blood pressure

1. BLOOD
PRESSUR
E

2. BLOOD BLOOD
PRESSUREPRESSURE
Dr shabeel pnDr shabeel pn

3. DEFINITIONDEFINITION
Blood pressure isBlood pressure is defined defined
as the lateral pressure exerted by as the lateral pressure exerted by
flowing blood on the walls of the flowing blood on the walls of the
arteriesarteries..

4. 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

5. 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

6. CARDIAC CYCLECARDIAC CYCLE
Systole
- .3sec
Diastole
- .5sec
Total - .8 sec

7. 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

8. MEASUREMENT OF BPMEASUREMENT OF BP
DIRECT METHODDIRECT METHOD
INDIRECT METHODINDIRECT METHOD
Palpatory methodPalpatory method
Auscultatory methodAuscultatory method

9. DIRECT METHODDIRECT METHOD

10. INDIRECT INDIRECT
METHODMETHOD

11. INSTRUMENTSINSTRUMENTS

12. SPHYGMOMANOMETSPHYGMOMANOMET
ERER

13. ANEROID ANEROID
BAROMETERBAROMETER

14. AUTOMATIC AUTOMATIC
INFLATION CUPINFLATION CUP

15. PROCEDUREPROCEDURE

16. KOROTKOFF’S KOROTKOFF’S
SOUNDSSOUNDS
Dissappears V
RestMuffled IV
5 mmHgGong sound III
20 mmHgMurmer II
10 mmHgTapping
sound
I
DURATIONNATURE OF
SOUND
PHASE

17. PALPATORY PALPATORY
METHODMETHOD

18. 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.

19. AUSCULTATORY GAPAUSCULTATORY GAP

A gap present after A gap present after
tapping soundtapping sound
Seen in hypertensive patientsSeen in hypertensive patients..

20. VARIATIONSVARIATIONS
PHYSIOLOGICALPHYSIOLOGICAL
PATHOLOGICALPATHOLOGICAL

21. PHYSIOLOGICALPHYSIOLOGICAL
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 effect
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]

22.  MEAL: MEAL:
B.P After a meal Due B.P After a meal Due
to in blood volumeto in blood volume
SLEEPSLEEP::
Less due to generalLess due to general
vasodialatation.vasodialatation.
77EMOTIONS:EMOTIONS:
Rage, anxiety, panic e.t.cRage, anxiety, panic e.t.c
production of adrenaline production of adrenaline

B.PB.P

23. 7. 7. ExerciseExercise
Moderate exerciseModerate exercise
Systolic B.P upto Systolic B.P upto
20-30 mmHg.20-30 mmHg.
Diastolic B.P unaltered.Diastolic B.P unaltered.
SevereSevere exerciseexercise
Systolic B.P upto Systolic B.P upto
40-50 mmHg40-50 mmHg
Diastolic B.PDiastolic B.P

24. 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 gravitational
effect effect
.77mmHg/cm..77mmHg/cm.

..

25. PATHOLOGICALPATHOLOGICAL
1.1.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 – 120-139/80-90mmHg
Stage I Hypertension-140-159/90-99Stage I Hypertension-140-159/90-99
mmHgmmHg
Stage II Hypertension->/160/100mmHgStage II Hypertension->/160/100mmHg

26. 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

27. COMPLICATIONS OF COMPLICATIONS OF
HYPERTENSIONHYPERTENSION
Renal failureRenal failure
LVHLVH
MIMI
Cerebral Cerebral
haemorrhagehaemorrhage
Retinal Retinal
haemorrhagehaemorrhage

28. COMPLICATIONS OF COMPLICATIONS OF
UNCONTROLLED HYPERTENTION UNCONTROLLED HYPERTENTION
DURING SURGERYDURING SURGERY
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.

29. PRE-OPERATIVE PRE-OPERATIVE
INVESTIGATIONINVESTIGATION
Chest x-rayChest x-ray
ECGECG
USG of kidneyUSG of kidney
Ophthalmic evaluation for retinal Ophthalmic evaluation for retinal
haemorrhagehaemorrhage
RFTRFT

30. MANAGEMENT OF MANAGEMENT OF
HYPERTENSIONHYPERTENSION
Non drug therapyNon drug therapy
Stop smokingStop smoking
Control obesityControl obesity
Regular exerciseRegular exercise
Decrease salt intakeDecrease salt intake
Drug therapyDrug therapy
Beta blockersBeta blockers
Calcium channel Calcium channel
blockersblockers
VasodialatorsVasodialators
DiureticsDiuretics
ACE inhibitorsACE inhibitors
VMC depressorsVMC depressors

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

32. During surgical proceduresDuring surgical procedures::
B.P should be monitored and B.P should be monitored and
controlled before,during and after controlled before,during and after
treatment.treatment.
Antihypertensives should be Antihypertensives should be
continued.continued.
LA solution without adrenaline or LA solution without adrenaline or
bupivacaine should be given.bupivacaine should be given.

33. 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

34. 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..

35. REGULATON OF REGULATON OF
ARTERIALARTERIAL
RAPIDLY ACTINGRAPIDLY ACTING
INTERMEDIATE ACTINGINTERMEDIATE ACTING
LONG TERM ACTINGLONG TERM ACTING
B.P

36. RAPIDLY ACTING RAPIDLY ACTING
MECHANISMMECHANISM
Baroreceptor reflexBaroreceptor reflex
Chemoreceptor reflexChemoreceptor reflex
CNS ischeamic responseCNS ischeamic response

37. BARORECEPTOR REFLEXBARORECEPTOR REFLEX
carotid body & aortic arch carotid body & aortic arch
B.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

38. LOCATION OF
BARORECEPTORS

39. CHEMORECEPTOR REFLEXCHEMORECEPTOR REFLEX
CAROTID SINUS $ AORTIC BODYCAROTID SINUS $ AORTIC BODY
B.P tissue ischeamiaB.P tissue ischeamia
Po2 and Pco2 in chemoreceptorsPo2 and Pco2 in chemoreceptors
stimulation of VMCstimulation of VMC
B.PB.P

40. INTERMEDITE ACTINGINTERMEDITE ACTING
CAPILLARY FLUID SHIFT MECHANISMCAPILLARY FLUID SHIFT MECHANISM
STRESS RELAXATIONSTRESS RELAXATION
REVERSE STRESS RELAXATIONREVERSE STRESS RELAXATION

41. CAPILLARY FLUID CAPILLARY FLUID
SHIFT MECHANISMSHIFT MECHANISM

42. 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 .

43. LONGTERM REGULATIONLONGTERM REGULATION

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

45. CONCLUSIONCONCLUSION