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Blood pressure
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A sphygmomanometer, a device used for measuring arterial pressure. Blood pressure (BP) is the pressure (force per unit area) exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as it moves away from the heart through arteries and capillaries, and toward the heart through veins. When unqualified, the term blood pressure usually refers to brachial arterial pressure: that is, in the major blood vessel of the upper left or right arm that takes blood away from the heart. Blood pressure may, however, sometimes be measured at other sites in the body, for instance at the ankle. The ratio of the blood pressure measured in the main artery at the ankle to the brachial blood pressure gives the Ankle Brachial Pressure Index (ABPI).

Contents
[hide]

1 Measurement o 1.1 Units o 1.2 Noninvasive measurement 1.2.1 Palpation methods 1.2.2 Auscultatory methods 1.2.3 Oscillometric methods o 1.3 Invasive measurement o 1.4 Home monitoring

2 Classification 3 Normal values 4 Physiology o 4.1 Mean arterial pressure o 4.2 Pulse pressure o 4.3 Vascular resistance o 4.4 Vascular pressure wave o 4.5 Regulation 5 Pathophysiology o 5.1 High arterial pressure o 5.2 Low arterial pressure 6 Other sites o 6.1 Venous pressure o 6.2 Pulmonary pressure o 6.3 Fetal blood pressure 7 See also 8 Footnotes 9 External links

[edit] Measurement

A medical student checking blood pressure using a sphygmomanometer and stethoscope. Arterial pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure (see Noninvasive measurement). Today blood pressure values are still reported in millimetres of mercury (mmHg), though aneroid and electronic devices do not use mercury. For each heartbeat, blood pressure varies between systolic and diastolic pressures. Systolic pressure is peak pressure in the arteries, which occurs near the end of the cardiac cycle when the ventricles are contracting. Diastolic pressure is minimum pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood. An example of normal measured values for a resting, healthy adult human is 115 mmHg systolic and 75 mmHg diastolic (written as 115/75 mmHg, and

spoken [in the US] as "one fifteen over seventy-five"). Pulse pressure is the difference between systolic and diastolic pressures. Systolic and diastolic arterial blood pressures are not static but undergo natural variations from one heartbeat to another and throughout the day (in a circadian rhythm). They also change in response to stress, nutritional factors, drugs, disease, exercise, and momentarily from standing up. Sometimes the variations are large. Hypertension refers to arterial pressure being abnormally high, as opposed to hypotension, when it is abnormally low. Along with body temperature, respiratory rate, and pulse rate, blood pressure measurements are the most commonly measured physiological parameters. Arterial pressures is usually measured non-invasively, without penetrating skin or artery. Measuring pressure invasively, by penetrating the arterial wall to take the measurement, is much less common, and usually restricted to a hospital setting.

[edit] Units
The standard unit for blood pressure measurement is mmHg (millimeter of mercury). For example, normal pressure can be stated as 120 over 80, where 120 means 120mmHg systolic pressure and 80 means 80mmHg diastolic pressure.

[edit] Noninvasive measurement

The noninvasive auscultatory (from the Latin for listening) and oscillometric measurements are simpler and quicker than invasive measurements, require less expertise in fitting, have virtually no complications, and are less unpleasant and painful for the patient. However, non-invasive measures may yield somewhat lower accuracy and small systematic differences in numerical results. Non-invasive measurement methods are more commonly used for routine examinations and monitoring. [edit] Palpation methods A minimum systolic value can be roughly estimated without any equipment by palpation, most often used in emergency situations. Palpation of a radial pulse indicates a minimum blood pressure of 80 mmHg, a femoral pulse indicates at least 70 mmHg, and a carotid pulse indicates a minimum of 60 mmHg. However, one study indicated that this method was not accurate enough and often overestimated patients' systolic blood pressure.[1] A more accurate value of systolic blood pressure can be obtained with a sphygmomanometer and palpating for when a radial pulse returns.[2] The diastolic blood pressure can not be estimated by this method.[3] [edit] Auscultatory methods

Auscultatory method aneroid sphygmomanometer with stethoscope

Mercury manometer The auscultatory method uses a stethoscope and a sphygmomanometer. This comprises an inflatable (Riva-Rocci) cuff placed around the upper arm at roughly the same vertical height as the heart, attached to a mercury or aneroid manometer. The mercury manometer measures the height of a column of mercury, giving an absolute result without need for calibration, and consequently not subject to the errors and drift of calibration which affect other methods. The use of mercury manometers is often required in clinical trials and for the clinical measurement of hypertension in high risk patients, such as pregnant women. A cuff of appropriate size is fitted smoothly and snugly, then inflated manually by repeatedly squeezing a rubber bulb until the artery is completely occluded. Listening with the stethoscope to the brachial artery at the elbow, the examiner slowly releases the pressure in the cuff. When blood just starts to flow in the artery, the turbulent flow creates a "whooshing" or pounding (first Korotkoff sound). The pressure at which this sound is first heard is the systolic blood pressure. The cuff pressure is further released until no sound can be heard (fifth Korotkoff sound), at the diastolic arterial pressure. Sometimes, the pressure is palpated (felt by hand) to get an estimate before auscultation. [edit] Oscillometric methods Oscillometric methods are sometimes used in the long-term measurement and sometimes in general practice. The equipment is functionally similar to that of the auscultatory method, but with an electronic pressure sensor (transducer) fitted in to detect blood flow,

instead of using the stethoscope and the expert's ear. In practice, the pressure sensor is a calibrated electronic device with a numerical readout of blood pressure. To maintain accuracy, calibration must be checked periodically, unlike the inherently accurate mercury manometer. In most cases the cuff is inflated and released by an electrically operated pump and valve, which may be fitted on the wrist (elevated to heart height), although the upper arm is preferred. They vary widely in accuracy, and should be checked at specified intervals and if necessary recalibrated. Oscillometric measurement requires less skill than the auscultatory technique, and may be suitable for use by untrained staff and for automated patient home monitoring. The cuff is inflated to a pressure initially in excess of the systolic arterial pressure, and then reduces to below diastolic pressure over a period of about 30 seconds. When blood flow is nil (cuff pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic pressure), cuff pressure will be essentially constant. It is essential that the cuff size is correct: undersized cuffs may yield too high a pressure, whereas oversized cuffs yield too low a pressure. When blood flow is present, but restricted, the cuff pressure, which is monitored by the pressure sensor, will vary periodically in synchrony with the cyclic expansion and contraction of the brachial artery, i.e., it will oscillate. The values of systolic and diastolic pressure are computed, not actually measured from the raw data, using an algorithm; the computed results are displayed. Oscillometric monitors may produce inaccurate readings in patients with heart and circulation problems, that include arterial sclerosis, arrhythmia, preeclampsia, pulsus alternans, and pulsus paradoxus. In practice the different methods do not give identical results; an algorithm and experimentally obtained coefficients are used to adjust the oscillometric results to give readings which match the auscultatory results as well as possible. Some equipment uses computer-aided analysis of the instantaneous arterial pressure waveform to determine the systolic, mean, and diastolic points. Since many oscillometric devices have not been validated, caution must be given as most are not suitable in clinical and acute care settings. The term NIBP, for Non-Invasive Blood Pressure, is often used to describe oscillometric monitoring equipment.

[edit] Invasive measurement

Arterial blood pressure (BP) is most accurately measured invasively through an arterial line. Invasive arterial pressure measurement with intravascular cannulae involves direct measurement of arterial pressure by placing a cannula needle in an artery (usually radial, femoral, dorsalis pedis or brachial). This procedure can be done by any licensed doctor or a Respiratory Therapist.

The cannula must be connected to a sterile, fluid-filled system, which is connected to an electronic pressure transducer. The advantage of this system is that pressure is constantly monitored beat-by-beat, and a waveform (a graph of pressure against time) can be displayed. This invasive technique is regularly employed in human and veterinary intensive care medicine, anesthesiology, and for research purposes. Cannulation for invasive vascular pressure monitoring is infrequently associated with complications such as thrombosis, infection, and bleeding. Patients with invasive arterial monitoring require very close supervision, as there is a danger of severe bleeding if the line becomes disconnected. It is generally reserved for patients where rapid variations in arterial pressure are anticipated. Invasive vascular pressure monitors are pressure monitoring systems designed to acquire pressure information for display and processing. There are a variety of invasive vascular pressure monitors for trauma, critical care, and operating room applications. These include single pressure, dual pressure, and multi-parameter (i.e. pressure / temperature). The monitors can be used for measurement and follow-up of arterial, central venous, pulmonary arterial, left atrial, right atrial, femoral arterial, umbilical venous, umbilical arterial, and intracranial pressures. Vascular pressure parameters are derived in the monitor's microcomputer system. Usually, systolic, diastolic, and mean pressures are displayed simultaneously for pulsatile waveforms (i.e. arterial and pulmonary arterial). Some monitors also calculate and display CPP (cerebral perfusion pressure). Normally, a zero key on the front of the monitor makes pressure zeroing extremely fast and easy. Alarm limits may be set to assist the medical professional responsible for observing the patient. High and low alarms may be set on displayed temperature parameters.

[edit] Home monitoring

For some patients, blood pressure measurements taken in a doctor's office may not correctly characterize their typical blood pressure. In up to 25% of patients, the office visit blood pressure reading is higher than their typical blood pressure. This type of error is called white coat hypertension and can result from anxiety related to an examination by a health care professional.[4] The misdiagnosis of hypertension for these patients can result in needless and possibly harmful medication. Debate continues regarding the significance of this effect. Some reactive patients will also react to many other stimuli throughout their daily lives, and require treatment. The white coat effect may be an indication which bears further investigation. On the other hand, in some cases a lower than typical blood pressure reading occurs at the doctor's office and these patients may fail to get needed treatment for hypertension.[5] Ambulatory blood pressure devices that take readings every half hour throughout the day and night have been used for identifying and mitigating these problems. Except for periods during sleep, home monitoring could be used for these purposes instead of ambulatory blood pressure monitoring.[6] Home monitoring may also be used to improve

hypertension management and to monitor the effects of lifestyle changes and medication related to blood pressure.[7] Compared to ambulatory blood pressure measurements, home monitoring has been found to be an effective and lower cost alternative.[6][8][9] Aside from the white coat effect, arterial pressure readings outside of a clinical setting are usually slightly lower in the majority of people. The studies that looked into the risks from hypertension and the benefits of lowering the arterial pressure in affected patients were based on readings in a clinical environment. When measuring blood pressure, an accurate reading requires that one not drink coffee, smoke cigarettes, or engage in strenuous exercise for 30 minutes before taking the reading. A full bladder may have a small effect on blood pressure readings, so if the urge to urinate exists, one should do so before the reading. For 5 minutes before the reading, one should sit upright in a chair with one's feet flat on the floor and with limbs uncrossed. The blood pressure cuff should always be against bare skin, as readings taken over a shirt sleeve are less accurate. During the reading, the arm that is used should be relaxed and kept at heart level, for example by resting it on a table.[10] Since arterial pressure varies throughout the day, measurements intended to monitor changes over longer time frames should be taken at the same time of day to ensure that the readings are comparable. Suitable times are:

immediately after awakening (before washing/dressing and taking breakfast/drink), while the body is still resting, immediately after finishing work.

Automatic self-contained blood pressure monitors are available at reasonable prices, some of which are capable of Korotkoff's measurement in addition to oscillometric methods, enabling irregular heartbeat patients to accurately measure their blood pressure at home.

[edit] Classification
The following classification of blood pressure applies to adults aged 18 and older. It is based on the average of seated blood pressure readings that were properly measured during 2 or more office visits.[7][11] Classification of blood pressure for adults Category Hypotension systolic, mmHg < 90 diastolic, mmHg < 60

Normal Prehypertension Stage 1 Hypertension Stage 2 Hypertension

90 119 120 139 140 159 160

60 79 80 89 90 99 100

[edit] Normal values

While average values for arterial pressure could be computed for any given population, there is often a large variation from person to person; arterial pressure also varies in individuals from moment to moment. Additionally, the average of any given population may have a questionable correlation with its general health, thus the relevance of such average values is equally questionable. However, in a study of 100 subjects with no known history of hypertension, an average blood pressure of 112/64 mmHg was found, [12] which is in the normal range. In children the normal ranges are lower than for adults.[13] In the elderly, blood pressure tends to be higher than normal adult values, largely because of reduced flexibility of the arteries. Factors such as age and gender[14] influence blood pressure values. Pressure also varies with exercise, emotional reactions, sleep, digestion and time of day. Blood pressure is also a function of the height of the individual.[15] Differences between left and right arm blood pressure measurements tend to be random and average to nearly zero if enough measurements are taken. However, in a small percentage of cases there is a consistently present difference greater than 10 mmHg which may need further investigation, e.g. for obstructive arterial disease.[16][17] The risk of cardiovascular disease increases progressively throughout the range of higher arterial pressure that begins at 115/75 mmHg.[18] In the past, hypertension was only diagnosed if secondary signs of high arterial pressure were present, along with a prolonged high systolic pressure reading over several visits. In the UK, patients readings are still considered normal up to 140/90 mmHg.[19] Clinical trials demonstrate that people who maintain arterial pressures at the low end of these pressure ranges have much better long term cardiovascular health. The principal medical debate concerns the aggressiveness and relative value of methods used to lower pressures into this range for those who do not maintain such pressure on their own. Elevations, more commonly seen in older people, though often considered normal, are associated with increased morbidity and mortality.

[edit] Physiology
The physics of the circulatory system are very complex. That said, there are many physical factors that influence arterial pressure. Each of these may in turn be influenced by physiological factors, such as diet, exercise, disease, drugs or alcohol, stress, obesity, and so-forth. Some physical factors are:

Rate of pumping. In the circulatory system, this rate is called heart rate, the rate at which blood (the fluid) is pumped by the heart. The volume of blood flow from the heart is called the cardiac output which is the heart rate (the rate of contraction) multiplied by the stroke volume (the amount of blood pumped out from the heart with each contraction). The higher the heart rate, the higher the arterial pressure, assuming no reduction in stroke volume. Volume of fluid or blood volume, the amount of blood that is present in the body. The more blood present in the body, the higher the rate of blood return to the heart and the resulting cardiac output. There is some relationship between dietary salt intake and increased blood volume, potentially resulting in higher arterial pressure, though this varies with the individual and is highly dependent on autonomic nervous system response and the renin-angiotensin system. Resistance. In the circulatory system, this is the resistance of the blood vessels. The higher the resistance, the higher the arterial pressure upstream from the resistance to blood flow. Resistance is related to vessel radius (the larger the radius, the lower the resistance), vessel length (the longer the vessel, the higher the resistance), as well as the smoothness of the blood vessel walls. Smoothness is reduced by the build up of fatty deposits on the arterial walls. Substances called vasoconstrictors can reduce the size of blood vessels, thereby increasing blood pressure. Vasodilators (such as nitroglycerin) increase the size of blood vessels, thereby decreasing arterial pressure. Resistance, and its relation to volumetric flow rate (Q) and pressure difference between the two ends of a vessel are described by Poiseuille's Law. Viscosity, or thickness of the fluid. If the blood gets thicker, the result is an increase in arterial pressure. Certain medical conditions can change the viscosity of the blood. For instance, low red blood cell concentration, anemia, reduces viscosity, whereas increased red blood cell concentration increases viscosity. Viscosity also increases with blood sugar concentrationvisualize pumping syrup. It had been thought that aspirin and related "blood thinner" drugs decreased the viscosity of blood, but studies found[20] that they act by reducing the tendency of the blood to clot instead.

In practice, each individual's autonomic nervous system responds to and regulates all these interacting factors so that, although the above issues are important, the actual arterial pressure response of a given individual varies widely because of both split-second and slow-moving responses of the nervous system and end organs. These responses are

very effective in changing the variables and resulting blood pressure from moment to moment.

[edit] Mean arterial pressure

The mean arterial pressure (MAP) is the average over a cardiac cycle and is determined by the cardiac output (CO), systemic vascular resistance (SVR), and central venous pressure (CVP),[21]

MAP can be approximately determined from measurements of the systolic pressure and the diastolic pressure while there is a normal resting heart rate,[21]

[edit] Pulse pressure

The up and down fluctuation of the arterial pressure results from the pulsatile nature of the cardiac output, i.e. the heartbeat. The pulse pressure is determined by the interaction of the stroke volume of the heart, compliance (ability to expand) of the aorta, and the resistance to flow in the arterial tree. By expanding under pressure, the aorta absorbs some of the force of the blood surge from the heart during a heartbeat. In this way the pulse pressure is reduced from what it would be if the aorta wasn't compliant.[22] The pulse pressure can be simply calculated from the difference of the measured systolic and diastolic pressures,[22]

[edit] Vascular resistance

The larger arteries, including all large enough to see without magnification, are low resistance conduits (assuming no advanced atherosclerotic changes) with high flow rates that generate only small drops in pressure.

[edit] Vascular pressure wave

Modern physiology developed the concept of the vascular pressure wave (VPW). This wave is created by the heart during the systole and originates in the ascending aorta. Much faster than the stream of blood itself, it is then transported through the vessel walls to the peripheral arteries. There the pressure wave can be palpated as the peripheral pulse. As the wave is reflected at the peripheral veins it runs back in a centripetal fashion. Where the crests of the reflected and the original wave meet, the pressure inside the

vessel is higher than the true pressure in the aorta. This concept explains why the arterial pressure inside the peripheral arteries of the legs and arms is higher than the arterial pressure in the aorta,[23][24][25] and in turn for the higher pressures seen at the ankle compared to the arm with normal ankle brachial pressure index values.

[edit] Regulation
The endogenous regulation of arterial pressure is not completely understood. Currently, three mechanisms of regulating arterial pressure have been well-characterized:

Baroreceptor reflex: Baroreceptors detect changes in arterial pressure and send signals ultimately to the medulla of the brain stem. The medulla, by way of the autonomic nervous system, adjusts the mean arterial pressure by altering both the force and speed of the heart's contractions, as well as the total peripheral resistance. The most important arterial baroreceptors are located in the left and right carotid sinuses and in the aortic arch.[26] Renin-angiotensin system (RAS): This system is generally known for its longterm adjustment of arterial pressure. This system allows the kidney to compensate for loss in blood volume or drops in arterial pressure by activating an endogenous vasoconstrictor known as angiotensin II. Aldosterone release: This steroid hormone is released from the adrenal cortex in response to angiotensin II or high serum potassium levels. Aldosterone stimulates sodium retention and potassium excretion by the kidneys. Since sodium is the main ion that determines the amount of fluid in the blood vessels by osmosis, aldosterone will increase fluid retention, and indirectly, arterial pressure.

These different mechanisms are not necessarily independent of each other, as indicated by the link between the RAS and aldosterone release. Currently, the RAS system is targeted pharmacologically by ACE inhibitors and angiotensin II receptor antagonists. The aldosterone system is directly targeted by spironolactone, an aldosterone antagonist. The fluid retention may be targeted by diuretics; the antihypertensive effect of diuretics is due to its effect on blood volume. Generally, the baroreceptor reflex is not targeted in hypertension because if blocked, individuals may suffer from orthostatic hypotension and fainting.

[edit] Pathophysiology
[edit] High arterial pressure
Main article: Hypertension

Overview of main complications of persistent high blood pressure. Arterial hypertension can be an indicator of other problems and may have long-term adverse effects. Sometimes it can be an acute problem, for example hypertensive emergency. All levels of arterial pressure put mechanical stress on the arterial walls. Higher pressures increase heart workload and progression of unhealthy tissue growth (atheroma) that develops within the walls of arteries. The higher the pressure, the more stress that is present and the more atheroma tend to progress and the heart muscle tends to thicken, enlarge and become weaker over time. Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysms, and is the leading cause of chronic renal failure. Even moderate elevation of arterial pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.[27] In the past, most attention was paid to diastolic pressure; but nowadays it is recognised that both high systolic pressure and high pulse pressure (the numerical difference between systolic and diastolic pressures) are also risk factors. In some cases, it appears that a decrease in excessive diastolic pressure can actually increase risk, due probably to the increased difference between systolic and diastolic pressures (see the article on pulse pressure).

[edit] Low arterial pressure

Main article: Hypotension Blood pressure that is too low is known as hypotension. The similarity in pronunciation with hypertension can cause confusion. Hypotension is a medical concern only if it causes signs or symptoms, such as dizziness, fainting, or in extreme cases, shock.[11] When arterial pressure and blood flow decrease beyond a certain point, the perfusion of the brain becomes critically decreased (i.e., the blood supply is not sufficient), causing lightheadedness, dizziness, weakness or fainting.

Sometimes the arterial pressure drops significantly when a patient stands up from sitting. This is known as orthostatic hypotension (postural hypotension); gravity reduces the rate of blood return from the body veins below the heart back to the heart, thus reducing stroke volume and cardiac output. When people are healthy, the veins below their heart quickly constrict and the heart rate increases to minimize and compensate for the gravity effect. This is carried out involuntarily by the autonomic nervous system. The system usually requires a few seconds to fully adjust and if the compensations are too slow or inadequate, the individual will suffer reduced blood flow to the brain, dizziness and potential blackout. Increases in G-loading, such as routinely experienced by aerobatic or combat pilots 'pulling Gs', greatly increases this effect. Repositioning the body perpendicular to gravity largely eliminates the problem. Other causes of low arterial pressure include:

Sepsis Hemorrhage - blood loss Toxins including toxic doses of blood pressure medicine Hormonal abnormalities, such as Addison's disease

Shock is a complex condition which leads to critically decreased perfusion. The usual mechanisms are loss of blood volume, pooling of blood within the veins reducing adequate return to the heart and/or low effective heart pumping. Low arterial pressure, especially low pulse pressure, is a sign of shock and contributes to and reflects decreased perfusion. If there is a significant difference in the pressure from one arm to the other, that may indicate a narrowing (for example, due to aortic coarctation, aortic dissection, thrombosis or embolism) of an artery.

[edit] Other sites

Blood pressure generally refers to the arterial pressure in the systemic circulation. However, measurement of pressures in the venous system and the pulmonary vessels plays an important role in intensive care medicine but requires an invasive central venous catheter.

[edit] Venous pressure

Venous pressure is the vascular pressure in a vein or in the atria of the heart. It is much less than arterial pressure, with common values of 5 mmHg in the right atrium and 8 mmHg in the left atrium.

[edit] Pulmonary pressure

Normally, the pressure in the pulmonary artery is about 15 mmHg at rest.[28] Increased blood pressure in the capillaries of the lung cause pulmonary hypertension, with interstitial edema if the pressure increases to above 20 mmHg, and to frank pulmonary edema at pressures above 25 mmHg.[29]

[edit] Fetal blood pressure

Further information: Fetal circulation#Blood pressure In pregnancy, it is the fetal heart and not the mother's heart that builds up the fetal blood pressure to drive its blood through the fetal circulation. The blood pressure in the fetal aorta is approximately 30 mmHg at 20 weeks of gestation, and increases to ca 45 mmHg at 40 weeks of gestation.[30] The average blood pressure for full-term infants: Systolic 65-95 mm Hg Diastolic 30-60 mm Hg [31]

[edit] See also

Ambulatory blood pressure Antihypertensive Central venous pressure Hypertension Hypotension Korotkoff sounds Auscultatory gap Mean arterial pressure Prehypertension Pulse pressure Pulse rate Sphygmomanometer Vital signs

[edit] Footnotes
1. ^ Deakin CD, Low JL (September 2000). "Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study". BMJ 321 (7262): 6734. doi:10.1136/bmj.321.7262.673. PMID 10987771. PMC: 27481. http://bmj.com/cgi/pmidlookup?view=long&pmid=10987771. 2. ^ Interpretation - Blood Pressure - Vitals, "University of Florida". Retrieved on 2008-03-18. 3. ^ G8 Secondary Survey, "Manitoba". Retrieved on 2008-03-18.

4. ^ Jhalani, Juhee a; Goyal, Tanya a; Clemow, Lynn a; Schwartz, Joseph E. b; Pickering, Thomas G. a; Gerin, William a. Anxiety and outcome expectations predict the white-coat effect.. 10(6), December 2005. Lippincott Williams & Wilkins, Inc.. pp. pp317319. http://www.bpmonitoring.com/pt/re/bpm/abstract.00126097-20051200000006.htm;jsessionid=LpvGzJN7PDC1yqJtnQj3ZWfmzgdnhWycyzsKybSHsr2F Lx3hR1vh!1805002056!181195629!8091!-1. 5. ^ Elliot, Victoria Stagg (2007-06-11). "Blood pressure readings often unreliable". American Medical News (American Medical Association). http://www.amaassn.org/amednews/2007/06/11/hlsa0611.htm. Retrieved 2008-08-16. 6. ^ a b Mancia G, De Backer G, Dominiczak A, et al (June 2007). "2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J 28 (12): 1462536. doi:10.1093/eurheartj/ehm236. PMID 17562668. 7. ^ a b Chobanian AV, Bakris GL, Black HR, et al (December 2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension 42 (6): 120652. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957. 8. ^ Niiranen, TJ; Kantola IM, Vesalainen R, et al (2006). "A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment". Am J Hypertens 19 (5): 46874. doi:10.1016/j.amjhyper.2005.10.017. PMID 16647616. 9. ^ Shimbo, Daichi; Thomas G. Pickering, Tanya M. Spruill, et al (2007). "Relative utility of home, ambulatory, and office blood pressures in the prediction of endorgan damage" ([dead link]). Am J Hypertens 20 (5): 47682. doi:10.1016/j.amjhyper.2006.12.011. PMID 17485006. http://www.nature.com/ajh/journal/v20/n5/abs/ajh200783a.html. 10. ^ National Heart, Lung and Blood Institute. Tips for having your blood pressure taken. http://www.nhlbi.nih.gov/hbp/detect/tips.htm. 11. ^ a b "Diseases and Conditions Index - Hypotension". National Heart Lung and Blood Institute. September 2008. http://www.nhlbi.nih.gov/health/dci/Diseases/hyp/hyp_whatis.html. Retrieved 2008-09-16. 12. ^ Pesola GR, Pesola HR, Nelson MJ, Westfal RE (January 2001). "The normal difference in bilateral indirect blood pressure recordings in normotensive individuals". Am J Emerg Med 19 (1): 435. doi:10.1053/ajem.2001.20021. PMID 11146017. http://www.sciencedirect.com/science? _ob=ArticleURL&_udi=B6W9K-45SRDHCC&_user=10&_coverDate=01%2F31%2F2001&_rdoc=1&_fmt=&_orig=search &_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=1 0&md5=74f2b32e088d88986cd307f6c7219331. 13. ^ National Heart, Lung and Blood Institute. Blood Pressure Tables for Children and Adolescents. http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.htm. (Note that the median blood pressure is given by the 50th percentile and hypertension is defined by the 95th percentile for a given age, height, and gender.)

14. ^ Reckelhoff, Jane F. (2001 May). "Gender Differences in the Regulation of Blood Pressure". Hypertension 37 (5): 1199208. PMID 11358929. PMID 11358929. http://hyper.ahajournals.org/cgi/content/abstract/hypertensionaha;37/5/1199. 15. ^ National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.pdf. 16. ^ Eguchi K, Yacoub M, Jhalani J, Gerin W, Schwartz JE, Pickering TG (February 2007). "Consistency of blood pressure differences between the left and right arms". Arch Intern Med 167 (4): 38893. doi:10.1001/archinte.167.4.388. PMID 17325301. http://archinte.ama-assn.org/cgi/content/full/167/4/388. 17. ^ Agarwal R, Bunaye Z, Bekele DM (March 2008). "Prognostic significance of between-arm blood pressure differences". Hypertension 51 (3): 65762. doi:10.1161/HYPERTENSIONAHA.107.104943. PMID 18212263. 18. ^ Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM (February 2006). "Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association". Hypertension 47 (2): 296308. doi:10.1161/01.HYP.0000202568.01167.B6. PMID 16434724. 19. ^ "Hypertension: management of hypertension in adults in primary care", NICE Clinical Guideline 34, London, England: National Institute for Health and Clinical Excellence (NICE), June 2006 20. ^ Rosenson RS, Wolff D, Green D, Boss AH, Kensey KR (February 2004). "Aspirin. Aspirin does not alter native blood viscosity". J. Thromb. Haemost. 2 (2): 3401. PMID 14996003. 21. ^ a b Klabunde, Richard E. (2007). "Cardiovascular Physiology Concepts - Mean Arterial Pressure". http://www.cvphysiology.com/Blood%20Pressure/BP006.htm. Retrieved 2008-09-29. 22. ^ a b Klabunde, Richard E. (2007). "Cardiovascular Physiology Concepts - Pulse Pressure". http://www.cvphysiology.com/Blood%20Pressure/BP003.htm. Retrieved 2008-10-02. 23. ^ Messerli FH, Williams B, Ritz E (2007). "Essential hypertension". Lancet 370 (9587): 591603. doi:10.1016/S0140-6736(07)61299-9. PMID 17707755. 24. ^ O'Rourke M (01 Jul 1995). "Mechanical principles in arterial disease". Hypertension 26 (1): 29. PMID 7607724. http://hyper.ahajournals.org/cgi/content/full/26/1/2. 25. ^ Mitchell GF (2006). "Triangulating the peaks of arterial pressure". Hypertension 48 (4): 5435. doi:10.1161/01.HYP.0000238325.41764.41. PMID 16940226. http://hyper.ahajournals.org/cgi/content/full/48/4/543. 26. ^ Klabunde, Richard E. (2007). "Cardiovascular Physiology Concepts - Arterial Baroreceptors". http://www.cvphysiology.com/Blood%20Pressure/BP012.htm. Retrieved 2008-09-09. 27. ^ Textbook of Medical Physiology, 7th Ed., Guyton & Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220. 28. ^ What Is Pulmonary Hypertension? From Diseases and Conditions Index (DCI). National Heart, Lung, and Blood Institute. Last updated September 2008. Retrieved on 6 April, 2009.

29. ^ Chapter 41, page 210 in: Cardiology secrets By Olivia Vynn Adair Edition: 2, illustrated Published by Elsevier Health Sciences, 2001 ISBN 1560534206, 9781560534204 30. ^ Struijk PC, Mathews VJ, Loupas T, et al (October 2008). "Blood pressure estimation in the human fetal descending aorta". Ultrasound Obstet Gynecol 32 (5): 67381. doi:10.1002/uog.6137. PMID 18816497. 31. ^ Sharon, S. M. & Emily, S. M.(2006). Fundations of Maternal-Newborn Nursing. (4th ed p.476). Philadelphia:Elsevier.

[edit] External links

How Do I Keep My Heart Healthy? Articles providing tips on how one can have a stronger, healthier heart. High Blood Pressure, The Institute for Good Medicine at the Pennsylvania Medical Society Blood Pressure Association (UK) British Hypertension Society: list of validated blood pressure monitors Blood pressure monitoring Pulmonary Hypertension Cleveland Clinic Blood Pressure Calculator for Diagnosis of High blood pressure in Children and Adolescents [hide]

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Cardiac action potential (Atrial action potential, Conduction Ventricular action potential) Effective refractory system / period Pacemaker potential EKG (P wave, PR Cardiac interval, QRS complex, QT interval, ST segment, T electrophysiology wave, U wave) Hexaxial reference system Chamber pressure Other Blood flow Central venous pressure/right atrial pressure Right ventricular pressure Pulmonary artery pressure Pulmonary wedge pressure/left atrial pressure Left ventricular pressure Aortic pressure Ventricular remodeling Compliance Vascular resistance (Total peripheral resistance) Pulse Perfusion Pulse pressure (Systolic - Diastolic) Mean arterial pressure Vascular Blood Jugular venous pressure system/ pressure Hemodynamics Portal venous pressure Baroreflex Kinin-kallikrein system Renin-angiotensin Regulation system Vasoconstrictors/Vasodilators Autoregulation of BP (Myogenic mechanism, Tubuloglomerular feedback) heart navs: anat/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc vascular navs: anat/physio/dev, noncongen/systemic vasculitis/congen/neoplasia, symptoms+signs/eponymous, proc Retrieved from "http://en.wikipedia.org/wiki/Blood_pressure" Categories: Blood pressure | Cardiovascular system | Blood | Medical signs Hidden categories: All articles with dead external links | Articles with dead external links from May 2009 | Cite web templates using unusual accessdate parameters
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yriad Benefit Of Yoga To Reduce High Blood Pressure

By Patricia | November 26, 2008

How Does Yoga Cures Blood Pressure

Life today is full of stress, anxiety and tight schedules. Combine this with unhealthy, onthe-go meals, the lack of proper exercise and mental duress, and what you get is high blood pressure. Known as the silent killer, high blood pressure can further result in complicated and life threatening conditions.

What Is High Blood Pressure

High blood pressure is caused when the arteries are strained due to an imbalance in the body, generally triggered by stress. The arteries are now unable to effectively carry blood through the body and to the vital organ. In such a situation, the heart tries to correct the blood flow by exerting added pressure on the arteries. This condition is known as high blood pressure or hypertension. Common indications of high blood pressure include constant headaches, blurred vision and fatigue. If unchecked, high blood pressure can result in heart failure, kidney failures, and strokes. High blood pressure is usually controlled with prescribed pharmaceutical drugs. These tend to be very strong, bringing a set of side effects along, and result in lifelong dependency. Many people opt for yoga and meditation due to its myriad benefits. This holistic practice is known to keep blood pressure in check and decreases dependency on medication. Not only does it keep hypertension at bay, it also improves overall health, both physical and mental. Gentle Exercise exercise is vital for good health. Doctors advise patients to incorporate some form of exercise in their daily routine to control hypertension. However care must be taken not to strain the already stressed body, further. This is where yoga is so beneficial. Yoga is a mild form of exercise. It incorporates a series of static postures and breathing techniques. It ensures the body is active but also relaxed and calm. Improves Circulation Yoga improves blood circulation and boosts immunity. The postures and breathing techniques ensure an adequate amount of oxygen is supplied to the body, this regulates the blood pressure. Yoga also helps flush out the toxins and waste in the body. With regular practice, you will feel energized and healthy. The body will feel light and lithe.

Stress Relief Stress is the main cause of hypertension and yoga is the most effective way to control stress. Yoga emphasizes on proper breathing and correct posture; the two most effective ways to beat stress. Yoga teaches you to breathe to lung capacity, which boosts oxygen supply to the body. Yoga also strengthens the back and abdominal muscles, which improves posture and releases the pressure on the heart and lungs, and allows easy breathing. In addition, meditation, a component of yoga, helps to control thought and achieve a still mind. This allows you to rise above the stress and calm the body and mind. This entry was posted in Benefits of Yoga and tagged blood pressure and, blood pressure and heart rate, high blood pressure and kidney, stress and high blood pressure, stress and hypertension, yoga and high blood pressure. Bookmark the permalink. Comments are closed, but you can leave a trackback: Trackback URL.

Hypotension
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Hypotension
Classification and external resources ICD-10 ICD-9 DiseasesDB MedlinePlus MeSH I95. 458 6539 007278 [1]

In physiology and medicine, hypotension refers to an abnormally low blood pressure. This is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the opposite of hypertension, which is high blood pressure. Hypotension can be life-threatening.

Contents
[hide]

1 Normal physiology 2 Mechanisms and causes 3 Syndromes 4 Indicators 5 Symptoms

6 Treatment 7 References 8 External links

[edit] Normal physiology

Blood pressure is continuously regulated by the autonomic nervous system, using an elaborate network of receptors, nerves, and hormones to balance the effects of the sympathetic nervous system, which tends to raise blood pressure, and the parasympathetic nervous system, which lowers it. The vast and rapid compensation abilities of the autonomic nervous system allow normal individuals to maintain an acceptable blood pressure over a wide range of activities and in many disease states.

[edit] Mechanisms and causes

Reduced blood volume, called hypovolemia, is the most common mechanism producing hypotension. This can result from hemorrhage, or blood loss; insufficient fluid intake, as in starvation; or excessive fluid losses from diarrhea or vomiting. Hypovolemia is often induced by excessive use of diuretics. Other medications can produce hypotension by different mechanisms. Decreased cardiac output despite normal blood volume, due to severe congestive heart failure, large myocardial infarction, or bradycardia, often produces hypotension and can rapidly progress to cardiogenic shock. Arrhythmias often result in hypotension by this mechanism. Beta blockers can cause hypotension both by slowing the heart rate and by decreasing the pumping ability of the heart muscle. Varieties of meditation and/or other mental-physiological disciplines can create temporary hypotension effects, as well, and should not be considered unusual. Excessive vasodilation, or insufficient constriction of the resistance blood vessels (mostly arterioles), causes hypotension. This can be due to decreased sympathetic nervous system output or to increased parasympathetic activity occurring as a consequence of injury to the brain or spinal cord or of dysautonomia, an intrinsic abnormality in autonomic system functioning. Excessive vasodilation can also result from sepsis, acidosis, or medications, such as nitrate preparations, calcium channel blockers, angiotensin II receptor blockers ACE inhibitors. Many anesthetic agents and techniques, including spinal anesthesia and most inhalational agents, produce significant vasodilation.

[edit] Syndromes
Orthostatic hypotension, also called "postural hypotension", is a common form of low blood pressure. It occurs after a change in body position, typically when a person stands up from either a seated or lying position. It is usually transient and represents a delay in the normal compensatory ability of the autonomic nervous system. It is commonly seen

in hypovolemia and as a result of various medications. In addition to blood pressurelowering medications, many psychiatric medications, in particular antidepressants, can have this side effect. Simple blood pressure and heart rate measurements while lying, seated, and standing (with a two-minute delay in between each position change) can confirm the presence of orthostatic hypotension. Orthostatic hypotension is indicated if there is a drop in 20 mmHg of systolic pressure (and a 10 mmHg drop in diastolic pressure in some facilities) and a 20 bpm increase in heart rate. Neurocardiogenic syncope is a form of dysautonomia characterized by an inappropriate drop in blood pressure while in the upright position. Neurocardiogenic syncope is related to vasovagal syncope in that both occur as a result of increased activity of the vagus nerve, the mainstay of the parasympathetic nervous system. Another, but rarer form, is postprandial hypotension, which occurs 3075 minutes after eating substantial meals. When a great deal of blood is diverted to the intestines to facilitate digestion and absorption, the body must increase cardiac output and peripheral vasoconstriction in order to maintain enough blood pressure to perfuse vital organs, such as the brain. It is believed that postprandial hypotension is caused by the autonomic nervous system not compensating appropriately, because of ageing or a specific disorder.

[edit] Indicators
For most individuals, a healthy blood pressure is 115/75 mmHg. A small drop in blood pressure, even as little as 20 mmHg, can result in transient hypotension.[1] Evaluation of neurocardiogenic syncope is done with a tilt table test.

[edit] Symptoms
The cardinal symptom of hypotension is lightheadedness or dizziness. If the blood pressure is sufficiently low, fainting and often seizures will occur. Low blood pressure is sometimes associated with certain symptoms, many of which are related to causes rather than effects of hypotension:

Chest pain Shortness of breath Irregular heartbeat Fever higher than 101 F (38.3 C) Headache Stiff neck Severe upper back pain Cough with phlegm Prolonged diarrhea or vomiting Dysphagia

Dysuria Foul-smelling urine Adverse effect of medications Acute, life-threatening allergic reaction Seizures Loss of consciousness Profound fatigue Temporary blurring or loss of vision

[edit] Treatment
The treatment for hypotension depends on its cause. Asymptomatic hypotension in healthy people usually does not require treatment. Adding electrolytes to a diet can also relieve symptoms of mild hypotension. In mild cases, where the patient is still responsive, laying the person in dorsal decubitus (lying on the back) position and lifting the legs will increase venous return, thus making more blood available to critical organs at the chest and head. The Trendelenburg position, though used historically, is no longer recommended.[2] The treatment of hypotensive shock ALWAYS follows the first four following steps. Outcomes in terms of mortality are directly linked to the speed in which hypotension is corrected. In parenthases are the still debated methods for achieveing, and benchmarks for evaluating, progress in correcting hypotension. The seminal study [3] on Early Goal Directed Therapy is an elegant deliniation of these general principles. Unfortunately, it does focus on hypotension due to infection and thus is not applicable to all forms of severe hypotension. 1. Volume Recussitation (usually with crystalloid) 2. Blood Pressure Support (with norepinephrine or equivalent) 3. Ensure adequate tissue perfusion (maintain SvO2 >70 with use of blood or additional pressors]) 4. Address the underlying problem (i.e. antibiotic for infection, stent or CABG for infarction, steroids for adrenal insufficiency, etc...) Medium term (and less well demonstrated) treatments of hypotension include: 5. Blood sugar control (80-150 by one study) 6. Early nutrition (PO or by tube to prevent ileus)

7. Steroid support

Under the microscope: High blood pressure

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Average rating: More than 16 million people have high blood pressure and 5 million of us don't know about it until it causes problems. Find out what the symptoms are and how can you lower yours

What is blood pressure?

Blood pressure is the pressure placed on the body's blood vessels by circulating blood. Because our circulation varies throughout the day, depending on whether we are resting or being active, our blood pressure also varies. If blood pressure is consistently high or low it's a sign that there could be an underlying health problem that is affecting the pressure of blood circulating around the body.

How is blood pressure measured?

Two readings are taken when you have your blood pressure measured. A cuff is placed around the top of the arm, which is connected to a machine. The cuff is tightened and the machine then reads the force of pressure in your body. It's measured in millimetres of

mercury (mmHg). The two readings are for systolic pressure, which is when your blood pressure goes up and diastolic pressure, when your blood pressure goes down. The reading will be systolic pressure over diastolic pressure. A healthy reading for an adult is 120 over 80mmHg or lower.

What is high blood pressure?

High blood pressure, also called hypertension, is when you have a reading of 140/90mmHg or more. This indicates that your blood vessels are having more difficulty than normal pumping blood around the body. High blood pressure can lead to a stroke or heart disease.

What causes high blood pressure?

High blood pressure occurs for many different reasons. As you get older high blood pressure is a risk but there are other diet and lifestyle factors that contribute, such as obesity, a family history of high blood pressure or stroke, medication, smoking, drinking, eating too much salt, stress and your ethnic origin - people of African or Afro-Caribbean descent have a greater risk.

What are the symptoms of high blood pressure?

There are often no symptoms of high blood pressure or immediate problems, which is why it is so important to get regular health checks, especially if you smoke, are overweight, stressed or drink a lot of alcohol.

How can high blood pressure be treated?

You might be able to change your blood pressure by changing your diet and lifestyle. But your GP may also prescribe pills to regulate your blood pressure. It's likely that they'll also advise you to swap to a low fat diet, cut back on salt, reduce your alcohol units and lower your stress levels.

What is low blood pressure?

Low blood pressure, also called hypotension, is when you have a reading of around 90/60mmHg. This indicates that your body is slower than normal at pushing blood around the blood vessels.

What causes low blood pressure?

There are lots of reasons for low blood pressure. Often it's a side-effect of medication. As you get older low blood pressure can occur because your blood vessels lose their elasticity. You may feel faint when you stand up suddenly, this this is an indication of low blood pressure and is called postural hypotension.

There are other reasons why low blood pressure occurs but these are quite rare. Damage to the nerves supplying your blood vessels, caused by diabetes, can bring down your blood pressure. Internal bleeding and poor nutrition can also result in low blood pressure.

What are the symptoms of low blood pressure?

Like high blood pressure there are no specific symptoms. You may feel faint regularly, tired all the time and dizzy. These are also symptoms of anaemia, which is quite common in women, and ME/CFS (chronic fatigue syndrome). If you experience any of these symptoms or you just don't feel yourself you should see your GP.

How can low blood pressure be treated?

Unless it's a sign of a serious illness it won't be treated specifically but your doctor will probably advise you to adjust your diet and lifestyle. You may need to increase your intake of high GI foods or sleep with your pillows raised. There is some good news if you have low blood pressure. You have some protection against the causes of high blood pressure such as eating too much salt, or being overweight.

Where to next?
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Foods that Lower High Blood Pressure

Contributor By Leonor Crossley eHow Contributing Writer Rate: (0 Ratings) A blood pressure reading above 120/80 mm Hg may be cause for alarm and is an indication of high blood pressure. Often, high blood pressure is not marked by noticeable symptoms. That is why it is important to have one's blood pressure checked regularly. If the blood pressure is found to be high, it could lead to a heart attack, stroke, kidney damage and other severe health problems if not controlled by prescribed medication. There are also particular foods that a person can eat more of to lower high blood pressure.

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Skim Milk and Celery

1. According to "Today Show" nutritionist Joy Bauer, using skim milk is a great way to lower one's blood pressure by approximately 3 percent to 10 percent. The calcium and vitamin D contained within the milk work together to help reduce the risk of cardiovascular disease.

Celery is a great vegetable to eat to control one's blood pressure. It contains natural oil that seems to aid in consistent blood flow within the body.

Spinach, Sunflower Seeds and Beans

2. These foods contain two ingredients that are vital to maintaining a safe blood pressure: magnesium and potassium. The sunflower seeds should be unsalted since too much salt can cause blood pressure to rise. The beans can be of any variety such as pinto, lima, kidney, black and others. Other foods that have a high level of magnesium are broccoli, grain, wheat and oysters. These should also be included in a healthy diet.

Baked White Potato, Bananas and Soybeans

3. These foods can help to maintain a healthy blood pressure because they contain a great amount of potassium, which helps to clear the artery walls of fat-blocking substances. The human body seems to retain sodium when a person has a low level of potassium. This causes the blood pressure to rise. Eating a healthy level of potassium causes the body to get rid of sodium to maintain healthy functioning of the body. Other foods rich in potassium that should be included in a healthy diet are raisins, figs, nuts, tomatoes, apricots, sweet potatoes and red grapes. It is important not to take potassium supplements unless they are recommended by a doctor. Having too much potassium in the body can cause severe heart palpitations and lead to life-threatening conditions.

Dark Chocolate and Fish

4. According to a study in the July 4, 2007, issue of the Journal of the American Medical Association, eating a small amount of dark chocolate daily (less than half an ounce) contributes to a lower blood pressure reading. Fish that is not fried in oil is also a great choice to lower one's high blood pressure. Salmon is one of the best fish for good health because it contains a lot of omega-3 acid, which is great for the heart.