The measurement of blood pressure

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The measurement of blood pressure

• M. Jurajda D. Hájekdhajek_at_med.muni.cz

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Blood pressure

• Is the pressure of arterial blood BP
• The heart is a pulse pump, that is why BP varies
  during heart cycle
• Systolic BP(SBP),diastolic BP (DBP), mean
  BP(MAP).
• MAP is the integral of BP over time,
  approximately MAPDBP(SBP-DBP)/3
• BP is continuos variable with inter - and
  intra-individual variability

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Ohms principle
U IR

• BP COTPVR

COSVPR
CO cardiac output, SV systolic volume, PR pulse
rate, TPRV total peripheral vascular resistance
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Note

• PR is the number of pulses per minute. In healthy
  individuals it equals to heart rate (HR) that is
  the number of heart cycles (systols or diastols)
  per minute.
• In individuals with dysrhytmias HRgtPR since
  several systols are not strong enough to open the
  aortal valve and produce palpable pulse.

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BP is influenced by

• sympaticus
• RAAS
• corticoids

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BP measurement

• invasive
• non- invasive

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The methods of non-invasive BP measurement

• Auscultation method
• Oscilometric method
• The method of Penáz

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The conditions of BP measurement sitting patient
after 10 minutes rest on dominant arm. The
sfygmomanometer placed on the level of heart.
!!!The cuff mus be of appropriate size !!! (for
arm circumference below 33 cm 12 cm, for the
circumferences from 33 to 41 cm 15 cm and for
the circumferences above 41 the 18 cm should be
used). BP measurement in also standing position
is essential in patients with diabetes and/or
treated hypertension to avoid orthostatic
hypotension.
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Inter-individual variability

• Sources
• Examples
• The definition of norm (reference values)

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Intra-individual variability

• Sources
• Examples
• The measurement of variables influencing the
  intra-individual variability

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holter

• Continuous recording of ECG
• Norman Jeff Holter 1949 ECG
• http//www.ecglibrary.com/ecghist.html
• Sometimes, not correctly used as a term for
  continuous recording of any physiological value
  in internal medicine namely in cardiology ?
• Distinguish from telemetry

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Systemic (arterial) hypertension

• BP above 140/90 mm Hg
• Increased resistance
• Increased volume
• Decreased compliance of aorta

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Ethiopatogenetic classification Primary
(essential) hypertension - many pathogenic
processes but not the primary cause are
known Secondary hypertension - The BP elevation
is caused by known exactly defined pathological
process (renal, reno-vascular, endocrine etc.)
The diagnosis of essential hypertension (EH) is
done per ex-clusionem (Secondary hypertension
should be excluded.
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• BP COTPVR

COSVPR
CO cardiac output, SV systolic volume, PR pulse
rate, TPRV total peripheral vascular resistance
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The definition, prevalence and classification of
hypertension According to WHO/ISH criteria
(1993) arterial hypertension - elevated BP above
140/90 mm Hg founded at least in 2 from 3
measurements (Isolated systolic hypertension -
SBP above 160 a and DTK lt 90 mm Hg)
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Blod pressure holter

• Continuous BP recording during 24 hrs

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• Ambulatory BP monitoring during 24 or 48 hrs. is
  indicated when suspected
• white coat phenomena
• resistance to treatment
• episodic hypertension
• episods of hypotension
• diabetic vegetative dysautonomy
• And also in
• drug testing and research

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Reference values of 24 hrs. BP monitoring
(routinely used) - average awake values lt 135/85
mmHg, - average sleep values lt 120/70 mmHg - 24
hrs. average lt 130/80 mm Hg. Less then 15 BP
values above 140/90 mm Hg during awake and above
120/80 mm Hg during sleep
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Prevalence of hypertension in Czech
Republic 15-20 per cent in adult population
increasing with ageing above 160/95 mm Hg. When
most recent definition is used (BP below 140/90
mm Hg) the qualified guess of hypertension
prevalence ranges from 20-24 per cent. 5 per
cent in youngs, 60 per cent in persons above 40
yrs. of age
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Risk factors in hypertension

• Organ involvement (e.g. left ventricle
  hypertrophy)
• Metabolic disorders (e.g. dyslipidemia, diabetes)
• Smoking
• Genetic factors (familiar history)

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Essential hypertension (EH) is present in 95
per cent and secondary hypertension (SH) in less
then 5 per cent of in patients with hypertension.
The diagnosis of SH is essential to be stated
since causal treatment is possible ( e.g. in
patients with feochromocytoma, Conn syndroma,
renovascular hypertension).
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According to BP the hypertension is classified
as Slight - BP 140-179/90-104 mm Hg (The values
from140-159/90-94 mm Hg are considered to be
border line) Middle grade - BP 180-199/105-114
mm Hg Severe - BP above 200/115 mm Hg.
Rezistent to treatment when the combination of 3
drugs does not lead to BP decrease below 160/100
mm Hg.
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According to stadia systemic hypertension is
scassified as (WHO) Ist. stadium BP elevated,
no organ changes IInd stadium BP elevated organ
involvement (e.g. left ventricle hypertrophy,
renal involvement) without substantial function
deterioration III. stadium BP elevated, organ
more severe organ involvement and namely function
failure present (heart failure, decreased
glomerular filtration, brain stroke). IV.
stadium - malignant hypertension
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• Treatment
• The aim of therapy
• BP decrease below 140/90 mm Hg.
• Prevention of organ involvement or its
  regression.

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Non pharmacological treatment

• Body weight reduction
• Sodium intake reduction to 5-6 g/day
• Spirit consumption reduction to less than 30
  g/day
• The treatment of other risk factors (e.g. diet in
  hypercholesterolemia)
• The reduction of administration of drugs
  increasing sodium retention (non-steroid
  antiflogistics, steroids)

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The practical training

• BP measurement before and after static and
  dynamic load
• Statistics of measured data
• The formulation of conclusions