SlideShare ist ein Scribd-Unternehmen logo
1 von 27
Blood Pressure.
Dr. Debashis Priyadarshan Sahoo
PGT, First year
Department of General medicine
NEIGRIHMS
Definition:
• Arterial blood pressure can be defined as the lateral pressure exerted
by moving column of blood on the walls of arteries.
1. It ensures blood flow to various organs.
2. It has important role in gas and nutrient exchange across capillaries.
3. Required for formation of urine and lymph.
• Systolic blood pressure: maximum BP in the arteries attainable during
systole.
• Diastolic blood pressure: minimum blood pressure obtained at the end of
the ventricular diastole.
• Pulse pressure: difference between systolic and diastolic blood pressure.
• Mean arterial blood pressure: DBP+ 1/3 pulse pressure.
Recording of blood pressure:
2 methods: Direct method and Indirect method.
1. Direct method: Invasive method
2. Indirect methods: Palpatory method and Auscultatory method
Recommended blood pressure measuring
techniques :
• BP should be measured in sitting position and patient should sit for 5 minutes
before measurement. For elderly patients and eliciting postural hypotension,
supine position can be used.
• Length of bladder should be approximately 80% of total length and 40% of total
circumference of upper arm.
• In antecubital fossa brachial artery is palpated and stethoscope is put on that area
for Korotkoff sound.
• Wrap the cuff approximately 2.5inch above the antecubital fossa.
Instruments:
• Aneroid
sphigmomanometer
This Photo by Unknown Author is licensed under CC BY-SA
This Photo by Unknown Author is licensed under CC BY-SA
Methods:
• Palpatory method: Deflate the cuff fully, wrap the cuff around the arm, feel the radial pulse,
inflate the cuff until radial pulse disappears, inflate the cuff 30-40mm over and release the pressure
slowly till the pulse reappears. This is the systolic blood pressure. Diastolic blood pressure cannot
be measured by palpatory method.
• Auscultatory method: Keep the bell of stethoscope over brachial artery and inflate the cuff to a
level higher than the systolic blood pressure determined by palpatory method. Slowly deflate the
cuff and record the systolic and diastolic blood pressure for determining systolic and diastolic
blood pressure based on Korotkoff sound. 5 types of Korotkoff sounds are heard. Tapping
sound(Korotkoff 1) is SBP and No sound(Korotkoff 5) is DBP
Factors affecting blood pressure:
1. Cardiac output (CO= SV X PR)
2. Circulating blood volume (mainly affects systolic BP)
3. Elasticity of vessel wall
4. Viscosity of blood
Hypertension: (JNC 8)
• Average 2 or more readings are taken in each of 2 or more visits.
• Pre-hypertensive: risk of progression to hypertension is high.
• Hypertensive urgency: > 180/100 mm hg without target organ damage.
• Hypertensive emergency: > 180/100mm Hg with target organ damage.
• Malignant hypertension: > 200/130 with grade III or IV retinal
damage.
Grading of
hypertension:
STAGES SBP(MM
HG)
DBP(MM HG)
Normal <120 <80
Pre-hypertension 120-139 80-89
Stage 1
hypertension
140-159 90-99
Stage 2
hypertension
> 160 > 100
Etiology:
• Primary:
1. Environmental (multiple genes, DM, obesity and heart disease)
2. Genetic (DNA methylation is implicated in stress hypertension and pre-ecalmpsic hypertension)
• Secondary:
1. Renal: parenchymal and renovascular
2. Vascular: COA, Collagen vascular diseases
3. Endocrine: Conn’s syndrome, Cushing syndrome, pheochromocytoma, CAH, hyperthyroidism
4. Neurogenic: Tumor, ICT, GBS
5. Drugs: Ethanol, NSAIDS
6. Miscellaneous: PIH, OSA
Nonpharmacological therapies:
• Weight loss
• Stop alcoholism and smoking
• Reduce sodium intake
• Aerobic exercise
• Adequate intake of potassium, calcium and magnesium
• Reduce intake of saturated fat and cholesterol.
Lifestyle changes:
• Smoking Cessation
• Control blood glucose and lipids
• Diet Eat healthy (i.e., DASH diet)
• Moderate alcohol consumption
• Reduce sodium intake to no more than 2,400 mg/day
• Physical activity: Moderate-to-vigorous activity 3-4 days a week averaging
40 min per session.
Recommendation 1:
In age group > 60years:
1. Start drug treatment if BP > 150/90 mm Hg
2. Treatment goal of is < 150/90 mm Hg.
Recommendation 2:
In the general population <60 years:
1. Initiate pharmacologic treatment to lower BP at DBP > 90mmHg
2. Treatment goal DBP <90mmHg.
Recommendation 3:
In the general population <60 years:
1. Initiate pharmacologic treatment to lower BP at SBP>140mmHg
2. Treatment goal SBP <140mmHg.
Recommendation 4:
In the population aged >18 years with CKD:
1. Initiate treatment: SBP>140mm Hg and DBP>90mm Hg.
2. Treatment goal: SBP<140mmHg and DBP<90mmHg.
Recommendation 5:
In the population aged>18years with diabetes:
1. Initiate treatment: SBP>140mm Hg and DBP>90mm Hg.
2. Treatment goal: SBP<140mmHg and DBP<90mmHg.
Recommendation 6:
NON-BLACK – FIRST LINE :
In nonblack individuals including patients with diabetes, initial
antihypertensives recommended are:
1. Thiazide diuretics
2. Calcium channel blockers(CCB)
3. Angiotensin converting enzyme inhibitors(ACEI)
4. Angiotensin receptor blocker(ARB)
Recommendation 7:
BLACK – FIRST LINE :
In nonblack individuals including patients with diabetes, initial
antihypertensives recommended are:
1. Thiazide diuretics
2. Calcium channel blockers(CCB)
Recommendation 8:
CKD- FIRST LINE/ADD-ON:
In adults aged >18years with chronic kidney disease and hypertension,
preferred agents are ACEIs or ARBs.
Recommendation 9:
• Don’t combine ACEI and ARB.
• If BP goal is not reached within one month of treatment, increase the dose
of the drug or add 2nd drug. If not reached with 2 drugs, add and titrate a
third drug.
• If goal cannot be reached using only the drugs from class of thiazide, CCB,
ACEI or ARB, or there is any contraindication, or need of use of more than
3 drugs to reach goal, antihypertensives of other classes to be added.
Strategies to dose antihypertensives:
A. Start one drug, titrate to maximum dose, and then add a second drug.
B. Start one drug and then add a second drug before achieving maximum
dose of the initial drug.
C. Begin with 2 drugs at the same time, either as 2 separate pills or as a
single pill combination : when SBP>160mmHg and DBP: > 100mmHg or
if SBP is >20 mm Hg above goal and/or DBP is >10 mm Hg above goal.
Indications:
• HF: Beta blockers, ACEI, ARB, (CCB less indicated)
• Post MI: Beta blocker, ACEI, ARB.
• CAD risk: Beta blocker, ACEI, CCB
• DM: ACEI, ARB, CCB (BB less indicated)
• CKD: ACEI, ARB, CCB(BB less indicated)
• Recurrent stroke prevention: ACEI, Diuretics(BB less indicated)
Summary :
This Photo by Unknown Author is licensed under CC BY-NC-ND
Thank You..

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (19)

Hypertension ppt
Hypertension pptHypertension ppt
Hypertension ppt
 
Hypertension PDF
Hypertension PDF Hypertension PDF
Hypertension PDF
 
Hypertension
HypertensionHypertension
Hypertension
 
A case about Atherosclerosis
A case about AtherosclerosisA case about Atherosclerosis
A case about Atherosclerosis
 
Angina Pectoris
Angina PectorisAngina Pectoris
Angina Pectoris
 
Hypertension
HypertensionHypertension
Hypertension
 
Hypertention ppt
Hypertention pptHypertention ppt
Hypertention ppt
 
Hypertension
HypertensionHypertension
Hypertension
 
Hypertension
HypertensionHypertension
Hypertension
 
Heart failure
Heart failureHeart failure
Heart failure
 
Congestive heart failure
Congestive heart failure Congestive heart failure
Congestive heart failure
 
Hypertensive heart disease
Hypertensive heart diseaseHypertensive heart disease
Hypertensive heart disease
 
Essential Hypertension
Essential Hypertension Essential Hypertension
Essential Hypertension
 
Heart failure definition classification
Heart failure  definition classificationHeart failure  definition classification
Heart failure definition classification
 
Hypertension pathophysiology
Hypertension pathophysiologyHypertension pathophysiology
Hypertension pathophysiology
 
Hypertension - Causes Symptoms Diagnosis and Treatment
Hypertension - Causes Symptoms Diagnosis and TreatmentHypertension - Causes Symptoms Diagnosis and Treatment
Hypertension - Causes Symptoms Diagnosis and Treatment
 
CORONARY ARTERY DISEASE WITH HYPERTENSION
CORONARY ARTERY DISEASE WITH HYPERTENSIONCORONARY ARTERY DISEASE WITH HYPERTENSION
CORONARY ARTERY DISEASE WITH HYPERTENSION
 
Hypertension basics 2014
Hypertension basics 2014Hypertension basics 2014
Hypertension basics 2014
 
Hypertension
HypertensionHypertension
Hypertension
 

Ähnlich wie Blood pressure..

bloodpressure.ppt
bloodpressure.pptbloodpressure.ppt
bloodpressure.pptUmmedSingh17
 
Management of hypertension and treatment options
Management of hypertension and treatment optionsManagement of hypertension and treatment options
Management of hypertension and treatment optionsdrsanjayjain
 
Hypertension; Basics- Recommendations - Special Situations
Hypertension; Basics-  Recommendations - Special SituationsHypertension; Basics-  Recommendations - Special Situations
Hypertension; Basics- Recommendations - Special SituationsRajat Biswas
 
Hypertension jnc 8 guideline(1)
Hypertension jnc 8 guideline(1)Hypertension jnc 8 guideline(1)
Hypertension jnc 8 guideline(1)Dr.Chandan Kumar
 
M3 - Hypertension
M3 - HypertensionM3 - Hypertension
M3 - HypertensionBibul2
 
Hypertension Guidelines JNC 8
Hypertension Guidelines JNC 8Hypertension Guidelines JNC 8
Hypertension Guidelines JNC 8nik_sat
 
Guidelines for treatment of hypertension
Guidelines for treatment of  hypertensionGuidelines for treatment of  hypertension
Guidelines for treatment of hypertensionSanjay S
 
APPROACH TO HYPERTENSION.pptx
APPROACH TO HYPERTENSION.pptxAPPROACH TO HYPERTENSION.pptx
APPROACH TO HYPERTENSION.pptxAbhinav Tiwari
 
Management of hypertension (final)
Management of hypertension (final)Management of hypertension (final)
Management of hypertension (final)IJAZ HUSSAIN
 
HYPERTENSIVE NEPHROPATHY.pptx
HYPERTENSIVE NEPHROPATHY.pptxHYPERTENSIVE NEPHROPATHY.pptx
HYPERTENSIVE NEPHROPATHY.pptxMariaMahamed
 
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...thito6
 
ESC/ESH 2018
ESC/ESH 2018ESC/ESH 2018
ESC/ESH 2018desktoppc
 
Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...
Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...
Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...Vinh Pham Nguyen
 
Caso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaa
Caso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaaCaso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaa
Caso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaaBrunoHernndez16
 
Htn urgency and emg
Htn urgency and emgHtn urgency and emg
Htn urgency and emgSudhir Dev
 
Hypertension guidelines
Hypertension guidelinesHypertension guidelines
Hypertension guidelinesSachin Shende
 
HYPERTENSION IN ELDERY 2023.pptx
HYPERTENSION IN ELDERY 2023.pptxHYPERTENSION IN ELDERY 2023.pptx
HYPERTENSION IN ELDERY 2023.pptxpramodprasad31
 
JNC-8.ppt
JNC-8.pptJNC-8.ppt
JNC-8.pptdtettam1
 

Ähnlich wie Blood pressure.. (20)

bloodpressure.ppt
bloodpressure.pptbloodpressure.ppt
bloodpressure.ppt
 
Management of hypertension and treatment options
Management of hypertension and treatment optionsManagement of hypertension and treatment options
Management of hypertension and treatment options
 
Hypertension; Basics- Recommendations - Special Situations
Hypertension; Basics-  Recommendations - Special SituationsHypertension; Basics-  Recommendations - Special Situations
Hypertension; Basics- Recommendations - Special Situations
 
Hypertension jnc 8 guideline(1)
Hypertension jnc 8 guideline(1)Hypertension jnc 8 guideline(1)
Hypertension jnc 8 guideline(1)
 
M3 - Hypertension
M3 - HypertensionM3 - Hypertension
M3 - Hypertension
 
Hypertension Guidelines JNC 8
Hypertension Guidelines JNC 8Hypertension Guidelines JNC 8
Hypertension Guidelines JNC 8
 
Guidelines for treatment of hypertension
Guidelines for treatment of  hypertensionGuidelines for treatment of  hypertension
Guidelines for treatment of hypertension
 
APPROACH TO HYPERTENSION.pptx
APPROACH TO HYPERTENSION.pptxAPPROACH TO HYPERTENSION.pptx
APPROACH TO HYPERTENSION.pptx
 
Management of hypertension (final)
Management of hypertension (final)Management of hypertension (final)
Management of hypertension (final)
 
HYPERTENSIVE NEPHROPATHY.pptx
HYPERTENSIVE NEPHROPATHY.pptxHYPERTENSIVE NEPHROPATHY.pptx
HYPERTENSIVE NEPHROPATHY.pptx
 
htn.pptx
htn.pptxhtn.pptx
htn.pptx
 
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...
 
ESC/ESH 2018
ESC/ESH 2018ESC/ESH 2018
ESC/ESH 2018
 
Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...
Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...
Dieu tri-benh-tang-huyet-ap-va-chien-luoc-phoi-hop-thuoc-nham-dat-muc-tieu-di...
 
Caso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaa
Caso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaaCaso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaa
Caso clĂ­nico hasaaaaaaaaaaaaaaaaaaaaaaaaa
 
Htn urgency and emg
Htn urgency and emgHtn urgency and emg
Htn urgency and emg
 
Hypertension guidelines
Hypertension guidelinesHypertension guidelines
Hypertension guidelines
 
HYPERTENSION IN ELDERY 2023.pptx
HYPERTENSION IN ELDERY 2023.pptxHYPERTENSION IN ELDERY 2023.pptx
HYPERTENSION IN ELDERY 2023.pptx
 
Hypertension Management
Hypertension ManagementHypertension Management
Hypertension Management
 
JNC-8.ppt
JNC-8.pptJNC-8.ppt
JNC-8.ppt
 

KĂźrzlich hochgeladen

💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...gragneelam30
 
Shazia Iqbal 2024 - Bioorganic Chemistry.pdf
Shazia Iqbal 2024 - Bioorganic Chemistry.pdfShazia Iqbal 2024 - Bioorganic Chemistry.pdf
Shazia Iqbal 2024 - Bioorganic Chemistry.pdfTrustlife
 
👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...
👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...
👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...Sheetaleventcompany
 
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...Namrata Singh
 
Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...Sheetaleventcompany
 
Intramuscular & Intravenous Injection.pptx
Intramuscular & Intravenous Injection.pptxIntramuscular & Intravenous Injection.pptx
Intramuscular & Intravenous Injection.pptxsaranpratha12
 
Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...
Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...
Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...Sheetaleventcompany
 
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...Sheetaleventcompany
 
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...gragneelam30
 
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service AvailableCall Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service AvailableJanvi Singh
 
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...GENUINE ESCORT AGENCY
 
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...rajnisinghkjn
 
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...Sheetaleventcompany
 
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...Sheetaleventcompany
 
Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...
Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...
Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...Sheetaleventcompany
 
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxSwetaba Besh
 
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...Namrata Singh
 
Electrocardiogram (ECG) physiological basis .pdf
Electrocardiogram (ECG) physiological basis .pdfElectrocardiogram (ECG) physiological basis .pdf
Electrocardiogram (ECG) physiological basis .pdfMedicoseAcademics
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Sheetaleventcompany
 
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...dishamehta3332
 

KĂźrzlich hochgeladen (20)

💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
 
Shazia Iqbal 2024 - Bioorganic Chemistry.pdf
Shazia Iqbal 2024 - Bioorganic Chemistry.pdfShazia Iqbal 2024 - Bioorganic Chemistry.pdf
Shazia Iqbal 2024 - Bioorganic Chemistry.pdf
 
👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...
👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...
👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...
 
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
 
Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} ❤️VVIP ANJU Call Girls in Dehradun U...
 
Intramuscular & Intravenous Injection.pptx
Intramuscular & Intravenous Injection.pptxIntramuscular & Intravenous Injection.pptx
Intramuscular & Intravenous Injection.pptx
 
Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...
Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...
Call Girl In Indore 📞9235973566📞 Just📲 Call Inaaya Indore Call Girls Service ...
 
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
 
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
 
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service AvailableCall Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
 
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
 
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
 
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
 
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
 
Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...
Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...
Jaipur Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Jaipur No💰...
 
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
 
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
 
Electrocardiogram (ECG) physiological basis .pdf
Electrocardiogram (ECG) physiological basis .pdfElectrocardiogram (ECG) physiological basis .pdf
Electrocardiogram (ECG) physiological basis .pdf
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
 
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
 

Blood pressure..

  • 1. Blood Pressure. Dr. Debashis Priyadarshan Sahoo PGT, First year Department of General medicine NEIGRIHMS
  • 2. Definition: • Arterial blood pressure can be defined as the lateral pressure exerted by moving column of blood on the walls of arteries. 1. It ensures blood flow to various organs. 2. It has important role in gas and nutrient exchange across capillaries. 3. Required for formation of urine and lymph.
  • 3. • Systolic blood pressure: maximum BP in the arteries attainable during systole. • Diastolic blood pressure: minimum blood pressure obtained at the end of the ventricular diastole. • Pulse pressure: difference between systolic and diastolic blood pressure. • Mean arterial blood pressure: DBP+ 1/3 pulse pressure.
  • 4. Recording of blood pressure: 2 methods: Direct method and Indirect method. 1. Direct method: Invasive method 2. Indirect methods: Palpatory method and Auscultatory method
  • 5. Recommended blood pressure measuring techniques : • BP should be measured in sitting position and patient should sit for 5 minutes before measurement. For elderly patients and eliciting postural hypotension, supine position can be used. • Length of bladder should be approximately 80% of total length and 40% of total circumference of upper arm. • In antecubital fossa brachial artery is palpated and stethoscope is put on that area for Korotkoff sound. • Wrap the cuff approximately 2.5inch above the antecubital fossa.
  • 6.
  • 7. Instruments: • Aneroid sphigmomanometer This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-SA
  • 8. Methods: • Palpatory method: Deflate the cuff fully, wrap the cuff around the arm, feel the radial pulse, inflate the cuff until radial pulse disappears, inflate the cuff 30-40mm over and release the pressure slowly till the pulse reappears. This is the systolic blood pressure. Diastolic blood pressure cannot be measured by palpatory method. • Auscultatory method: Keep the bell of stethoscope over brachial artery and inflate the cuff to a level higher than the systolic blood pressure determined by palpatory method. Slowly deflate the cuff and record the systolic and diastolic blood pressure for determining systolic and diastolic blood pressure based on Korotkoff sound. 5 types of Korotkoff sounds are heard. Tapping sound(Korotkoff 1) is SBP and No sound(Korotkoff 5) is DBP
  • 9. Factors affecting blood pressure: 1. Cardiac output (CO= SV X PR) 2. Circulating blood volume (mainly affects systolic BP) 3. Elasticity of vessel wall 4. Viscosity of blood
  • 10. Hypertension: (JNC 8) • Average 2 or more readings are taken in each of 2 or more visits. • Pre-hypertensive: risk of progression to hypertension is high. • Hypertensive urgency: > 180/100 mm hg without target organ damage. • Hypertensive emergency: > 180/100mm Hg with target organ damage. • Malignant hypertension: > 200/130 with grade III or IV retinal damage.
  • 11. Grading of hypertension: STAGES SBP(MM HG) DBP(MM HG) Normal <120 <80 Pre-hypertension 120-139 80-89 Stage 1 hypertension 140-159 90-99 Stage 2 hypertension > 160 > 100
  • 12. Etiology: • Primary: 1. Environmental (multiple genes, DM, obesity and heart disease) 2. Genetic (DNA methylation is implicated in stress hypertension and pre-ecalmpsic hypertension) • Secondary: 1. Renal: parenchymal and renovascular 2. Vascular: COA, Collagen vascular diseases 3. Endocrine: Conn’s syndrome, Cushing syndrome, pheochromocytoma, CAH, hyperthyroidism 4. Neurogenic: Tumor, ICT, GBS 5. Drugs: Ethanol, NSAIDS 6. Miscellaneous: PIH, OSA
  • 13. Nonpharmacological therapies: • Weight loss • Stop alcoholism and smoking • Reduce sodium intake • Aerobic exercise • Adequate intake of potassium, calcium and magnesium • Reduce intake of saturated fat and cholesterol.
  • 14. Lifestyle changes: • Smoking Cessation • Control blood glucose and lipids • Diet Eat healthy (i.e., DASH diet) • Moderate alcohol consumption • Reduce sodium intake to no more than 2,400 mg/day • Physical activity: Moderate-to-vigorous activity 3-4 days a week averaging 40 min per session.
  • 15. Recommendation 1: In age group > 60years: 1. Start drug treatment if BP > 150/90 mm Hg 2. Treatment goal of is < 150/90 mm Hg.
  • 16. Recommendation 2: In the general population <60 years: 1. Initiate pharmacologic treatment to lower BP at DBP > 90mmHg 2. Treatment goal DBP <90mmHg.
  • 17. Recommendation 3: In the general population <60 years: 1. Initiate pharmacologic treatment to lower BP at SBP>140mmHg 2. Treatment goal SBP <140mmHg.
  • 18. Recommendation 4: In the population aged >18 years with CKD: 1. Initiate treatment: SBP>140mm Hg and DBP>90mm Hg. 2. Treatment goal: SBP<140mmHg and DBP<90mmHg.
  • 19. Recommendation 5: In the population aged>18years with diabetes: 1. Initiate treatment: SBP>140mm Hg and DBP>90mm Hg. 2. Treatment goal: SBP<140mmHg and DBP<90mmHg.
  • 20. Recommendation 6: NON-BLACK – FIRST LINE : In nonblack individuals including patients with diabetes, initial antihypertensives recommended are: 1. Thiazide diuretics 2. Calcium channel blockers(CCB) 3. Angiotensin converting enzyme inhibitors(ACEI) 4. Angiotensin receptor blocker(ARB)
  • 21. Recommendation 7: BLACK – FIRST LINE : In nonblack individuals including patients with diabetes, initial antihypertensives recommended are: 1. Thiazide diuretics 2. Calcium channel blockers(CCB)
  • 22. Recommendation 8: CKD- FIRST LINE/ADD-ON: In adults aged >18years with chronic kidney disease and hypertension, preferred agents are ACEIs or ARBs.
  • 23. Recommendation 9: • Don’t combine ACEI and ARB. • If BP goal is not reached within one month of treatment, increase the dose of the drug or add 2nd drug. If not reached with 2 drugs, add and titrate a third drug. • If goal cannot be reached using only the drugs from class of thiazide, CCB, ACEI or ARB, or there is any contraindication, or need of use of more than 3 drugs to reach goal, antihypertensives of other classes to be added.
  • 24. Strategies to dose antihypertensives: A. Start one drug, titrate to maximum dose, and then add a second drug. B. Start one drug and then add a second drug before achieving maximum dose of the initial drug. C. Begin with 2 drugs at the same time, either as 2 separate pills or as a single pill combination : when SBP>160mmHg and DBP: > 100mmHg or if SBP is >20 mm Hg above goal and/or DBP is >10 mm Hg above goal.
  • 25. Indications: • HF: Beta blockers, ACEI, ARB, (CCB less indicated) • Post MI: Beta blocker, ACEI, ARB. • CAD risk: Beta blocker, ACEI, CCB • DM: ACEI, ARB, CCB (BB less indicated) • CKD: ACEI, ARB, CCB(BB less indicated) • Recurrent stroke prevention: ACEI, Diuretics(BB less indicated)
  • 26. Summary : This Photo by Unknown Author is licensed under CC BY-NC-ND