Cardiovascular Medicine Book



Blood Pressure

Aka: Blood Pressure, BP Examination, Korotkoff Sound
  1. See Also
    1. Hypertension
    2. Hypertension Criteria
    3. Pediatric Vital Signs
  2. Equipment: Blood Pressure cuff size
    1. Poor cuff fit results in inaccurate Blood Pressure
      1. Undersized cuff artificially raises Blood Pressure
      2. Oversized cuff artificially lowers Blood Pressure
    2. Pediatric Cuff size
      1. Minimum Cuff Width
        1. Width >2/3 length of upper arm
        2. Width >40% of arm circumference
      2. Minimum Cuff length
        1. Bladder nearly encircles arm
        2. Bladder length 80-100% of circumference
    3. Adult Cuff size
      1. Cuff Width: 40% of limb's circumference
      2. Cuff Length: Bladder at 80% of limb's circumference
      3. Indications for large cuff or thigh cuff
        1. Upper arm circumference >34 cm
      4. Indications for Forearm cuff (with radial palpation)
        1. Upper arm circumference >50 cm
  3. Preparation: Positioning of Blood Pressure Cuff
    1. Cuff applied directly over skin (not through clothes)
      1. Clothes artificially raises Blood Pressure
    2. Center inflatable Bladder over brachial artery
    3. Position lower cuff border 2.5 cm above antecubital
    4. Patient's arm slightly flexed at elbow
    5. Position stethoscope bell over brachial artery
  4. Technique: BP measurement
    1. Patient should be comfortable, with empty Bladder and legs uncrossed
    2. Wait 5 minutes of rest before checking Blood Pressure
    3. Check Blood Pressure in right arm, while seated
    4. Take Blood Pressure at heart level
    5. Inflate cuff rapidly to level above suspected SBP
    6. Deflate cuff slowly at a rate of 2-3 mmHg per second
    7. Listen for auditory vibrations from artery (Korotkoff)
      1. Systolic Blood Pressure: Onset of consecutive sounds
      2. Diastolic Blood Pressure: Disappearance of sounds
  5. Technique: Obtain Multiple Blood Pressure measurements
    1. Validation of abnormal readings
      1. Recheck Blood Pressure twice more at same visit
      2. Blood Pressure improves to <160/89 after 30 minutes rest in >30% with Severe Hypertension
        1. Grassi (2008) J Clin Hypertens 10(9): 662-7 [PubMed]
    2. Aortic Coarctation
      1. Left and right arm, and one lower extremity
    3. Orthostatic Hypotension
      1. Most common chronically in the elderly (fall risk)
      2. Check Blood Pressure and Pulse, Supine and Standing (Postural Blood Pressure)
  6. Interpretation
    1. See Hypertension Criteria
    2. See Hypotension
  7. Interpretation: Children
    1. See Pediatric Vital Signs
    2. Formulas for Systolic Blood Pressure estimate (for over age 1 year)
      1. Median SBP = 90 mmHg + (2 x Age in years)
      2. Minimum SBP = 70 mmHg + (2 x Age in years)
    3. Rough estimate for Systolic Blood Pressure (SBP)
      1. Typical systolic Blood Pressure
        1. Infant: 80
        2. Preschool: 90
        3. Adolescent: 100
      2. Minimal systolic Blood Pressure
        1. Infant: >60
        2. Toddler >70
        3. Preschool >75
        4. School-age: >80
        5. Teen >90
    4. Term Newborn (3 kg)
      1. Age 12 hours: 50-70 / 25-45
      2. Age 96 hours: 60-90 / 20-60
      3. Age 7 days: 74 +/- 22 mmHg (Systolic BP)
      4. Age 42 days: 96 +/- 20 mmHg (Systolic BP)
    5. Infant (6 months old)
      1. Blood Pressure: 87-105 / 53-66
    6. Toddler (2 years old)
      1. Blood Pressure: 95-105/53-66
    7. School age (7 years old)
      1. Blood Pressure: 97-112 / 57-71
    8. Adolescent (15 years old)
      1. Blood Pressure: 112-128 / 66-80

Blood Pressure (C0005823)

Definition (MSHCZE) Zkr. TK – tlak, kterým krev působí na stěnu cév, zejm. tepen. Zdrojem TK je činnost srdce čerpajícího krev do aorty, která slouží jako pružný rezervoár krve. TK v průběhu srdečního cyklu (systoly a diastoly) stoupá a klesá, nejvyšší hodnoty dosahuje v systole (systolický t.), kdy je také objem krve v aortě největší. (cit. Velký lékařský slovník online, 2013 )
Definition (NCI_NCI-GLOSS) The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).
Definition (NCI) The pressure of the circulating blood against the walls of the blood vessels.
Definition (MSH) PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS.
Definition (CSP) force exerted by the blood on the walls of the arteries and other vessels.
Concepts Organism Function (T040)
MSH D001794
SnomedCT 75367002
LNC LP40259-1, LP90874-6, MTHU008342
English Blood Pressure, Pressure, Blood, BLOOD PRESSURE, BP, blood pressure, Blood pressure, BP - Blood pressure, Blood pressure (observable entity), Blood pressure, NOS
Swedish Blodtryck
Spanish presión arterial, presión arterial (entidad observable), presión sanguínea (entidad observable), presión sanguínea, tensión arterial, Presión Sanguínea
Czech krevní tlak, tlak krve
Finnish Verenpaine
Japanese 血圧
Polish Ciśnienie krwi
Norwegian Blodtrykk
Portuguese Pressão Sanguínea
French Pression sanguine
German Blutdruck
Italian Pressione sanguigna
Dutch Bloeddruk, Druk, bloed-
Derived from the NIH UMLS (Unified Medical Language System)

Korotkoff sounds (C0277892)

Concepts Finding (T033)
SnomedCT 85549003
English korotkoff sound, korotkoff sounds, korotkoffs sounds, Korotkoff sounds, Korotkoff sounds (function), Korotkoff sounds (observable entity), Korotkoff sounds, function (observable entity)
Spanish ruidos de Korotkoff (entidad observable), ruidos de Korotkoff (función), ruidos de Korotkoff
Derived from the NIH UMLS (Unified Medical Language System)

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