8/2/2019 How to Measure BP
1/25
Blood Pressure How to
easure
Ahmed Khashaba, MD
Cardiology Department
Ain Shams University
8/2/2019 How to Measure BP
2/25
....
8/2/2019 How to Measure BP
3/25
considered routine and is often
performed by those with the least
training
Jones DW, et al:Hypertension 2001; 37:185
8/2/2019 How to Measure BP
4/25
Blood pressure of all adults should be measured by
any trained healthcare professional whenever its appropr a e.
medical visits
To determine cardiovascular risk
To monitor antihypertensive treatment
8/2/2019 How to Measure BP
5/25
E ui ment factors
Observer factors
Patient factors
8/2/2019 How to Measure BP
6/25
Sources of Error in BP Measurement
Single armSingle arm
Auscultatory gapAuscultatory gap
Conversation withConversation with
observersobservers
Quick deflationQuick deflationNo rest periodNo rest period
Atrial FibrillationAtrial Fibrillation
Korotkoff IVKorotkoff IV
Digit preferenceDigit preference
White coat effectWhite coat effect
Expectation biasExpectation bias
CaffeineCaffeinestract onsstract ons
Background noiseBackground noise
SmokingSmoking
Full bowel/bladderFull bowel/bladder
Hearing acuityHearing acuityCrossed legsCrossed legs
8/2/2019 How to Measure BP
7/25
Blood Pr essur e Assessm ent :
Pa t i en t p r epar a t i on and pos t u r e
St andard i zed t echn ique :
Pat ien t1. No caffeine in the preceding hour.2. No smoking or nicotine in the preceding 15-30 minutes.3. No use of substances containing adrenergic stimulants
such as phenylephrine or pseudoephedrine (may bepresent in nasal decongestants or ophthalmic drops).
4. Bladder and bowel comfortable.. u e env ronmen . om or a e room empera ure.
6. No tight clothing on arm or forearm.
7. No acute anxiety, stress or pain.. .
8/2/2019 How to Measure BP
8/25
Blood Pr essur e Assessm ent :
Pa t i en t p r epar a t i on and post u r e
St andard i zed t echn ique :
Pos tu re
The atient should be calml seated for at least 5
minutes, with his or her back well supported andarm supported at the level of the heart. His or her
crossed.
and during the procedure.
8/2/2019 How to Measure BP
9/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e
Standardized technique:
Use a mercury manometer or a recently
electronic device.
Aneroid devices should only be used if
there is an established calibrationcheck every 6-12 months.
8/2/2019 How to Measure BP
10/25
Recom m ended Techn ique
fo r Measu r ing Blood Pr essu r e
Elec t r on ic osci l lom et r ic dev ices :
Use a validated electronic deviceaccording to BHS, AAMI or IPstandards.
Off ice
For self blood pressuremeasurement devices, a logo onthe packaging ensures that thistype of device and model meetsthe international standards for
accurate blood pressuremeasuremen .
AAMI=Association for the Advancement of Medical Instrumentation
H om e / Se lf
BHS=British Hypertension Society; IP: International Protocol.
8/2/2019 How to Measure BP
11/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e ( con t .)
cuff with theappropriate size
8/2/2019 How to Measure BP
12/25
Ar m ci r cu m f er en ce ( cm ) Size o f Cu f f ( cm )
From 18 to 26 9 x 18 (child)
rom oadult model)
,
More than 41 18 x 36 (extra large,
8/2/2019 How to Measure BP
13/25
f o r Measu r ing Blood Pr essu r e ( con t .)
Locate brachial andradial pulse
Position cuff at the
heart level
Arm should besupported
8/2/2019 How to Measure BP
14/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e ( con t . )
To exclude possibility of
auscultatory gap,ncrease cu pressurerapidly to 20-30 mmHgabove level of
disappearance of radialpulse
Place stethoscope overthe brachial artery
8/2/2019 How to Measure BP
15/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e ( con t . )
Drop pressure by 2 mmHg /
Appearance of sound (phase IKorotkoff) = systolic pressure
Record measurement
Drop pressure by 2 mmHg /beat
Disa earance of sound hase VKorotkoff) = diastolic pressure
Record measurement
Take 2 blood pressuremeasurements, 1 minute apart
8/2/2019 How to Measure BP
16/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e ( con t . )
S st o l i c BP
200
180
No sound
Koro tko f f sounds
160
140
Clear sou n d Ph ase 1
Muffling Phase 2
Auscultatory gapNo sound
120
100
Muffled sound
Muffled sound
Phase 3
Phase 4
Poss ib le read in gs :
80
60
40 No sou n d Ph ase 5 136 / 100184 / 86 = correct136 / 86
20
0
m m H g
8/2/2019 How to Measure BP
17/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e
St andar d i zed t echn ique :
For initial readings, take the blood
pressure in both arms and subsequentlymeasure it in the arm with the highestrea ng.
erea er, a e wo measuremen s onthe side where BP is highest.
8/2/2019 How to Measure BP
18/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e ( con t . )
Record the blood pressure to thec oses mm g on emanometer
as well as the arm used
and whether the patient wassupine, sitting or standing.
8/2/2019 How to Measure BP
19/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e ( con t . )
Avoid digit
five (5) or zeros(0) by not
down.
Record the heartrate.
8/2/2019 How to Measure BP
20/25
Recom m en ded Tech n i u e
fo r Measu r ing Blood Pr essu r e ( con t . )
to determine and monitor
to test for postural hypotension, if
present, which may modify thetreatment.
8/2/2019 How to Measure BP
21/25
Blood Pr essur e Assessm ent :
Pa t i en t p r epar a t i on and post u r e
St and in g pos i t i on
or pa en s over age , a e cs anpatients being treated with
,
postural changes while taking bloodpressure reading, i.e. after one to fiveminutes in the standing position andunder circumstances when the patientscomp a ns o symp oms sugges ve ohypotension.
8/2/2019 How to Measure BP
22/25
Th r esh o l d f o r I n i t i a t i o n o f Tr e at m en t an d
Targ e t Values
Con d i t i on I n i t ia t ion
Target
m m H g
Diastolic systolic 140/90
160
8/2/2019 How to Measure BP
23/25
Blo od r essu r e m easu r em en t w i t h s eci f ic
dev ices
Mercury Blood Pressure Monitor
Electronic Blood Pressure Monitor
8/2/2019 How to Measure BP
24/25
Blood Pr essu r e Measu r em en t w i t h Aner o id
B lood Pr essur e Mon i t o r
no t be used
i f t he r e is no t
an es tab l i shedca l i b ra t i on check
ev er y 6 - 1 2 m o n t h s.
8/2/2019 How to Measure BP
25/25
BP measurement should not be erformed li htl .BP measurement should not be erformed li htl .
Use standardized protocolUse standardized protocol
The measurement of blood pressure through auscultation remains
the most widely accepted method in everyday practice.
The measurement of blood pressure through auscultation remains
the most widely accepted method in everyday practice.
Reliance on automated devices may lead to inaccurate readings inthe presence of arrhythmias.
Reliance on automated devices may lead to inaccurate readings inthe presence of arrhythmias.
Mercury sphyg. are still considered the gold-standard measuring
devices for indirect blood ressure determination
Mercury sphyg. are still considered the gold-standard measuring
devices for indirect blood ressure determination
Aneroid sphygmomanometers are considered accurate ifAneroid sphygmomanometers are considered accurate if
..