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

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

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

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

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

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

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

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

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

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

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

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

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

Which of the following will increase the loudness of Korotkoff sounds? Have the patient open and close their fist 8-10 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

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

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

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

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.

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

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

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

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

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

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

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