Intro to Blood Pressure

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Written By:
Cindy Maley / Product Manager

Almost everyone knows that

blood pressure is one of the most important measurements in
medicine. Every time a patient visits a physician's office or
hospital, one of the first measurements taken is their blood
pressure. Since blood pressure plays such a vital role in
monitoring a person's overall health, I thought I would write
about the basics of blood pressure and some of the
terminology used in blood pressure measurement.
What is Blood Pressure?
Blood pressure is the force/pressure of the blood pushing
against the walls of the arteries. With each heartbeat, blood
is being pumped out into our arteries and throughout the
body.
What is the difference between systolic and diastolic
blood pressure?
Blood pressure is always recorded as 2 numbers, such as
120/80, where the top number is the systolic pressure and
the bottom number is the diastolic pressure. Systolic pressure
is the pressure on the arteries as the heart contracts and
pumps blood. The diastolic pressure is the pressure on the
arteries when the heart is at rest in between heartbeats.
How is blood pressure measured?

When a cuff is wrapped around a patient's upper arm and

inflated, the brachial artery is occluded (i.e. blood flow
through the artery has been stopped). As the cuff is gradually
deflated, blood flow is re-established and accompanied by
sounds of "tapping" (thumping) that can be detected with a
stethoscope held over the brachial artery just below the cuff.
When the first sound of "tapping" is heard, that signifies the
systolic pressure and when the "tapping" ceases, that
signifies the diastolic pressure.
What are Korotkoff Sounds?
Korotkoff sounds (or K-Sounds) are the "tapping" sounds
heard with a stethoscope as the cuff is gradually deflated.
Traditionally, these sounds have been classified into five
different phases (K-1, K-2, K-3, K-4, K-5) and are shown in the
figure below.
K-1 (Phase 1): The appearance of the clear "tapping"
sounds as the cuff is gradually deflated. The first clear
"tapping" sound is defined as the systolic pressure.

K-2 (Phase 2): The sounds in K-2 become softer and

longer and are characterized by a swishing sound since
the blood flow in the artery increases. (the murmurs heard for

most of the area between the systolic and diastolic pressures.)

K-3 (Phase 3): The sounds become crisper and louder in

K-3 which is similar to the sounds heard in K-1.

K-4 (Phase 4): As the blood flow starts to become less

turbulent in the artery, the sounds in K-4 are muffled and
softer. Some professionals record diastolic during Phase 4
and Phase 5. (at pressures within 10 mmhg above the diastolic blood

pressure, were described as "thumping" and "muting").

K-5 (Phase 5): In K-5, the sounds disappear completely

since the blood flow through the artery has returned to
normal. The last audible sound is defined as the diastolic
pressure.

Based
on: http://www.medphys.ucl.ac.uk/teaching/undergrad/project
s/2003/group_03/how.html
What is the Auscultatory method of blood pressure
measurement?
The auscultatory method (also known as the Riva Rocci
Korotkoff or manual method for blood pressure
measurement) is the LISTENING of Korotkoff sounds in the
brachial artery. The gold standard for clinical blood pressure
measurement has always been to take a blood pressure using
the auscultatory method where a trained healthcare provider
uses a sphygmomanometer and listens for the Korotkoff
sounds using a stethoscope. However, there are many
variables that affect the accuracy of this method and
numerous studies have shown that physicians and healthcare
providers rarely follow the established guidelines for taking
proper manual blood pressure measurements (Pickering et al,
2005). (For more information on the proper technique for
manual blood pressure measurements, please refer to
instructions in the Learning Center.
What is the Oscillometric method of blood pressure
measurement?
The oscillometric method is the MEASURING of the pressure
variations in the blood pressure cuff caused by the oscillation
of blood flow through the brachial artery. The blood pressure
values are then calculated by an empirically derived
algorithm. Most automated blood pressure monitors use the
oscillometric method for blood pressure since is it less
susceptible to external noise.

What is Mean Arterial Pressure (MAP)?

MAP is the average arterial pressure during a single cardiac
cycle (i.e. the average blood pressure in the arteries). The
equation to calculate MAP is MAP = Diastolic +1/3(SystolicDiastolic). MAP is a useful measurement since it indicates
both overall health and risk for developing various
cardiovascular diseases.
What is hypertension?
Hypertension, or high blood pressure, is classified as a blood
pressure measurement of 140/90 mmHg or above. According
to the American Heart Association, hypertension affects
nearly one out of every three Americans. Hypertension is a
major risk factor associated with many cardiovascular
diseases and plays a significant role in the progression of
congestive heart failure, stroke, heart attacks, kidney failure,
and premature death. Factors that contribute to the
prevalence of hypertension are smoking, stress, drugs,
alcohol, nutrition, diabetes, obesity, and limited physical
activity.
When I get my blood pressure taken, what does that
measurement mean?
There are four different categories that blood pressure
readings fall into and are shown in the table below. If your
blood pressure measurement falls into two different
categories, then you would be placed in the higher blood
pressure category (i.e. if your measurement is 130/94, then
you would be considered to have Stage 1 Hypertension.)

Top
number
(systolic)
in mm Hg
Below 120
120-139

Bottom
number
(diastolic)
in mm Hg
an
d
or

Below 80
80-89

Your
category*

What to do**

Normal blood
Maintain or adopt a
pressure
healthy lifestyle
Prehypertension Maintain or adopt a
healthy lifestyle. If
blood pressure goal isn't
reached in about six

140-159

or

160 or more or

90-99

Stage 1
hypertension

100 or more

Stage 2
hypertension

months, talk to your

doctor about taking one
or more medications.
Maintain or adopt a
healthy lifestyle. If
blood pressure goal isn't
reached in about six
months, talk to your
doctor about taking one
or more medications.
Maintain or adopt a
healthy lifestyle. Talk to
your doctor about taking
more than one
medication.

*Ranges may be lower for children and teenagers. Talk to your child's doctor if you're concerned your child
has high blood pressure.
**Note: These recommendations address high blood pressure as a single health condition. If you also have
heart disease, diabetes, chronic kidney disease or certain other conditions, you'll need to treat your blood
pressure more aggressively.

http://www.mayoclinic.com/health/blood-pressure/HI00043

References:
American Heart Association: Heart Disease and Stroke
Statistics - 2010
Update.http://www.americanheart.org/downloadable/heart/12
65665152970DS-3241%20H...
Pickering, T.G., Hall J.E., Appel L.J., Falkner B.E., Graves J., Hill
M.N., Jones D.W., Kurtz T., Sheps S.G, Roccella E. J.
Recommendations for Blood Pressure Measurement in
Humans and Experimental Animals: Part 1: Blood Pressure
Measurement in Humans: A Statement for Professionals From
the Subcommittee of Professional and Public Education of the
American Heart Association Council on High Blood Pressure
Research. Hypertension 2005 (45):142-161.