION
 Survey conducted among 120
inmates of ladies hostel of RDC
CONCLUSION