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. What would you tell a person about their blood pressure reading?
Definition of Blood Pressure
Numerical Value
Blood Pressure Category
When to Recheck
Medications if Necessary
Lifestyle Modifications

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

13. Which of the following can cause sounds to be heard down to zero mmHg?
Anemia
Vigorous exercise
Heavy pressure on the stethoscope
All of the above D

14. A cuff with a bladder too small for the patients arm will result in:
An inaccurately high reading
An inaccurately low reading
Sounds heard down to zero mmHg A

15. If the cuff is applied too loosely, the pressure reading will be:
Too low
Too high
Not affected B

16. Unless otherwise indicated, measure the blood pressure using the patient’s ____ arm.
Right
Left
Either arm is alright A

17. Common causes of errors in blood pressure measurement include:
Cuff applied over clothing
Leaks in the pressure bulb or tubing
Arm above or below heart level
All of the above E

18. Some factors that can alter blood pressure are:
Smoking
Anxiety and other emotional states
Talking
Full bladder
All of the above
B & D only E

19. When using the Auscultatory-Palpatory technique of blood pressure measurement, the pressure in the cuff should be raised:
20-30 mmHg higher than the point where the pulse disappeared.
30 mmHg higher than the systolic pressure
20 mmHg higher than the systolic pressure A

20. While taking a blood pressure, the first sound heard through the stethoscope is at 150 mmHg and sounds are heard from “150” until the last sound is heard at 78 mmHg. What is the patient’s blood pressure?
150/78
148/76
150/76
148/78 C

21. While taking a blood pressure, the screener is not sure if the first sounds were heard at 170 mmHg. What action should be taken?
Immediately deflate the cuff to “0”, wait 30 seconds and reinflate the cuff.
Immediately reinflate the cuff above 170 mmHg and listen carefully for the first Korotkoff sounds.
Deflate the cuff to “0”. Immediately reinflate the cuff to 30 mmHg above estimated systolic pressure and listen carefully for the first Korotkoff sounds. A

22. A or C dependent on experience
When performing the Auscultatory-Palpatory technique of blood pressure measurement, you feel the radial pulse disappear at 175 mmHg. What should you do next?
Continue to inflate the cuff to 205 mmHg; place the stethoscope over the brachial artery; slowly deflate the cuff and listen for the Korotkoff sounds.
Place the stethoscope over the brachial artery, slowly deflate the cuff and listen for the Korotkoff sounds.
Deflate the cuff fully; wait 30 seconds; place the stethoscope over the brachial artery; reinflate to 205 mmHg and listen for the Korotkoff sounds.
A or C dependent on experience D

23. Which of the following will increase the loudness of Korotkoff sounds?
Have the patient open and close their fist times after the pressure cuff has been inflated above systolic level.
Rapidly inflate the cuff
Raise the patient’s arm above heart level for several seconds- inflate the cuff above the systolic level while the arm is still elevated- lower the arm and proceed with the blood pressure measurement.
All of the above
A & C only D

24. The patient, a 25- year old white male, has just run up five flights of stairs- what action should be taken?
Have the patient rest 5 minutes and then proceed with measurement
Wait until pulse has returned to normal before measuring blood pressure
Have patient return in 30 minutes for blood pressure check- advise the patient not to do any exercise or other strenuous activity before returning. C

25. To avoid incorrectly assessing the systolic blood pressure due to the auscultatory gap, the auscultatory-palpatory technique of blood pressure measurement should always be used. T
True
False

26. A diagnosis of hypertension (high blood pressure) cannot be made from one blood pressure reading
True
False T

27. A high diastolic blood pressure indicates a greater risk for complications (in most people, especially those over age 55) than a high systolic blood pressure.
True
False F
Systolic and diastolic blood pressures are closely correlated with risk of cardiovascular disease independently and in combination.
High systolic pressure may contribute more to the risk of complications than high diastolic pressure, especially in the 50 and older population.

28. You shouldn’t have your blood pressure checked immediately after smoking.
True
False T

29. If the initial blood pressure reading is greater than or equal to 120/80, two or more readings should be taken.
True
False T

30. Race: Whites are at greater risk than Blacks for developing hypertension
True
False F

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

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

33. Oral Contraceptives: The “pill” raises the blood pressure in almost all of the women who take it.
True
False T

34. Stress: Prolonged and intense stress can contribute to the development of hypertension.
True
False T

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