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Blood  Pressure  Notes:  
 
Blood  pressure  is  the  pressure  exerted  by  blood  on  a  wall  of  a  blood  vessel
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KORTOKOFF  SOUNDS  
1
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Sound  increases  in  intensity  
3
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Sound  becomes  muffled  
5
...
   
Invasively-­‐  insertion  of  cannula  into  artery  and  specialised  monitoring  equipment      
Non-­‐invasively-­‐  sphygmomanometer,  cuff  and  stethoscope/  automatic  machine
...
 
Feel  for  a  pulse  in  the  brachial  artery,  once  you  have  found  the  pulse  apply  the  blood  
pressure  cuff  with  the  arrow  pointing  down  towards  the  artery
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 The  cuff  should  encircle  80%  of  the  arm,  if  it  doesn’t  it  
under/over  measures  BP
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 Inflate  the  cuff  until  you  can  no  longer  
feel  the  pulse  and  let  the  cuff  down  gradually
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Now  begin  to  re-­‐inflate  the  cuff  up  to  30mmHg  over  estimated  systolic  pressure
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 Once  those  sounds  appear  
that  is  your  systolic  blood  pressure
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Blood  pressure  needs  to  be  taken  and  be  elevated  on  at  least  3  occasions  for  a  diagnosis  of  
hypertension  to  be  made
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1  million  premature  deaths  worldwide
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SECONDARY  HTN  
Results  from  an  identifiable  cause:  
• Kidney  problems  –  renal  artery  stenosis/  renal  artery  disease  (can’t  dilate  properly)  
• Aortic  coarctation  (narrowing  of  aorta)  
• Pregnancy  
• Contraceptive  pill  –  causes  higher  levels  of  angiotenisogen,  this  causes  a  release  of  
aldosterone
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TREATMENT    
 
Effective  treatment  of  HTN  reduces  morbidity  and  mortality  significantly
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LIFESTYLE  CHANGES:  
• Smoking  cessation    
• Reduction  in  alcohol/caffeine/salt  intake  
• More  fruit  and  veg  
• More  exercise    
• Less  stress  
• Achieve  ideal  body  weight    
• Statins  for  primary  prevention  
• Aspirin  if  over  50    
 
ANTI  HYPERTENSIVE  DRUGS:    
• Beta  blockers  (BISOPROLOL)  –  prevent  activation  of  adrenergic  receptors  that  are  
responsible  for  increased  cardiac  action
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• Calcium  Channel  Blockers  –  Slow  the  movement  of  calcium  into  the  heart  and  blood  
vessel  walls
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Ø NONDIYDROPYRIDINES  –  additional  effect,  block  calcium  entering  conduction  
tissues,  slowing  heart  rate
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 ACE  inhibitors  reduce  levels  of  
angiotenisin  II  meaning  blood  vessels  vasodialate  and  reduce  the  amount  of  water  
retained  in  the  body
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 Symptoms  include  syncope,  blurred  vision,  lack  of  concentration  
and  dizziness
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Common  causes:  
• Anemia    
• Dehydration  
• Pregnancy    
• Blood/fluid  loss    
• Endocrine  problems  –  low  blood  sugar  
• Heart  problems  e
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 bradys/MI  
 
Postural  hypotension  (most  common):  
Failure  of  normal  change  in  blood  pressure  as  a  response  to  postural  changes  e
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 from  

siting  to  standing
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A  drop  in  blood  pressure  more  than  20mmHg  within  3  minutes  of  standing  due  to  blood  
pooling  in  the  lower  limbs
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Postprandial  Hypotension  
Drop  in  systolic  blood  pressure  of  20mmHg  or  more  20  minutes  after  eating  a  meal
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Neurally  Mediation  Hypotension  
Drop  in  blood  pressure  after  standing  for  long  periods  of  time
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Shy  Drager  Syndrome    
Rare  disorder  which  causes  progressive  damage  to  the  autonomic  nervous  system  which  
controls  involuntary  functions  like  blood  pressure,  heart  rate,  breathing  and  digestion
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 If  medication  is  prescribed  it  is  
usually  a  vasoconstrictor  or  a  medication  that  increases  blood  volume,  therefore  increasing  
blood  pressure

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