BP Picture

Mean BP by age and sex are given in table E and figure 2. These show a tend- ency for systolic BP to rise with age over the age range 18-79 years, while diastolic BP rise until age 45-54 years for men and age 55-64 years for women, after which they decline. At younger ages BP are higher for men than for women; at older ages this is reversed.

With increasing age there is a tendency for the distribution of BP to be dis- placed toward higher values. Con- currently, the relationship between systolic and diastolic BP is altered. Distributions of systolic and diastolic BP Picture are given in tables 1-17 for each age-sex group. Many of the numbers presented in these tables have high sam- pling variability, but when considered overall, they present a consistent picture of the relation be- tween systolic and diastolic pressures, Estimating techniques and reliability are discussed in Ap- pendix II.

Differences in mean values, of course, are only part of the story. The mean BP for adults aged 18-79 years were 130.9 systolic and 78.7 diastolic. However, 16 percent had BP below both 120 systolic and 70 diastolic, while the same percentage had either a systolic pressure of at least 160 or a diastolic pressure of at least 95. For young men aged 18-24 years the proportions were much greater at the lower end of the scale and smaller at the upper end: 26 percent had BP below 120/70 while only about 2 percent were as high as 160 systolic or 95 diastolic. For women 75-79 years of age the distribution was reversed, 2 percent with BP less than 120/70 and 46 percent with at least 160 systolic or 95 diastolic.

Effects of Sex on BP Picture

Sex can have an influence on bp, although it is just one of many factors that can affect an individual's bp. Bp Picture is the force of blood against the walls of the arteries as the heart pumps it around the body. It is typically measured in millimeters of mercury (mm Hg) and is expressed as two numbers:

systolic pressure over diastolic pressure (e.g., 120/80 mm Hg).

Here are some ways in which sex can impact bp:

Baseline Differences: On average, men tend to have slightly higher bp than women of the same age. This difference typically becomes more noticeable after the age of 50.
Hormonal Differences: Hormones, such as estrogen and testosterone, can influence bp. For example, estrogen has a vasodilatory (blood vessel relaxing) effect, which can help lower bp. This is one reason why women often have lower bp than men before menopause. After menopause, when estrogen levels decline, women's bp may start to rise and become more similar to men's.
Risk Factors: Men and women may have different risk factors for high bp. For example, obesity, smoking, and excessive alcohol consumption are risk factors for both sexes, but the impact of these factors on bp can vary between men and women.
Age: Bp tends to increase with age in both men and women, but the rate of increase may differ. Women often experience an accelerated rise in bp after menopause.
Response to Medications: Some bp Picture medications may have different effects in men and women. Healthcare providers may need to adjust the type or dosage of medication based on a person's sex.

It's important to note that while these sex-related differences in bp exist on average, there is considerable individual variation. Many other factors, including genetics, lifestyle, diet, and overall health, play significant roles in determining a person's bp.

BP Picture

Maintaining a healthy lifestyle, which includes eating a balanced diet, regular exercise, managing stress, limiting alcohol intake, and avoiding smoking, is crucial for controlling bp regardless of one's sex. Individuals with hypertension (high bp) should work closely with their healthcare providers to develop a personalized treatment plan that takes into account their unique circumstances.

High BP is known as Hypertension in medical community- it is one of the most important silent killers. Presently it is estimated that India has 5 crore patients suffering from Hypertension. An increase of bp from 120/80 mmHg to 150/100 mmHg can reduce our lifespan by 11.5 years. High bp is also known to increase risks of paralysis(Stroke) by 20 percent and coronary heart disease(blockage in the arteries of heart) by 15 percent.

There are many causes of HT. It may be caused by overweight, wrong food habits (especially high salt diet, low intake of potassium and calcium and high fat diet), stress or psychosocial factors, lack of physical activity and so on. Smoking and high bp if combined together, increase the chances of heart attack much more. But it is assumed that, psychological stress is the most important cause of high BP and contributes 50% to the cause of this disease.

Hypertension is one of the major killer diseases and yet it damages silently. In case of the heart, it leads to blockages, heart attacks, enlargement of the heart and heart failures. It also leads to stroke or paralysis, sudden unconsciousness(TIA), brain damage and loss of memory. In the Eye - it can lead to bleeding and complete blindness. It can not only lead to kidney damage but also damage to many other organs.

Bath importance for bp

Taking a bath can have some potential benefits for your bp, although it's important to understand that the effects may be temporary and not a primary treatment for hypertension (high bp).

Here are some ways in which bathing can influence bp:

Relaxation: A warm bath can promote relaxation, reduce stress, and calm the nervous system. Lowering stress and anxiety levels can have a positive impact on bp, especially for those who experience stress-related spikes in their bp.
Peripheral Vasodilation: Warm water can cause the blood vessels in your skin to dilate (expand), which can lead to a temporary drop in blood pressure. This effect is similar to what happens when you use a hot tub or sauna. However, this reduction in bp is generally mild and short-lived.
Improved Circulation: Bathing can improve overall circulation by increasing blood flow to muscles and skin. Improved circulation can have a positive impact on bp regulation over time.
Better Sleep: A warm bath before bedtime can help some people relax and sleep better. Getting adequate, quality sleep is essential for maintaining healthy bp levels.

While bathing can offer these potential benefits, it's important to note that it's not a replacement for medical treatment if you have hypertension or other cardiovascular issues. If you have high bp, it's crucial to follow your healthcare provider's recommendations, which may include medication, dietary changes, exercise, and lifestyle modifications.

Additionally, if you have concerns about how bathing might affect your blood pressure, it's advisable to consult with a healthcare professional. They can provide personalized advice based on your specific health condition and help you develop a comprehensive plan to manage your bp effectively.

The cause of concern is that most of the high bp cases go undetected because it often does not have any symptoms. A doctor mostly detects it during a casual check-up. Even after the diagnosis - a large number of high BP Picture patients do not take treatment or remain inadequately treated. There is a saying "Out of all the patients of hypertension, 50% go undetected, out of those who get detected/50% do not take treatment and out of those who take treatment, 50% are not adequately treated."

The silver lining or the good message is that high bp can be measured very easily and non-invasively within few seconds. The instrument to measure bp is not expensive, is easy to use and can be used with very little training. Almost 60% of the bp patients can be treated with lifestyle changes only and rest of the 40% can be well managed with a combination of lifestyle and drugs. But all of them are manageable. Even in the absence of lifestyle changes, drugs can take care for short periods.

Life today is full of tensions and pressures. High bp has started even in young age group, both in males and females. Every individual living under pressure or excessive stress or having a sedentary lifestyle and every executive above the age of 25 must get their bp checked up regularly. Remember that the normal bp is 120/80 mmHg and not above this. In case of three consective readings more than 130/85 mmHg, the treatment must be started.

1. WORKING OF THE CARDIOVASCULAR SYSTEM

(a) Cardiovascular System

Cardiovascular system includes heart, blood vessels which circulate blood to different parts of your body. Heart is divided into four chambers and with each beat of your heart a constant quantity of blood is released from heart's fourth chamber (left ventricle) which is also known as pumping chamber of the heart. The blood is thrown into the blood vessels that spread throughout your body. The main function of the blood is to carry food to different parts of body for the proper functioning of systems in your body. Aorta, largest artery, is connected to the left ventricle and serves as the main channel for blood leaving your heart. The aorta further divides into smaller arteries, which in turn divide into even smaller arteries known as arterioles.

In our body there are very small tubes we can't see with our naked eyes known as capillaries. These vessels can be seen with microscope and the main function of these tubes is the exchange of tiny food particles and oxygen. Oxygen and food is delivered to every cell of the body and waste products are collected back by these capillaries.

The blood from the different parts of the body is collected through other type of vessels known as veins and is sent back to the heart. From heart blood is routed to lungs, where it releases carbon dioxide and picks up oxygen. The process is known as gaseous exchange. This freshly oxygenated blood is sent back to the heart, ready to begin another journey.

(b) What is High bp or Hypertension?

Hypertension or High bp is the increment of the pressure exerted by the flowing biood on the walls of the tubes(arteries) that carry the blood from the heart to every part of the body.

To understand bp and the effects of it on different organs one must know the regulation of bp in the body. The following information will make it easy for you to understand how high bp develops and why it can be so dangerous.

(c) Need for BP:

Any liquid flows from high pressure zone to low pressure zone. As far as the flow of blood in our body is concerned an initial pressure head has to be created. When the left ventricle of the heart pumps some blood into the already filled arterial system - a high pressure in created . This pushes blood towards the low pressure zone. So, the blood flows a little. But immediately the ventricle contracts again. So, another bout of flow occurs. The contraction goes indefinitely this way and thus establishes a continuous flow of blood throughout the body. bp is the amount of pressure exerted by blood to facilitate blood in reaching to the different parts of the body.

The pressure at the main tubes of the body when the heart (Left Ventricle) contracts is equivalent to 120 millimeter of Mercury(written as mmHg) and is called the systolic pressure. As this pressure pushes the blood away from the heart to the small arteries this pressure falls to 80 mmHg. This is called Diastolic pressure. By that time the left ventricle pumps again more blood into the system creating one more wave of higher bp. So the pressure keeps on fluctuating between 120 and 80 mmHg with every contraction and relaxation of the heart. This can be felt if you feel your pulse in the wrist. It is this pressure that keeps on moving the blood throughout our body. The work of the flowing blood is to deliver the food and oxygen to the cells of the body and come back again to the heart through tubes known as Veins to be pushed again.

All-together our arteries and veins have about 5 liters of blood at a time and with every contraction the left ventricle pushes some 70 ml of blood with a higher pressure of 120 mmHg. The next moment it again receives another 70 ml to be pushed again. This goes on and on. Without this bp the flow of blood would not have happened and we would have been dead.

(d) The Organs that control BP:

The Five major organs that help to control your bp are heart, kidney, arteries, nervous system and hormones.

Heart:

Heart is a muscular organ. When these muscles contract, a force is created sufficient to eject the blood into the main artery (aorta). The harder your heart muscle has to work to release the blood, the greater the force is exerted on the arteries.

Arteries:

Arteries are blood carrying tubes from the heart to the parts of the body. Smaller arteries are called Arteriols and capillaries. These arteries are lined by smooth muscles that allow them to contract and expand as blood passes. The more elastic your arteries are, the less resistant they are to the flow of blood and less force that is exerted on their walls. When arteries loose their elasticity or become narrowed, resistance to blood flow increases and additional force is needed to push blood through the vessels. These arteries are also supplied by the nerves of the Sympathetic Nervous System. These nerves when stimulated lead to constriction of the arteries leading to Higher bp.

Kidneys:

One of the main functions of kidneys is to maintain the volume of water at normal level and regulate the amount of sodium in the body. Water is dependent on sodium. If there is retention of sodium, it retains more water in the body. This extra fluid can overload your blood vessels and increase bp. The kidneys also release some chemicals called Angiotensinogen which also has a major role to play in the control of bp. Some enzymes called ACE (Angiotensinogen Converting enzyme) help is increasing the action of these released chemicals released from the kidneys.

Nervous system:

The Nervous system which is controlled by the brain and the nerves which encircle the spinal cord (called Sympathetic Nervous system) play a major role in control of our bp. The nervous system releases neurotransmitters which can stimulate a organ called Hypothalamus which control the emotional brain. Whenever the hypothalamus is excited there is release of many hormones into the blood stream which lead to contraction of the arteries leading to high BP. The nerves also control the proteins (receptors) called alpha and beta receptors which stimulate the heart -leading to increased contraction and increases rate of the heart. This also leads to high BP.

All our stress and tensions are mediated through the brain and nervous system. So, directly or indirectly our stress or psychological pressure is translated to High BP through the nervous system.

Hormones:

Our hormones also control our BP through their action on the heart, on the arteries and nerves. The main among them is adrenaline (called Epinephrine) which is called the stress hormone. Whenever they are secreted they lead to increased heart rate, increased contraction of the heart and squeezing of the arteries. When to cut down the stress the immediate effect is lowering of the BP. Cortisol, ACTH, Aldosterone, Thyroxine - are some of the hormones which play an important role in controlling of BP. Many new hormones and neuro hormones have been discovered by the medical science in recent days which have various effects on BP.

2. CAUSES OR RISK FACTORS FOR

HIGH BP Picture

High BP is not caused by a single reason, but many factors together lead to increment of bp. These causes are known as Risk factors for High BP. These risk factors can be divided into two major groups - Modifiable and Non Modifiable. Non modifiable causes can not be changed. But the modifiable causes are much more common and can be changed - by our own efforts.

Non-modifiable risk factors:

These are the risk factors you can't change. It means that there is no medicine to keep them in control. These risk factors are:

Age: With age BP rises in both male and female.
Genetic Factors: The importance of genetic factors in increasing BP has been confirmed. Studies have shown that the children of normotensive parents (BP within normal limits) have 3 per cent possibility of developing high BP, whereas this possibility is 45 per cent in children of two high BP parents.

(b) Modifiable risk factors:

These are the risk factors you can change. The factors which come in this category are:

Obesity: Obesity is one of the proven risk factors for high BP. With the increase in weight the risk for developing high BP increases. Research studies have shown that when people lose their weight their BP decreases.
Fats: Increased fat intake (both Cholesterol and Triglycerides) can raise
bp. Increased blood level of both Cholesterol and Triglycerides also lead to atherosclerosis and this also tends to increase the bp.
Alcohol: High alcohol intake is associated with an increased risk of high BP. Recent studies have shown that high systolic BP is more dangerous than high diastolic BP. It appears that alcohol raises systolic pressure more than diastolic.
Physical inactivity: It increases BP indirectly by increasing body weight and other unknown methods.
Psychological stress: In persons with stress there is over reactivity of the sympathetic nervous system. Due to this over reactivity more adrenalin is released in the blood and there is rise in BP.
Salt intake: Evidences show that high salt intake increases BP proportionally. For instance, the higher incidence of high BP is found in Japan where salt intake is more.
Smoking: Smoking and tobacco intake has also been associated with high bp.
Other factors: Other factors which can raise BP are oral contraceptives, noise, vibration, temperature.

(C) Does Tension or Stress lead to Hypertension?

Does everyone at work have a say in how your job is done-except you? Does getting stuck in traffic makes you boil over, along with your radiator? Do you regularly get hot under the collar over things that other people just shrug off? If so, you're a candidate for one of the latest medical discoveries: stress-induced hypertension.

The Stress Reaction

Whenever you are under stress, your body starts a reaction called Stress reaction. It shoots your blood up with adrenaline, which raises your bp Picture, blood sugar and heart rate. It even increases your muscle tone. bp drops slowly, until the next aggravation comes along. Too much of this and the body gives up and boosts its baseline bp to a permanently higher levels. Stress and High bp

People who experience chronic stress are more likely to have chronically high bp. How do you know if you suffer from chronic stress? It is simple: if you feel stressed out, you are. In fact, people vary widely in their reaction to stress. That's why, those who get upset easily are more likely to have stress-induced hypertension. It is now

assumed that stress in life contributes to 50% of cause of high BP.

The Power of Adrenaline

It has happened to everyone. It begins when you are startled, frightened or angry. Your heart pounds, your breath is shallow and you sweat profusely. Your intestines shut down. You feel tense, apprehensive and ready to respond to danger. The substance responsible for all these changes is adrenaline, a hormone, which your body secretes to give you the strength and alertness to fight off or escape danger. It's the classic "fight or flight" response and it was ideal when most of the dangers humans face were physical. By fighting or running away, people both resolve their problem and work off the tension that adrenaline produces.

Adrenaline also causes jitters when you are under stress, whether that stress directly threatens your safety or not. These stressful events could be being stuck in traffic, having a dead line to meet or conflict with family members. Even positive stresses, like a promotion or getting married, can affect you. Unfortunately, you can't respond to most stresses by running away or fighting them.

What can be done about stress?

A feeling of helplessness is one of the most common stressors in our society. But you don't have to be a helpless victim of stress induced hypertension. Stress management programs that exist can help you learn the fine art of relaxation. Techniques like deep breathing, progressive muscle relaxation & regular exercise can also help you let off your steam safely.

Get your bp checked. If it's high, or if you feel too much under stress, ask your doctor where you can get into a stress- reduction program. Or maybe your workplace has a program. Start right now by taking a deep breath.

3. Common knowledge about High bp Picture

(a) What is Normal BP or High bp?

Normal BP: It is the amount of pressure exerted by blood on the walls of blood carrying vessels, enough to facilitate blood to reach to the different parts of the body. BP should be always less than 120/80 mmHg.

According to the data gathered from the Framingham Heart Study,

50 percent of people who have a first heart attack and two thirds of those who have a first stroke have BP higher than 160/95 mm of Hg.

The incidence of hypertension among people in lower socio- economic groups is under estimated because of the inadequate access to medical care.

If left untreated, high bp continues to rise gradually over the years, causing the heart to overwork itself to the point where serious damage can occur. Untreated hypertension also places other systems and organs (e.g., the kidneys) at greater risks of damage leading to dysfunction or failure of organ.

Hypertension has often been called the "silent killer", because mild to moderate levels usually go unnoticed by patients until serious damage has already been done. To clarify the risk factors, high bp measurements for adults have been ranked according to risk categories of increasing severity, ranging from "normal" to "stage 4." An important exception, to the information listed above is noted among patients with diabetes and/or kidney disease. These patients require treatment, if their bp rises above 130/80 mm of Hg.

(b) How is High bp Picture diagnosed?

While diagnosing hypertension, a physician considers the full medical history of a patient. For example, the physician will ask whether high bp runs in the family and what the patient's dietary habits are (e.g., salt intake). The physician will also give the patient a complete physical examination, which will include checking the patient's bp in both arms, while standing and lying down. In some cases, the physician may even ask the patient to take his or her own bp at home and bring in a daily log of bp

measurements.

This strategy will help to establish the patient's normal bp pattern and to rule out White Coat Hypertension (high bp only while in a physician's office).

Once a diagnosis has been made and serious problems (like kidney disease) have been ruled out, then the treatment can begin. However, a very high bp may require additional testing to rule out an unusual cause. For example, a Renal Doppler Sonogram or scan may be ordered to evaluate for high bp due to disease of the blood vessels of the kidneys (renovascular hypertension). Also, a 24- hour urine test may be needed to rule out an endocrine disorder, such as Cushing Disease or Pheochromocytosis.

Hypertension may occur in either adults or children. Some people may also be diagnosed with the opposite condition: low bp (hypotension). Although some hypertensives do not need to take medication, as long as they can control their risk factors (e.g., weight). Most cases generally require long-term treatment with medications.

(c) What are the symptoms of High bp?

The majority of people with mild to moderate hypertension cannot tell when their bp is too high. In fact, about one-third of hypertensive people are not aware of their condition. Patients may experience chest pain (angina), shortness of breath or other symptoms related to heart disease. If you have some of the difficulties listed below you should check your BP immediately.

Symptoms

Fatigue
Confusion
Nausea or upset stomach
Vision changes or problems
Excessive'sweating
Paleness or redness of skin
Nose bleeding
Anxiety or nervousness
Palpitations (strong, fast or obviously irregular heartbeat)
Ringing or buzzing in ears
Impotence
Headache
Dizziness

If you discover one day that you have High BP you should undergo the following tests also to know the reason or know the extent of damage by the bp so far.

Tests

Urine Analyser and various blood tests (e.g., electrolytes and waste products test to rule out kidney disease, serum lipid profile). 2. Electrocardiogram (ECG), which

measures the heart's electrical activity. By analyzing the ECG results, a physician can check for heart-related problems that could be associated with high bp (e.g., left ventricular hypertrophy).

Echocardiogram, which uses sound

waves to visualize the structures and functions of the heart. This test is also used to check for heart-related problems such as left ventricular hypertrophy.

Chest x-ray to rule out an enlarged heart.

TYPES OF HYPERTENSION

There are different types of hypertensions, which are as follows: primary, secondary, renovascular, labile, malignant and resistant. Until the year 2000, these different types were generally diagnosed by paying attention to people's diastolic BP (the lower number of a BP reading). In other words, someone with "high BP" actually had diastolic hypertension. However, the National Heart Lung and Blood Institute of USA recommended that healthcare professionals should evaluate not only systolic BP, but also their diastolic BP while making a diagnosis of hypertension. Nowadays, syotolic BP is considered more important than diastolic BP.

Most people with high BP are diagnosed with primary hypertension, which means that researchers only understand the risk factors for the condition but not the root cause. However, these people show substantial improvement with stress management techniques.

Primary (Essential) Hypertension

Though the main causes of High BP is excessive stress, excess weight, and lack of exercise and so on, our medical science describes 90-95% of High BP cases as Primary, or Essential Hypertension. The rest 5-10% are called Secondary Hypertension - where the cause is very much clear (like Kidney disease, drug induced High BP). The following are factors that are associated with essential hypertension and may increase the risk of developing the condition:

Stress
Family history of hypertension Obesity.
Lack of regular exercise
Smoking
Advanced age.
High caffeine intake
Diet high in fats and oils High cholesterol levels
Inherited problems in the body's angiotensin-renin system, which influences all factors related to controlling BP: blood vessel contraction, heart cell development, sodium and water balance and the "salt genes" which play an important role in the relationship between salt and hypertension.

Inherited problems in the body's sympathetic nervous system, include those which control heart rate, BP and the width of blood vessels.

What is Secondary hypertension?

Secondary hypertension is a condition in which the cause of the high BP is known (e.g., sleep, apnea or some form of kidney or endocrine diseases). The high BP is secondary to another disease or disorder and the hypertension usually disappears once the underlying condition is controlled or cured. These underlying conditions include the following:

Sleep
Kidney or endocrine disease
Cirrhosis of the liver
Cushing disease (in which the body produces excess steroids) Pheochromocytoma (adrenaline-producing tumor)
Coarctation of the aorta (a condition in which the aorta is pinched, constricted or narrowed at some point along its length, often resulting in high BP in the arms and low BP in the legs).

Some more Factors that could cause secondary hypertension

Pregnancy (pregnancy-induced hypertension): Pregnancy can worsen the hypertension of women who already have it, or cause

hypertension in women with no history of it. After the delivery, hypertension tends to resolve in women with no prior history of it. However, women who develop hypertension during pregnancy are likely to develop it again later in life.

Certain medications: Prescribed medications that can cause temporarily high BP include certain Non Steroidal Anti-Inflammatory drugs (NSAIDs) and estrogen (in either oral contraceptives or hormone replacement therapy). Over the counter (OTC) medications that can cause the same effect include NSAIDS (e.g., ibuprofen or naproxen), cold, cough and sinus medications and many eye drops.

Cocaine use: Not only can cocaine cause BP to rise sharply, but it can also cause heart attack and stroke in healthy people of any age.

Alcohol: Long-term overuse of alcohol, caffeine or real licorice, which contain a steroid-like substance can cause HT.

Some more types of Hypertension

Renovascular hypertension is one of the most common forms of secondary hypertension and is caused due to decreased blood flow to the kidneys. Usually, this blood flow gets restricted when the arteries to the kidneys become narrow(renal artery stenosis). Renal blood vessels narrow down due to one of the two following conditions atherosclerosis or fibromuscular dysplasia. Atherosclerosis is a disease in which arteries become hardened and narrowed, as a result of plaque that has build up along the inside of the artery walls. Fibromuscular dysplasia is a condition in which cells from the artery walls overgrow, causing the arteries to narrow down.

Isolated Systolic Hypertension

Isolated systolic hypertension (ISH) is when only systolic BP (the larger number of a BP reading) is elevated. ISH occurs mainly in older people because systolic pressure increases with age while diastolic pressure usually declines after the age of 55. ISH patients have a rise in systolic pressure (above 140) but diastolic pressure remains normal. ISH is a common cause of stroke.

Labile or Transient Hypertension

Labile or transient, hypertension is a temporary rise in BP during stressful situations. BP then returns to normal.

Many young people who have labile hypertension for several years and go on to develop primary hypertension, especially if they have a family history of hypertension. However, even labile hypertension may result in complications such as heart disease, kidney disease and stroke, if left untreated. It is often treated successfully with beta blockers or other medications and stress management.

Resistant Hypertension

Resistant hypertension is high BP that does not respond to typical treatments and therapies. Because of this, it is difficult to control and often requires lifestyle changes and two or three different medications in order to properly treat this condition. People with resistant hypertension, are urged to work closely with the physician who manages their condition and are advised to very carefully follow all of the physician's orders regarding diet, exercise and medications.

Malignant (Accelerated) Hypertension

Malignant or accelerated hypertension occurs in less than one percent of hypertensive patients. It is defined as a sudden rise in diastolic BP to over 125. This very high diastolic BP can be associated with damage to the brain, heart, eyes and kidneys. The condition is considered life threatening and immediate medical attention is extremely important. Treatment generally, requires intensive care hospitalization with potent medications delivered through an intravenous (IV.) line to take effect as quickly as possible. Symptoms include loss of vision, nausea, drowsiness, confusion and headache.

White Coat Hypertension

Some people - knowingly or unknowingly - become anxious, when they have their BP measured in hospital setup. These people may have normal BP at other times, but when it is measured in a medical setting, it is always high. This condition is called "white- coat hypertension" and is fairly common.

If your doctor suspects your high BP is white-coat hypertension, then you may need to measure your BP at home and keep a note of your reading. Or your doctor may recommend that you wear a portable device (ambulatory monitor) that measures your BP periodically throughout the day while you go about your regular activities. These two methods generally give a more realistic and accurate assessment of your BP.

BP is generally measured by using an instrument called Sphygmomanometer medically. It also needs a stethoscope. This measurement takes only a few minutes and can be taught to anyone with a little training. These instruments can be bought by a patient who has High BP for about Rs.1000. Before you start measurement please go through the theory of BP measurement.

GENERAL TECHNIQUE

bp is measured by wrapping an arm cuff (attached to a sphygmomanometer) around the patient's arm and then using a stethoscope to listen to the brachial artery located at the inside elbow on the same arm. The cuff is then pumped full of air until circulation is very briefly cut off. Then some air will be slowly let out of the device, loosening the cuff's grip on the arm and releasing the blood to

flow freely again. As the air is let out, the exam iner watches the numbers coming down on a simple monitor (sphygmomanometer) and waits until he or she hears the first heart beat. The number at which it is heard is the systolic pressure. The examiner remembers this as the numbers continue to come down on the monitor and notes the number at which he or she hears the last heartbeat. The number at which that occurs is the diastolic pressure.

UNDERSTANDING THE TECHNIQUE OF MEASUREMENT OF BP

Blood flows into our hands through brachial artery which enters the arm after arising from the main supply line of the body called Aorta. This artery can be felt with our fingers just above the elbow joint. A branch of the same artery called Radial artery can also be felt flowing the blood at the wrist. When we want to measure the pressure of flowing blood in these tubes we squeeze the brachial artery by a cuff applied on the arm on the underlying arm bone (called Humerus). When the applied pressure exceeds the bp the flow of the blood to the arm is stopped. We have to usually feel the artery pulse disappear as the pressure is increased by the cuff.

Now the pressure of the cuff is gradually released and we put a stethoscope chest piece on the pulse area and hear the sound of flowing blood. As soon as the applied pressure falls just below the systolic pressure the blood flow of the brachial artery will start - and this flow being turbulent will lead to sounds which can be picked up by the stethoscope. This will be a ticking sound to begin with. At this time the pressure is noted in the pressure meter attached to the cuff. This is the Systolic pressure.

Now the pressure of the cuff is gradually lowered and the sound is monitored. As soon as we reach the diastolic pressure- the blood flow will have no obstruction and the flow will be streamlined which do not give any sound. So as soon as the sound disappears the pressure is noted. This is the Diastolic pressure.

When we start learning the measurement of bp we need more practice which make us conversant with the application of the cuff, slow and steady, release of pressure and listening of the sounds. After about 10-15 times of practice the person is almost trained.

To know how BP fluctuates throughout the day, BP monitoring is also available. Many clinicians now prefer to treat BP patients after a complete knowledge about the BP variations in the whole of the day.

TYPES OF BP EQUIPMENTS:

Mercury Sphygmomanometer: This has a mercury column and is available in steel boxes. This has a tube, a cuff and a rubber bulb. This is the best and most dependable type of BP measuring equipment. Such machines are best for home use. You need to buy a stethoscope with this. This machine is not suitable for travel as it is heavy, bulky and has chances of breakage.
Dial Type Portable Sphygmomanometer: This has become more popular these days. Instead of Mercury column it has a pointer needle. If you buy it remember they must be of good quality. They have low weight, are small and can be carried to any place comfortably. You also need a stethoscope with it.
Electronic or Digital automatic BP machines: These do not need any expertise to measure also. The machine has a microphone which picks up the sounds in the brachial artery and give you a measurement. It also inflates and deflates the cuff automatically. These machines may not be accurate always so before you buy please cross check the readings with a doctor's measurement. If the readings are matching you can buy. It usually costs Rs.2500.

DO'S AND DON'TS ABOUT BP MEASUREMENTS:

Bp is best measured after at least five minutes of rest or quiet sitting.
Two readings three minutes apart are desirable, especially for those under stress.
The cuff should be at the level of the heart.
BP should be measured at least one hour after taking meals or tea or coffee intake.
The bladder inside the cuff should cover at 80% of the upper
arm.
BP measurement should not be measured for at least 30 minutes after smoking.