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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The blood pressure is defined by the systolic pressure (when the pulse first becomes audible) and the diastolic pressure (when the Korotkoff sounds are no longer heard). Normal blood pressure at home is <130/85 mmHg and in the clinic is <140/90 mmHg. A wide pulse pressure is typical of aortic incompetence, PDA or a large arteriovenous fistula. A small pulse pressure can occur in severe AS.
Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chronic hypertension in pregnancy (CHTN) is defined as either a history of hypertension preceding the pregnancy or a blood pressure ≥140/90 prior to 20 weeks’ gestation (Table 1.1). Though controversial, the 5th Korotkoff sound is used for the diastolic reading. Careful consideration should be taken to appropriate BP measuring technique. Blood pressure measurements can be obtained using a manual or an automated cuff with the patient in the right upper arm, sitting position, resting for at least 10 minutes, avoid caffeinated beverages and use of appropriate size cuff. Severe CHTN is defined as SBP ≥160 mmHg or DBP ≥110 mmHg. Guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) have changed the criteria for diagnosing hypertension in non-pregnant adults [1]. These recommendations include classifying blood pressure into four categories: (1) normal (SBP <120 mmHg and DBP <80 mmHg); (2) elevated (SBP of 120–129 mmHg and DBP <80 mmHg); (3) stage 1 hypertension (SBP of 130–139 mmHg or DBP of 80–89 mmHg); and (4) stage 2 hypertension (SBP of ≥140 mmHg or DBP of ≥90 mmHg) (Table 1.2). These changes were made to assist in clinical and public health decision making and reflect data to suggest modifiable long-term cardiovascular risk even in the elevated and stage 1 hypertension ranges. However, ACOG continue their recommendation for diagnosis of SBP of ≥140 mmHg or DBP of ≥90 mmHg [2].
Measuring and monitoring vital signs
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Although many clinical settings predominantly use electronic devices, it is imperative to learn the technique of manual BP recording and ensure you are competent in this skill. This will also allow you to be able to gain a better understanding of Korotkoff sounds and what we refer to as systolic and diastolic BP readings. Although BP can be measured at several sites, in most clinical situations, the brachial artery is used as it is convenient and easily accessible, so it is the artery you are most likely to have seen used in practice. Some electronic devices measure BP at the radial artery. It is advisable to avoid recording the BP on an arm that is affected by disability (e.g. weakness due to a stroke, lymph node removal), or where an intravenous infusion is in place. When a person has suffered trauma or surgery affecting both arms, the thigh can be used for which a larger cuff is needed. Skinner et al. (2013) explain that BP is a key vital sign that should be recorded in trauma. Measuring BPs in both arms is sometimes practised when a person presents with chest pain or unexplained back pain (Skerrett 2012). This practice can help establish blood flow issues around the person’s body.
Hypertension among obese children and youth age 8-12:Project EDDY-Kids 2019
Published in Child and Adolescent Obesity, 2021
G. Wolske, M. Joseph, H. Rosenauer, K. Widhalm
In the course of the pursued Viennese EDDY-Kids Project 2019 (Widhalm et al. 2018) we took one measurement at the beginning of the study in January (t0, baseline) and followed up in 2-month intervals (t1, t2), finishing in June. To receive more reliable blood pressure values and to oversee progress in those values, there were taken three measurements over the period of the project (Negroni-Balasquide et al. 2016). The sample included a control group in third grade (age ~9, 58 children, 33 boys and 25 girls) and an intervention group in fourth grade (age ~10, 65 children, 37 boys and 28 girls). Blood pressure was measured using auscultation according to international guidelines (Flynn et al. 2017), using a stethoscope with a blood pressure monitor (sphygmomanometer). A cuff of appropriate size was attached to the upper arm and inflated up to the expected arterial blood pressure. During the subsequent slow deflation, the manifestation and disappearance of Korotkoff sounds can be detected via the stethoscope at the brachial artery. The systolic pressure corresponds to the value indicated at the first appearance of Korotkoff sounds: at that moment, systolic pressure exceeds cuff pressure. Conversely, the Korotkoff sounds disappear when cuff pressure falls below arterial pressure, indicating a diastolic value.
Respiratory waveform variation can prevent pulsus paradoxus measurement by sphygmomanometry
Published in Journal of Asthma, 2019
Jonas Alexander Pologe, Kara Lynn Wolley, Donald H. Arnold
PP is defined in clinical medicine as an exaggerated increase in the normal fluctuation of left ventricular stroke volume (LVSV) during the respiratory cycle that results in a change in systolic pressure of at least 10 mmHg [7, 8]. Clinically, manual measurement of PP is made by inflating a sphygmomanometer, placed on the upper arm, above systolic pressure and slowly deflating the cuff while listening for heart sounds with a stethoscope in the antecubital space below the cuff [7, 8]. The highest systolic pressure during the respiratory cycle will be heard as an intermittent first Korotkoff sound. As the cuff is very slowly deflated to pressures approaching the lowest systolic pressure, typically seen during the inspiratory phase of the respiratory cycle, first Korotkoff sounds will be heard more frequently. Once the lowest systolic pressure is reached first Korotkoff sounds will be heard continuously throughout the respiratory cycle. PP is the pressure difference between the first intermittent Korotkoff sound (at the maximum systolic pressure) and the point at which these sounds are heard continuously (at the minimum systolic pressure).
A multicentre study on unattended automated office blood pressure measurement in treated hypertensive patients
Published in Blood Pressure, 2018
Jan Filipovský, Jitka Seidlerová, Jiří Ceral, Petra Vysočanová, Jiří Špác, Miroslav Souček, Ivan Řiháček, Markéta Mateřánková, Petr König, Hana Rosolová
Conventional blood pressure (BP) measurement by auscultation of the Korotkoff sounds is fraught with potential sources of error. Recently, unattended automated office blood pressure (uAutoOBP) measurement has attracted attention of hypertension specialists, especially after main results of the SPRINT trial had been published [1]. In this large study, blood pressure was measured in a separate room using automated BP device after 5 minutes of rest. The mean systolic pressure in intensive treatment group was 121 mm Hg compared to 136 mm Hg in standard treatment group. Patients in the intensive treatment group had by 25% lower risk of the primary composite endpoint and by 27% of all-cause mortality. However, several reports [2,3] suggest that uAutoOBP is on average lower than office blood pressure and therefore, threshold for diagnosis of hypertension as well as goal BP during treatment might be different.