Blood Preassure

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Blood pressure

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For information about high blood pressure, seeHypertension.

Blood pressure

Diagnostics

Asphygmomanometer,a device used for measuring

arterial pressure.

MeSH D001795

Blood pressure(BP), sometimes referred to as arterial blood pressure, is thepressure

exerted by circulatingbloodupon the walls ofblood vessels,and is one of the principalvital signs.When used without further specification, "blood pressure" usually refers to the

arterialpressure of thesystemic circulation.During each heartbeat, blood pressure varies

between a maximum (systolic)and a minimum (diastolic)pressure.[1]

The blood pressure in

the circulation is principally due to the pumping action of the heart.[2]

Differences in meanblood pressure are responsible for blood flow from one location to another in the

circulation. The rate of mean blood flow depends on the resistance to flow presented by the

blood vessels. Mean blood pressure decreases as thecirculating bloodmoves away from the

heartthrough arteries andcapillariesdue toviscouslosses of energy. Mean blood pressure

drops over the whole circulation, although most of the fall occurs along the small arteriesandarterioles.

[3]Gravity affects blood pressure viahydrostaticforces (e.g., during standing)

and valves in veins,breathing,and pumping from contraction of skeletal muscles alsoinfluence blood pressure in veins.

[2]

The measurement blood pressurewithout further specification usually refers to thesystemic arterial pressure measured at a person'supper armand is a measure of the pressure

in thebrachial artery,major artery in the upper arm. A persons blood pressure is usually
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expressed in terms of the systolic pressure over diastolic pressure and is measured in

millimetres of mercury (mmHg), for example 140/90.

Contents

[hide]

1 Systemic arterial blood pressureo 1.1 Classification

1.1.1 Normalo 1.2 Physiology

1.2.1 Mean arterial pressure 1.2.2 Pulse pressure 1.2.3 Armleg gradient 1.2.4 Vascular resistance 1.2.5 Vascular pressure wave 1.2.6 Regulation

o 1.3 Measurement 1.3.1 Noninvasive

1.3.1.1 Palpation 1.3.1.2 Auscultatory 1.3.1.3 Oscillometric 1.3.1.4 White-coat hypertension 1.3.1.5 Home monitoring

1.3.2 Invasiveo 1.4 Fetal blood pressureo 1.5 Disorders

1.5.1 High 1.5.2 Low 1.5.3 Fluctuating blood pressure

2 At other siteso 2.1 Systemic venous pressureo 2.2 Pulmonary pressure

3 Relation to wall tension 4 References 5 Further reading 6 External links

[edit] Systemic arterial blood pressure

[edit]Classification

Classification of blood pressure for adults

Category systolic,mmHg diastolic,mmHg
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Hypotension < 90 < 60

Desired 90119 6079

Prehypertension 120139 8089

Stage 1Hypertension 140159 9099

Stage 2 Hypertension 160179 100109Hypertensive Crisis 180 110

The table on the right shows the classification of blood pressure adopted by the AmericanHeart Association for adults who are 18 years and older.

[4]It assumes the values are a result

of averaging blood pressure readings measured at two or more visits to the doctor.[6][7]

In theUK,blood pressures are usually categorised into three groups: low (90/60 or lower),

high (140/90 or higher), and normal (values above 90/60 and below 130/80).[8][9]

[edit]Normal

While average values for arterial pressure could be computed for any given population,

there is often a large variation from person to person; arterial pressure also varies inindividuals from moment to moment. Additionally, the average of any given population

may have a questionable correlation with its general health; thus the relevance of such

average values is equally questionable. However, in a study of 100 human subjects with no

known history of hypertension, an average blood pressure of 112/64 mmHg was found,[10]

which are currently classified as desirable or "normal" values. Normal values fluctuate

through the 24-hour cycle, with highest readings in the afternoons and lowest readings at

night.[11][12]

Various factors, such as age and sex influence average values, influence a person's averageblood pressure and variations. In children, the normal ranges are lower than for adults anddepend on height.

[13]As adults age, systolic pressure tends to rise and diastolic tends to

fall.[14]

In the elderly, blood pressure tends to be above the normal adult range,[15]

largely

because of reduced flexibility of the arteries. Also, an individual's blood pressure varieswith exercise, emotional reactions, sleep, digestion and time of day.

Differences between left and right arm blood pressure measurements tend to be random andaverage to nearly zero if enough measurements are taken. However, in a small percentage

of cases there is a consistent difference greater than 10 mmHg which may need further

investigation, e.g. forobstructive arterial disease.[16][17]

The risk of cardiovascular disease increases progressively above 115/75 mmHg.[18]

In the

past,hypertensionwas only diagnosed if secondary signs of high arterial pressure were

present, along with a prolonged high systolic pressure reading over several visits.Regarding hypotension, in practice blood pressure is considered too low only if noticeable

symptomsare present.[5]
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Clinical trials demonstrate that people who maintain arterial pressures at the low end of

these pressure ranges have much better long term cardiovascular health. The principal

medical debate concerns the aggressiveness and relative value of methods used to lower

pressures into this range for those who do not maintain such pressure on their own.Elevations, more commonly seen in older people, though often considered normal, are

associated with increasedmorbidityandmortality.

Reference rangesfor blood pressure

Stage Approximate age Systolic Diastolic

Infants 1 to 12 months 75100 5070

Toddlers 1 to 4 years 80110 5080

Preschoolers 3 to 5 years 80110 5080

School age 6 to 13 years 85120 5080

Adolescents 13 to 18 years 95140 6090

[edit]Physiology

There are many physical factors that influence arterial pressure. Each of these may in turnbe influenced by physiological factors, such as diet, exercise, disease, drugs or alcohol,

stress,obesity,and so-forth.[20]

Some physical factors are:

Rate of pumping. In the circulatory system, this rate is calledheart rate,the rate atwhich blood (the fluid) is pumped by theheart.The volume of blood flow from the

heart is called thecardiac outputwhich is theheart rate(the rate of contraction)

multiplied by thestroke volume(the amount of blood pumped out from the heartwith each contraction). The higher the heart rate, the higher themean arterial

pressure,assuming no reduction in stroke volume or central venous return.

Volume of fluid orblood volume,the amount of blood that is present in the body.The more blood present in the body, the higher the rate of blood return to the heart

and the resulting cardiac output. There is some relationship between dietary salt

intake and increased blood volume, potentially resulting in higher arterial pressure,

though this varies with the individual and is highly dependent on autonomicnervous system response and therenin-angiotensin system.

[21][22][23]

Resistance. In the circulatory system, this is the resistance of the blood vessels. Thehigher the resistance, the higher the arterial pressure upstream from the resistance to

blood flow. Resistance is related to vessel radius (the larger the radius, the lower theresistance), vessel length (the longer the vessel, the higher the resistance), blood

viscosity, as well as the smoothness of the blood vessel walls. Smoothness is

reduced by the build up of fatty deposits on the arterial walls. Substances calledvasoconstrictorscan reduce the size of blood vessels, thereby increasing blood

pressure.Vasodilators(such asnitroglycerin)increase the size of blood vessels,

thereby decreasing arterial pressure. Resistance, and its relation to volumetric flow
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rate (Q) and pressure difference between the two ends of a vessel are described by

Poiseuille's Law.

Viscosity,or thickness of the fluid. If the blood gets thicker, the result is an increasein arterial pressure. Certainmedical conditionscan change the viscosity of theblood. For instance, anemia (lowred blood cellconcentration), reduces viscosity,

whereas increased red blood cell concentration increases viscosity. It had beenthought thataspirinand related "blood thinner"drugs decreased the viscosity ofblood, but instead studies found

[24]that they act by reducing the tendency of the

blood to clot.

In practice, each individual's autonomic nervous system responds to and regulates all these

interacting factors so that, although the above issues are important, the actual arterial

pressure response of a given individual varies widely because of both split-second and

slow-moving responses of thenervous systemand end organs. These responses are veryeffective in changing the variables and resulting blood pressure from moment to moment.

Moreover, blood pressure is the result of cardiac output increased by peripheral resistance:

blood pressure =cardiac outputXperipheral resistance.As a result, an abnormal change

in blood pressure is often an indication of a problem affecting the heart's output, the blood

vessels' resistance, or both. Thus, knowing the patient's blood pressure is critical to assessany pathology related to output and resistance.

[edit]Mean arterial pressure

Themean arterial pressure(MAP) is the average over acardiac cycleand is determined bythecardiac output(CO),systemic vascular resistance(SVR), andcentral venous pressure

(CVP),[25]

MAP can be approximately determined from measurements of the systolic pressure

and the diastolic pressure while there is a normal resting heart rate,[25]

[edit]Pulse pressure
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Curve of the arterial pressure during one cardiac cycle

The up and down fluctuation of thearterialpressure results from the pulsatile nature of the

cardiac output,i.e. the heartbeat. Thepulse pressureis determined by the interaction of thestroke volumeof the heart, compliance (ability to expand) of theaorta,and theresistanceto

flow in thearterial tree.By expanding under pressure, the aorta absorbs some of the force

of the blood surge from the heart during a heartbeat. In this way, the pulse pressure is

reduced from what it would be if the aorta wasn't compliant.[26]

The loss of arterialcompliance that occurs with aging explains the elevated pulse pressures found in elderly

patients.

The pulse pressure can be simply calculated from the difference of the measured systolic

and diastolic pressures,[26]

[edit]Armleg gradient

The arm

leg (blood pressure) gradientis the difference between the blood pressuremeasured in the arms and that measured in the legs. It is normally less than 10 mmHg,

[27]

but may be increased in e.g.coarctation of the aorta.[27]

[edit]Vascular resistance

The larger arteries, including all large enough to see without magnification, are conduits

with lowvascular resistance(assuming no advancedatheroscleroticchanges) with highflow rates that generate only small drops in pressure. The smaller arteries and arterioles

have higher resistance, and confer the main drop in blood pressure along the circulatory

system.

[edit]Vascular pressure wave

Modern physiology developed the concept of the vascular pressure wave (VPW). This

wave is created by the heart during thesystoleand originates in theascending aorta.Much

faster than the stream of blood itself, it is then transported through the vessel walls to theperipheralarteries.There the pressure wave can bepalpatedas the peripheralpulse.As the

wave is reflected at the peripheral veins, it runs back in a centripetal fashion. When the
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reflected wave meets the next outbound pressure wave, the pressure inside the vessel rises

higher than the pressure in the aorta. This concept explains why the arterial pressure inside

theperipheral arteriesof the legs and arms is higher than the arterial pressure in the

aorta,[28][29][30]

and in turn for the higher pressures seen at the ankle compared to the armwith normalankle brachial pressure indexvalues.

[edit]Regulation

Theendogenousregulation of arterial pressure is not completely understood, but thefollowing mechanisms of regulating arterial pressure have been well-characterized:

Baroreceptor reflex:Baroreceptorsin thehigh pressure receptor zones(mainly intheaortic archandcarotid sinus)detect changes in arterial pressure. These

baroreceptors send signals ultimately to themedulla of the brain stem,specifically

to theRostral ventrolateral medulla(RVLM). The medulla, by way of the

autonomic nervous system,adjusts the mean arterial pressure by altering both theforce and speed of the heart's contractions, as well as thetotal peripheral resistance.

The most important arterial baroreceptors are located in the left and rightcarotid

sinusesand in theaortic arch.[31]

Renin-angiotensin system(RAS): This system is generally known for its long-termadjustment of arterial pressure. This system allows thekidneyto compensate for

loss inblood volumeor drops in arterial pressure by activating an endogenousvasoconstrictorknown asangiotensin II.

Aldosteronerelease: Thissteroid hormoneis released from theadrenal cortexinresponse to angiotensin II or high serumpotassiumlevels. Aldosterone stimulates

sodiumretention and potassium excretion by the kidneys. Since sodium is the mainion that determines the amount of fluid in the blood vessels byosmosis,aldosterone

will increase fluid retention, and indirectly, arterial pressure.

Baroreceptorsinlow pressure receptor zones(mainly in thevenae cavaeand thepulmonary veins,and in theatria)result in feedback by regulating the secretion ofantidiuretic hormone(ADH/Vasopressin),reninandaldosterone.The resultant

increase inblood volumeresults an increasedcardiac outputby theFrankStarling

law of the heart,in turn increasing arterial blood pressure.

These different mechanisms are not necessarily independent of each other, as indicated bythe link between the RAS and aldosterone release. Currently, the RAS is targeted

pharmacologically byACE inhibitorsandangiotensin II receptor antagonists.The

aldosterone system is directly targeted byspironolactone,analdosterone antagonist.The

fluid retention may be targeted bydiuretics;the antihypertensive effect of diuretics is due toits effect on blood volume. Generally, the baroreceptor reflex is not targeted in

hypertensionbecause if blocked, individuals may suffer fromorthostatic hypotensionand

fainting.

[edit]Measurement
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rthttp://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law_of_the_hearthttp://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law_of_the_hearthttp://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law_of_the_hearthttp://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law_of_the_hearthttp://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law_of_the_hearthttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Aldosterone_antagonisthttp://en.wikipedia.org/wiki/Aldosterone_antagonisthttp://en.wikipedia.org/wiki/Aldosterone_antagonisthttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Orthostatic_hypotensionhttp://en.wikipedia.org/wiki/Orthostatic_hypotensionhttp://en.wikipedia.org/wiki/Orthostatic_hypotensionhttp://en.wikipedia.org/wiki/Faintinghttp://en.wikipedia.org/wiki/Faintinghttp://en.wikipedia.org/w/index.php?title=Blood_pressure&action=edit&section=11http://en.wikipedia.org/w/index.php?title=Blood_pressure&action=edit&section=11http://en.wikipedia.org/w/index.php?title=Blood_pressure&action=edit&section=11http://en.wikipedia.org/w/index.php?title=Blood_pressure&action=edit&section=11http://en.wikipedia.org/wiki/Faintinghttp://en.wikipedia.org/wiki/Orthostatic_hypotensionhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Aldosterone_antagonisthttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law_of_the_hearthttp://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law_of_the_hearthttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Blood_volumehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Antidiuretic_hormonehttp://en.wikipedia.org/wiki/Atrium_(heart)http://en.wikipedia.org/wiki/Pulmonary_veinshttp://en.wikipedia.org/wiki/Venae_cavaehttp://en.wikipedia.org/wiki/Low_pressure_receptor_zoneshttp://en.wikipedia.org/wiki/Baroreceptorhttp://en.wikipedia.org/wiki/Osmosishttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Adrenal_cortexhttp://en.wikipedia.org/wiki/Steroid_hormonehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/wiki/Vasoconstrictorhttp://en.wikipedia.org/wiki/Blood_volumehttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Renin-angiotensin_systemhttp://en.wikipedia.org/wiki/Blood_pressure#cite_note-KlabundeArtBar2007-30http://en.wikipedia.org/wiki/Aortic_archhttp://en.wikipedia.org/wiki/Carotid_sinushttp://en.wikipedia.org/wiki/Carotid_sinushttp://en.wikipedia.org/wiki/Total_peripheral_resistancehttp://en.wikipedia.org/wiki/Autonomic_nervous_systemhttp://en.wikipedia.org/wiki/Rostral_ventrolateral_medullahttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Carotid_sinushttp://en.wikipedia.org/wiki/Aortic_archhttp://en.wikipedia.org/wiki/High_pressure_receptor_zoneshttp://en.wikipedia.org/wiki/Baroreceptorhttp://en.wikipedia.org/wiki/Baroreceptor_reflexhttp://en.wikipedia.org/wiki/Endogenoushttp://en.wikipedia.org/w/index.php?title=Blood_pressure&action=edit&section=10http://en.wikipedia.org/wiki/Ankle_brachial_pressure_indexhttp://en.wikipedia.org/wiki/Blood_pressure#cite_note-29http://en.wikipedia.org/wiki/Blood_pressure#cite_note-27http://en.wikipedia.org/wiki/Blood_pressure#cite_note-27http://en.wikipedia.org/wiki/Peripheral_arteries


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A medical student checking blood pressure using a sphygmomanometer and stethoscope.

Arterial pressure is most commonly measured via asphygmomanometer,which historicallyused the height of a column of mercury to reflect the circulating pressure.

[32]Blood pressure

values are generally reported inmillimetres of mercury(mmHg), though aneroid andelectronic devices do not usemercury.

For each heartbeat, blood pressure varies between systolic and diastolic pressures. Systolicpressure is peak pressure in the arteries, which occurs near the end of thecardiac cycle

when theventriclesare contracting. Diastolic pressure is minimum pressure in the arteries,

which occurs near the beginning of the cardiac cycle when the ventricles are filled withblood. An example of normal measured values for a resting, healthy adult human is 120

mmHgsystolicand 80 mmHgdiastolic(written as 120/80 mmHg, and spoken [in the US

and UK] as "one-twenty over eighty").

Systolic and diastolic arterial blood pressures are not static but undergo natural variations

from one heartbeat to another and throughout the day (in acircadianrhythm). They alsochange in response tostress,nutritional factors,drugs,disease, exercise, andmomentarily

from standing up.Sometimes the variations are large.Hypertensionrefers to arterial

pressure being abnormally high, as opposed tohypotension,when it is abnormally low.Along withbody temperature,respiratory rate,andpulse rate,blood pressure is one of thefour main vital signs routinely monitored by medical professionals and healthcare

providers.[33]

Measuring pressureinvasively,by penetrating the arterial wall to take the measurement, is

much less common and usually restricted to a hospital setting.

[edit]Noninvasive

The noninvasiveauscultatoryand oscillometric measurements are simpler and quicker thaninvasive measurements, require less expertise, have virtually no complications, are less

unpleasant and less painful for the patient. However, noninvasive methods may yield

somewhat lower accuracy and small systematic differences in numerical results.Noninvasive measurement methods are more commonly used for routine examinations and

monitoring.

[edit]Palpation
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A minimum systolic value can be roughly estimated bypalpation,most often used in

emergency situations,but should be used with caution.[34]

It has been estimated that, using

50%percentiles,carotid, femoral and radial pulses are present in patients with a systolic

blood pressure > 70 mmHg, carotid and femoral pulses alone in patients with systolic bloodpressure of > 50 mmHg, and only a carotid pulse in patients with a systolic blood pressure

of > 40 mmHg.

[34]

A more accurate value of systolic blood pressure can be obtained with a

sphygmomanometerand palpating the radial pulse.[35]

The diastolic blood pressure cannot

be estimated by this method.[36]

The American Heart Association recommends thatpalpation be used to get an estimate before using the auscultatory method.

[edit]Auscultatory

Auscultatory method aneroid sphygmomanometer with stethoscope

Mercury manometer

The auscultatory method (from the Latin word for "listening") uses astethoscopeand asphygmomanometer.This comprises an inflatable (Riva-Rocci)cuffplaced around the

upperarmat roughly the same vertical height as the heart, attached to a mercury oraneroid

manometer.The mercury manometer, considered the gold standard, measures the height ofa column of mercury, giving an absolute result without need for calibration and,

consequently, not subject to the errors and drift of calibration which affect other methods.
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The use of mercury manometers is often required inclinical trialsand for the clinical

measurement ofhypertensionin high-risk patients, such aspregnant women.

A cuff of appropriate size is fitted smoothly and snugly, then inflated manually by

repeatedly squeezing a rubber bulb until the artery is completely occluded. Listening with

the stethoscope to thebrachial arteryat theelbow,the examiner slowly releases thepressure in the cuff. When blood just starts to flow in the artery, theturbulent flowcreates a

"whooshing" or pounding (firstKorotkoff sound). The pressure at which this sound is first

heard is the systolic blood pressure. The cuff pressure is further released until no sound can

be heard (fifth Korotkoff sound), at the diastolic arterial pressure.

The auscultatory method is the predominant method of clinical measurement.[37]

[edit]Oscillometric

The oscillometric method was first demonstrated in 1876 and involves the observation ofoscillations in the sphygmomanometer cuff pressure

[38]which are caused by the oscillations

ofblood flow,i.e., thepulse.[39]The electronic version of this method is sometimes used in

long-term measurements and general practice. It uses a sphygmomanometer cuff, like theauscultatory method, but with an electronicpressure sensor(transducer)to observe cuff

pressure oscillations, electronics to automatically interpret them, and automatic inflation

and deflation of the cuff. The pressure sensor should be calibrated periodically to maintainaccuracy.

Oscillometric measurement requires less skill than the auscultatory technique and may be

suitable for use by untrained staff and for automated patient home monitoring.

The cuff is inflated to a pressure initially in excess of the systolic arterial pressure and thenreduced to below diastolic pressure over a period of about 30 seconds. When blood flow is

nil (cuff pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic

pressure), cuff pressure will be essentially constant. It is essential that the cuff size is

correct: undersized cuffs may yield too high a pressure; oversized cuffs yield too low apressure. When blood flow is present, but restricted, the cuff pressure, which is monitored

by the pressure sensor, will vary periodically in synchrony with the cyclic expansion and

contraction of the brachial artery, i.e., it willoscillate.The values of systolic and diastolicpressure are computed, not actually measured from the raw data, using an algorithm; the

computed results are displayed.

Oscillometric monitors may produce inaccurate readings in patients with heart and

circulation problems, which include arterial sclerosis,arrhythmia,preeclampsia,pulsusalternans,andpulsus paradoxus.

In practice the different methods do not give identical results; an algorithm and

experimentally obtained coefficients are used to adjust the oscillometric results to givereadings which match the auscultatory results as well as possible. Some equipment uses

computer-aided analysis of the instantaneous arterial pressurewaveformto determine the
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systolic, mean, and diastolic points. Since many oscillometric devices have not been

validated, caution must be given as most are not suitable in clinical and acute care settings.

The term NIBP, for non-invasive blood pressure, is often used to describe oscillometric

monitoring equipment.

[edit]White-coat hypertension

For some patients, blood pressure measurements taken in a doctor's office may notcorrectly characterize their typical blood pressure.

[40]In up to 25% of patients, the office

measurement is higher than their typical blood pressure. This type of error is calledwhite-

coat hypertension(WCH) and can result from anxiety related to an examination by a health

care professional.[41]

The misdiagnosis of hypertension for these patients can result inneedless and possibly harmful medication. WCH can be reduced (but not eliminated) with

automated blood pressure measurements over 15 to 20 minutes in a quiet part of the office

or clinic.[42]

Debate continues regarding the significance of this effect.[citation needed]Some reactive

patients will react to many other stimuli throughout their daily lives and require treatment.In some cases a lower blood pressure reading occurs at the doctor's office.

[43]

[edit]Home monitoring

Ambulatory blood pressuredevices that take readings every half hour throughout the day

and night have been used for identifying and mitigating measurement problems likewhite-

coat hypertension.Except for sleep, home monitoring could be used for these purposesinstead of ambulatory blood pressure monitoring.

[44]Home monitoring may be used to

improve hypertension management and to monitor the effects of lifestyle changes and

medication related to blood pressure.[6]Compared to ambulatory blood pressuremeasurements, home monitoring has been found to be an effective and lower cost

alternative,[44][45][46]

but ambulatory monitoring is more accurate than both clinic and home

monitoring in diagnosing hypertension. Ambulatory monitoring is recommended for mostpatients before the start of antihypertensive drugs.

[47]

Aside from the white-coat effect, blood pressure readings outside of a clinical setting areusually slightly lower in the majority of people. The studies that looked into the risks from

hypertensionand the benefits of lowering blood pressure in affected patients were based on

readings in a clinical environment.

When measuring blood pressure, an accurate reading requires that one not drink coffee,smoke cigarettes, or engage in strenuous exercise for 30 minutes before taking the reading.

A full bladder may have a small effect on blood pressure readings; if the urge to urinateexists, one should do so before the reading. For 5 minutes before the reading, one should sit

upright in a chair with one's feet flat on the floor and with limbs uncrossed. The blood

pressure cuff should always be against bare skin, as readings taken over a shirt sleeve areless accurate. During the reading, the arm that is used should be relaxed and kept at heart

level, for example by resting it on a table.[48]
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Since blood pressure varies throughout the day, measurements intended to monitor changes

over longer time frames should be taken at the same time of day to ensure that the readings

are comparable. Suitable times are:

immediately after awakening (before washing/dressing and taking breakfast/drink),while the body is still resting,

immediately after finishing work.Automatic self-contained blood pressure monitors are available at reasonable prices, someof which are capable of Korotkoff's measurement in addition to oscillometric methods,

enabling irregular heartbeat patients to accurately measure their blood pressure at home.

[edit]Invasive

Arterial blood pressure (BP) is most accurately measured invasively through anarterialline.Invasive arterial pressure measurement with intravascularcannulaeinvolves direct

measurement of arterial pressure by placing a cannula needle in an artery (usuallyradial,femoral,dorsalis pedisorbrachial).

The cannula must be connected to a sterile, fluid-filled system, which is connected to an

electronic pressure transducer. The advantage of this system is that pressure is constantlymonitored beat-by-beat, and a waveform (a graph of pressure against time) can be

displayed. This invasive technique is regularly employed in human and veterinaryintensive

care medicine,anesthesiology,and for research purposes.

Cannulation for invasive vascular pressure monitoring is infrequently associated with

complications such asthrombosis,infection,andbleeding.Patients with invasive arterial

monitoring require very close supervision, as there is a danger of severe bleeding if the linebecomes disconnected. It is generally reserved for patients where rapid variations in arterial

pressure are anticipated.

Invasive vascular pressure monitors are pressure monitoring systems designed to acquire

pressure information for display and processing. There are a variety of invasive vascularpressure monitors for trauma, critical care, andoperating roomapplications. These include

single pressure, dual pressure, and multi-parameter (i.e. pressure / temperature). The

monitors can be used for measurement and follow-up of arterial, central venous, pulmonary

arterial, left atrial, right atrial, femoral arterial, umbilical venous, umbilical arterial, andintracranial pressures.

[edit]Fetal blood pressure

Further information:Fetal circulation#Blood pressure

Inpregnancy,it is the fetal heart and not the mother's heart that builds up the fetal blood

pressure to drive its blood through the fetal circulation.
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The blood pressure in the fetal aorta is approximately 30 mmHg at 20 weeks of gestation,

and increases to approximately 45 mmHg at 40 weeks of gestation.[49]

The average blood pressure for full-term infants:

Systolic 6595 mm HgDiastolic 3060 mm Hg

[50]

Blood pressure is the measurement of force that is applied to the walls of the blood vessels

as the heart pumps blood throughout the body.[51]

The human circulatory system is 400,000

miles long, and the magnitude of blood pressure is not uniform in all the blood vessels in

the human body. The blood pressure is determined by the diameter, flexibility and theamount of blood being pumped through the blood vessel.

[51]Blood pressure is also affected

by other factors including exercise, stress level, diet and sleep.

The average normal blood pressure in the brachial artery, which is the next direct artery

from the aorta after thesubclavian artery,is 120mmHg/80mmHg. Blood pressure readings

are measured in millimeters of mercury (mmHg) using sphygmomanometer. Two pressuresare measured and recorded namely as systolic and diastolic pressures. Systolic pressure

reading is the first reading, which represents the maximum exerted pressure on the vessels

when the heart contracts, while the diastolic pressure, the second reading, represents the

minimum pressure in the vessels when the heart relaxes.[52]

Other major arteries havesimilar levels of blood pressure recordings indicating very low disparities among major

arteries. The innominate artery,

Documents

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