1. Measuring Blood Pressure

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

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

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

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

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