Alternative Blood High Medicine Pressure
Alternative Blood High Medicine Pressure
Blood pressure (BP) is a force exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum (systolic) and a minimum (diastolic) pressure. The mean BP, due to pumping by the heart and resistance in blood vessels, decreases as the circulating blood moves away from the heart through arteries. It has its greatest decrease in the small arteries and arterioles, and continues to decrease as the blood moves through the capillaries and back to the heart through veins. Gravity, valves in veins, and pumping from contraction of skeletal muscles, are some other influences on BP at various places in the body.
The term blood pressure usually refers to the pressure measured at a person's upper arm. It is measured on the inside of an elbow at the brachial artery, which is the upper arm's major blood vessel that carries blood away from the heart. A person's BP is usually expressed in terms of the systolic pressure and diastolic pressure, for example 120/80.
Measurement
Arterial pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure. Today BP values are still reported in millimetres of mercury (mmHg), though aneroid and electronic devices do not use mercury.
For each heartbeat, BP varies between systolic and diastolic pressures. Systolic pressure is peak pressure in the arteries, which occurs near the end of the cardiac cycle when the ventricles are contracting. Diastolic pressure is minimum pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood. An example of normal measured values for a resting, healthy adult human is 120 mmHg systolic and 80 mmHg diastolic (written as 120/80 mmHg, and spoken as "one-twenty over eighty").
Systolic and diastolic arterial BPs are not static but undergo natural variations from one heartbeat to another and throughout the day (in a circadian rhythm). They also change in response to stress, nutritional factors, drugs, disease, exercise, and momentarily from standing up. Sometimes the variations are large. Hypertension refers to arterial pressure being abnormally high, as opposed to hypotension, when it is abnormally low. Along with body temperature, respiratory rate, and pulse rate, BP measurements are the most commonly measured physiological parameters.
Arterial pressures are usually measured non-invasively, without penetrating skin or artery. Measuring pressure invasively, by penetrating the arterial wall to take the measurement, is much less common, and usually restricted to a hospital setting.
Noninvasive measurement
The non invasive auscultatory and oscillometric measurements are simpler and quicker than invasive measurements, require less expertise in fitting, have virtually no complications, and are less unpleasant and painful for the person. However, noninvasive methods may yield somewhat lower accuracy and small systematic differences in numerical results. Non-invasive measurement methods are more commonly used for routine examinations and monitoring.
Palpation method
A minimum systolic value can be roughly estimated without any equipment by palpation, most often used in emergency situations. Historically, students have been taught that palpation of a radial pulse indicates a minimum BP of 80 mmHg, a femoral pulse indicates at least 70 mmHg, and a carotid pulse indicates a minimum of 60 mmHg. However, at least one study indicated that this method often overestimates patients' systolic BP. A more accurate value of systolic BP can be obtained with a sphygmomanometer and palpating for when a radial pulse returns. The diastolic blood pressure can not be estimated by this method. Sometimes palpation is used to get an estimate before using the auscultatory method.
Auscultatory method
The auscultatory method (from the Latin word for listening ) uses a stethoscope and a sphygmomanometer. This comprises an inflatable ( Riva-Rocci ) cuff placed around the upper arm at roughly the same vertical height as the heart, attached to a mercury or aneroid manometer. The mercury manometer measures the height of a column of mercury, giving an absolute result without need for calibration, and consequently not subject to the errors and drift of calibration which affect other methods. The use of mercury manometers is often required in clinical trials and for the clinical measurement of hypertension in high risk patients, such as pregnant women.
A cuff of appropriate size is fitted smoothly and snugly, then inflated manually by repeatedly squeezing a rubber bulb until the artery is completely occluded. Listening with the stethoscope to the brachial artery at the elbow, the examiner slowly releases the pressure in the cuff. When blood just starts to flow in the artery, the turbulent flow creates a "whooshing" or pounding (first Korotkoff sound). The pressure at which this sound is first heard is the systolic BP. The cuff pressure is further released until no sound can be heard (fifth Korotkoff sound), at the diastolic arterial pressure.
The auscultatory method has been predominant since the beginning of BP measurements but in other cases it's being replaced by other noninvasive techniques.
Oscillometric method
The Oscillometric method was first demonstrated in 1876 and involves the observation of oscillations in the sphygmomanometer cuff pressure which are caused by the oscillations of blood flow, i.e. the pulse. The electronic version of this method is sometimes used in long-term measurements and general practice. It uses a sphygmomanometer cuff like the auscultatory method, but with an electronic pressure sensor (transducer) to observe cuff pressure oscillations, electronics to automatically interpret them, and automatic inflation and deflation of the cuff. The pressure sensor should be calibrated periodically to maintain accuracy.
Oscillometric measurement requires less skill than the auscultatory technique, and may be suitable for use by untrained staff and for automated patient home monitoring.
The cuff is inflated to a pressure initially in excess of the systolic arterial pressure, and then reduces to below diastolic pressure over a period of about 30 seconds. When blood flow is nil (cuff pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic pressure), cuff pressure will be essentially constant. It is essential that the cuff size is correct: undersized cuffs may yield too high a pressure, whereas oversized cuffs yield too low a pressure. When blood flow is present, but restricted, the cuff pressure, which is monitored by the pressure sensor, will vary periodically in synchrony with the cyclic expansion and contraction of the brachial artery, i.e., it will oscillate. The values of systolic and diastolic pressure are computed, not actually measured from the raw data, using an algorithm; the computed results are displayed.
Oscillometric monitors may produce inaccurate readings in patients with heart and circulation problems, that include arterial sclerosis, arrhythmia, preeclampsia, pulsus alternans, and pulsus paradoxus.
In practice the different methods do not give identical results; an algorithm and experimentally obtained coefficients are used to adjust the oscillometric results to give readings which match the auscultatory results as well as possible. Some equipment uses computer-aided analysis of the instantaneous arterial pressure waveform to determine the systolic, mean, and diastolic points. Since many oscillometric devices have not been validated, caution must be given as most are not suitable in clinical and acute care settings.
The term NIBP, for Non-Invasive Blood Pressure, is often used to describe oscillometric monitoring equipment.
White-coat hypertension
For some patients, BP measurements taken in a doctor's office may not correctly characterize their typical BP. In up to 25% of patients, the office measurement is higher than their typical BP. This type of error is called white-coat hypertension (WCH) and can result from anxiety related to an examination by a health care professional. The misdiagnosis of hypertension for these patients can result in needless and possibly harmful medication. WCH can be reduced (but not eliminated) with automated BP measurements over 15 to 20 minutes in a quiet part of the office or clinic.
Debate continues regarding the significance of this effect. Some reactive patients will also react to many other stimuli throughout their daily lives, and require treatment. In some cases a lower BP reading occurs at the doctor's office.
Home monitoring
Ambulatory blood pressure devices that take readings every half hour throughout the day and night have been used for identifying and mitigating measurement problems like white-coat hypertension. Exce
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