Running head: QUANTITATIVE PAPER

Quantitative Paper
Kristin Caroza, Davis Legaspi-David, Ayessa Escandar, and Leslie Ramos
Touro University Nevada

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Outline of Proposal

Title
The effects of academic examinations on blood pressure of occupational therapy students
Research Question
Will academic exams effect the blood pressure of Occupational Therapy students of Touro
Universitys 2016 cohort?
Hypothesis
Students blood pressure will increase the day before their anatomy exam.
Background Literature Review
Kang, Y. (2010). Psychological stress-induced changes in salivary alpha-amylase and adrenergic
activity. Nursing & Health Sciences, 12(4), 477-484. doi: 10.1111/j.14422018.2010.00562.x
What is the problem or issue that your study addresses?
Physical and mental health conditions are arising more from stress and increasing
economic burden on the healthcare system. In the USA, stress-related disorders have
already cost $42 billion per year in 2001. Also, according to the World Health
Organization, by the year 2020, stress related mental health conditions will be highly
prevalent and will be second only to ischemic heart disease. In order to prevent
detrimental effects of stress on individuals, much effort has been made in health-related
disciplines, to relieve and manage stress. Therefore this study is aimed to determine the
level of salivary alpha-amylase as a measure of adrenergic activity that is useful as a
physiological marker of psychological stress. Specifically, the study will attempt to

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examine the relationships among salivary amylase concentration, plasma catecholamine

levels, blood pressure, and heart rate during psychological stress
Why is it important?
This study is important because in order to better cope with stress or to eliminate
some stress, it is important to first identify how stress may affect human responses.
Therefore, it is necessary to measure several types of human responses, such as blood
pressure, to identify if there is a correlation.
What is known about the topic?
In this study, college students were recruited through flyers and announcements at
their university. Thirty-three healthy, unmediated, non-smoking college students
participated and were allocated into an experimental group of 16 participants and a
control group of the remaining 17 participants. For the experiment, the academic finalterm test of a college sophomore major course was used to measure psychological stress.
The levels of salivary alpha-amylase and plasma catecholamines, blood pressure, and
heart rate were measured. The obtained data were analyzed by the Statistical Package for
Social Science software program. The results, specific to systolic and diastolic blood
pressures showed that there were significant increases in both the systolic and diastolic
blood pressure before the experiment and decreases after the experiment.
What has worked?
The sampling of blood pressure was taken in a 15 minute interval for a total of
four times before the stress event and at 15 minute intervals for 30 minutes after the stress
event. Therefore, seven samples were acquired from each participant. The participants
anxiety levels were verbally attained prior to and following the test. The overall stress

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level was verbally questioned a single time after the psychological stress event. Through
this data collection and after data analysis, the researchers were able to determine that
there was a significant difference between the experimental and control group.
How will your study add to the knowledge base once it is done?
This study is similar to the study we are conducting by evaluating students and the
relation of their blood pressures to the stress of an exam. Therefore, this study concludes
by supporting our hypothesis that with an increase in stress, such as the anatomy exam,
blood pressure will increase as well.
What new information will your study add to our understanding of the topic or
addressing the topic/problem?
Our study will provide the basic knowledge of how the increase of blood pressure
can correlate with the stresses of taking an exam. Also, it can provide further knowledge
or a basic foundation to other researches that maybe trying to understand possible
illnesses that may develop through induced stress levels. Lastly, it can be used as an aid
when potentially developing an intervention for stress management.
Hughes, B. M. (2005). Study, examinations, and stress: blood pressure assessments in college
students. Educational Review, 57(1), 21-36. doi: 10.1080/0013191042000274169
What is the problem or issue that your study addresses?
The peer review article that I have chosen brings up the correlation of how stress
leads to anxiety, which ultimately negatively affects the academic performance of college
students. Particularly, in the article it talks about how college students academic
performances are hindered due to the mental, behavioral, interpersonal development, and
physical stresses that there schools have placed upon them. Furthermore, the article goes

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more in debt by addressing how there are numerous researches the talks about the
relationship between student stress on mental health, but a lack of research geared
towards how student life influences physical health specifically, blood pressure.
Why is it important?
Well from a medical perspective, it is important to figure out what aspects of
student life causes blood pressure levels to elevate among students, and what the extent
of the impact might be. Blood pressure responses to psychological stresses remain a
significant indicator of the risk of future illnesses such as heart disease.
What is known about the topic?
There are many stressors that typically emerge from studies done that are based
on student life, such as relationship problems, loneliness, money problems and parental
problems. However, one stressor that is constantly brought up by students is their concern
about their grades. Student grade results have shown to be the most frequently reported
precursor to a depressive episode among students who participated in a large multi-site
North American survey in the late 1980s and was again the most reported in a follow up
study conducted 10 years later.
What has worked?
One of the procedures that were successful in this research study was the control
group methodology during observation of examination results and cardiovascular
reactivity. By computing for partial correlation to control gender, it resulted in a
significantly positive association between academic performance and systolic blood
pressure.

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How will your study add to the knowledge base once it is done?
My groups study will add further knowledge towards specifically addressing
whether or not first year occupational therapy students tend to develop arise in their blood
pressure level due to certain class exams.
What new information will your study add to our understanding of the topic or
addressing the topic/problem?
Based on the experimental procedure that my group has developed for our
research study, the new information that we will potentially add is to be able to determine
an early timeframe of when blood pressure tends to rise amongst first year occupational
therapist student. Specifically, does blood pressure rise closer towards exam day or does
it occur way earlier. Also, how do the blood pressure levels of the students compare a
day after the exam?
Conley, K. M., & Lehman, B. J. (2012). Test Anxiety and Cardiovascular Responses to Daily
Academic Stressors. Stress and Health, 28(1), 41-50. doi: 10.1002/smi.1399
What is the problem or issue that your study addresses?
This study addresses how daily academic stressors and test anxiety affect blood
pressure on undergraduate students.
Why is it important?
This study acknowledges the academic stressors and test anxiety of college
students in relation to elevated blood pressure. These young individuals continue to put
their hearts under stress which will lead to a higher risk for cardiovascular disease and
negative health outcomes. It is crucial for students to learn how to cope with everyday

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stresses and high test anxiety to manage future academic courses and potential job
success. It will be inevitable that everyday stress will occur so it is important for the
individual to learn how to manage their health and blood pressure.
What is known about the topic?
Previous research have distinguish between two types of academic stressors, acute
stressors and anticipatory stressors. Acute stressors are short-term and immediate threats
on a goal like taking an examination. In contrast, anticipatory stressors are long-term
events that may influence a goal in the future such as writing a paper. In a previous
study, blood pressure elevates during anticipatory stress situations and significantly
increases during acute stress events. Academic stressors that have been reported from
college students are from examinations, papers, presentations, and studying. Even among
young healthy participants of increase cardiovascular responses, they may still be at risk
for heart disease and early hypertension in adulthood.
What has worked?
This study was conducted during five consecutive weekdays. The participants
wore an ambulatory blood pressure monitor and were required to complete a brief
assessment on their posture, activity level, food consumption, and others. Participants
completed an end-of-day report which indicates the most stressful events, reasons why
the event was stressful, and the time of day the event occurred. In addition, test anxiety
was measured by a four point Likert scale that consisted of 20 items. These measures
worked as the results show an increase of blood pressure during acute academic stress
events among students that were reported with high test anxiety.

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How will your study add to the knowledge base once it is done?
Our study involves 16 graduate students in an accelerated occupational therapy
program. Throughout the program, our participants will undergo many acute academic
stress events that may affect their overall health and blood pressure. We believe that our
participants will show increase blood pressure during anticipatory academic stressors
because of the high pace nature of the OT program. In this article, the results did not
show significant findings on high blood pressure during anticipatory academic
stress. Our finding may contribute to this knowledge base by looking at participants in a
higher level of education and a higher intensity of academic stress.
What new information will your study add to our understanding of the topic or
addressing the topic/problem?
Our study has the potential to present new information in regards to blood
pressure levels before and after a big examination in an accelerated graduate school
program. Most studies have been done on undergraduate school students. In addition,
our participants range from 22 to 47 years of age. The additional stress and anxiety that
comes with age such as children and independent living can influence blood pressure
Zhang, Z., Su, H., Peng, Q., Yang, Q., & Cheng, X. (2011). Exam Anxiety Induces Significant
Blood Pressure and Heart Rate Increase in College Students. Clinical & Experimental
Hypertension, 33(5), 281-286. doi: 10.3109/10641963.2010.53185
What is the problem or issue that your study addresses?
This study addresses the effects of increase anxiety, blood pressure, and heart rate before
and during the examination period.

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Why is it important?
This study is important because high blood pressure is a precursor to
cardiovascular disease, one of the leading causes of death among adults. One of the
biggest stressors among college students today are academic exams, which also correlates
to a higher blood pressure. Information from this experiment is important because it
helps provide information on specific factors that affect stress and health among college
students as well as indorse initiatives to help students cope with their stress as well as
reduce risk factors of cardiovascular disease.
What is known about the topic?
Anxiety has been demonstrated as an independent factor for hypertension (FHH).
Individuals with family hypertensive history had a higher blood pressure (BP) increase
amplitude during review sessions and exam periods. Results indicate that the students
with FHH are susceptible to anxiety, higher BP and, heart rate in the peri-exam period.
What has worked?
The study indicated that that blood pressure increased gradually from the basic
period to the exam period. Also, a significant increase of blood pressure occurred during
review period. As for the result of blood pressure for participants with anxiety, the study
indicated that anxiety is an independent factor for a blood pressure increase although
blood pressure was somewhat higher in the anxiety group than in the non-anxiety group.
Therefore, blood pressure increase during exam period in young medical students, and
their increased amplitudes are positively connected with the extent of anxiety.
How will your study add to the knowledge base once it is done?

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Our study is quite similar to this experiment in the fact that we are measuring
blood pressure of students in response to the stress of an academic exam. In the case of
our study, we are adding to the knowledge base by specifically measuring the blood
pressure of Occupational Therapy Grad-School students in response to a difficult
Anatomy midterm.
What new information will your study add to our understanding of the topic or
addressing the topic/problem?
New information that our study will add to the understanding of the topic in
regards to the effects of academic exams on blood pressure is that our sample includes a
large range of ages starting with individuals as young as 22 to as old as 47. We could
further add possible new information on the effect of academic exams on the blood
pressure of students in early adulthood versus middle adulthood.
Methods
What type of quantitative study will this be?
Non Experimental: Correlational Design
Why did you choose this type of research design?
We chose this design because we wanted to see the relationship between blood pressure
of students and academic exams.
Who is in your sample?
Our participants include the Occupational Therapy Students of Touro University
Nevadas 2016 cohort. We used a simple random sample method using a computer generated
list that assigned students to a number. Then, the research group members who were blind to the

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list of students and their assigned numbers randomly selected numbers to determine who will be
in their study.
What are the procedures for conducting data in your study?
We are going to collect the blood pressure of students a week before a midterm exam, the
day before the midterm exam, and a week after the midterm exam.
Are you using any other instruments to measure outcomes?
We are using a Sphygmomanometer.
What methods for data analysis are you planning on using?
Excel
Participant
Number

Age

Gender Blood

Medications being used that may affect

Pressure

blood pressure

Results
For what period of time did you recruit participants?
The first blood pressure examination was taken the day before the second anatomy exam,
which was on September 18, 2014. The second blood pressure examination was taken during a
week where there were no class examinations, which was on September 23, 2014. We recruited
participants between the week of August 25th to 29th in order to allow sufficient time to let the
participants know that they were randomly chosen for the study and to receive their verbal
consent.
Who did you actually get in your study?

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We used first year occupational therapy students from Touro University Nevada who are
currently undertaking an anatomy course. There were 4 males and 12 females in our study with
a mean age of 27.6 years. Refer to tables 3a, 3b, 4a, 4b.
How many people were recruited, how many refused, and how many did you end up with?
How many completed the study? The drop-outs represent your attrition rate and you need
to explain why.
16 Occupational Therapy students from Touro University were recruited for the study. All
students who were recruited participated and completed the study.
How many were randomly assigned to the control group or the treatment group?
Out of 36 first year occupational therapy students, 16 students were randomly assigned to
the treatment group.

Participant
Number

Age

Gender Blood
Pressure

Medications being used that may affect

blood pressure

22

120/82
117/80

N/A

22

120/80
145/90

N/A

26

122/88
118/78

N/A

47

130/78
115/75

N/A

32

100/70
100/70

N/A

25

110/78
110/78

N/A

23

110/68
110/70

N/A

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23

120/88
118/80

N/A

22

120/80
120/80

N/A

10

22

110/80
116/80

N/A

11

22

116/80
112/78

N/A

12

24

116/76
116/80

YES

13

42

124/78
136/90

YES
YES

14

24

132/90
126/100

N/A

15

26

124/70
115/80

N/A

16

39

136/80
122/80

N/A

Discussion
Begin this section with a clear statement of support or nonsupport for your original
research hypotheses or research question.
As we obtained our results, we were able to conclude from our study that there was no
correlation between an increase in blood pressure before an exam compared to after an exam was
taken. By running a t-test on both systolic and diastolic measurements, our results displayed a
p-value 0.34 for systolic measurements and a p-value 0.19 for diastolic measurements. Therefore
with this newfound results, our group continues to still support our original research hypothesis
that students blood pressure will increase the day before their anatomy exam compared to after.
As a group, we continued to support our original hypothesis because we felt that there were

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many limitations that could have caused our results to be skewed. Also, through reading further
studies that conducted a similar test as ours, many resulted that there was an increase of blood
pressure either during the test or right before.
If your hypotheses were not supported, offer explanations of why. Use literature from your
background section or find others.
As our group obtained the results of our study, we compared the differences we made
with gathering the measurements of blood pressures in comparison to how other researches did
it. In particular to one of the research articles our group read, Psychological Stress-Induced
Changes in Salivary Alpha-Amylase and Adrenergic Activity, one of the researches obtained their
measurements of blood pressure from their participants by taking 4 blood pressure
measurements, in 15-minute intervals, right before and after the exam took place. Also, in
several other research articles our group read, all blood pressure measurements were gathered
right before and after the exam. However, for our study we were only able to attain one blood
pressure measurement the day before the exam and one blood pressure measurement a couple of
days after. Due to an increase time gap between, taking the blood pressure of the participants
compared to when they actually took their anatomy exam could have caused a possibility to why
our hypothesis was not supported by our results.
In a second research article named, Study, Examinations, and Stress: Blood Pressure
Assessments in College Students, the blood pressure that was obtained from the participants was
through an automatic blood pressure device, consequently assuring that the blood pressure
measurement was accurate and consistent. As we compared this to our procedure of obtaining
the blood pressure measurement from our participants, every researcher took the blood pressure
from 4 participant which may have caused an inconsistency with the blood pressure

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measurements. This component of our research could be another possibility to why our
hypothesis was not supported by our results.
Compare similarities and differences between your findings and other studies. If you do
not have enough studies to compare, then find them in the literature.
A comparison with our findings and the findings of other studies show a similarity
towards an increase in blood pressure with young college students during exams. In general, all
of our research has indicated an increase in systolic blood pressure due to academic stress such
as an anatomy exam our participants experienced. In the article, Psychological Stress-Induced
Changes in Salivary Alpha-Amylase and Adrenergic Activity, the data implicated that there were
significant increases in the participants systolic and diastolic blood pressure before the exam
and a decrease after. Our study indicated in Figure 2 that half the participants showed this same
pattern of an increase of blood pressure before the exam and a decrease after, however 31.3%
showed no difference, while 18.8% displayed the opposite results.
Explain surprising findings. This can mean going back to your background literature or
finding other literature. Did you find that one subset of your sample responded better to
the intervention versus another?
One of the surprising findings that we found from our research was that when examining
the group as a whole, some of the test subjects did not display the systolic blood pressure trend
that we were expecting to see before and after taking the anatomy exam. What we were
assuming was going to happen was that all of the test subjects were going to display a relatively
higher systolic blood pressure a day before taking the exam as compared to their systolic blood
pressure days after the exam. However, what ended up happening instead was that two of the test
subjects concluded with having a much higher blood systolic pressure compared to their initial

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blood pressure measurements at the begin of the study. In addition, five of the subjects did not
show any change in their systolic blood pressure before and after the test. Furthermore, another
surprising finding was between the male and female subjects in our research. Our female
subjects on average tend to display a much higher systolic blood pressure before the exam
compared to our male subject. However, this trend switched because after the exam as our male
subjects ended up having a higher systolic blood pressure relative to their female counterparts.
Our last surprising finding was when comparing the systolic blood pressure between age groups.
Test subjects who are between the ages of 22 to 24 exhibited showing a higher systolic blood
pressure compared to subject who are 25 or above.
Draw conclusions from your findings. Situate your study in the grand theme of the
literature on your topic.
Although previous research indicated that the stress caused by academic exams correlated
with a rise in blood pressure, there was no significance in the effect of an anatomy exam on the
blood pressure of Occupational Therapy students of Touro University overall. Occupational
Therapy students from Touro University Nevada often undergo several other examinations
throughout their program. With the amount of previous experience in taking exams, it is possible
that the students had habituated to testing and felt less stressed before taking their anatomy
midterm. However, it is important to note that although the anatomy exam did not correlate to a
higher blood pressure on average among the students, there was a significance among different
age groups. While students who were 22-24 years of age experienced a slight increase of blood
pressure a week after the anatomy exam, students within the age group of 25-29 and 30+ years
old displayed a decrease in blood pressure a week after the anatomy exam on average. This data
suggests that older students may be more susceptible to a blood pressure increase and stress

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caused by academic exams but return back to a normal temperament and blood pressure once the
exam is over.
Discuss any barriers to implementing an intervention or procedures.
The main barrier of this research was during the process of gathering blood pressure
measurements. Our group was not able to obtain the best measurements of blood pressure of
each participant due to time constraints. Not all participants would be willing to have their blood
test taken right before the exam because they could still be in the process of studying. Also,
because the researchers also had to take the same exam as the participants, we did not want to
use the time before the exam taking the participants blood pressures when we need to be
studying and focused for the exam. Additionally, participants in the study took the anatomy lab
exams during different times, therefore it would have been difficult to gather each participant
after each exam.
Limitations
Discuss potential limitations affecting internal validity or external validity, e.g., any sources
of bias such as sampling, imprecise measures, or other weaknesses in the study, etc.
When collecting data for our study, it was important to practice ethical research by
receiving informed consent by asking for the participants permission to take their blood pressure
a week prior to recording data. Due to the nature of informing participants ahead of time, it is
possible that it affected data because they knew that someone would be monitoring their blood
pressure, thus made them more conscious about their health. Other limitations that may affect
the internal validity of our study include the tools that were used to record blood pressure. In our
study, we used a manual sphygmomanometer in conjunction with a stethoscope to record blood
pressure instead of an electronic version. Using this method allows different variables of human

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error including possible bias and misreading measurements. Another element that impacted our
study was that there were 2 students who were taking medications that influenced their blood
pressure. This indicated other physiological factors that impacted blood pressure among the
participants besides the stress from the academic exam. Our study is also sociologically limited
in its ability to generalize the gathered information to a larger population because all of the
participants were college graduates and were pursuing higher level education to be Occupational
Therapists. Since the participants were students within the health field, it is possible that they are
more conscious about maintaining wellness, thus affecting their blood pressure overall despite
the stressors of an academic exam.
Explain what remains unsolved at the end of your study. Here you can discuss
recommendations for future research.
Future research may expand on these finding in several ways. The participants in the
study consisted of a small sample size that included 16 first year occupational therapy graduate
students. In regards to age, it may be important to include age differences in response to
academic exams. Although we had participants ranging from ages 22 to 47, the sample is not the
best representation of that whole spectrum. Half of the participants were ages 22 to 24 and the
other half were grouped together in a range of 24 to 47. Increase blood pressure may be
influence by the increase of age. The increase of age leads to higher levels of responsibility in
terms of having a family, paying bills, etc. This can influence blood pressure on top of having to
study for an academic exam. In addition, the participants in the study were mainly female with
only 4 of 16 participants that were male. There wasnt a strong correlation in this study which
leads to exploring the differences in blood pressure between genders. Another area that can be
addressed is the time to take participants blood pressure before and after an exam. Multiple

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blood pressure readings throughout the day may give an accurate measurement. Future research
should explore these potential connections.
Discusses limitations in the ability to generalize the findings.
Although our results did not show significant findings of elevated blood pressure before
academic exams, it is important for students to be aware of how stress impacts their overall
health. Our study showed a slight increase in systolic blood pressure the day before the exam
versus a week after. This result shows clinical significance in regards to changes in blood
pressure from academic exams. Managing a healthy blood pressure before high stress academic
exams may improve their performance. In addition, this would also prevent possible health
problems linked to stress like heart disease or hypertension. The occupational therapy students
at Touro University Nevada undergo a rigorous and accelerated program that includes many
academic examinations. An intervention may be important for those who show increases in their
blood pressure as a first year student because of the potential risk for their cardiovascular health.

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References

Conley, K. M., & Lehman, B. J. (2012). Test Anxiety and Cardiovascular Responses to Daily
Academic Stressors. Stress and Health, 28(1), 41-50. doi: 10.1002/smi.1399
Kang, Y. (2010). Psychological stress-induced changes in salivary alpha-amylase and adrenergic
activity. Nursing & Health Sciences, 12(4), 477-484. doi:10.1111/j.14422018.2010.00562.x
Hughes, B. M. (2005). Study, examinations, and stress: blood pressure assessments in college
students. Educational Review, 57(1), 21-36. doi: 10.1080/0013191042000274169
Zhang, Z., Su, H., Peng, Q., Yang, Q., & Cheng, X. (2011). Exam Anxiety Induces Significant
Blood Pressure and Heart Rate Increase in College Students. Clinical & Experimental
Hypertension, 33(5), 281-286. doi: 10.3109/10641963.2010.53185

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21

Tables and Figures

160
140

Systolic BP

120
100
80

Before Exam (systolic)

60

After Exam (systolic)

40
20
0
1 2 3 4 5 6 7 8 9 10111213141516
Individual Subjects

Figure 1a: Systolic Blood Pressure of the Individual Subjects. This figure illustrates the systolic
blood pressure of each subject by comparing the systolic blood pressure before and after the
exam.
120

Diastolic BP

100
80
60

Before Exam (Diastolic)

40

After Exam (Diastolic)

20
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Individual Subjects

Figure 1b: Diastolic Blood Pressure of the Individual Subjects. This figure illustrates the
diastolic blood pressure of each subject by comparing the systolic blood pressure before and after
the exam.

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22

31%
Same Systolic BP
Increase Systolic BP

50%

Decrease Systolic BP

19%

Figure 2a: Systolic Blood Pressure of the Individual Subjects by Percentage. This figure
illustrates the percentage of how many participants had the same, increase, or decrease of
systolic blood pressure, before and after the exam.

31%
38%
Same Diastolic BP
Increased Diasolic BP

Decreased Diastolic BP

31%

Figure 2b: Diastolic Blood Pressure of the Individual Subjects by Percentage. This figure
illustrates the percentage of how many participants had the same, increase, or decrease of
diastolic blood pressure, before and after the exam.

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160
140

Systolic BP

120
100
80

Male before exam

60

Male after exam

40
20
0
1

Male Individual Subjects

Figure 3a: Systolic Blood Pressure of Individual Male Subjects. This figure illustrates the
comparison of the systolic blood pressures of each individual male participant before and after
the exam.
100
90
80

Diastolic BP

70
60
50

Male Before Exam

40

Male After Exam

30
20
10
0
1

Male Individual Participants

Figure 3b: Diastolic Blood Pressure of Individual Male Subjects. This figure illustrates the
comparison of the diastolic blood pressures of each individual male participant before and after
the exam.

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24

160
140

Systolic BP

120
100
80

Female before exam

60

Female after exam

40
20
0
1

10

11

12

Female Individual Participants

Figure 4a: Systolic Blood Pressure of Individual Female Subjects. This figure illustrates the
comparison of the systolic blood pressures of each individual female participant before and after
the exam.

120

Diastolic BP

100
80
60

Female Before Exam

Female After Exam

40

20
0
1

10 11 12

Female Individual Participants

Figure 4b: Diastolic Blood Pressure of Individual Female Subjects. This figure illustrates the
comparison of the diastolic blood pressures of each individual female participant before and after
the exam.

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25

124
122

Systolic BP

120
118

systolic before

116

systolic after
114
112
110
age 22-24

age 25-29

age 30 and above

Age Groups

Figure 5a: The Systolic Blood Pressure by Age Groups. This figure illustrates the average
systolic blood pressure by age groups and compares the measurements of their average systolic
blood pressures before and after the exam.
84
82

Diastolic BP

80
78
76
74

Diastolic Before

72

Diastolic After

70
68
66
Age 22-24

Age 25-29

Age 30+

Age Groups

Figure 5b: The Diastolic Blood Pressure by Age Groups. This figure illustrates the average
diastolic blood pressure by age groups and compares the measurements of their average diastolic
blood pressures before and after the exam.