Py 5.

12 : Measurements of Arterial
Blood Pressure
 What is blood pressure?
• Blood pressure is the pressure of the blood in the arteries as it
is pumped around the body by the heart. Blood pressure does
not stay the same all the time. It changes to meet your body’s
needs. It is affected by various factors including body position,
breathing, emotional state, exercise and sleep.
OBJECT:- Recording of systemic arterial blood pressure.

APPARATUS:- An examination couch , sphygmomanometer

and stethoscope.
The arterial blood pressure is the pressure exerted by a column of
blood on the vessel wall while flowing through it.
Components

(1) Systolic BP: It is the Maximum pressure exerted during

systole.
Normal range: 100-120 mmHg
(2) Diastolic BP: It is the minimum pressure exerted during
diastole.
Normal range : 70-80 mmHg

(3) Pulse pressure: It is the difference of systolic and diastolic

B.P.
Normal range : 40 mmHg

(4) Mean BP: It is the average pressure throughout the cardiac

cycle and is compound as : Diastolic BP + 1/3
pulse pressure;
Normal : 95-100mmHg (average 96 mmHg).
 Systolic BP undergoes considerable fluctuation, e.g. increased
due to excitement, anxiety, nervousness , after meals, etc. and
decreased by rest and during sleep. Therefore , for resting
measurements the subject should be quiet for at least five
minutes before the measurements are made.

Systemic arterial BP can be measured by two methods:-

1. Direct method
2. Indirect method
Direct method:
• In this , a cannula is introduced into an artery and secured in
position with the help of a ligature. The other end of the
cannula is connected to a mercury manometer, consequently
the mercury column . This measures the End Pressure , i.e.
lateral wall pressure (lateral pressure) plus the increment of
pressure caused by the conversion of kinetic energy of flow
into pressure energy from the point at which cannula is tied
with the artery.
• Disadvantage: Direct method is unsafe , inconvenient and
involves high risk of infection. It is appropriate only for
purposes such as measurement of B.P. in animals.
 Indirect method
PRINCIPLE: It involves the balancing of pressure in a bag, i.e.
Air pressure against the pressure of the blood in an artery . The
air pressure is estimated by means of mercury or air (aneroid)
manometer.
APPARATUS: Sphygmomanometer , (devised by Riva-Rocci)
It consists of:
1. An inflatable flat rubber bag covered by a non-distensible
cloth envelope called Riva – Rocci cuff . The cavity of the
bag is connected by a long rubber tube to a manometer and
by a short tube to a rubber pump. By this means the bag can
be inflated to any desired pressure.
2. A small valve is provided between the pump and the bag which
permits the escape of air and reduction of the pressure as required
to compensate tissue resistance.

3. The manometer is a U- shaped tube , one limb being broader

than the other. The broader limb is graduated from 0 to 300 mm,
with the smallest division corresponding to a reading of 2mmHg.

4. The inflatable bag dimensions for adults are: 23×12.5 cm;

width of this bag varies with the age of the individual:
(A) Below 1 year : 2.5 cm
(B) Below 4 year : 5 cm
(C) Below 8 year : 8 cm
(D) Adult : 12.5 cm
• To overcome tissue resistance, the Rule of Thumb is that the
inflatable arm bag should be 20% wider than the arm diameter
and length should cover 2/3rd of the arm circumference (a
length-to-width ratio of 2:1). Therefore, wider cuff should be
used for recording the B.P. in obese individual and in lower
limb to overcome tissue resistance.
Procedure
• Two methods are commonly in use for measuring of systemic
arterial B.P. :-
• 1. Palpatory method
• 2. Auscultatory method
Palpatory method
1. Allow the subject to sit
comfortably in a chair for 5
minutes.
2. The uninflated cuff of
sphygmomanometer is
wrapped firmly around the
bare upper arm 2.5-3 cm
above the elbow joint at the
heart level.
3. Feel for the radial pulse and
inflate the rubber bag to
increase the pressure 20-
30mmHg above the point at
which the radial pulse will
disappear at the wrist.
 Palpatory method
4. Now deflate the cuff slowly , releasing the pressure 2-3
mmHg/sec. while lowering the pressure , keep palpating the
radial artery and reading is taken just when pulse starts
reappearing. This gives systolic B.P.
Disadvantage : (A) In this method diastolic B.P. cannot be
estimated .
(B) Systolic B.P. estimated is lower than the
actual by 6-10mmHg because :
● when the pressure in the cuff just balance the brachial artery
pressure, only a small amount of blood flows through the artery
which may be not be sufficient enough to produce a pulse wave.
● some time is taken by the blood to flow from the brachial
artery to radial artery, during this mercury column falls further.
 Auscultatory method
This method was introduced by Russian physician,
KOROTKOFF in 1905.

1. Allow the subject to sit comfortably in a chair for 5 minutes.

2. The uninflated cuff of sphygmomanometer is wrapped firmly

around the upper arm 2.5-3 cm above the elbow joint at
the heart level.

3. Place the chest piece of stethoscope over the arm medial to the
tendon of biceps where pulsation of brachial artery are felt.
 Auscultatory method
4. Inflate the cuff rapidly untill the pressure in it is well above the
systolic B.P. as measured by the Palpatory method. The brachial artery
gets occluded by the cuff and no sound can be heard with the
stethoscope.

5. Now gradually lower the cuff pressure by opening the valve till a clear
sharp trapping sound is heard . The cuff pressure at which the sound is
heard first, gives a measure of systolic B.P.

6. The pressure in cuff is further progressively lowered while listening

for the appearance of the sound of korotkoff”s. the sound undergoes a
series of changes in quality and becomes dull and muffled, to finally
disappear.

7. The cuff pressure at which the sound becomes muffled and disappear
is the diastolic B.P.
PRINCIPLE INVOLVED IN RECORDING BLOOD
PRESSURE
KOROTOKOFF SOUND

SBP
120 mm Hg Tapping sound 1

110 mm Hg Murmurish 2

95 mm Hg Banging sound 3

Muffing sound 4
85 mm Hg

DBP- 80 mm Hg No sound 5
 Blood measuring apparatus

Mercury sphygmomanometer
They measure blood pressure by observing the height of a
column of mercury
Stethoscope
 precautions
1. The subject should be quiet for at least five minutes before the
measurements are taken.
2. The cuff should not be tied too tight or too loose.
3. Cuff should be placed at the level of the heart while taking a
reading.
4. The cuff tubing should lie over the inner side of the arm and
directed inferiorly.
5. The cuff should not be left inflated for the long periods, else it
produces reflex spasm of the artery and a high reading will be
obtained.
6. Do not apply pressure over the artery with chest piece of
stethoscope. This partial obstruction of the artery and diastolic
B.P. will be underestimated.

7. The cuff should not be left inflated for long periods, specially
in persons suffering from purpura or tetany.