Measurement of Blood Pressure

Blood Pressure
Definition: The force exerted by the blood against the blood vessel wall. The highest pressure in the cycle is the systolic blood pressure and the lowest is the diastolic. BP = Heart Rate x Total Peripheral Resistance* * blood volume, viscosity, vessel elasticity sympathetic activity, kidney function

Blood pressure
Blood Pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. When this pressure rises and stays that way over time, it can damage the body in many ways. Pressure occurs when the flow is met by resistance from blood vessel walls

Laminar Flow
Blood flows faster in the center of a blood vessel, because the blood near the sides are hitting the walls of the vessels. Is caused by the friction (resistance) between the blood and the vessel walls. Value depends on 3 factors: cardiac output diameter of arteries the quantity of blood

Blood Flow

Normal blood flow velocity 0,5 m/s 1 m/s (Systolic, large vessel)

Diastolic
It is the pressure that is exerted on the walls of the various Definition arteries around the body in between heart beats when the heart is relaxed. 60 80 mmHg (adults); 65 Normal range mmHg (infants); 65 mmHg (6 to 9 years) Diastolic readings are particularly important in the Importance with age monitoring blood pressure in younger individuals. Diastolic represents the Blood Pressure minimum pressure in the arteries. Ventricles of the heart Fill with blood Blood Vessels Relaxed Blood Pressure The lower number is diastolic reading pressure. "Diastolic" comes from the Etymology Greek diastole meaning "a drawing apart."

Systolic
It measures the amount of pressure that blood exerts on arteries and vessels while the heart is beating.

90 120 mmHg (adults); 95 mmHg (infants); 100 mmHg (6 to 9 years) As a person's age increases, so too does the importance of their systolic blood pressure measurement.
Systolic represents the maximum pressure exerted on the arteries. Left ventricles contract Contracted The higher number is the systolic pressure. "Systolic" comes from the Greek systole meaning "a drawing together or a contraction."

Systolic Pressure
Systolic pressure is the maximum pressure exerted by the blood against the artery walls. It results when the ventricles contract. Normally, it measures 120 mm Hg.
Systolic

Diastolic Pressure
Diastolic Pressure is the lowest pressure in the artery. It result when the ventricles are relaxed and is usually around 80 mm Hg.
Diastolic

Types of Measuring
Blood Pressure
Palpatory Method Non-Invasive
(Riva-Rocci Method)

Blood Flow
Ultrasound Doppler Laser Doppler Flowmetry Strain Gage Plethysmography Electric-Impedance Plethysmogr. Photoelectric Plethysmography Thermal Convection Probes

Auscultatory Method

Ultrasonic Method
Oscillometric Method Tonometry

Invasive

Extravascular Sensor Intravascular Sensor

General on System Parameters

Dye Dilution Method Thermal Dilution Method Radioisotopes

Equipment
Aneroid Oscillometric Hybrid Mercury (used only for accuracy check in MI)

RECOMMENDED BLOOD PRESSURE MEASUREMENT TECHNIQUE

The Thecuff cuffmust mustbe belevel levelwith withheart. heart. If arm circumference exceeds If arm circumference exceeds 33 33cm, cm, aalarge largecuff cuff must mustbe beused. used. Place Placestethoscope stethoscopediaphragm diaphragmover over brachial artery. brachial artery.

2. 2.

1. 1.
The Thepatient patientshould should be relaxed be relaxedand andthe the arm must be arm must be supported. supported. Ensure Ensureno notight tight clothing constricts clothing constricts the thearm. arm.
Stethoscope

Mercury machine

The Thecolumn columnof of mercury mercurymust mustbe be vertical. vertical. Inflate Inflateto toocclude occludethe the pulse. Deflate at 2 pulse. Deflate at 2to to 33mm/s. Measure mm/s. Measure systolic systolic(first (firstsound) sound) and anddiastolic diastolic (disappearance) (disappearance)to to nearest 2 mm Hg. nearest 2 mm Hg.

3. 3.

Continuing Medical Implementation

Korotkoff Sounds
First Phase A clear tapping sound; onset of the sound for two consecutive beats is considered systolic Second Phase The tapping sound followed by a murmur Third Phase A loud crisp tapping sound Fourth Phase Abrupt, distinct muffling of sound, gradually decreasing in intensity Fifth Phase The disappearance of sound, is considered diastolic blood pressure- two points below the last sound heard
Korotkoff sounds
200 180 Clear sound 160 140 120 100 Muffled sound 80 60 40 20 0 mm Hg No sound Phase 5 Phase 4 Muffling No sound Phase 1 Phase 2 Auscultator y gap Phase 3 No sound

Clear sound

Steps for Measuring BP

Seated for 5 minutes Patient Position Expose Upper arm Center of upper arm at heart level Cuff applied 1 inch above crease at elbow Locate brachial artery Palpate radial pulse Inflate cuff until pulse disappears Let air out Place stethoscope on brachial artery Pump up cuff to 20-30 above point of obliteration Let air out at 2 mmHg per second

cont.
Note 1st and 5th Korotkoff sounds Chart: #s Position Arm used Cuff size Normal, pre-hypertension, stage 1 hypertension, or stage 2 hypertension Recommendations of whats next

Common errors made in blood pressure measurement:

Choosing wrong size cuff Taking only 1 reading Deflating cuff too quickly Gauge not at eye level Not obtaining Estimated Systolic Not hearing true sounds/distracted Cuff not applied correctly (e.g.. over sleeve) or client position incorrect

BP Categories for Diagnosis and Treatment

* Taken from JNC 7, (JAMA, 2003;289:2560-2572)

Also consider the ABCS

Cholesterol Aspirin

Blood Pressure
No Smoking

Aspirin
Recommend

the use of aspirin for men ages 45 to 79 years old when the potential benefit due to a reduction in MI (myocardial infarction) outweighs the potential harm due to an increase in gastrointestinal hemorrhage.
Recommend

the use of aspirin for women ages 55-79 years when the potential benefit of a reduction in ischemic stroke outweighs the potential harm of an increase in gastrointestinal hemorrhage. MQIC April 2011

http://www.uspreventiveservicestaskforce.org/uspstf09/aspirincvd/aspcvd sum.htm

Cholesterol
Total cholesterol level- optimal level is less than 200 mg/dl LDL (bad cholesterol) optimal level is less than 100 mg/dl

HDL (good cholesterol) optimal level is more than 40mg/dl

BP Lowering Tactics
Stop Smoking Reduce Weight Exercise Low salt Low protein No caffeine Mild sedation Sufficient rest Dont oversleep

Thank You