Things to note when measuring blood pressure

With the rapid development of human society's economy, people's lives are getting better and better in today's society. And because of this, many cardiovascular and cerebrovascular diseases began to occur frequently in people. Especially in recent decades, the number of people suffering from blood pressure diseases has increased sharply, and both high blood pressure and low blood pressure are endangering people's health. Therefore, people began to pay close attention to the blood pressure status of the human body. No matter what type of illness people go to the hospital for, there is often a part where blood pressure is measured.

Measuring blood pressure seems to be a very normal and simple thing to people. Sometimes people even think that these things can be done even by people who have not received special education. But is this really the case? Is measuring blood pressure really that simple?

Notes on measuring blood pressure

Daily blood pressure measurement is the main means of diagnosing, treating, evaluating the severity and classification of hypertension. In clinical practice, an indirect measurement method is usually used, that is, blood pressure is measured at the brachial artery in the upper arm. The mercury sphygmomanometer is always regarded as the gold standard for clinical blood pressure measurement. The standard measurement position is the upper arm, and the standard body position is sitting. Now some precautions are proposed.

1. Avoid measuring blood pressure too high - when the peripheral arteries become very stiff due to severe atherosclerosis, the cuff must have a higher pressure to compress it. If the pressure is not enough, the measured blood pressure will be high. This may result in the patient overdosing on antihypertensive drugs and causing postural hypotension or other adverse reactions.

2. Correctly judge diastolic blood pressure - For pregnant women, patients with arteriovenous fistula, patients with aortic valve insufficiency, and elderly patients with large pulse pressure gradient and target organ damage, when Korotkoff sounds phase 5 are difficult to disappear for a while, Korotkoff sounds phase 4 should be regarded as DBP.

3. Pay attention to the supine blood pressure measured by the nurse - the SBP and DBP of healthy people and hypertensive patients are higher when they are supine than when they are sitting, and the increase in SBP is more significant, and the blood pressure in the left upper limb is higher than that in the right upper limb. This phenomenon is more prominent in patients with hypertension and should be noted. It is necessary to record on the nursing homepage whether the measurement is the left or right upper limb. Especially when measuring the blood pressure of the right upper limb of patients in shock in the supine position, the blood pressure measured by nurses during clinical operations should be analyzed more. In addition, the blood pressure of the elderly, obese people, people with short stature, women and people with low blood pressure when sitting are more easily affected, so the blood pressure of the above groups should be regularly measured and cared for in sitting and supine positions. Because prolonged increase in blood pressure in the supine position can also cause target organ damage.

4. Be alert to the unreliability of blood pressure when the radial artery pulse disappears - aortic arch syndrome, also known as pulselessness, is caused by stenosis or occlusion of the brachiocephalic blood vessels, which causes the radial artery pulse to weaken or disappear. The most common causes are Takayasu arteritis, atherosclerosis, Raynaud's disease, and diabetes. In the above cases, the popliteal artery and tibial artery of the lower limbs that are not stenotic or occluded can be measured for analysis.

5. Pay attention to changes in blood pressure during arrhythmia - when the heart rate is very irregular, the stroke volume and blood pressure of each heartbeat can vary greatly. You should measure it several times and take the average value. For example, when there is atrial fibrillation, 2 to 24 hours of dynamic observation can provide data similar to those of people with normal heart rate; when there is severe bradycardia (heart rate <47 beats/minute), deflation should be slower than usual to avoid underestimation of SBP and overestimation of DBP. In view of the consequences of inaccurate measurement, including the risks of overtreatment and undertreatment, it is recommended to strengthen the training of clinical medical staff responsible for clinical observation and analysis of blood pressure and record the measurement site in the medical record.

Key points for blood pressure measurement

1. The person being measured should sit comfortably with his/her back resting, not talking, with his/her upper arms exposed or with only shirt sleeves left, no clothes rolled up, legs not crossed, and five fingers relaxed and straight.

2. The lower end of the cuff should be 2 to 3 cm above the antecubital fossa, and the bell-shaped head of the stethoscope should be placed on the brachial artery that can be palpated in the antecubital fossa. The middle of the cuff should be at the level of the right atrium (midpoint of the sternum).

3. The cuff should wrap around at least 80% of the circumference of the upper arm. If it is <80% (the upper arm is thicker), the radial artery blood pressure can be measured. Similarly, the lower end of the cuff should be 2 to 3 cm above the radial artery pulse, and the bell-shaped head of the stethoscope should be placed on the palpable radial artery pulse.

4. When starting to measure, the cuff should be inflated to a level at least 30 mmHg above the point where the radial artery pulse disappears. When deflated, the mercury column should drop by 2 to 3 mmHg per second.

5. The first (Korotkoff phase 1) and last (Korotkoff phase 5) sounds heard should be considered as SBP and DBP. The blood pressure should be measured on both upper arms for comparison first.

Through such a long introduction to the precautions for measuring blood pressure above, people can know that measuring blood pressure is not as simple and easy as people think. There are many things in life, like measuring blood pressure, that people always think are very easy. In fact, they are not that simple, so people should practice everything to truly understand it.