Normal blood pressure is defined as a systolic BP between 100 and 120 mm Hg and a diastolic BP below 80 mm Hg (in adults over age 18). Prehypertension is present when measured blood pressures are between 120 and 140 mm Hg systolic or between 80 and 90 mm Hg diastolic. When either the systolic pressure exceeds 140 mm Hg or the diastolic exceeds 90 mm Hg, and these values are confirmed on two additional visits, stage I hypertension (high blood pressure) is present. See: illustration

Low blood pressure is sometimes present in healthy individuals, but it indicates shock in patients with fever, active bleeding, allergic reactions, active heart disease, spinal cord injuries, or trauma. Blood pressure should be checked routinely whenever a patient sees a health care provider because controlling abnormally high blood pressure effectively prevents damage to the heart and circulatory system as well as the kidneys, retina, brain, and other organs.

Patient care

Elevated blood pressures should first be addressed by giving advice to patients about lifestyle modifications, such as limiting the intake of alcohol, following a diet approved by the American Heart Association, and increasing the level of physical exercise. Weight loss in obese patients is also advisable. Medications are added to lifestyle instructions most of the time. Antihypertensive medications are used according to evidence-based guidelines and the side effects these drugs may cause in particular patients. Diuretics, for example, are esp. helpful in blacks and elderly patients (but may be inadvisable in patients with gout); beta blockers are the drugs of choice in patients with a history of myocardial infarction (but would be contraindicated in patients with advanced heart block); alpha blockers are well suited for men with prostatic hypertrophy; and angiotensin-converting enzyme inhibitors prevent kidney disease in patients with diabetes mellitus. Other antihypertensive drug classes include the angiotensin II receptor antagonists, centrally active alpha antagonists, and calcium channel blockers. Low blood pressure is not treated in healthy patients; in patients with acute illnesses, it is often corrected with hydration or pressor agents.

Palpation method: The same arm, usually the right, should be used each time the pressure is measured. The arm should be raised to heart level if the patient is sitting, or kept parallel to the body if the patient is recumbent. The patient's arm should be relaxed and supported in a resting position. Exertion during the examination could result in a higher blood pressure reading. Either a mercury-gravity or aneroid-manometer type of blood pressure apparatus may be used. The blood compression cuff should be the width and length appropriate for the size of the subject's arm: narrow (2.5 to 6 cm) for infants and children and wide (13 cm) for adults. The inflatable bag encased in the cuff should be 20% wider than one third the circumference of the limb used. The deflated cuff is placed evenly and snugly around the upper arm so that its lower edge is about 1 in above the point of the brachial artery where the bell of the electronic sensor will be applied. While feeling the radial pulse, inflate the cuff until the pressure is about 30 mm above the point where the radial pulse was no longer felt. Deflate the cuff slowly and record as accurately as possible the pressure at which the pulse returns to the radial artery. Systolic blood pressure is determined by this method; diastolic blood pressure cannot be determined by this method.

This method is used for both continuous and intermittent readings, and while it formerly was used primarily in ICUs, it now is used routinely by nursing assistants on units throughout health care agencies and in clinics and physicians' offices. Measuring blood pressure at the wrist is more comfortable than a conventional BP cuff because it derives readings without pumping a bladder full of air, and with accuracy rivaling direct measurement from an arterial catheter. The sensor is placed directly over the radial artery and connected to an electronic monitor. Pressure is monitored every 15 heartbeats and systolic, diastolic, mean arterial pressure, waveforms, and pulse rate are displayed. The first reading appears in 15 seconds, and the sensor measures pressures from 40 to 240 mm Hg, with preset alarms to alert the nurse to extreme highs and lows. Results are not affected by low cardiac output, arrhythmias, hypothermia, or obesity, and this method is being used increasingly on adults in hospital special care units where frequent serial readings are required.

Auscultatory method: Begin as above. After inflating the cuff until the pressure is about 30 mm above the point where the radial pulse disappears, place the bell of the stethoscope over the brachial artery just below the blood pressure cuff. Then deflate the cuff slowly, about 2 to 3 mm Hg per heartbeat. The first sound heard from the artery is recorded as the systolic pressure. The point at which sounds are no longer heard is recorded as the diastolic pressure. For convenience the blood pressure is recorded as figures separated by a slash. The systolic value is recorded first.

Sounds heard over the brachial artery change in quality at some point prior to the point the sounds disappear. Some physicians consider this the diastolic pressure. This value should be noted when recording the blood pressure by placing it between the systolic pressure and the pressure noted when the sound disappears. Thus, 120/90/80 indicates a systolic pressure of 120 with a first diastolic sound change at a pressure of 90 and a final diastolic pressure of 80. The latter pressure is the point of disappearance of all sounds from the artery. When the values are so recorded, the physician may use either of the last two figures as the diastolic pressure. When the change in sound and the disappearance of all sound coincide, the result should be written as follows: 120/80/80.

Normal blood pressure is defined as a systolic BP between 100 and 120 mm Hg and a diastolic BP below 80 mm Hg (in adults over age 18). Prehypertension is present when measured blood pressures are between 120 and 140 mm Hg systolic or between 80 and 90 mm Hg diastolic. When either the systolic pressure exceeds 140 mm Hg or the diastolic exceeds 90 mm Hg, and these values are confirmed on two additional visits, stage I hypertension (high blood pressure) is present. See: illustration

Low blood pressure is sometimes present in healthy individuals, but it indicates shock in patients with fever, active bleeding, allergic reactions, active heart disease, spinal cord injuries, or trauma. Blood pressure should be checked routinely whenever a patient sees a health care provider because controlling abnormally high blood pressure effectively prevents damage to the heart and circulatory system as well as the kidneys, retina, brain, and other organs.

Patient care

Elevated blood pressures should first be addressed by giving advice to patients about lifestyle modifications, such as limiting the intake of alcohol, following a diet approved by the American Heart Association, and increasing the level of physical exercise. Weight loss in obese patients is also advisable. Medications are added to lifestyle instructions most of the time. Antihypertensive medications are used according to evidence-based guidelines and the side effects these drugs may cause in particular patients. Diuretics, for example, are esp. helpful in blacks and elderly patients (but may be inadvisable in patients with gout); beta blockers are the drugs of choice in patients with a history of myocardial infarction (but would be contraindicated in patients with advanced heart block); alpha blockers are well suited for men with prostatic hypertrophy; and angiotensin-converting enzyme inhibitors prevent kidney disease in patients with diabetes mellitus. Other antihypertensive drug classes include the angiotensin II receptor antagonists, centrally active alpha antagonists, and calcium channel blockers. Low blood pressure is not treated in healthy patients; in patients with acute illnesses, it is often corrected with hydration or pressor agents.

Palpation method: The same arm, usually the right, should be used each time the pressure is measured. The arm should be raised to heart level if the patient is sitting, or kept parallel to the body if the patient is recumbent. The patient's arm should be relaxed and supported in a resting position. Exertion during the examination could result in a higher blood pressure reading. Either a mercury-gravity or aneroid-manometer type of blood pressure apparatus may be used. The blood compression cuff should be the width and length appropriate for the size of the subject's arm: narrow (2.5 to 6 cm) for infants and children and wide (13 cm) for adults. The inflatable bag encased in the cuff should be 20% wider than one third the circumference of the limb used. The deflated cuff is placed evenly and snugly around the upper arm so that its lower edge is about 1 in above the point of the brachial artery where the bell of the electronic sensor will be applied. While feeling the radial pulse, inflate the cuff until the pressure is about 30 mm above the point where the radial pulse was no longer felt. Deflate the cuff slowly and record as accurately as possible the pressure at which the pulse returns to the radial artery. Systolic blood pressure is determined by this method; diastolic blood pressure cannot be determined by this method.

This method is used for both continuous and intermittent readings, and while it formerly was used primarily in ICUs, it now is used routinely by nursing assistants on units throughout health care agencies and in clinics and physicians' offices. Measuring blood pressure at the wrist is more comfortable than a conventional BP cuff because it derives readings without pumping a bladder full of air, and with accuracy rivaling direct measurement from an arterial catheter. The sensor is placed directly over the radial artery and connected to an electronic monitor. Pressure is monitored every 15 heartbeats and systolic, diastolic, mean arterial pressure, waveforms, and pulse rate are displayed. The first reading appears in 15 seconds, and the sensor measures pressures from 40 to 240 mm Hg, with preset alarms to alert the nurse to extreme highs and lows. Results are not affected by low cardiac output, arrhythmias, hypothermia, or obesity, and this method is being used increasingly on adults in hospital special care units where frequent serial readings are required.

Auscultatory method: Begin as above. After inflating the cuff until the pressure is about 30 mm above the point where the radial pulse disappears, place the bell of the stethoscope over the brachial artery just below the blood pressure cuff. Then deflate the cuff slowly, about 2 to 3 mm Hg per heartbeat. The first sound heard from the artery is recorded as the systolic pressure. The point at which sounds are no longer heard is recorded as the diastolic pressure. For convenience the blood pressure is recorded as figures separated by a slash. The systolic value is recorded first.

Sounds heard over the brachial artery change in quality at some point prior to the point the sounds disappear. Some physicians consider this the diastolic pressure. This value should be noted when recording the blood pressure by placing it between the systolic pressure and the pressure noted when the sound disappears. Thus, 120/90/80 indicates a systolic pressure of 120 with a first diastolic sound change at a pressure of 90 and a final diastolic pressure of 80. The latter pressure is the point of disappearance of all sounds from the artery. When the values are so recorded, the physician may use either of the last two figures as the diastolic pressure. When the change in sound and the disappearance of all sound coincide, the result should be written as follows: 120/80/80.