1. Determine the normal pressure.

-With the new guidelines released by the American Heart Association (AHA) and
the American College of Cardiology, revisions were released last November
2017 to address the condition earlier to prevent adverse events. The new blood
pressure categories are:

Normal: Less than 120/80 mm Hg.

Elevated: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm
Hg.
Stage 1: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89
mm Hg.
Stage 2: Systolic at least 140 mm Hg or diastolic at least 90 mm Hg.
Hypertensive crisis: Systolic over 180 mm Hg and/or diastolic over 120 mm Hg,
with patients requiring medication changes.

Stage Approximate age Systolic Diastolic

Infants 1 to 12 months 75–100 50–70

Toddlers and preschoolers 1 to 5 years 80–110 50–80

School age 6 to 12 years 85–120 50–80

2. Techniques in determining blood pressure.

When Should Blood Pressure Be Measured?

 Before taking any morning doses of high blood pressure medicine
 No less than 1 hour after exercising, smoking or consuming caffeine
 After allowing for about 10 minutes to adjust to the temperature in the examining room

Choose the Proper Blood Pressure Cuff Size

 Arm circumference 22 to 26 cm, 'small adult' cuff, 12 x 22 cm
 Arm circumference 27 to 34 cm, 'adult' cuff: 16 x 30 cm
  Arm circumference 35 to 44 cm, 'large adult' cuff: 16 x 36 cm
 Arm circumference 45 to 52 cm, 'adult thigh' cuff; 16 x 42

Accurate Blood Pressure Readings Require Proper

Positioning
In general, blood pressure should be measured while you are seated comfortably. The arm
being used should be relaxed, uncovered, and supported at the level of the heart. Only the
part of the arm where the blood pressure cuff is fastened needs to be at heart level, not the
entire arm.
Multiple Blood Pressure Readings Should Be Taken
One blood pressure reading is not enough to get an accurate measurement. While the specifics of
how many readings are necessary can change based on many factors, the essential need for multiple
measurements does not.

To ensure an accurate reading, your doctor should be checking your blood pressure over time, and
watching the how the values change between office visits. More than this, though, he should actually
be taking your blood pressure more than once during each office visit.

Because things like temperature and stress can change blood pressure, more than one reading in a
single office visit allows the ability to correct for these variations. For example, your blood pressure
is often higher at the beginning of an office visit than at the end. Taking a reading at both the
beginning and the end gives a more accurate average reading.

Your doctor should be checking your blood pressure:

 In both arms, not just one

 At both the beginning and the end of your appointment

3. What is blood pressure?

-Blood pressure is the force exerted by the blood against any unit area of the vessel wall. Blood
pressure (BP) is the pressure of circulating blood on the walls of blood vessels. Used without further
specification, "blood pressure" usually refers to the pressure in large arteries of the systemic
circulation. Blood pressure is usually expressed in terms of the systolic pressure (maximum during
one heart beat) over diastolic pressure (minimum in between two heart beats) and is measured in
millimeters of mercury (mmHg), above the surrounding atmospheric pressure (considered to be zero
for convenience).
It is one of the vital signs, along with respiratory rate, heart rate, oxygen saturation, and body
temperature. Normal resting blood pressure in an adult is approximately 120 millimetres of mercury
(16 kPa) systolic, and 80 millimetres of mercury (11 kPa) diastolic, abbreviated "120/80 mmHg".
4. How do you measure blood pressure?
In the measurement procedure a cuff is wrapped around a person’s arm with an inflatable
rubber bag inside the cuff centered over the brachial artery. Enough air pressure is pumped into
the cuff to close the artery. Air pressure is then released by opening the thumb valve. When the
pressure in the cuff is equal to the pressure on the artery, the artery opens and the blood begins
to return to the part of the artery that was closed. As the blood returns to the artery, pulse
sounds begin. These sounds can be heard through a stethoscope placed over the brachial pulse
point. The sounds continue for a time while the cuff is deflated slowly, eventually becoming too
faint to hear. The cuff is connected by tubing to a manometer, which shows the amount of
pressure on the artery. When the first pulse sounds are heard, the reading on the manometer
measures the systolic blood pressure. The last sound heard is the diastolic blood pressure.

5. Define systolic, diastolic, pulse pressure.

a. Systolic blood pressure (the upper number) — indicates how much pressure your blood is exerting
against your artery walls when the heart beats.

b. Diastolic blood pressure (the lower number) — indicates how much pressure your blood is exerting
against your artery walls while the heart is resting between beats.

a. Pulse pressure Pulse pressure is the difference between

the systolic and diastolic pressure readings. It is measured in millimeters of
mercury (mmHg). It represents the force that the heart generates each time it contracts.
For example, if resting blood pressure is 120/80 mm Hg, then the pulse pressure is 40
mmHg

6. What is the relative significance between systolic and diastolic pressure?

 Comparison chart
Diastolic versus Systolic comparison chart
Diastolic
Definition It is the pressure that is exerted on
the walls of the various arteries
around the body in between heart
beats when the heart is relaxed.
Normal range 60 – 80 mmHg (adults); 65 mmHg
(infants); 65 mmHg (6 to 9 years)
Importance Diastolic readings are particularly
with age important in monitoring blood
pressure in younger individuals.
Blood Diastolic represents the minimum
Pressure pressure in the arteries.
Ventricles of Fill with blood
the heart
Blood Relaxed
Vessels
Blood The lower number is diastolic
Pressure pressure.
reading
Etymology "Diastolic" comes from the Greek
diastole meaning "a drawing apart."
7. Arterial blood pressure definition.
Arterial Blood Pressure
The measurement of blood pressure without further specification usually refers to
systemic arterial pressure measured at the upper arm. The measurement of blood
Systolic
It measures the amount of
pressure that blood exerts on
arteries and vessels while the
heart is beating.
90 – 120 mmHg (adults); 95
mmHg (infants); 100 mmHg (6 to
9 years)
As a person's age increases, so
does the importance of their
systolic blood pressure
measurement.
Systolic represents the maximum
pressure exerted on the arteries.
Left ventricles contract
Contracted
The higher number is systolic
pressure.
"Systolic" comes from the Greek
systole meaning "a drawing
together or a contraction."
pressure without further specification usually refers to the systemic arterial pressure,
defined as the pressure exerted by circulating blood upon the walls of blood vessels.

8. Factors maintaining pulse pressure.

The pulse pressure is calculated by subtracting the diastolic pressure from
the systolic pressure. In other words, it is the change in pressure from the
diastolic level to the systolic level. It is determined by two factors,
the stroke volume and the compliance of the arterial system. The stroke
volume, of course, is the amount of the blood injected into arteries by each
heart beat. The compliance is determined by the elasticity of the arterial
system. Flexible arteries that expand easily have a high compliance. Stiff
arteries have a low compliance.

9. Factors normally affecting arterial blood pressure.

Factors Affecting Blood Pressure
Peripheral Resistance
Vessel Elasticity
Blood Volume
Cardiac Output

Variables Affecting Blood Flow and Blood Pressure

Five variables influence blood flow and blood pressure:
 Cardiac output
 Compliance
 Volume of the blood
 Viscosity of the blood
 Blood vessel length and diameter

Cardiac Output
Cardiac output is the measurement of blood flow from the heart through the
ventricles, and is usually measured in liters per minute. Any factor that causes
cardiac output to increase, by elevating heart rate or stroke volume or both, will
elevate blood pressure and promote blood flow.

Compliance
Compliance is the ability of any compartment to expand to accommodate
increased content. The greater the compliance of an artery, the more effectively it
is able to expand to accommodate surges in blood flow without increased
resistance or blood pressure.

Blood Volume
Similarly, as blood volume decreases, pressure and flow decrease. As blood
volume increases, pressure and flow increase.

Blood Viscosity
Viscosity is the thickness of fluids that affects their ability to flow. Clean water, for
example, is less viscous than mud. The viscosity of blood is directly proportional
to resistance and inversely proportional to flow; therefore, any condition that
causes viscosity to increase will also increase resistance and decrease flow.

Vessel Length and Diameter

The length of a vessel is directly proportional to its resistance: the longer the
vessel, the greater the resistance and the lower the flow.

10. Which is more significant: Rise in systolic or diastolic pressure?

- Which number is more important?
Typically, more attention is given to systolic blood pressure (the top number) as a major risk factor for
cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age
due to the increasing stiffness of large arteries, long-term build-up of plaque and an increased incidence of
cardiac and vascular disease.

However, elevated systolic or diastolic blood pressure alone may be used to make a diagnosis of high blood
pressure. And, according to recent studies, the risk of death from ischemic heart disease and stroke doubles
with every 20 mm Hg systolic or 10 mm Hg diastolic increase among people from age 40 to 89.