Blood Pressure

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

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