25 June 2012

Blood pressure: measured correctly

Under pressure

Alexey Vodovozov, ABC magazineFor a long time, devices measuring blood pressure (BP) were considered "grandmother's" devices.

However, recently hypertension has become much younger, and a large number of middle-aged and even young people have begun to require devices. For advice on their choice, they most often turn to pharmacy workers.

Size mattersCuffs are standard – for a shoulder circumference of 22-33 cm and large – with an upper limit of up to 42-45 cm in most shoulder automatic devices and 50 cm in mechanical ones.

Some manufacturers have models with small children's (up to 22 cm) and extra-large (42-60 cm) cuffs.

NB! Incorrect selection of the cuff size is a direct way to an erroneous measurementMechanical

Along with the undoubted advantages, including cheapness, there are also significant disadvantages.

First, a phonendoscope is required to listen to sound effects. Secondly, certain skills and experience are needed, on which the correctness of reading the readings directly depends.

Thirdly, it is almost impossible to measure blood pressure independently, help is required. Plus, a mechanical tonometer with a spring pressure gauge (round dial and arrow) has large errors in measurement accuracy that accumulate over the years.

However, this cannot be said about a mercury tonometer. This is one of the oldest medical measuring devices, giving maximum accuracy. But on sale it is extremely rare.


Such tonometers are semi-automatic and automatic. They do not require a phonendoscope, as they are equipped with sound sensors.

A huge range of models – from the simplest to the most "fancy" – allows you to choose the most suitable device for this particular case. For example, for people suffering from arrhythmia, special devices have been released that correct for heart rhythm disorders.

Automatic models independently pump and bleed air out of the cuff, minimizing human involvement.

PositiveDo not require special skills

  • Possibility of independent pressure measurement
  • High measurement accuracy, little dependent on the "human factor"
  • In addition to blood pressure, the pulse rate is determined
  • Memory for several dozen recent results, complex models allow you to keep AD diaries separately for several users.

MinusesDependence on the power source (batteries or adapter)

  • The cost can reach up to 7000 rubles.

NB! Models with wrist cuffs are mainly suitable for athletes to track pulse and blood pressure during training or for young people under 40 years of age for whom measurement accuracy is not essential. With age, the vessels become less elastic, so after 40 years, tonometers with shoulder cuffs are required.important!

Warn the buyer that it is necessary to take three consecutive blood pressure measurements at intervals of 3-5 minutes. The last digits are taken as the result.It is interesting

In more than 20 percent of cases, the cause of increased pressure during a doctor's examination is the so-called examination hypertension, which is popularly called a reaction to a white coat.

Emotions play a leading role here. Repeated measurement in a calm environment shows that the pressure is within normal limits.

The "white coat" syndrome has been known for a long time. However, there are patients who are particularly sensitive to the appearance of a medical officer, and it is for them that pressure measurement is a vital procedure.

Australian scientists decided to check how dangerous the "white coat" syndrome is for hypertensive patients. To do this, they examined more than 8,500 visitors from 11 clinics in Australia. During the examination, the results of pressure measurements by nurses and doctors were compared.

The doctor, according to scientists, "raises" the pressure by as much as 29 units, while from the type of nurse it jumps only by 17 units. Moreover, the closer the blood pressure is to normal, the smaller the difference between people's reactions to different medical staff, that is, chronic hypertensive patients react most acutely.

Although the "white coat" syndrome is not new to doctors, such a difference in the patient's reaction to doctors and nurses has become a discovery for researchers. For people with high blood pressure, the ideal solution in this case may be monitoring blood pressure during the day at home using a special bracelet.

So far, scientists believe that it is necessary to draw the attention of doctors to this problem and, possibly, change the existing guidelines for the diagnosis and treatment of arterial hypertension, making them different for different categories of patients.

Comment on the topic
Alexey Fedorov, cardiosurgeon, PhD

It would seem that it was difficult – I took a tonometer, twisted the cuff, pressed the button – and here they are, systolic with diastolic. But here, as in every case, there are pitfalls. If you stumble upon such a thing, you will miss or overdo 10-20 mmHg. Such an inaccuracy can not only spoil the mood, but also lead to more serious consequences in the form of an incorrect diagnosis and unnecessary medications.

In order to measure the pressure correctly, it is necessary:

  • Avoid stressful situations 20-30 minutes before the measurement and sit quietly for 5 minutes. If you still had to worry, it's better to postpone the AD check for half an hour
  • Refrain from drinking strong tea, coffee, caffeinated soft drinks and do not smoke for an hour before the measurement
  • Do not take medications that include adrenostimulants (for example, instill Naphthysine in the nose), immediately before blood pressure control
  • Sit on a chair, put your feet straight in front of you, put your hand on the table so that it is at the level of the heart
  • To pump pressure by 20 mmHg more than your usual systolic ("upper") pressure if you use a mechanical tonometer
  • The cuff should be deflated at a rate of 3 mmHg per second, as recommended by the American Heart Association. For speeding, the technique can be "fined" with the wrong indicator. In this sense, the electronic tonometer has the best high–speed qualities - automation blows off the cuff strictly by seconds.
  • If the patient suffers from dizziness, there have been episodes of loss of consciousness, you need to measure the pressure after an orthostatic test – first lie down, take a measurement after 5 minutes, then get on your feet and measure again after 2 minutes. Sometimes it is possible to fix the so–called orthostatic hypotension in this way - a decrease in pressure after taking an upright position.
  • It is important to always measure blood pressure on both hands, normally the difference in readings should not exceed 10 mmHg. If it is greater, it may indicate a rather severe vascular disease.

Published in the journal "Russian pharmacies", No. 15-2011

Portal "Eternal youth" http://vechnayamolodost.ru25.06.2012

Found a typo? Select it and press ctrl + enter Print version