This document summarizes blood pressure, including defining it as the lateral pressure exerted by flowing blood on artery walls. It discusses types of blood pressure depending on the blood vessel, normal ranges, measurement methods, factors that affect blood pressure both physiologically and pathologically, complications of hypertension, and mechanisms that regulate arterial blood pressure over rapid, intermediate, and long term timescales.

1. BLOOD PRESSURE

2. BLOOD PRESSURE Dr shabeel pn

3. DEFINITION Blood pressure is defined as the lateral pressure exerted by flowing blood on the walls of the arteries .

4. TYPES OF BLOOD PRESSURE Depending on the NATURE OF BLOOD VESSEL – Arterial B.P Venous B.P Capillary B.P

5. BLOOD PRESSURE IS DETERMINED BY: Force with which heart pumps the blood Resistance offered by the vessels B.P = C.O x P.R

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

7. ARTERIAL BLOOD PRESSURE TYPE NORMAL RANGE Systolic BP 110-130mmHg Diastolic BP 60-80mmHg Pulse pressure 40mmHg Mean arterial 93-100mmHg pressure

8. MEASUREMENT OF BP DIRECT METHOD INDIRECT METHOD Palpatory method Auscultatory method

9. DIRECT METHOD

10. INDIRECT METHOD

11. INSTRUMENTS

12. SPHYGMOMANOMETER

13. ANEROID BAROMETER

14. AUTOMATIC INFLATION CUP

15. PROCEDURE

16. KOROTKOFF’S SOUNDS Dissappears V Rest Muffled IV 5 mmHg Gong sound III 20 mmHg Murmer II 10 mmHg Tapping sound I DURATION NATURE OF SOUND PHASE

17. PALPATORY METHOD

18. BASIS OF KOROTKOFF’S SOUND Sounds are heard due to turbulence Cuff pressure > Systolic. P Lumen is occluded No sounds are heard. Cuff pressure <just below> systolic .P Blood flow at height of systole Tapping sound Cuff pressure < diastolic.P Streamline flow No sounds.

19. AUSCULTATORY GAP A gap present after tapping sound Seen in hypertensive patients .

20. VARIATIONS PHYSIOLOGICAL PATHOLOGICAL

21. PHYSIOLOGICAL AGE : in B.P Old age Lipid deposition in lamina propria Loss of windkessel effect SEX: Males > Females upto menopause. After menopause Equal. Plasma cholesterol Estrogen Vasodialator NO [ERF]

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

23. 7. Exercise Moderate exercise Systolic B.P upto 20-30 mmHg. Diastolic B.P unaltered. Severe exercise Systolic B.P upto 40-50 mmHg Diastolic B.P

24. 8. Gravity Above heart level B.P Below heart level B.P Magnitude of gravitational effect .77mmHg/cm. .

25. PATHOLOGICAL Hypertension Persistent increase in systemic arterial B.P is known as hypertension. According to JNC VII Normal - 120/80 mmHg. Pre hypertension – 120-139/80-90mmHg Stage I Hypertension-140-159/90-99 mmHg Stage II Hypertension->/160/100mmHg

26. Benign Primary Hypertension Malignant Secondary -Atherosclerosis -Pheochromocytoma -Cushing syndrome -Glomerulonephritis -Gestational -Drug induced White coat hypertension

27. COMPLICATIONS OF HYPERTENSION Renal failure LVH MI Cerebral haemorrhage Retinal haemorrhage

28. COMPLICATIONS OF UNCONTROLLED HYPERTENTION DURING SURGERY Reflects cardiac status Anaesthetic risk of the patient. Excessive bleeding from operation site Blood loss.

29. PRE-OPERATIVE INVESTIGATION Chest x-ray ECG USG of kidney Ophthalmic evaluation for retinal haemorrhage RFT

30. MANAGEMENT OF HYPERTENSION Non drug therapy Stop smoking Control obesity Regular exercise Decrease salt intake Drug therapy Beta blockers Calcium channel blockers Vasodialators Diuretics ACE inhibitors VMC depressors

31. DIETARY APPROACH TO STOP HYPERTENSION.

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

33. HYPOTENSION Fall in B.P below normal range is known as hypotension. TYPES Primary/Essential hypotension. Secondary hypotension. -MI -Hypoactivity of pituitary gland -Hypoactivity of adrenal gland -Tuberculosis Orthostatic hypotension

34. TREATMENT OF HYPOTENSION Correct the underlying etiology. Orthostatic hypotension Change to supine position with head below the heart level & leg raised .

35. REGULATON OF ARTERIAL RAPIDLY ACTING INTERMEDIATE ACTING LONG TERM ACTING B.P

36. RAPIDLY ACTING MECHANISM Baroreceptor reflex Chemoreceptor reflex CNS ischeamic response

37. BARORECEPTOR REFLEX carotid body & aortic arch B.P impulse to tractus solitarius supress VMC&stimulate CIC vasodialatation rate and force of contraction PR CO

38. LOCATION OF BARORECEPTORS

39. CHEMORECEPTOR REFLEX CAROTID SINUS $ AORTIC BODY B.P tissue ischeamia Po2 and Pco2 in chemoreceptors stimulation of VMC B.P

40. INTERMEDITE ACTING CAPILLARY FLUID SHIFT MECHANISM STRESS RELAXATION REVERSE STRESS RELAXATION

41. CAPILLARY FLUID SHIFT MECHANISM

42. STRESS RELAXATION MECHANISM B.P in blood storage organs vasodialatation B.P . REVERSE STRESS RELAXATION B.P vasoconstriction perfusion .

43. LONGTERM REGULATION

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

45. CONCLUSION