3 - Blood Pressure

What should prompt you to make blood pressure a staple in your entrance testing?

• HTN

• Renal conditions

• CVD

• Obesity

• Physical inactivity

• Heavy alcohol intake

• Smoking

• Family history of: HTN or CVD

According to The American Heart Association (AHA), how prevalent is high blood pressure (HBP) among American adults?

Nearly 50% American adults have ↑BP (many don’t know they have it)

Define systolic BP. What does it correlate to?

→ blood is pumped out of the heart and into the arteries to enter the peripheral circulation

• max BP

• correlates to heart’s pumping efficiency + elasticity of arterial walls

Define diastolic BP. What does it correlate to?

→ occurs when the ventricles are relaxed & filling with blood

• correlates to PVR

What is the primary way HBP causes harm to the arteries and heart?

↑ workload of heart and blood vessels & forcing them to work less efficiently

How does HBP lead to the start of atherosclerosis?

1. Force and friction of ↑BP damages the delicate tissues inside the arteries

2. LDL (bad) cholesterol forms plaque along tiny tears in the artery walls

How does plaque buildup exacerbate hypertension?

↑ plaque + damage → narrow artery diameter → ↑ BP 

• this can further lead to arrhythmia or heart attack

What is Primary Hypertension caused by? How prevalent is it?

Cause: none

• can be familial (involving environmental & genetic factors)

-make up 90–95% of HTN cases

• ↑ prevalance w/ age

What is Secondary Hypertension caused by? How prevalent is it?

Cause: conditions affecting the kidneys, arteries, heart, or endocrine system OR may occur during pregnancy

• occurs as a result of a pre-existing condition

• makes up 5–10% of HTN cases

What are the typical symptoms of hypertension?

Asymptomatic

Note: Symptoms occur when it’s too late (Stage 4 HTN)

What are the symptoms associated with Acute ER cases of hypertension (>180/120mmHg)?

• Headaches (suboccipital pulsating headaches during early AM)

• Confusion

• Visual disturbance

• Nausea

• Vomiting

List non-pathological sources of elevated BP.

• Anger

• Stress/Anxiety

• Weight gain

• BP increases during exercise

• BP increases after meals/caffeine

• White coat reaction

List the systemic conditions (ROS) reported by a patient in their case history, which indicate the need to take their blood pressure.

• HTN

• Hyperlipidemia

• CAD

• Carotid artery disease

• Congestive heart failure

• Renal failure

• DM

• MI

• Stroke

What information must be recorded when measuring BP?

• Systolic and Diastolic measurement in mmHg

• Right or Left arm

• Patient’s position

• Time

• Cuff Size

Draw the table showing the BP categories, with their corresponding Systolic and Diastolic BP.

List the most common errors when measuring BP.

• Using the wrong size cuff

• Using an incorrect arm position

• Wrong diaphragm placement 

• Not setting stethoscope to the ‘on’ position

• Releasing air too quickly/slowly

When do you do the Carotid Artery assessment?

When patient reports transient vision loss (“amaurosis fugax”)

Define Amaurosis fugax.

→  sudden vision loss in one eye that feels like a “curtain coming down over the vision”

• lasts more than 1 min

• painless

Amaurosis fugax, combined with which systemic factors (ROS), indicates a higher risk of Carotid Artery Disease?

• HTN

• Hyperlipidemia

• DM

• CAD

• Stroke

• Smoking

What does the assessment of the carotid arteries include?

Listening for a systolic bruit

What is a bruit?

→ “whoosh" sound

• sound of turbulence in blood flow when the normal laminar flow is disrupted by the narrowing (stenosis) of the artery

If a bruit is audible, what % of patients have been shown to have significant stenosis on angiography?

77%

What is the order where the stethescope is placed intially and then repositioned?

1. Common carotid artery (approximately 2.5 cm above the clavicle bone)

2. Bifurcation of the common carotid

3. Internal carotid artery

What are the Most Common Errors in Carotid Artery Assessment?

1. Not being an experienced practitioner

2. Using too much pressure holding the bell → this can cause a bruit to be heard when there’s isn’t actually one present

Why is palpating the carotid arteries generally discouraged for non-experienced practitioners?

can dislodge a plaque → stroke