BLOOD PRESSURE

BLOOD BLOOD PRESSUREPRESSURE

Dr shabeel pnDr shabeel pn

DEFINITIONDEFINITION Blood pressure isBlood pressure is

defined as the lateral pressure defined as the lateral pressure exerted by flowing blood on the walls exerted by flowing blood on the walls of the arteriesof the arteries..

TYPES OF BLOOD TYPES OF BLOOD PRESSUREPRESSURE

Depending on the Depending on the NATURE OFNATURE OF BLOODBLOOD

VESSELVESSEL – –

ArterialArterial B.PB.P

Venous B.PVenous B.P

Capillary B.PCapillary B.P

BLOOD PRESSURE IS BLOOD PRESSURE IS DETERMINED BY:DETERMINED BY:

Force with which heart pumps the Force with which heart pumps the bloodblood

Resistance offered by the vesselsResistance offered by the vessels

B.P = C.O x P.RB.P = C.O x P.R

CARDIAC CYCLECARDIAC CYCLE

Systole - .3sec

Diastole - .5sec

Total - .8 sec

ARTERIAL BLOOD ARTERIAL BLOOD PRESSUREPRESSURE

TYPE TYPE NORMAL RANGENORMAL RANGE

Systolic BP 110-130mmHgSystolic BP 110-130mmHg

Diastolic BP 60-80mmHgDiastolic BP 60-80mmHg

Pulse pressure 40mmHgPulse pressure 40mmHg

Mean arterial 93-100mmHgMean arterial 93-100mmHg

pressurepressure

MEASUREMENT OF MEASUREMENT OF BPBP

DIRECT METHODDIRECT METHOD

INDIRECT METHODINDIRECT METHOD

Palpatory methodPalpatory method Auscultatory methodAuscultatory method

DIRECT METHODDIRECT METHOD

INDIRECT INDIRECT METHODMETHOD

INSTRUMENTSINSTRUMENTS

SPHYGMOMANOMSPHYGMOMANOMETERETER

ANEROID ANEROID BAROMETERBAROMETER

AUTOMATIC AUTOMATIC INFLATION CUPINFLATION CUP

PROCEDUREPROCEDURE

KOROTKOFF’S KOROTKOFF’S SOUNDSSOUNDS

PHASEPHASE NATURE OF NATURE OF SOUNDSOUND

DURATIONDURATION

II Tapping Tapping soundsound

10 mmHg10 mmHg

II II MurmerMurmer 20 mmHg20 mmHg

IIIIII Gong soundGong sound 5 mmHg5 mmHg

IVIV MuffledMuffled RestRest

VV DissappearsDissappears

PALPATORY PALPATORY METHODMETHOD

BASIS OF KOROTKOFF’S BASIS OF KOROTKOFF’S SOUNDSOUND

Sounds are heard due to turbulence Sounds are heard due to turbulence

Cuff pressure > Systolic. P Lumen is Cuff pressure > Systolic. P Lumen is occluded No sounds are heard.occluded No sounds are heard.

Cuff pressure <just below> systolic .PCuff pressure <just below> systolic .P

Blood flow at height of systole Blood flow at height of systole Tapping soundTapping sound

Cuff pressure < diastolic.P Cuff pressure < diastolic.P Streamline flow No sounds.Streamline flow No sounds.

AUSCULTATORY AUSCULTATORY GAPGAP

A gap present after A gap present after tapping soundtapping sound

Seen in hypertensive patientsSeen in hypertensive patients..

VARIATIONSVARIATIONS

PHYSIOLOGICALPHYSIOLOGICAL

PATHOLOGICALPATHOLOGICAL

PHYSIOLOGICALPHYSIOLOGICAL1.1. AGEAGE: in B.P: in B.P Old age Lipid deposition in lamina Old age Lipid deposition in lamina

propria Loss of windkessel effectpropria Loss of windkessel effect2.2. SEX:SEX: Males > Females upto menopause.Males > Females upto menopause. After menopause Equal.After menopause Equal. Plasma cholesterolPlasma cholesterol

Estrogen Estrogen Vasodialator NO [ERF] Vasodialator NO [ERF]

3.3. MEAL: MEAL:

B.P After a meal Due to B.P After a meal Due to in blood volume in blood volume

44 SLEEPSLEEP::

Less due to generalLess due to general

vasodialatation.vasodialatation.

55 EMOTIONS:EMOTIONS:

Rage, anxiety, panic e.t.cRage, anxiety, panic e.t.c

production of adrenaline production of adrenaline

B.PB.P

7. 7. ExerciseExercise

Moderate exerciseModerate exercise Systolic B.P upto 20-Systolic B.P upto 20-30 mmHg.30 mmHg.

Diastolic B.P unaltered.Diastolic B.P unaltered.

SevereSevere exerciseexercise Systolic B.P upto 40-Systolic B.P upto 40-

50 mmHg50 mmHg Diastolic B.PDiastolic B.P

8.8.GravityGravity

Above heart level Above heart level B.P B.P Below heart level Below heart level B.P B.P

Magnitude of Magnitude of gravitational effect gravitational effect

.77mmHg/cm..77mmHg/cm.

..

PATHOLOGICALPATHOLOGICAL1.1. HypertensionHypertension Persistent increase in systemic arterial Persistent increase in systemic arterial

B.P is known as hypertension.B.P is known as hypertension.According to JNC VIIAccording to JNC VII

Normal - 120/80 mmHg.Normal - 120/80 mmHg.Pre hypertension – 120-139/80-90mmHgPre hypertension – 120-139/80-90mmHgStage I Hypertension-140-159/90-99Stage I Hypertension-140-159/90-99

mmHgmmHgStage II Hypertension->/160/100mmHgStage II Hypertension->/160/100mmHg

BenignBenign

PrimaryPrimary

Hypertension Hypertension MalignantMalignant

SecondarySecondary

-Atherosclerosis-Atherosclerosis

-Pheochromocytoma-Pheochromocytoma

-Cushing syndrome-Cushing syndrome

-Glomerulonephritis-Glomerulonephritis

-Gestational-Gestational

-Drug induced-Drug induced

White coat hypertensionWhite coat hypertension

COMPLICATIONS COMPLICATIONS OF HYPERTENSIONOF HYPERTENSION

Renal failureRenal failure

LVHLVH

MIMI

Cerebral Cerebral haemorrhagehaemorrhage

Retinal Retinal haemorrhagehaemorrhage

COMPLICATIONS OF COMPLICATIONS OF UNCONTROLLED UNCONTROLLED

HYPERTENTION DURING HYPERTENTION DURING SURGERYSURGERY

Reflects cardiac status Reflects cardiac status Anaesthetic risk of the patient.Anaesthetic risk of the patient.

Excessive bleeding from operation site Excessive bleeding from operation site

Blood loss.Blood loss.

PRE-OPERATIVE PRE-OPERATIVE INVESTIGATIONINVESTIGATION

Chest x-rayChest x-rayECGECGUSG of kidneyUSG of kidneyOphthalmic evaluation for retinal Ophthalmic evaluation for retinal

haemorrhagehaemorrhageRFTRFT

MANAGEMENT OF MANAGEMENT OF HYPERTENSIONHYPERTENSION

Non drug therapyNon drug therapyStop smokingStop smokingControl obesityControl obesityRegular exerciseRegular exerciseDecrease salt intakeDecrease salt intake

Drug therapyDrug therapyBeta blockersBeta blockersCalcium channel Calcium channel blockersblockersVasodialatorsVasodialatorsDiureticsDiureticsACE inhibitorsACE inhibitorsVMC depressorsVMC depressors

DIETARY APPROACH TO DIETARY APPROACH TO STOP HYPERTENSION.STOP HYPERTENSION.

During surgical During surgical proceduresprocedures::

B.P should be monitored and controlled B.P should be monitored and controlled before,during and after treatment.before,during and after treatment.

Antihypertensives should be continued.Antihypertensives should be continued.

LA solution without adrenaline or LA solution without adrenaline or bupivacaine should be given.bupivacaine should be given.

HYPOTENSIONHYPOTENSION Fall in B.P below normal range is known as Fall in B.P below normal range is known as

hypotension.hypotension. TYPESTYPES

Primary/Essential hypotension.Primary/Essential hypotension.Secondary hypotension.Secondary hypotension.

-MI -MI -Hypoactivity of pituitary gland-Hypoactivity of pituitary gland -Hypoactivity of adrenal gland-Hypoactivity of adrenal gland -Tuberculosis-Tuberculosis

Orthostatic hypotensionOrthostatic hypotension

TREATMENT OF TREATMENT OF HYPOTENSIONHYPOTENSION

Correct the underlying etiology. Correct the underlying etiology.

Orthostatic hypotension Change Orthostatic hypotension Change to supine position with head below the to supine position with head below the heart level & leg raisedheart level & leg raised..

REGULATON OF REGULATON OF ARTERIALARTERIAL

RAPIDLY ACTINGRAPIDLY ACTING

INTERMEDIATE ACTINGINTERMEDIATE ACTING

LONG TERM ACTINGLONG TERM ACTING

B.P

RAPIDLY ACTING RAPIDLY ACTING MECHANISMMECHANISM

Baroreceptor reflexBaroreceptor reflex

Chemoreceptor reflexChemoreceptor reflex

CNS ischeamic responseCNS ischeamic response

BARORECEPTOR REFLEXBARORECEPTOR REFLEX carotid body & aortic carotid body & aortic

archarchB.P impulse to tractus solitariusB.P impulse to tractus solitarius supress VMC&stimulate CICsupress VMC&stimulate CIC

vasodialatation rate and vasodialatation rate and force offorce of contraction contraction

PR COPR CO

LOCATION OF BARORECEPTORS

CHEMORECEPTOR CHEMORECEPTOR REFLEXREFLEX

CAROTID SINUS $ AORTIC CAROTID SINUS $ AORTIC BODYBODY

B.P tissue ischeamiaB.P tissue ischeamia

Po2 and Pco2 in chemoreceptorsPo2 and Pco2 in chemoreceptors

stimulation of VMCstimulation of VMC

B.PB.P

INTERMEDITE ACTINGINTERMEDITE ACTING

CAPILLARY FLUID SHIFT MECHANISMCAPILLARY FLUID SHIFT MECHANISM

STRESS RELAXATIONSTRESS RELAXATION

REVERSE STRESS RELAXATIONREVERSE STRESS RELAXATION

CAPILLARY FLUID CAPILLARY FLUID SHIFT MECHANISMSHIFT MECHANISM

STRESS RELAXATION STRESS RELAXATION MECHANISMMECHANISM

B.P in blood storage organs B.P in blood storage organs

vasodialatation B.P .vasodialatation B.P .

REVERSE STRESS REVERSE STRESS RELAXATIONRELAXATION

B.P vasoconstriction perfusion .B.P vasoconstriction perfusion .

LONGTERM REGULATIONLONGTERM REGULATION

Survey conducted among 120 Survey conducted among 120 inmates of ladies hostel of RDCinmates of ladies hostel of RDC

CONCLUSIONCONCLUSION