BLOOD PRESSURE

MEASUREMENT

by
Barathi
 Diseases Attributable to
Hypertension
Stroke
Coronary heart disease
Heart failure
Cerebral hemorrhage
Myocardial infarction

Left ventricular
hypertrophy Hypertension Chronic kidney failure

Hypertensive
Aortic aneurysm encephalopathy
Retinopathy
Peripheral vascular disease
All
Vascula
r
WHAT IS BLOOD
PRESSURE?
Blood pressure (BP) is a measure
of the force that the circulating
blood exerts against the arterial
wall.
 SYSTOLIC
PRESSURE
• Systolic pressure is the maximum
pressure exerted by the blood against
the arterial walls.
• It results when the ventricles contract (
systole )
 DIASTOLIC
PRESSURE
•Diastolic Pressure is the
lowest pressure in the artery.
•It result when the ventricles
are relaxed (diastole )
British Hypertension Society classification of
blood pressure levels
Blood Systolic BP Diastolic BP (mmHg)
pressure (mmHg)
<120 <80 Optimal
<130 <85 Normal
130-139 85-89 High normal
Hypertension

140-159 90-99 Grade 1 (mild)

160-179 100-109 Grade 2 (moderate)

>180 >110 Grade 3 (severe)

Isolated systolic hypertension

140-159 <90 Grade 1

>160 <90 Grade 2
 Blood Pressure
measurement
• Office
BP measurement:
Two readings, 5 minutes apart, sitting.

• Ambulatory BP monitoring:
For white coat hypertension.

• Self-measurement of BP:
Information on response to therapy, may
improve adherence to therapy.
 • Devices: Aneroid. Mercury.
Electronic.
Devices
:Aneroid. Electronic
Mercury. .
 Time of
measurement
• Usemultiple readings at different times
during the waking hours of the patient.

• For
patient taking antihypertensive
medications monitoring of blood
pressure should be done before taking
the scheduled dose.
 Patient
position
• BPshould be measured in sitting
position. Patient should sit for 5
minutes before measuring BP.

• In
elderly, supine and standing position
can be used to detect postural
hypotension.
Selecting the most accurate blood pressure
cuff

• The length of the bladder should

be at least 80% of the
circumference of the upper arm.

• The width of the bladder should be

approximately 40% of the
circumference of the upper arm.
 Where to listen for blood pressure
sounds

1Locate the antecubital fossa of

the patient’s arm and palpate the
brachial artery. This location is
the point over which the
stethoscope is placed to listen
for Korotkoff sounds later.

2Wrap the cuff approximately

2.5 inch above the antecubital
fossa.

From www.images.md
 Determining the palpated systolic pressure
and the maximum inflation level

3. While palpating the

radial pulse, inflate the cuff
until you feel the radial
pulse disappear.
Note the pressure on the
manometer at this point and
rapidly deflate the cuff.

From www.images.md
 Measurement of
BP
4Place the stethoscope lightly over the brachial
artery and inflate the cuff to a pressure 30 mm Hg
greater than estimated systolic pressure.
5Deflate the cuff slowly at a rate of 2 mm Hg per
heartbeat.
6Systolic pressure equal the pulse first heard by
auscultation
7Deflate the cuff until the sounds become
muffled and then disappear. The
disappearance of sound estimate the
diastolic pressure.

8Record the blood pressure reading in even

numbers. Note patient’s position, cuff size,
and arm used for measurement.
 Korotkoff
sounds
These noises are produced from under the distal half of the
BP cuff between systole and diastole because the artery
collapses completely and reopens with each heartbeat. As
the artery wall rapidly opens it causes a snapping or tapping
sound (like the sail of a boat snapping in the wind). As the
cuff pressure falls below the diastolic pressure, the sound
disappears as the vessel wall no longer collapses but gently
expands with each beat. The first appearance of the sound
(phase 1) indicates systole. As the pressure is reduced, the
sounds muffle (phase 4) and then disappear (phase 5). Inter-
observer agreement is better for phase 5 and this is recorded
as diastolic BP. Occasionally muffled sounds persist (phase
4) and do not disappear; in this case, record phase 4 as the
diastolic pressure.
 RECOMMENDED BLOOD
MEASUREMENT
PRESSURE
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© Continuing Medical
Implementation
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 Common problems in BP
measurement
• BP different in each arm: A difference >10 mmHg suggests
peripheral vascular disease and raises the possibility of renal
artery stenosis as the cause of hypertension. Record the highest
pressure and treat this
• Wrong cuff size: A cuff of 12.5 × 23 cm is suitable for only 60%
of Europeans. The bladder should encircle between 80% and
100% of the arm. In obese patients with large arms a normal-
sized cuff will over- estimate BP and the error is greater when
the centre of the cuff is not over the brachial artery. Therefore for
obese patients a larger cuff must be used. Using too large a cuff
produces only a small under-estimation of BP (2-3 mm in systolic
BP)
• Auscultatory gap: Up to 20% of elderly hypertensive
patients have phase 1 Korotkoff sounds which begin at
systolic pressure but then disappear for varying lengths of
time, reappearing before diastolic pressure. If the first
appearance of the sound is missed, the systolic pressure will
be recorded at a falsely low level. Avoid this by palpating the
systolic pressure first
• Excess pressure of stethoscope: Excess pressure can
artificially lower the diastolic reading by 10 mmHg. The
systolic pressure is not usually affected
• Patient's arm at the wrong level: The patient's elbow
should be level with his heart. Hydrostatic pressure effects
mean that if the arm is 7 cm higher, both systole and
diastole pressures will be 5 mmHg lower. If the arm is 7 cm
lower than the heart, they will be about 6 mm higher
• Postural change: When a healthy person stands, the pulse
increases by about 11 bpm and stabilizes after 1 min. The
BP stabilizes after 1-2 min. Check the BP after a patient
has been standing for 2 min; a drop of ≥20 mmHg on
standing is postural hypotension
•Abnormal pulse pressure: The pulse pressure is the
difference between the systolic and diastolic pressures. A
pulse pressure of
≥80 mmHg suggests aortic regurgitation, while a low pulse
pressure may occur in aortic stenosis.
thank
you