Blood pressure measurement

Reviewed by Dr Patrick Davey, cardiologist

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Blood pressure is measured by inflating a cuff around the arm.

Most people have had their blood pressure taken at some time. It's a simple and painless procedure that gives a lot of useful information about the heart and the condition of the blood vessels.

What is measured?

The doctor measures the maximum pressure (systolic) and the lowest pressure (diastolic) made by the beating of the heart. The systolic pressure is the maximum pressure in an artery at the moment when the heart is beating and pumping blood through the body. The diastolic pressure is the lowest pressure in an artery in the moments between beats when the heart is resting. Both the systolic and diastolic pressure measurements are important if either one is raised, it means you have high blood pressure (hypertension).

How is blood pressure measured?

To take a blood pressure reading, you need to be relaxed and comfortably seated, with your arm well supported. Alternatively, you can lie on an examination couch. A cuff that inflates is wrapped around your upper arm and kept in place with Velcro. A tube leads out of the cuff to a rubber bulb. Another tube leads from the cuff to a reservoir of mercury at the bottom of a vertical glass column. Whatever pressure is in the cuff is shown on the mercury column. The mercury is held within a sealed system only air travels in the rubber tubing and the cuff. Air is then blown into the cuff and increasing pressure and tightening is felt on the upper arm. The doctor puts a stethoscope to your arm and listens to the pulse while the air is slowly let out again. The systolic pressure is measured when the doctor first hears the pulse. This sound will slowly become more distant and finally disappear. The diastolic pressure is measured from the moment the doctor is unable to hear the sound of the pulse. The blood pressure is measured in terms of millimetres of mercury (mmHg). Blood pressure can be measured in other ways, such as using an automatic blood pressure gauge that can also be used at home.

Electronic measuring devices

Electronic blood pressure measuring devices are becoming the norm now mercury is being phased out because of its hazardous nature. Most of these are now accurate enough for routine clinical use and are relatively inexpensive. They eliminate many of the errors in blood pressure measurement that human beings can generate.

Ambulatory blood pressure monitoring

Ambulatory blood pressure monitoring (ABPM) involves measuring your blood pressure for 24 hours as you go about your daily routine and when asleep. You wear a device that measures your blood pressure at regular intervals. The information is recorded on a chip in the device and allows the doctor to get a detailed picture of blood pressure variation in a normal environment. Average daytime ABPM blood pressure is lower than equivalent blood pressure readings. A high reading using ABPM is: above 135/85 for the general population above 130/80 for people with diabetes. ABPM may be used: when blood pressure levels show unusual variability when high blood pressure is resistant to drug treatment three or more drugs when symptoms suggest the possibility of low blood pressure due to over-treatment to aid the diagnosis of high blood pressure related to anxiety in the clinical setting, known as 'white coat hypertension'.

High blood pressure (hypertension)

Reviewed by Dr Patrick Davey, cardiologist
162

Every adult over 40 should get their blood pressure checked.

The heart is a pump designed to force blood through our body. Blood is pumped from the heart through the arteries out to our muscles and organs. Pumps work by generating pressure. Put simply, too much pressure puts a strain on the arteries and on the heart itself. This can cause an artery to rupture or the heart to fail under the strain in the worst case stopping altogether. Blood pressure depends on a combination of two factors: how forcefully the heart pumps blood around the body how narrowed or relaxed your arteries are. Hypertension occurs when blood is forced through the arteries at an increased pressure. Around 10 million people in the UK have high blood pressure that's one in five of us.

What is normal blood pressure?

Blood pressure is measured using two numbers. An example of this could be 'the blood pressure is 120 over 80', which is written as '120/80mmHg'. The first figure is the systolic blood pressure the maximum pressure in the arteries when the heart contracts (beats) and pushes blood out into the body. The second figure is the diastolic blood pressure. This is the minimum pressure in the arteries between beats when the heart relaxes to fill with blood. Because the height of a mercury column is used in blood pressure gauges, standard blood pressure readings are always written as so many millimetres of mercury, which is abbreviated to mmHg.

The systolic pressure is always listed first, then the diastolic pressure. A typical normal blood pressure reading would be 120/80 mmHg.

What's classed as high?

There is a natural tendency for blood pressure to rise with age due to the reduced elasticity of the arterial system. Age is therefore one of the factors that needs to be taken into account in deciding whether a person's blood pressure is too high. In general terms, people with a systolic blood pressure consistently above 140mmHg and/or a diastolic pressure over 85mmHg need treatment to lower their blood pressure. People with slightly lower blood pressures (130 to140mmHg systolic or 80 to 85mmHg diastolic) may also need treatment if they have a high risk of developingcardiovascular disease, eg stroke or angina (chest pains).

What are the symptoms?

One of the big problems with high blood pressure is that it hardly ever causes symptoms. This means it may go unnoticed until it causes one of its later complications, such as a stroke or heart attack. Despite the popularity of such ideas, nosebleeds and ruddy complexions are hardly ever caused by high blood pressure. Severe hypertension can cause symptoms such as: headache sleepiness confusion coma.

What complications are caused by high blood pressure?

Atherosclerosis: narrowing of the arteries. Stroke: haemorrhage or blood clot in the brain. Aneurysm: dangerous expansion of the main artery either in the chest or the abdomen, which becomes weakened and may rupture. Heart attack. Heart failure: reduced pumping ability. Kidney failure. Eye damage.

What causes hypertension?

For more than 95 per cent of people with high blood pressure, the cause is unknown. This is called 'primary' or 'essential hypertension'. In the remaining 5 per cent or so, there is an underlying cause. This is called 'secondary hypertension'. Some of the main causes for secondary hypertension are: chronic kidney diseases diseases in the arteries supplying the kidneys chronic alcohol abuse hormonal disturbances endocrine tumours.

What factors increase the risk of hypertension?

Anyone can suffer from high blood pressure, but certain factors can seriously aggravate hypertension and increase the risk of complications: a tendency in the family to suffer hypertension obesity smoking diabetes Type 1 or Type 2 kidney diseases high alcohol intake excessive salt intake lack of exercise certain medicines, such as steroids.

What can I do?

Every adult near or past middle age should know their numbers ie your height, weight, blood pressure and cholesterol levels. You should also have regular blood pressure tests if there is a family tendency for hypertension. This way, treatment can be started before any complications arise. Change your lifestyle: stop smoking lose weight exercise regularly as a minimum, 20 minute sessions, three times a week, sufficiently intense to induce some breathlessness cut down on alcohol aiming for less than 21 units a week for men, 14 units a week for women eat a varied diet avoid all salt in food reduce stress by trying different relaxation techniques or by avoiding stressful situations. These changes will lower blood pressure to reduce your risk of developing the condition in the first place or to treat hypertension. If your blood pressure requires medical treatment, you will probably have to take medicine on a regular basis. If so, never stop taking it without consulting your GP, even if you feel fine. Hypertension can lead to serious complications if left untreated.

What can your doctor do?

Pinpoint risk factors and help you change your lifestyle to reduce blood pressure. Offer medication for the reduction of blood pressure and arrange regular monitoring. Sometimes blood pressure control is not straightforward. Many people require more than one drug on a regular basis to get their blood pressure under good control. Your GP may wish to seek the advice of an expert in hypertension if your blood pressure seems particularly difficult to control.

What are the treatment targets?

Diabetes considerably increases the risk of cardiovascular disease if hypertension is also present, so the targets for blood pressure control in diabetes are tighter. For people who don't have diabetes, the treatment goals for blood pressure for are: systolic pressure of less than 140mmHg diastolic pressure of less than 85mmHg. For people with diabetes, the goals are: systolic pressure of less than 130mmHg diastolic pressure of less than 80mmHg.

Which medicines are used to treat hypertension?

ACE inhibitors stop the production of a hormone called angiotensin II that makes the blood vessels narrow. As a result, the vessels expand, improving blood flow. Tension in the circulation is also lowered by the kidneys filtering more fluid from the blood vessels into urine. This also helps reduce blood pressure. If your blood pressure is not easily controlled on simple medication, your doctor will probably use a medicine of this type. Angiotensin-II receptor antagonists work in a similar way to ACE inhibitors. But instead of stopping the production of angiotensin II, they block its action. This allows the blood vessels to expand, improving blood flow and reducing blood pressure. Beta-blockers block the effect of the hormone adrenaline and the sympathetic nervous system on the body. This relaxes the heart so that it beats more slowly, lowering the blood pressure. Alpha-blockers cause the blood vessels to relax and widen. Combining them with beta-blockers has a greater effect on the resistance in the circulation. Calcium-channel blockers reduce muscle tension in the arteries, expanding them and creating more room for the blood flow. In addition, they slightly relax the heart muscle so it beats more slowly, reducing blood pressure. Diuretics help the body get rid of excess salt and fluids via the kidneys. In certain cases, they relax blood vessels, reducing the strain on your circulation. The following medicines are used less frequently. Indapamide (eg Natrilix) is a mildly diuretic preparation that also relaxes the peripheral arteries. Hydralazine (eg Apresoline) relaxes the vascular walls in the peripheral arteries thereby reducing the blood pressure. Methyldopa (eg Aldomet) stimulates the alpha receptors in the brain that relax the blood vessels, causing the blood pressure to drop. Moxonidine (eg Physiotens) is another medicine that acts on receptors in the involuntary part of the brain, causing blood pressure to decrease. Minoxidil (Loniten) relaxes the small arteries so that blood pressure drops. It must be used in combination with other hypertension medicines.

Cholesterol
An important factor in determining the danger of high blood pressure is yourcholesterol a high cholesterol increases the sensitivity of the arteries to high blood pressure and makes them more likely to be damaged. This means that when treating blood pressure, it's crucial to know what the cholesterol is and if it is raised, to bring it down. While diet, exercise, ideal weight and regular exercise are all important in reducing cholesterol, most people with high blood pressure and normal or high cholesterol also need a cholesterol lowering drug, such as a statin.

In the long term

By treating hypertension well, complications can be avoided and average life expectancy will remain almost normal. Without treatment, life expectancy may well be reduced due to the risk of developing complications such as heart failure or stroke.