1. Blood pressure measurement PHCL 326 (1+1) Clinical skills for pharmacists

2. Overview JNC VII classification. Blood Pressure measurement techniques. Pulse measurement techniques.

3. JNC VII classification BP classificationSBP (mmHg)DBP (mmHg) Normal< 120And < 80 Prehypertension120 – 139Or 80-89 Stage 1 Hypertension 140 – 159Or 90 – 99 Stage 2 Hypertension >= 160Or >= 100

4. Blood Pressure measurement Office BP measurement: Two readings, 5 minutes apart, sitting. Ambulatory BP monitoring: For white coat hypertension. Self-measurement of BP: Information on response to therapy, may improve adherence to therapy.

5. Devices: Aneroid. Mercury. Electronic.

6. Blood Pressure measurement Devices Features: 1- Ease of use. Electronic > Aneroid > Mercury 2- Cost. Electronic > Mercury > Aneroid 3- Accuracy. Mercury > Aneroid > Electronic 4- Memory. Electronic only.

7. Time of measurement Use multiple readings at different times during the waking hours of the patient. For patient taking antihypertensive medications monitoring of blood pressure should be done before taking the scheduled dose.

8. Factors that affect BP measurement Smoking. Caffeine. Cuff size. Pain. Medication use.

9. Patient position BP should be measured in sitting position. Patient should sit for 5 minutes before measuring BP. In elderly, supine and standing position can be used to detect postural hypotension.

10. Measurement of BP in the clinic From www.images.md

11. Selecting the most accurate blood pressure cuff From www.images.md

12. Selecting the most accurate blood pressure cuff From www.images.md

13. Selecting the most accurate blood pressure cuff The length of the bladder should be at least 80% of the circumference of the upper arm. The width of the bladder should be approximately 40% of the circumference of the upper arm.

14. Where to listen for blood pressure sounds From www.images.md 1- Locate the antecubital fossa of the patient’s arm and palpate the brachial artery. This location is the point over which the stethoscope is placed to listen for Korotkoff sounds later. 2- Wrap the cuff approximately 2.5 inch above the antecubital fossa.

15. Determining the palpated systolic pressure and the maximum inflation level From www.images.md 3. While palpating the radial pulse, inflate the cuff until you feel the radial pulse disappear. Note the pressure on the manometer at this point and rapidly deflate the cuff.

16. Measurement of BP 4- Place the stethoscope lightly over the brachial artery and inflate the cuff to a pressure 30 mm Hg greater than estimated systolic pressure. 5- Deflate the cuff slowly at a rate of 2 mm Hg per heartbeat. 6- Systolic pressure equal the pulse first heard by auscultation

17. Measurement of BP 7- Deflate the cuff until the sounds become muffled and then disappear. The disappearance of sound estimate the diastolic pressure. 8- Record the blood pressure reading in even numbers. Note patient’s position, cuff size, and arm used for measurement.

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