Blood pressure is the lateral pressure exerted by the blood against the walls of the blood vessels, especially

the arteries while flowing through it. It varies with the‡Strength of the heartbeat, ‡The elasticity of the arterial walls, ‡The volume and viscosity of the blood, and ‡a person's health, age, and physical condition. BP = CO X PR = SV X HR X PR 

Blood pressure is always given as these two numbers, the systolic and diastolic pressures. What Is Normal Blood Pressure? A blood pressure reading below 120/80 (120 over 80) mmHg is considered normal. In general, lower is better. (Not too low)

Systolic pressure (SP) (120 mm Hg) is the highest pressure measured when the ventricles are contracting and exerting maximal force on the blood Diastolic pressure (DP) (80 mmHg) is the lowest pressure measured when the ventricles are completely relaxed. The pressure is due the walls of the artery constricting blood. Pulse pressure (PP): The difference between the systolic and diastolic blood pressure. PP= (SP-DP) mm Hg = 40 mm Hg Mean pressure (MP): It is roughly the arithmetic mean of the diastolic and systolic blood pressure. MP = (SP+ DP)/2= 100 mm Hg A close approximation to the mean pressure may be obtained by adding the diastolic pressure with one third of the pulse pressure.

Basal blood pressure: 
BP normally differs from person to person It also varies in the same individual under different condition. So the term used ³Normal range of blood pressure´ When an individual is with the least possible stress Basal blood pressure is generally considered. it may also be regarded as the lowest pressure necessary in maintaining blood flow sufficient for need of the body . When a subject is in reclining state, 5-6 hours after last meal, in a comfortably warm room, after resting for at least 30-40 minutes and with a mind at possible ease, the basal pressure is obtained. In adult males, the average systolic pressure is 125-130 mm of hg ±15 (viz., from 110-145 mm of Hg) and Average diastolic pressure, 70-90 mm of Hg.

Hypertension: Hypertension is high blood pressure. Hypotension: Hypotension is low blood pressure. 
Doctors classify blood pressures under 140/90 mmHg as either normal or prehypertension. Normal blood pressure is lower than 120/80 mmHg. Prehypertension is blood pressure between 120 and 139 mmHg for systolic pressure and between 80 and 89 mmHg for diastolic pressure.

What Is High Blood Pressure? A blood pressure of 140/90 mmHg or higher is considered high BP There are two levels of high blood pressure: stage 1 and stage 2

There is an exception to the above definition of high blood pressure. A blood pressure of 130/80 mmHg or higher is considered high blood pressure in people with diabetes and chronic kidney disease.

Factors affecting normal BP Emotion: increases cardiac output and peripheral resistance. Stress: The effects of stress can vary, but long-term, chronic stress appears to raise blood pressure. Sleep: reduces BP up to 20 mm Hg. Age: BP increases with advancing age. Fat in the diet: saturated fats and cholesterol in foods raise blood cholesterol, which increases the risk for heart disease. Obesity: is a contributing factor because excess body fat, especially central fat, can precipitate hypertension. Smoking: causes peripheral vascular disease (narrowing of the vessels), as well as hardening of the arteries. These conditions can lead to heart disease and stroke, and are contributing factors in high blood pressure. Some drugs: may cause hypertension or make controlling hypertension more difficult.

Measurement and recording of Blood Pressure Arterial BP can be measured by two methods1. Direct method-Requires surgical procedure 2. Indirect method-This is the standard method for measuring BP. -It requires no surgical procedure -Pressure can be measured only through listening sound. -The instrument used is known as sphygmomanometer - There are three indirect methods a)Oscillatory method b)Palpatory method c)Auscultatory method All these method commonly measure the pressure of the brachial artery.

Invasive Measurement This is the only direct measurement of blood pressure. In order to perform this measurement, a tube (catheter) is inserted into an artery of interest. A pressure transducer is connected to the tube and the pressure is measured. Because there is risk associated with puncturing an artery, this invasive means of measurement is not commonly used except in cases when it is vitally important to quickly determine changes in blood pressure. Most commonly, the catheter is inserted into the radial artery (located at the wrist). 

The axillary artery begins at the lateral border of the first rib as a continuation of the subclavian artery. It changes its name to brachial artery and moves along the humerus (upper arm bone) ends about 1 cm. below the bend of the elbow, where it divides into the radial and ulnar arteries.   

When blood pressure is measured, it is considered that the blood flowing through the arteries because it has a higher pressure than the blood in the veins. Blood pressure is measured using two numbers. The first number, which is higher, is taken when the heart beats during the systole phase. The second number is taken when the heart relaxes during the diastole phase. A column of mercury rises and falls with the beat of the heart. The height of the column is measured in millimeters. Auscultatory Method: ‡A cuff attached to a mercury manometer (sphygmomanometer) is wrapped around the arm at the label of the heart. ‡A stethoscope is placed over the brachial artery at the elbow. ‡The cuff is rapidly inflated until the pressure in it is raised (200 mm Hg) well above the expected systolic pressure in the brachial artery. ‡The artery is occluded by the cuff, and no sound is heard with the stethoscope. ‡The pressure in the cuff is then lowered slowly. 

At the point at which systolic pressure in the artery just exceeds the cuff pressure a tapping sound is heard. (The sound is due to the occurrence of turbulence in the flow of blood through the narrowed blood vessels when the manometric pressure just coincides with the systolic BP) The cuff pressure at which the tapping sounds are first heard pressure.


As the cuff pressure is lowered further - the sounds become louder, then dull and muffled. Finally disappear (Sounds of Korotkoff.) The lowest pressure at which the sound can still be heard is the diastolic pressure. The blood pressure in the brachial artery in young adults in the sitting or lying position at rest in approximately 120/80 mm Hg.

As the pressure is released the following variation of sounds are heard: First Phage- Sudden appearance of a clear tapping sound. This indicates systolic pressure. It persists while the pressure falls through 15mm of Hg Second Phage- the tap sound is replaced by murmur persisting for another 15mm of Hg. Third phage- the murmur is replaced by a clean loud gong sound lasting for the next 20 mm of hg. Fourth Phage- the loud sound suddenly becomes muffled and rapidly begins to fade. This point indicates diastolic pressure. Fifth Phage- absence of all sounds. Four most common errors in measuring BP are: 1. Using the wrong size cuff. 2. Applying the cuff incorrectly 3. Not positioning the stethoscope directly above the artery. Incorrect placement will result in too low of a systolic and too high of a diastolic pressure measurement. 4. Incorrect interpretation of the sounds heard.

Hypertension Two forms of high blood pressure have been described: Essential (or primary) hypertension and Secondary hypertension. Essential hypertension is a far more common condition and accounts for 95% of hypertension. The cause of essential hypertension is multifactorial, that is, there are several factors whose combined effects produce hypertension. Causes: Although the exact cause of primary hypertension isn't known, contributing factors include‡Heredity, ‡Obesity, ‡Lack of exercise, ‡Diet -- including salt intake -- cigarette smoking, ‡Sex, ‡Race, ‡Age etc.

Secondary hypertension accounts for 5% of hypertension, the high blood pressure is secondary to (caused by) a specific abnormality in one of the organs or systems of the body. Causes: Secondary hypertension may be linked to‡Kidney disease, ‡Endocrine disorders, ‡The use of oral contraceptives, and ‡Excessive use of alcohol.

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