THE MEASUREMENT OF BLOOD PRESSURE The most common measurement of blood pressure is the indirect measurement of arterial pressure

by means of the sphygmomanometer. This method actually measures the effect of an externally applied pressure upon the circulation. Most commonly, an inflatable bag and cuff are wrapped around the patient s left arm at the level of the heart. As the bag is inflated, the pressure acts to stop the blood flow through the brachial artery While the bag is inflated the gauge pressure is read on a mercury manometer or a pressure gauge . As the pressure in the bar is .slowly released the person listens with a stethoscope for sounds in the brachial artery The pressure noted on the gauge at the onset of these sounds is a measure of the systolic pressure. The sounds change as the pressure is lowered because of changes in the nature of the flow. When the bag pressure is completely released, no appreciable amount of sound will be heard in the normal artery Experimental studies indicate that the best index. of the diastolic pressure is the point at which the Korotkoff sounds become muffled, rather than the point at which they become inaudible. Though there is some doubt about the exact physical significance of muffing point . it appears to be a more consistent measurement than the inaudibility point. . The blood pressure is normally recorded as systolic/diastolic (for example 120/800) where the units are mm of Hg. To obtain a direct measurement of the blood pressure, some pressure measuring device must be connected directly into the circulatory system. The measurement of the central venous pressure (CVP) requires the placement of a catheter in the central venous system near the heart.

The normal central venous pressure is .generally considered to be 5 to 12 cm of wafer above the level of the right atrium. The ventricles of the heart may be viewed as twin force pumps which provide the pressure necessary to move the blood through the circulatory system. The right v . For a closed fluid system, the flow rate is the same through any cross section of the system. For the blood system the flow rate through the aorta is about 5 liters/min and is the same through the total cross section of the capillary system if there is no change in the volume of the circulating fluid. The heart provides energy to the blood in the form of pressure energy and kinetic energy.

Upon demand, vasodilatation and other mechanisms reduce the flow resistance of the system so that s large increase in flow rate can be achieved by a moderate increase in blood pressure. The maximum blood pressure in the arterial system occurs when the left ventricle contracts, and is called the systolic pressure. The minimum pressure, which occurs during the rest cycle of the heart, is called the diastolic pressure. The diastolic pressure is a result of the elastic recoil of the blood vessels, in a rigid pipe system there would be no such recoil and the diastolic pressure would be zero. Arterial pressures are measured indirectly by inflating a cuff to a pressure greater than the systolic pressure so that the blood flow in the brachial artery is cut off. As the cuff pressure is lowered, the turbulence of .intermittent flow through the artery produces sounds which can be monitored for the measurement of systolic and diastolic pressure. For venous pressure measurements, a catheter is connected to a water manometer or pressure transducer.