Differences Between Measured and Calculated Mean Arterial Pressure
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Hypertension – Adult – Clinical Practice Guideline
Hypertension – Adult – Clinical Practice Guideline Table of Contents EXECUTIVE SUMMARY ........................................................................................................... 3 SCOPE ...................................................................................................................................... 4 METHODOLOGY ...................................................................................................................... 5 INTRODUCTION ....................................................................................................................... 5 RECOMMENDATIONS .............................................................................................................. 5 Establish the Diagnosis ........................................................................................... 5 Patient Evaluation ................................................................................................... 7 Treatment Goals ..................................................................................................... 7 Lifestyle Modifications ............................................................................................. 8 Table 4 – Lifestyle Modifications ........................................................................ 9 Medication Treatment............................................................................................ 11 Figure 1 - Initiation and Titration of Antihypertensive Medication ..................... 13 Table 7 - Antihypertensive -
Pressure on Perfusion - Mean Arterial Pressure in Relation to Cerebral Ischemia and Kidney Injury
Pressure on Perfusion - Mean Arterial Pressure in Relation to Cerebral Ischemia and Kidney Injury Line Larsen and Carina Dyhr Jørgensen Affiliation: Department of Cardiac Thoracic Surgery University Hospital Odense Sdr. Boulevard 29 5000 Odense C, Denmark Supervisor: Claus Andersen, MD, Consultant Anaesthesiologist, Department of Anaesthesiology, V, OUH. Poul Erik Mortensen, MD, Consultant Surgeon, Department of Cardiac Thoracic Surgery, T, OUH. Pressure on Perfusion Line Larsen and Carina Dyhr Jørgensen Index Abstract ........................................................................................................................................................... 2 Introduction ..................................................................................................................................................... 3 Aim ................................................................................................................................................................ 8 Hypothesis ..................................................................................................................................................... 8 Methodological considerations ....................................................................................................................... 9 Materials and methods .................................................................................................................................. 10 Study design ............................................................................................................................................... -
High Blood Pressure
KNOW THE FACTS ABOUT High Blood Pressure What is high blood pressure? What are the signs and symptoms? Blood pressure is the force of blood High blood pressure usually has no against your artery walls as it circulates warning signs or symptoms, so many through your body. Blood pressure people don’t realize they have it. That’s normally rises and falls throughout the why it’s important to visit your doctor day, but it can cause health problems if regularly. Be sure to talk with your it stays high for a long time. High blood doctor about having your blood pressure pressure can lead to heart disease and checked. stroke—leading causes of death in the United States.1 How is high blood pressure diagnosed? Your doctor measures your blood Are you at risk? pressure by wrapping an inflatable cuff One in three American adults has high with a pressure gauge around your blood pressure—that’s an estimated arm to squeeze the blood vessels. Then 67 million people.2 Anyone, including he or she listens to your pulse with a children, can develop it. stethoscope while releasing air from the cuff. The gauge measures the pressure in Several factors that are beyond your the blood vessels when the heart beats control can increase your risk for high (systolic) and when it rests (diastolic). blood pressure. These include your age, sex, and race or ethnicity. But you can work to reduce your risk by How is it treated? eating a healthy diet, maintaining a If you have high blood pressure, your healthy weight, not smoking, and being doctor may prescribe medication to treat physically active. -
What Is High Blood Pressure?
ANSWERS Lifestyle + Risk Reduction by heart High Blood Pressure BLOOD PRESSURE SYSTOLIC mm Hg DIASTOLIC mm Hg What is CATEGORY (upper number) (lower number) High Blood NORMAL LESS THAN 120 and LESS THAN 80 ELEVATED 120-129 and LESS THAN 80 Pressure? HIGH BLOOD PRESSURE 130-139 or 80-89 (HYPERTENSION) Blood pressure is the force of blood STAGE 1 pushing against blood vessel walls. It’s measured in millimeters of HIGH BLOOD PRESSURE 140 OR HIGHER or 90 OR HIGHER mercury (mm Hg). (HYPERTENSION) STAGE 2 High blood pressure (HBP) means HYPERTENSIVE the pressure in your arteries is higher CRISIS HIGHER THAN 180 and/ HIGHER THAN 120 than it should be. Another name for (consult your doctor or immediately) high blood pressure is hypertension. Blood pressure is written as two numbers, such as 112/78 mm Hg. The top, or larger, number (called Am I at higher risk of developing HBP? systolic pressure) is the pressure when the heart There are risk factors that increase your chances of developing HBP. Some you can control, and some you can’t. beats. The bottom, or smaller, number (called diastolic pressure) is the pressure when the heart Those that can be controlled are: rests between beats. • Cigarette smoking and exposure to secondhand smoke • Diabetes Normal blood pressure is below 120/80 mm Hg. • Being obese or overweight If you’re an adult and your systolic pressure is 120 to • High cholesterol 129, and your diastolic pressure is less than 80, you have elevated blood pressure. High blood pressure • Unhealthy diet (high in sodium, low in potassium, and drinking too much alcohol) is a systolic pressure of 130 or higher,or a diastolic pressure of 80 or higher, that stays high over time. -
Unit 10 Shock,Resuscitation Part A
Vanderbilt University Medical Center Emergency General Surgery Service Surgical Residency Rotation and Curriculum UNIT 10SHOCK, RESUSCITATION, AND SURGICAL CRITICAL CARE PART A: SHOCK AND RESUSCITATION UNIT OBJECTIVES: 1. Demonstrate an understanding of the pathophysiology of shock and its categories. 2. Demonstrate an understanding of the mechanisms and pathophysiology of cardiopulmonary arrest. 3. Demonstrate the ability to manage the treatment of shock and cardiopulmonary arrest. COMPETENCY-BASED KNOWLEDGE OBJECTIVES: 1. Define the categories of shock based upon type, and explain the etiology and pathophysiology of each type of shock: a. Cardiogenic b. Hypovolemic c. Distributive (septic, anaphylactic, neurogenic, and adrenal insufficiency mediated) d. Obstructive (cardiac tamponade, tension pneumothorax, pulmonary embolus) 2. Summarize the clinical presentation and hemodynamic parameters associated with each type of shock. 3. Propose an algorithm for diagnosing and initiating treatment for each shock type. 4. Discuss the pathophysiology, including the mechanism of arrest, for each of the following situations: a. Acute myocardial infarction f. Substance abuse b. Acute dysrhythmia g. Hypothermia c. Congestive heart failure h. Acute stroke d. Pulmonary embolus i. Hemorrhagic shock e. Tension pneumothorax 5. Explain the indications for and the pharmacokinetics of each of the following drugs: a. Lidocaine g. Quinidine b. Bretylium h. Isoproterenol c. Digoxin i. Amiodarone d. Propanolol j. Dopamine e. Verapamil k. Dobutamine f. Pronestyl l. Adenosine (Adenocard®) 6. Summarize the indications and the appropriate techniques for cardioversion and defibrillation. Vanderbilt University Medical Center Emergency General Surgery Service Surgical Residency Rotation and Curriculum 7. Outline the signs and symptoms of acute airway obstruction and define the appropriate intervention in adult and pediatric patients. -
Arteries to Arterioles
• arteries to arterioles Important: The highest pressure of circulating blood is found in arteries, and gradu- ally drops as the blood flows through the arterioles, capillaries, venules, and veins (where it is the lowest). The greatest drop in blood pressure occurs at the transition from arteries to arterioles. Arterioles are one of the blood vessels of the smallest branch of the arterial circula- tion. Blood flowing from the heart is pumped by the left ventricle to the aorta (largest artery), which in turn branches into smaller arteries and finally into arterioles. The blood continues to flow through these arterioles into capillaries, venules, and finally veins, which return the blood to the heart. Arterioles have a very small diameter (<0.5 mm), a small lumen, and a relatively thick tunica media that is composed almost entirely of smooth muscle, with little elastic tissue. This smooth muscle constricts and dilates in response to neurochemical stimuli, which in turn changes the diameter of the arterioles. This causes profound and rapid changes in peripheral resistance. This change in diameter of the arteri- oles regulates the flow of blood into the capillaries. Note: By affecting peripheral resistance, arterioles directly affect arterial blood pressure. Primary function of each type of blood vessel: - Arteries - transport blood away from the heart, generally have blood that is rich in oxygen - Arterioles - control blood pressure - Capillaries - diffusion of nutrients/oxygen - Veins - carry blood back to the heart, generally have blood that is low in oxygen. -
Effect of Isoproterenol, Phenylephrine, and Sodium Nitroprusside on Fundus Pulsations in Healthy Volunteers
British Journal of Ophthalmology 1996; 80: 217-223 217 Effect of isoproterenol, phenylephrine, and sodium nitroprusside on fundus pulsations in Br J Ophthalmol: first published as 10.1136/bjo.80.3.217 on 1 March 1996. Downloaded from healthy volunteers Leopold Schmetterer, Michael Wolzt, Alex Salomon, Alexander Rheinberger, Christian Unfried, Gabriele Zanaschka, Adolf Friedrich Fercher Abstract have not yet been carried out and quantitative Aims/Background-Recently a laser inter- pressure flow relations in human choroidal ferometric method for topical measure- vessels are as yet unknown. Linear choroidal ment of fundus pulsations has been pressure flow relations have been obtained in developed. Fundus pulsations in the macu- animal experiments in different species.5-8 In lar region are caused by the inflow and out- the rabbit, the choroidal blood flow has been flow ofblood into the choroid. The purpose shown to be pressure independent when IOP ofthis work was to study the influence of a was less than 20-25 mm Hg.9 peripheral vasoconstricting (the a,x adreno- Blood vessels can be considered as cylin- ceptor agonist phenylephrine), a predomi- ders filled with fluid at a pressure greater than nantly positive inotropic (the non-specific that outside the cylinders. The pressure dif- I adrenoceptor agonist isoproterenol), and ference between the inside and the outside of a non-specific vasodilating (sodium nitro- a vessel is called the transmural pressure P. prusside) model drug on ocular fundus The corresponding tension T in the vessel pulsations to determine reproducibility wall can be calculated by Laplace's law and sensitivity ofthe method. P=T/R, where R is the radius of the cylinder. -
Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G
& Experim l e ca n i t in a l l C Aliya, J Clinic Experiment Cardiol 2011, 2:11 C f a Journal of Clinical & Experimental o r d l DOI: 10.4172/2155-9880.1000170 i a o n l o r g u y o J Cardiology ISSN: 2155-9880 Review Article Open Access Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G. College, Kakatiya University, Warangal, India Abstract Heart is one of the most important organs present in human body which pumps blood throughout the body using blood vessels. With each heartbeat, blood is sent throughout the body, carrying oxygen and nutrients to all the cells in body. The cardiac cycle is the sequence of events that occurs when the heart beats. Blood pressure is maximum during systole, when the heart is pushing and minimum during diastole, when the heart is relaxed. Vasodilation caused by relaxation of smooth muscle cells in arteries causes an increase in blood flow. When blood vessels dilate, the blood flow is increased due to a decrease in vascular resistance. Therefore, dilation of arteries and arterioles leads to an immediate decrease in arterial blood pressure and heart rate. Cardiac output is the amount of blood ejected by the left ventricle in one minute. Cardiac output (CO) is the volume of blood being pumped by the heart, by left ventricle in the time interval of one minute. The effects of vasodilation, how the blood quantity increases and decreases along with the blood flow and the arterial blood flow and resistance on cardiac output is discussed in this reviewArticle. -
Role of the Renin-Angiotensin-Aldosterone
International Journal of Molecular Sciences Review Role of the Renin-Angiotensin-Aldosterone System beyond Blood Pressure Regulation: Molecular and Cellular Mechanisms Involved in End-Organ Damage during Arterial Hypertension Natalia Muñoz-Durango 1,†, Cristóbal A. Fuentes 2,†, Andrés E. Castillo 2, Luis Martín González-Gómez 2, Andrea Vecchiola 2, Carlos E. Fardella 2,* and Alexis M. Kalergis 1,2,* 1 Millenium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, 8330025 Santiago, Chile; [email protected] 2 Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile; [email protected] (C.A.F.); [email protected] (A.E.C.); [email protected] (L.M.G.-G.); [email protected] (A.V.) * Correspondence: [email protected] (C.E.F.); [email protected] (A.M.K.); Tel.: +56-223-543-813 (C.E.F.); +56-223-542-842 (A.M.K.) † These authors contributed equally in this manuscript. Academic Editor: Anastasia Susie Mihailidou Received: 24 March 2016; Accepted: 10 May 2016; Published: 23 June 2016 Abstract: Arterial hypertension is a common condition worldwide and an important predictor of several complicated diseases. Arterial hypertension can be triggered by many factors, including physiological, genetic, and lifestyle causes. Specifically, molecules of the renin-angiotensin-aldosterone system not only play important roles in the control of blood pressure, but they are also associated with the genesis of arterial hypertension, thus constituting a need for pharmacological interventions. Chronic high pressure generates mechanical damage along the vascular system, heart, and kidneys, which are the principal organs affected in this condition. -
Hemodynamic Profile, Compensation Deficit, and Ambulatory Blood Pressure
UCLA UCLA Previously Published Works Title Hemodynamic profile, compensation deficit, and ambulatory blood pressure Permalink https://escholarship.org/uc/item/2210z7qp Journal Psychophysiology, 43(1) ISSN 0048-5772 Authors Ottaviani, C Shapiro, D Goldstein, I B et al. Publication Date 2006 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Hemodynamic Profile, Compensation Deficit, and Ambulatory Blood Pressure CRISTINA OTTAVIANI, a DAVID SHAPIRO, b IRIS B.GOLDSTEIN, b JACK E. JAMES, c ROBERT WEISS, d a Department of Psychology, University of Bologna, Italy b Department of Psychiatry, Univers ity of California, Los Angeles, USA c Department of Psychology, National University of Ireland, Galway, Ireland d Department of Biostatistics, University of California, Los Angeles, USA Address reprint requests to: David Shapiro, Department of Psychiatry and Biobehavioral Sciences 760 Westwood Plaza, Los Angeles, CA 90095, USA. E-Mail: [email protected] Abstract This study hypothesized that physiologically grounded patterns of hemodynamic profile and compensation deficit would be superior to traditional blood pressure reactivity in the prediction of daily -life blood pressure. Impedance cardiography -derived measures and beat -to -beat blood pressure were monitored continuously in 45 subjects during basel ine and four tasks. Ambulatory blood pressure measures were obtained combining data from one work and one off day. The mediating effects of gender and family history of hypertension were considered. Only gender was significantly associated with hemodynamic profile. Regression analysis indicated that typical reactivity meas ures failed to predict everyday life blood pressure . After controlling for gender and baseline blood pressure , hemodynamic patterns during specific tasks proved to be strong predictor s, overcoming limitations of previous reactivity models in predicting real -life blood pressure. -
Increased Pulse Pressure Is Associated with Reduced Baroreflex Sensitivity
Journal of Human Hypertension (2004) 18, 247–252 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Increased pulse pressure is associated with reduced baroreflex sensitivity R Virtanen1, A Jula2, H Huikuri3, T Kuusela4, H Helenius5, A Ylitalo6, L-M Voipio-Pulkki1,7, H Kauma3,8, YA Kesa¨niemi3,8 and J Airaksinen1 1Department of Medicine, University of Turku, Turku, Finland; 2Research Department of the Social Insurance Institution, Turku, Finland; 3Department of Medicine, University of Oulu, Oulu, Finland; 4Department of Physics, University of Turku, Turku, Finland; 5Department of Biostatistics, University of Turku, Turku, Finland; 6Division of Cardiology, Satakunta Central Hospital, Pori, Finland; 7Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; 8Biocenter Oulu, University of Oulu, Oulu, Finland Although pulse pressure (PP), heart rate variability significant when 24-h ambulatory diastolic blood pres- (HRV) and baroreflex sensitivity (BRS) have been shown sure, body mass index, smoking and alcohol intake were to predict cardiovascular events and mortality in various added as covariates in the multivariate analysis. In- populations, their relationships have not been clarified. creased ambulatory PP was also associated with We examined these associations in two separate increased beat-to-beat systolic arterial pressure varia- population-based samples of healthy middle-aged sub- bility. Associations between ambulatory PP and HRV jects. In population 1, data were obtained from 149 were not significant after controlling for age and gender. subjects (71 men and 78 women) aged 35–64 (mean 47.7) Our results suggest that elevated PP does not affect years, and in population 2, from 214 subjects (88 men overall HRV, but it interferes with baroreflex-mediated and 126 women) aged 40–62 (mean 50.5) years. -
Static and Dynamic Components of Right Ventricular Afterload Are Negatively Associated with Calf Survival at High Altitude1
Published September 29, 2016 Static and dynamic components of right ventricular afterload are negatively associated with calf survival at high altitude1 J. M. Neary,*2 R. D. Brown,† T. N. Holt,‡ K. R. Stenmark,† R. M. Enns,§ M. G. Thomas,§ and F. B. Garry‡ *Department of Animal and Food Sciences, College of Agricultural Sciences and Natural Resources, Texas Tech University, Lubbock 79409-2141; †Division of Pediatric Critical Care, School of Medicine, University of Colorado Denver, Aurora 80045; ‡Integrated Livestock Management, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins 80523-1678; and, §Department of Animal Sciences, The College of Agricultural Sciences, Colorado State University, Fort Collins 80523-1171. ABSTRACT: The purposes of this study were to pulse pressures (P = 0.03) at 3 mo of age than calves evaluate mean, systolic, and diastolic pulmonary that survived to 7 mo. Calves presumed to have died arterial pressures; pulmonary arterial pulse pres- tended to have greater systemic oxygen extraction sures; and systemic oxygen extraction fraction as fractions at 3 mo of age than calves that survived (P risk factors for the survival of suckling calves on one = 0.13). Diastolic pressure was not associated with ranch located at an altitude of 2,730 m in Colorado, survival (P = 0.27). Mean pulmonary arterial pres- USA. A prospective cohort study of 58 calves was sure is predominantly determined by static resistance performed. Pulmonary arterial pressures and sys- attributable to distal pulmonary arterial remodeling. temic oxygen extraction were measured when calves Pulse pressure and systolic pulmonary arterial pres- were approximately 3 mo (86 ± 7 d) and 7 mo (197 sure represents the dynamic or oscillatory resistance ± 6 d) of age.