Blood pressure (BP) represents the pressure exerted by the blood column on the inner lining of blood vessels, called the vascular endothelium, during myocardial contraction (systolic blood pressure) and cardiac relaxation (diastolic blood pressure).
Systolic pressure refers to the pressure exerted on the arterial walls during cardiac contraction and is physiologically between 100 and 130 mmHg.
Diastolic pressure is the pressure exerted on the arterial walls during the relaxation of the myocardium between 2 successive contractions, whose physiological values must be greater than 85 mmHg.
The American National Committee for the Prevention, Detection, Evaluation and Treatment of Cardiovascular Diseases has recently established that a normal, physiological blood pressure in adults is 135/85 mmHg.
How do we measure blood pressure correctly?
Low blood pressure: causes and symptoms (hypotension)
High blood pressure: causes and symptoms (hypertension)
What is the pulse and what are the normal values?
How do we measure blood pressure correctly?
The correct measurement of blood pressure (BP) both by the classical method and by the electronic method includes several rules, namely:
- Blood pressure determination should be performed after 5 minutes of patient rest
- During blood pressure determination, the arm on which the blood pressure cuff is applied (or the smart device bracelet) should be at heart level
- Avoiding smoking at least 15 minutes before taking the TA measurement
- Avoiding coffee consumption in the hour before BP determination
- Avoiding administration of adrenergic stimulants such as epinephrine or nasal decongestants
- Determination of blood pressure while standing in patients with diabetes or under antihypertensive treatment, immediately and a few minutes after standing up
- Blood pressure can be determined and serially measured within 24-48 hours, with the help of Holter devices that allow automatic recording of the patient’s systolic and diastolic blood pressure values, both during daily activities and during the night
Low blood pressure: causes and symptoms (hypotension)
The drop in blood pressure values below 90/60 mmHg is known in medical practice as arterial hypotension (low blood pressure) and is due in most situations to:
- States of severe dehydration (through vomiting, diarrhea, at the integumentary level in the case of extensive burns)
- Significant blood loss
- Septic shock
- Anaphylactic shock
- Endocrine disorders (parathyroid disorders, Addison’s disease, diabetes)
- Heart diseases (heart failure, valvular defects)
- Severe nutritional deficiency that causes anemia secondary to an inadequate intake of vitamin B12 and folic acid
The symptoms of patients with low blood pressure are represented by:
- The feeling of dizziness
- Syncope (temporary loss of consciousness)
- Blurred vision
- The feeling of nausea
- Concentration difficulties
- State of generalized fatigue
- The warning signs due to low blood pressure that require a consultation by a specialist doctor as soon as possible are: confusion, skin pallor accompanied by cold sweats, tachypnea with shallow breathing and weak threadlike pulse
High blood pressure: causes and symptoms (hypertension)
High blood pressure (hypertension) can be classified according to the values obtained after repeated measurements at regular time intervals and under appropriate conditions as follows:
- Systolic prehypertension 120-139 mmHg and diastolic prehypertension 80-89 mmHg
- Arterial hypertension stage I: systolic 140-159 mmHg, diastolic 90-99 mmHg
- Arterial hypertension stage II: systolic ≥ 160 mmHg, diastolic ≥ 100 mmHg
- Grade III arterial hypertension: systolic >180 mmHg, diastolic >110 mmHg
- Arterial hypertension can be primary or essential when it is not determined by a certain specific pathological context and manifests itself more frequently in the elderly, while secondary arterial hypertension is due to the action of certain pathological factors represented by: sleep apnea, kidney diseases, tumors of the adrenal glands, heart diseases, diabetes, thyroid pathologies or congenital vascular malformations
Frequently, arterial hypertension evolves non-specifically, the main symptoms that accompany the increase in BP values being:
- Cephalalgia
- Epistaxis (nosebleeds)
- Dyspnoea
The manifestation of these symptoms in the case of patients diagnosed with chronic hypertension requires a thorough medical evaluation due to the risk of severe complications represented by acute myocardial infarction, stroke, arterial aneurysms or vision loss.
What is the pulse and what are the normal values?
The pulse represents the heart rate or the number of heartbeats performed during one minute. It can be determined by palpating the radial artery at the level of the wrist or the carotid artery in the lateral area of the neck. By measuring the pulse, it is possible to quantify the number of electrical impulses generated by the sino-atrial node, which determines the contraction of the heart muscle and ensures the pumping of blood to the organs.
Physiological pulse values differ between the two sexes, with women having a slightly higher heart rate than men due to the smaller size of the heart. A smaller heart pumps a reduced amount of blood/beat, so more cardiac contractions are needed during a minute to ensure an adequate cardiac output.
The normal adult pulse is between 60 and 100 beats/minute.
The determination of the number of heartbeats performed in one minute by measuring the pulse is carried out in the case of people who feel disturbances of the heart rhythm (palpitations), in the presence of vertigo or during a routine medical examination performed by a doctor.
The determination of the pulse can be carried out both classically by palpating the radial and carotid arteries, as well as with the help of digital tensiometers, smart watches or by performing an electrocardiogram in health facilities.
The physiological variations of the pulse registered during daily activities represent the adaptation of the heart rate to the increased needs of the body during physical activity (fast walking, running, physical exercises) or during periods of stress, but they can also be influenced by the consumption of cardiac tissue stimulants represented coffee, energy drinks, alcohol or tobacco.
The physiological decrease of the pulse is found during night rest and in performance athletes, but it can also be determined by the administration of certain treatments with beta-blockers, antiarrhythmics or digitalis in patients suffering from certain specific cardiovascular diseases.
The pathological deviation of the pulse compared to the normal values that belong to the physiological range can be downward, registering values lower than 60 beats/minute-bradycardia, or upward, exceeding the maximum limit of 100 beats/minute-tachycardia.
Increased values of the pulse due to pathological causes are recorded in the presence of heart rhythm disorders represented by sinus tachycardia, atrial fibrillation/flutter, paroxysmal supraventricular tachycardias, ventricular tachycardias or malignant tachycardias that can endanger the patient’s life in the absence of adequate treatment. The distinction between the different types of supraventricular and ventricular tachycardia is made using the electrocardiogram, which allows obtaining a graphic representation of the heart rhythm.
The main causes of tachycardia that cause the pulse to accelerate are:
- Anemias
- Thyrotoxicosis (excess of thyroid hormones)
- Heart failure
- Pulmonary thromboembolism
- Myocarditis
- Febrile syndromes
- Hypovolemia (secondary to fluid losses through vomiting, diarrhea, extensive burns or significant bleeding)
- Congenital heart diseases and electrolyte disorders
- The pathological decrease in the pulse values is specific to sinus bradycardia, which manifests itself by the reduction of cardiac contractions below 60 beats/minute and is determined by high-grade atrioventricular blocks, sinus node diseases, hydro electrolytic disorders with significant losses of calcium and potassium involved in cardiac contraction, hypothyroidism and hypothermia
References:
- Hypertension, World Health Organization
- Hypertension in the elderly, Nikolaos Lionakis, Dimitrios Mendrinos, Elias Sanidas, Georgios Favatas, Maria Georgopoulou
- Salt shakedown: How and why you should eat less sodium, Harvard Health Publishing | Harvard Medical School
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