BLOOD PRESSURE

The determination of an individual's blood pressure is one of the most useful clinical measurements that can be taken. By "blood pressure" we mean the pressure exerted by the blood against the vessel walls, the arterial blood pressure being the most useful, and hence the most frequently measured pressure. One should become familiar with the following pressures used in cardiovascular physiology. Systolic blood pressure. The highest pressure in the artery, produced in the heart's contraction (systolic) phase. The normal value for a 20-year-old man is 120 mm Hg. Diastolic blood pressure. The lowest pressure in the artery, produced in the heart's relaxation (diastolic) phase. The normal value for a 20-year-old man is 80 mm Hg. Pulse pressure. The difference between the systolic and diastolic pressures. The normal value is 40 mm Hg. Mean blood pressure. Diastolic pressure plus one third of the pulse pressure. This is the average effective pressure forcing blood through the circulatory system. The normal value is 96 to 100 mm Hg. IMPORTANCE OF BLOOD PRESSURE MEASUREMENT: The mean blood pressure is a function of two factors - cardiac output (CO) and total peripheral resistance (TPR). Peripheral resistance depends on the calibre (diameter) of the blood vessels and the viscosity of the blood. Mean BP = Cardiac output (ml/sec) x TPR Cardiac output (ml/min) = Heart rate/min x Stroke volume (ml) Thus, the measurement of blood pressure provides us with information on the heart's pumping efficiency and the condition of the systemic blood vessels. In general, we say that the systolic blood pressure indicates the force of contraction of the heart, whereas the diastolic blood pressure indicates the condition of the systemic blood vessels (for instance, an increase in the diastolic blood pressure indicates a decrease in vessel elasticity). MEASUREMENT OF BLOOD PRESSURE: Blood pressure can be measured by several techniques. Basically they are categorized into two methods, 1. Direct method 2. Indirect method 1. Direct method The direct method involves directly inserting a tube or catheter into a blood vessel. The catheter is connected to a blood pressure transducer, which generates an electrical

signal. 2. Indirect method In this method, we measure the arterial blood pressure using two different methods: 1. The first method uses the sense of touch: it is thus called the palpatory method. 2. The second method uses the sense of hearing: it is thus called the auscultatory method. In either of these indirect methods, pressure is applied to the artery using an instrument called the sphygmomanometer. A sphygmomanometer, an instrument that measures pressure, is needed in both methods. Each sphygmomanometer consists of a cuff which is connected by lengths of tubing to an inflating bulb with a needle valve and to a mercury manometer. PALPATORY METHOD: 1. Have the subject seated, with his or her arm resting on a table. Wrap the pressure cuff snugly around the bare upper arm, making certain that the inflatable bag within the cuff is placed over the inside of the arm where it can exert pressure on the brachial artery. Wrap the end of the cuff around the arm and tuck it into the last turn, or press the fasteners together to secure the cuff on the arm. Close the valve on the bulb by turning it clockwise. 2. With one hand, palpate (feel) the radial pulse in the wrist. Slowly inflate the cuff by pumping the bulb with the other hand and note the pressure reading when the radial pulse is first lost. Then increase the pressure to around 20 mm Hg above this point. Slowly reduce the pressure in the cuff by turning the valve counterclockwise slightly to let air out of the bag. Note the pressure when the radial pulse first reappears. This is systolic blood pressure, the highest pressure in the systemic artery. 3. Let all the air out of the cuff, allow the subject to rest, and then run a second determination. Do not leave the cuff inflated for more than 2 minutes, because it is uncomfortable and will cause a sustained increase in blood pressure. 4. The systolic pressure recorded with the palpatory method is usually around 5 mm Hg lower than that obtained using the auscultatory method. A major disadvantage of the palpatory method is that it cannot be used to measure the diastolic pressure. AUSCULTATORY METHOD: 1. Place the bell of the stethoscope below the cuff and over the brachial artery where it branches into the radial and ulnar arteries. Use your fingers, rather than your thumb, to hold the stethoscope over the artery; otherwise you may be measuring the thumb arterial pressure rather than the brachial artery pressure. With no air in the cuff no sounds can be heard.

2. Inflate the cuff so the pressure is above diastolic (80-90 mm Hg), and you will be able to hear the spurting of blood through the partially occluded artery. Increase the cuff pressure to around 160 mm Hg; this pressure should be above systolic pressure so that the artery is completely collapsed and no sounds are heard. 3. Now, open the valve and begin to slowly lower the pressure in the cuff. As the pressure decreases you will be able to hear four phases of sound changes; these were first reported by Korotkoff in 1905 and are called Korotkoff sounds. Phase 1. Appearance of a fairly sharp thudding sound that increases in intensity during the next 10 mm Hg of drop in pressure. The pressure when the sound first appears is the systolic pressure. Phase 2. The sounds become a softer murmur during the next 10 to 15 mm Hg of drop in pressure. Phase 3. The sounds become louder again and have a sharper thudding quality during the next 10 to 15 mm Hg of drop in pressure. Phase 4. The sounds suddenly become muffled and reduced in intensity. The pressure at this point is termed the diastolic pressure. This muffled sound continues for another drop in pressure of 5 mm Hg, after which all sound disappears. The point where the sound ceases completely is called the end diastolic pressure. It is sometimes recorded along with the systolic and diastolic pressures in this manner: 120/80/75. ANALYSIS: The auscultatory method has been found to be fairly close to the direct method in the pressures recorded; usually the systolic pressure is about 3 to 4 mm Hg lower than that obtained with the direct method. Blood pressure varies with a person's age, weight, and sex. Below the age of 35, a woman generally has a pressure 10 mm lower than that of a man. However, after 40 to 45 years of age, woman's blood pressure increases faster than does a man's. The old rule of thumb of 100 plus your age is still a a good estimate of what your systolic pressure should be at any given age. After the age of 50, however, the rule is invalid. The increase in blood pressure with age is caused largely by the overall loss of vessel elasticity with age, part of which is due to the increased deposit of cholesterol and other lipids in the blood vessel walls.

Blood pressure is necessary to supply the organs of the body with oxygen and nutriments. In the human body the blood is found in blood vessels. They are mainly arteries and veins. The blood flowing through the blood vessels constantly exerts pressure on the vessel walls.The pressure is determined by the pumping force of the heart and the elasticity of blood vessels. The heart generally contracts and expands again 60 - 80 times per minute on average. In doing so, it pumps the blood under pressure into the arteries in order to supply the organs of the body with oxygen and nutriments. The blood vessels branch out more and more until they become capillary blood vessels (capillaries). This 'plumbing system' offers more or less resistance to the bloodstream, if it is under enough pressure. The pressure is highest at the moment of the heartbeat, that is when the heart is contracting. This pressure is known as the systolic blood pressure. The contraction phase of the heart in which the blood pressure rises is known as the systole. The blood pressure is at its lowest between two heartbeats, i.e. when the heart muscle relaxes. The blood pressure at this point is referred to as the diastolic blood pressure. The phase in which the heart relaxes and the blood pressure decreases is known as the diastole. Blood pressure is measured in mmHg. The systolic value is always stated first, then the diastolic value. For example: 120/80 mmHg means that the systolic blood pressure is 120 mmHg and the diastolic blood pressure is 80 mmHg.1 mmHg is the pressure that one millimetre (mm) of mercury (Hg) exerts. As a conversion: 1 mmHg = 0.00133 bar.

Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, blood [1] pressure varies between a maximum (systolic) and a minimum (diastolic) pressure. The blood [2] pressure in the circulation is principally due to the pumping action of the heart. Differences in mean blood pressure are responsible for blood flow from one location to another in the circulation. The rate of mean blood flow depends on the resistance to flow presented by the blood vessels. Mean blood pressure decreases as the circulating blood moves away from the heart through arteries, capillaries and veins due to viscous losses of energy. Mean blood pressure drops over the whole circulation, although most of the fall occurs along the small arteries [3] and arterioles. Gravity affects blood pressure via hydrostatic forces (e.g., during standing) and valves in veins, breathing, and pumping from contraction of skeletal muscles also influence blood [2] pressure in veins. The measurement blood pressure without further specification usually refers to the systemic arterial pressure measured at a person's upper arm and is a measure of the pressure in the brachial artery, major artery in the upper arm. A persons blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure and is measured in millimetres of mercury (mmHg), for example 140/90.

A sphygmomanometer, a device used for measuring arterial pressure