II. Precautions
- Blood Pressures are frequently inaccurate due to improper cuff size, technique, or inadequate rest before measurement
- Recent Nicotine in last 30-60 minutes can raise systolic Blood Pressure as much as 25 mmHg
- Avoid finger Blood Pressure monitors (and aside from morbidly obese patients, avoid wrist monitors)
III. Physiology
- See Blood Pressure Physiology
- Automated Blood Pressure mechanism (Oscillometric BP cuffs)
- Automated BP cuffs measure the mean arterial pressure during cuff deflation
- Automated cuffs often cycle repeatedly to obtain a single Blood Pressure reading
- Automated machine use the measured MAP to calculate the systolic (SBP) and diastolic Blood Pressure (DBP)
IV. Efficacy: Automated Blood Pressure
- U.S. Blood Pressure Validated Devices
- Automated Blood Pressure is now recommended over manual Blood Pressures
- Mercury sphygmomanometers have largely been replaced due to toxicity risk
- Both manual and automatic non-mercury Blood Pressure cuffs require ongoing calibration
- Manual Blood Pressures have significant inter-operator variation
- Blood Pressure Measurement should be performed by slowly lowering pressure in 2-3 mmHg increments
- Mercury sphygmomanometers have largely been replaced due to toxicity risk
- Some studies find automated Blood Pressures inaccurate, overestimating both systolic and diastolic Blood Pressure
- When accurate systolic or diastolic readings are needed emergently (e.g. Aortic Dissection), Arterial Lines are preferred
- Confirm elevated automated Blood Pressure with 2 manual, auscultated Blood Pressures
- Inaccurate readings are more common at the extremes of BMI (morbidly obese, very thin patients)
- Arrhythmias also result in inaccurate Blood Pressure readings (obtain multiple serial values)
- Flynn (2012) J Pediatr 160(3): 434-40 [PubMed]
- Mansoor (2016) Open Access Maced J Med Sci 4(3): 404–9 [PubMed]
- Other studies find automated Blood Pressures to be lower than manual when patient is at home or alone in clinic
V. Technique: Blood Pressure cuff size
- Poor cuff fit results in inaccurate Blood Pressure
- Undersized cuff artificially raises Blood Pressure
- Oversized cuff artificially lowers Blood Pressure
- Pediatric Cuff size
- Adult Cuff size
VI. Technique: Positioning of Blood Pressure Cuff
- Cuff applied directly over skin (not through clothes)
- Clothes artificially raises Blood Pressure
- Center inflatable Bladder over brachial artery
- Position lower cuff border 2.5 cm above antecubital
- Patient's arm slightly flexed at elbow
- Position stethoscope bell over brachial artery
VII. Technique: Blood Pressure Measurement
- Patient should be comfortable, seated with back supported and with empty Bladder
- Legs uncrossed and feet flat on the floor
- Patient should not speaking during measurement
- Wait 5 minutes of rest before checking Blood Pressure, and avoid Nicotine within prior 30 minutes
- Check Blood Pressure while seated, in right arm (Aortic Coarctation may falsely lower BP measurement)
- Take Blood Pressure with arm supported at heart level
- Inflate cuff rapidly to level above suspected SBP
- Deflate cuff slowly at a rate of 2-3 mmHg per second
- Listen for auditory vibrations from artery (Korotkoff)
- Systolic Blood Pressure: Onset of consecutive sounds
- Diastolic Blood Pressure: Disappearance of sounds
VIII. Technique: Obtain Multiple Blood Pressure Measurements
- Validation of abnormal readings
- Recheck Blood Pressure at least once or twice more at same visit
- Blood Pressure improves to <160/89 after 30 minutes rest in >30% with Severe Hypertension
-
Aortic Coarctation
- Left and right arm, and one lower extremity
-
Orthostatic Hypotension
- Most common chronically in the elderly (Fall Risk)
- Check Blood Pressure and Pulse, Supine and Standing (Postural Blood Pressure)
-
Hypertension
- See Hypertension Criteria
- Confirm office Blood Pressures on Home Blood Pressure Monitor (or Ambulatory Blood Pressure Monitoring)
IX. Interpretation
- See Hypertension Criteria
- See Hypotension
X. Interpretation: Children
- See Pediatric Vital Signs
- Formulas for Systolic Blood Pressure estimate (for over age 1 year)
- Median SBP = 90 mmHg + (2 x Age in years)
- Minimum SBP = 70 mmHg + (2 x Age in years)
- Rough estimate for Systolic Blood Pressure (SBP)
- Typical systolic Blood Pressure
- Infant: 80
- Preschool: 90
- Adolescent: 100
- Minimal systolic Blood Pressure
- Infant: >60
- Toddler >70
- Preschool >75
- School-age: >80
- Teen >90
- Typical systolic Blood Pressure
- Term Newborn (3 kg)
- Age 12 hours: 50-70 / 25-45
- Age 96 hours: 60-90 / 20-60
- Age 7 days: 74 +/- 22 mmHg (Systolic BP)
- Age 42 days: 96 +/- 20 mmHg (Systolic BP)
- Infant (6 months old)
- Blood Pressure: 87-105 / 53-66
- Toddler (2 years old)
- Blood Pressure: 95-105/53-66
- School age (7 years old)
- Blood Pressure: 97-112 / 57-71
- Adolescent (15 years old)
- Blood Pressure: 112-128 / 66-80
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Related Studies
| Definition (MSHCZE) | Zkr. TK – tlak, kterým krev působí na stěnu cév, zejm. tepen. Zdrojem TK je činnost srdce čerpajícího krev do aorty, která slouží jako pružný rezervoár krve. TK v průběhu srdečního cyklu (systoly a diastoly) stoupá a klesá, nejvyšší hodnoty dosahuje v systole (systolický t.), kdy je také objem krve v aortě největší. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI_NCI-GLOSS) | The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80). |
| Definition (NCI) | The pressure of the circulating blood against the walls of the blood vessels. |
| Definition (MSH) | PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS. |
| Definition (CSP) | force exerted by the blood on the walls of the arteries and other vessels. |
| Concepts | Organism Function (T040) |
| MSH | D001794 |
| SnomedCT | 75367002 |
| LNC | LP40259-1, LP90874-6, MTHU008342 |
| English | Blood Pressure, Pressure, Blood, BLOOD PRESSURE, BP, blood pressure, Blood pressure, BP - Blood pressure, Blood pressure (observable entity), Blood pressure, NOS |
| Swedish | Blodtryck |
| Spanish | presión arterial, presión arterial (entidad observable), presión sanguínea (entidad observable), presión sanguínea, tensión arterial, Presión Sanguínea |
| Czech | krevní tlak, tlak krve |
| Finnish | Verenpaine |
| Russian | KROVIANOE DAVLENIE, ДИАСТОЛИЧЕСКОЕ ДАВЛЕНИЕ, SISTOLICHESKOE DAVLENIE, ПУЛЬСОВОЕ ДАВЛЕНИЕ, PUL'SOVOE DAVLENIE, СИСТОЛИЧЕСКОЕ ДАВЛЕНИЕ, DIASTOLICHESKOE DAVLENIE, КРОВЯНОЕ ДАВЛЕНИЕ |
| Japanese | 血圧 |
| Croatian | KRVNI TLAK |
| Polish | Ciśnienie krwi |
| Norwegian | Blodtrykk |
| Portuguese | Pressão Sanguínea |
| French | Pression sanguine |
| German | Blutdruck |
| Italian | Pressione sanguigna |
| Dutch | Bloeddruk, Druk, bloed- |
Ontology: Blood pressure determination (C0005824)
| Definition (CCC) | Actions performed to measure the diastolic and systolic pressure of the blood |
| Definition (MSHCZE) | Techniky měření krevního tlaku. |
| Definition (MSH) | Techniques for measuring blood pressure. |
| Concepts | Health Care Activity (T058) |
| MSH | D001795 |
| SnomedCT | 46973005 |
| English | Blood Pressure Determination, Blood Pressure Determinations, Determination, Blood Pressure, Determinations, Blood Pressure, Blood pressure, BP, BP (blood pressure), blood pressure, blood pressure (physical finding), Blood pressure determination, rnrx blood pressure, rnrx blood pressure (treatment), take blood pressure, blood pressure determination, taking blood pressure, rnox take blood pressure (treatment), rnox take blood pressure, Measuring Blood Pressure, Blood Pressure, Blood pressure taking, Blood pressure taking (procedure), Blood pressure taking, NOS |
| Italian | Pressione arteriosa, Determinazione della pressione sanguigna |
| French | PA, Détermination de la pression artérielle, Mesure de la pression sanguine, Mesure de la pression artérielle, Pression artérielle |
| German | BP, Blutdruck, Blutdruckmessung |
| Portuguese | TA, Tensão arterial, Determinação da Pressão Arterial |
| Spanish | PA, medir la TA, medir la presión arterial (procedimiento), medir la presión arterial, medir la presión sanguínea, medir la tensión arterial, tomar la presión arterial del paciente, Presión arterial, Determinación de la Presión Sanguínea |
| Japanese | 血圧, ｹﾂｱﾂ |
| Swedish | Blodtrycksmätning |
| Czech | krevní tlak - měření, TK, Krevní tlak, měření krevního tlaku |
| Finnish | Verenpaineenmittaus |
| Russian | KROVIANOGO DAVLENIIA IZMERENIE, КРОВЯНОГО ДАВЛЕНИЯ ИЗМЕРЕНИЕ |
| Croatian | KRVNI TLAK, MJERENJE |
| Polish | Pomiar ciśnienia krwi |
| Hungarian | Vérnyomás |
| Norwegian | Blodtrykksmåling |
| Dutch | bloeddruk, Bloeddrukmeting |
Ontology: Blood pressure monitoring (C0026426)
| Definition (ALT) | Managing and/or monitoring a patient's blood pressure. |
| Concepts | Health Care Activity (T058) |
| SnomedCT | 2982008, 367038007, 367267001, 135840009 |
| English | Monitor blood pressure, Monitors blood pressure, bp monitor, Monitoring;BP, blood pressure monitoring, monitor blood pressure, blood monitor pressure, monitoring blood pressure, bp monitoring, bp monitors, rnox monitor blood pressure, rnox monitor blood pressure (treatment), Monitoring Blood Pressure, Blood pressure monitoring, Monitoring of blood pressure, Monitoring of blood pressure (regime/therapy), Blood pressure monitoring (procedure), Blood pressure monitoring (regime/therapy), Monitoring of blood pressure (procedure), Blood pressure monitoring management, BP montrng mgmt, monitoring BP |
| Spanish | monitoreo de la presión arterial, monitoreo de la tensión arterial, monitoreo de la tensión arterial (régimen/tratamiento), control de la presión sanguínea, control de la tensión arterial, control de la tensión sanguínea (régimen/tratamiento), control de la tensión sanguínea, monitoreo de la presión sanguínea, monitoreo de la tensión arterial (procedimiento), monitoreo de la tensión sanguínea |
Ontology: Korotkoff sounds (C0277892)
| Concepts | Finding (T033) |
| SnomedCT | 85549003 |
| English | korotkoff sound, korotkoff sounds, korotkoffs sounds, Korotkoff sounds, Korotkoff sounds (function), Korotkoff sounds (observable entity), Korotkoff sounds, function (observable entity) |
| Spanish | ruidos de Korotkoff (entidad observable), ruidos de Korotkoff (función), ruidos de Korotkoff |
Ontology: Blood pressure--Measurement (C3826646)
| Concepts | Health Care Activity (T058) |
| English | Blood pressure--Measurement |
