Measurement of Arterial

Blood Pressure
Jun Jiang MD
Second affiliated hospital
Zhejiang University School of Medicine

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 Measurement of Arterial
Blood Pressure
Methods for measuring the blood
pressure:
Direct method
Indirect method (sphygmomanometer)

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 Indirect Methods for
Measuring BP
Patient arrangement
Physically relaxed and emotionally at
ease
The patient may be sitting or lying in
supine position.
The arm should be at the heart level,
relaxed, slightly fixed and support on a
firm surface.

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Blood Pressure Cuff
Deflated before exam
Wrapped evenly and firmly around the arm
Distal margin of the cuff should be placed 2 t
o 3cm above the antecubital fossa
Place the diaphragm of the stethoscope over
the artery and close to the cuff.

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 Korotkoff
-Auscultatory Method
Beats become audible - the systolic
pressure
Sound of beats become louder
Blowing murmur
Sound of beats gradually diminish
Sound disappear - the diastolic blood
pressure

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 Definitions and Classification
of Blood Pressure Levels
WHO (1999)
Category systolic(mmHg) diastolic(mmHg)
Optimal ＜ 120 ＜ 80
Normal ＜ 130 ＜ 85
High-normal 130-139 85-89
Hypertension ≥140 ≥90
Isolated systolic ≥140 ＜ 90
hypertension

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 Abnormal Blood Pressure
Hypertension
Hypotension
Significant difference in two upper
extremities
Significant difference in upper and
lower extremities
Abnormality in pulse pressure

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 Hypertension

Essential hypertension
Secondary hypertension (Symptomatic
hypertension)
Renal causes, endocrine causes, etc

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 Low Blood Pressure
Systolic pressure ＜ 90mmHg
diastolic pressure ＜ 60mmHg
Decrease in cardiac output : acute myocardial in
farction, pericarditis with effusion, heart failure,
following hemorrhage
Decrease in peripheral resistance: septicemia, A
ddison’s disease, drug intoxications

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 Significant Difference in the
Upper Extremities
Little or no significant difference
Difference of pressure above 10mmHg
Primary arteritis of the aorta and its mai
n branches, obstruction of the innomina
te artery, aortic aneurysm

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 Significant Difference in the
Upper and Lower Extremities
Ordinarily the systolic pressure is slightl
y higher in the lower extremities than in
the upper (20~40mmHg)
Most common in coarctation of the aort
a (congenital narrowing)

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Abnormality in Pulse Pressure
The pulse pressure is the difference betw
een the systolic and diastolic pressures a
nd normally amounts to 30 or 40mmHg.
Pulse pressure increased: ＞ 40mmHg
atherosclerosis of the aorta, hyperthyroid
ism, aortic regurgitation, arteriovenous fi
stula, severe anemia, PDA (patent ductu
s arteriosus)

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 Pulse pressure decreased: ＜ 30mmHg
Aortic stenosis, hypotension, heart failur
e and massive pericardial effusion

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 Auscultation of vein
Venous hum over the jugular vein: a
soft low-pitched continuous murmur,
decrease or disappear in supine
position, especially in cases of marked
anemia
Loud murmur heard over dilated vein in
liver cirrhosis
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 Auscultation of Arteries

Normal artery sound

Peripheral vascular sign
Pathological sound: including systolic
and continuous murmur

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 Pistol-shot Sound
produced by the front of an arterial pulse
wave of higher than normal pulse pressure
striking the arterial wall

a loud first sound (pistol-shot sound) may be

heard over the femoral arteries without
exerting pressure

Occur in the condition with high pulse pressure

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 Durozier’s Sign
On pressing the stethoscope firmly over
the femoral artery in aortic
insufficiency, double intermittent
murmur may be heard.

It is seen in high pulse pressure

condition.

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 Capillary pulsation sign
Press down on the tip of the fingernail,
with each heartbeat, the border of pink
extends and recedes
Occur in the high pulse pressure
patients

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corrigan’s sign:Visible pulsationn of caroti
d artery
deMusset’s sign: a bob of the head with
heart beats

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 Peripheral vascular sign
Water-hammer pulse
Pistol-shot Sound
Durozier’s Sign
Capillary pulsation sign
corrigan’s sign
deMusset’s sign
Significance: high pulse pressure
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 Pathological murmur
Hyperthyroidism: Murmur heard in thyr
oid
Takayasu arteritis
Renal stenosis
Arteriovenous fistula

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 Thank You

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