Prepare:
- No smoking or caffeine x 30 min
- No constrictive clothing
- No talking
- Rest x 5 minutes
Equipment:
- Cuff size: width >40% arm circumference; length >80% arm circumference
Position:
- Device and columns at eye levels
- Arm at level of heart
- Legs uncrossed
- Normal breathing
- Cuff ~3cm above elbow
Performance:
- Korotkoff sounds
- Both arms – repeat after 2 minutes
- Orthostatic hypotension (drop in systolic BP of at least 20 mmHg in association with symptoms – dizziness/syncope; may have increased HR)
- Recumbent for 5 minutes, measure baseline BP and pulse
- Have patient stand and repeat measurements immediately and 2 minutes later
- Coarctation of the aorta
- BP elevated in both arms
- Determine BP in lower extremities (apply thigh cuff while patient prone, stethoscope placed over popliteal fossa; or apply regular cuff just above malleoli, stethoscope placed over dorsalis pedis or posterior tibial)
- Consider coarcation if leg systolic pressure is lower than arm
- Cardiac tamponade (pulsus paradoxus)
- Low arterial BP and rapid feeble pulse – must r/o tamponade
- Normal 5 mmHg fall in systolic BP with inspiration (PP if >10
- 1. Breathe normally, inflate cuff until no sounds hear
- 2. Gradually deflate until sounds heard in expiration only – NOTE
- 3. Continue until sounds heard in both phases – NOTE
- 4. Determine difference in pressures
Pitfalls:
- ↑BP – anxiety, pain, distended viscera, “white coat”
- Arrhythmias
- Auscultory gap
- Aortic insufficiency
- Wrong size cuff
Normal: <120/<80
PreHTN: 120-139/80-89
Stage 1: 140-159/90-99
Stage 2: ≥160/≥100
Treatment
- Weight loss
- Sodium restriction