Measuring Blood Pressure

Why Blood Pressure? Accurate Blood Pressure Measurement is the first step in treating hypertension or high blood pressure. 30% done inaccurately Primary factor in 68% of heart attacks and 75% of strokes. Hypertension is one of the major modifiable risk factors for many cardiovascular diseases Blood Pressure is measured almost every time we go to the doctor beginning at a young age. Blood Pressure tells us a lot about our health so it is important to measure it accurately. Accurate Blood Pressure Measurement is the first step in treating hypertension or high blood pressure. About 30% of blood pressure measurements are done inaccurately High Blood Pressure is the primary factor in 68% of heart attacks and 75% of strokes. Hypertension is one of the major modifiable risk factors for stroke, coronary heart disease, congestive heart failure, renal failure and peripheral vascular disease.

A few definitions Blood Pressure- measurement of the force exerted by blood against the walls of the arteries Systolic blood pressure- the pressure in the large arteries when the heart is contracted Diastolic Blood pressure- the pressure in the large arteries when the heart is relaxed

More definitions Hypertension- PERSISTENT elevation of either diastolic or systolic blood pressure Essential (primary) hypertension- high blood pressure with no identifiable cause Secondary hypertension- high blood pressure with a known cause Secondary Hypertension can be caused by- Sleep apnea Drug induced or related causes Chronic kidney disease Primary aldosteronism- excessive aldosterone hormone in the blood Renovascular disease- disease of the blood vessels of the kidneys Chronic steroid therapy and Cushing’s syndrome Pheochromocytoma- a tumor in the medulla of the adrenal glands Coarctation of the aorta- narrowing of the aorta Thyroid or parathyroid disease

Korotkoff Sounds First Phase Second Phase Third 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 When measuring blood pressure we are listening for the 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 Cont. Fourth Phase Fifth 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 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

Steps for Measuring Blood Pressure Seated for 5 minutes Patient Position Expose Upper arm Center of upper arm at heart level Nancy and Sarah are now going to demonstrate the correct way to measure blood pressure, we will go over each step as they do it Seated for 5 minutes No smoking, caffeine or vigorous exercise for 30 minutes before Patient Position Sit straight, both feet flat on floor, arm at slightly more than 90 degree angle on table with crease in elbow level with heart Expose Upper arm Use the right arm- for accuracy and for consistency Center of upper arm at heart level Elbow slightly flexed, Forearm with the palm facing upwards and supported on flat surface

Steps for measuring cont. Cuff applied 1 inch above crease at elbow Locate brachial artery Palpate radial pulse Inflate cuff until pulse disappears Cuff applied 1 inch above crease at elbow Make sure cuff is correct size Locate brachial artery Palpate radial pulse Inflate cuff until pulse disappears

Steps for measuring cont. 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 Let air out Place stethoscope on brachial artery Pump up cuff to 20-30 above point of obliteration 20 for kids 30 for adults Let air out at 2 mmHg per second

Steps for measuring 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 what’s next 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 what’s next

Normal Blood Pressure in Adults (18 or older) is: 115/75 Below 120/80 mmHg Below 160/90 mmHg Depends on your age B

Family History: Studies show that the tendency to develop hypertension runs in families. True False T

Diabetes: Persons with diabetes are at a greater risk for developing hypertension. True False T

Alcohol: Excessive alcohol consumption may be involved with the development of hypertension True False T