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• Choice of Sphygmomanometer
– Proper size :length of bladder 80% of arm
:width 40% of arm

• Rest the patient for 5 min

• Remove the clothing
How to measure the BP
How to measure the BP
• Secure the cuff snugly
– A loose cuff or bladder that balloons outside
cuff leads to false high blood pressure
• To determine how high to raise the cuff
pressure: Use the palpatory method
• First estimate the systolic pressure by palpation
• Feel the radial a.with the fingers of one hand
• Rapidly inflate the cuff until the radial pulse
• Add 30 mmHg to it to obtaint target for inflation
How to measure the BP
• This method prevents discomfort from unnecessary elevation
– avoid error caused by auscultatory gap a silent interval
between sytolic and diastolic BP
• Deflate cuff, wait for 15-20 sec
• Place bell of stethoscope over the brachial a.(make an air
seal with its full rim)
• Inflate the cuff rapidly to the determined level of the systolic
BP when you starts to hear the cardiac beats
• Deflate slowly 2-3mmHg per sec
How the BP to measure
• Note the level at which you hear the sounds of 2
consecutive beats (Korotkoff sounds)
• This is the sytolicBP

• Continue to lower pressure slowly until the sounds

become muffled and then disappear
• To confirm disappearance listen as pressure fall another 10-20mm
• Deflate the cuff rapidly to zero

• The disappearance point which is usually only a few

mm below the muffling point gives the best estimate
of the true diastolic BP
How to measure the BP
• If the muffling point and the disappearance point
are further apart ,or if as in AR the sounds never
disappear record both figures
• Read BP to nearest 2mmHg
• BP should be taken in both arms at least onse.
Normally there may be a difference of 5 mmHg
and sometimes 10.Take subsequent readings in
the arm with the highest pressure
• Pressure difference of more than 10-15 mmHg
suggest arterial compression or obstruction on
the side of low BP
Postural hypotension
• Normally on standing, systolic BP drops
slightly and diastolic raises slightly. A fall
in systolic of 20 mmHg or more is
considered orthostatic or postural
Causes of postural hypotension
1. Drugs (vasodilators)
2. Depletion of blood volume
3. Prolonged bed rest
4. Diseases of autonomic nervous system
BP classification
• Normal <130 <85

• High normal 130-139 85-89

• Mild 140-159 90-99

• Moderate 160-179 100-109
• Severe 180-209 110-119
• Very Severe >210 >120
Causes of hypertention
• Essential
• Renal
• Renovascular
• Endocrine :Cushing syndrome
» Conn
» Pheochromocytoma
» Acromegaly
Assesment of Hypertention
• It includes its effect on target organs
• The eyes :hypertensive retinopathy
• The heart :LVF
• The brain :neurological deficit
• The kidneys : hypertensive nephropathy