Sphygmomanometer

Sphygmomanometer

Definition

A sphygmomanometer is a device for measuring blood pressure.

Purpose

The sphygmomanometer is designed to monitor blood pressure by measuring the force of the blood in the heart where the pressure is greatest. This occurs during the contraction of the ventricles, when blood is pumped from the heart to the rest of the body (systolic pressure). The minimal force is also measured. This occurs during the period when the heart is relaxed between beats and pressure is lowest (diastolic pressure).

A sphygmomanometer is used to establish a baseline at a healthcare encounter and on admission to a hospital. Checking blood pressure is also performed to monitor the effectiveness of medication and other methods to control hypertension, and as a diagnostic aid to detect various diseases and abnormalities.

Description

A sphygmomanometer consists of a hand bulb pump, a unit that displays the blood pressure reading, and an inflatable cuff that is usually wrapped around a person's upper arm. Care should be taken to ensure that the cuff size is appropriate for the person whose blood pressure is being taken. This improves the accuracy of the reading. Children and adults with smaller or larger than average-sized arms require special sized cuffs appropriate for their needs. A stethoscope is also used in conjunction with the sphygmomanometer to hear the blood pressure sounds. Some devices have the stethoscope already built in.

A sphygmomanometer can be used or encountered in a variety of settings:

• home
• hospital
• primary care clinic or professional office
• ambulance
• dental office
• pharmacy and other retail establishment

There are three types of equipment in common use for monitoring blood pressure.

• A mercury-based unit has a manually inflatable cuff attached by tubing to the unit that is calibrated in millimeters of mercury. During blood pressure measurement , the unit must be kept upright on a flat surface and the gauge read at eye level. Breakage of the unit may cause dangerous mercury contamination and would require specialist removal for disposal. Due to the hazards of mercury, the use of mercury-based sphygmomanometers has declined sharply since 2000.
• An aneroid unit is mercury free and consists of a cuff that can be applied with one hand for self-testing; a stethoscope that is built in or attached; and a valve that inflates and deflates automatically with the data displayed on an easy-to-read gauge that will function in any position. The unit is sensitive and if dropped may require recalibration.
• An automatic unit is also mercury-free and is typically battery-operated. It has a cuff that can be applied with one hand for self-testing, and a valve that automatically inflates and deflates. Units with manual inflation are also available. The reading is displayed digitally and a stethoscope is not required. This is useful for persons who are hearing-impaired, for emergency situations when staff is limited, and for automatic input into instruments for storage or graphical display. A wrist monitor is also available for home testing. Some more expensive models also remember and print out recordings. The automatic units tend to be more portable than bulkier mercury devices.

Operation

The flow, resistance, quality, and quantity of blood circulating through the heart and the condition of the arterial walls are all factors that influence blood pressure. If blood flow in the arteries is restricted, the reading will be higher.

Blood pressure should be routinely checked every one to two years. It can be checked at any time but is best measured when a person has been resting for at least five minutes, so that exertion prior to the test will not unduly influence the outcome of the reading.

To record blood pressure, the person should be seated with one arm bent slightly, and the arm bare or with the sleeve loosely rolled up. With an aneroid or automatic unit, the cuff is placed level with the heart and wrapped around the upper arm, one inch above the elbow. Following the manufacturer's guidelines, the cuff is inflated and then deflated while an attendant records the reading.

If the blood pressure is monitored manually, a cuff is placed level with the heart and wrapped firmly but not tightly around the arm one inch above the elbow over the brachial artery. Wrinkles in the cuff should be smoothed out. Positioning a stethoscope over the brachial artery in front of the elbow with one hand and listening through the earpieces, the health professional inflates the cuff well above normal levels (to about 200 mm Hg), or until no sound is heard. Alternatively, the cuff should be inflated 10 mm Hg above the last sound heard. The valve in the pump is slowly opened. Air is allowed to escape no faster than 5 mm Hg per second to deflate the pressure in the cuff to the point where a clicking sound is heard over the brachial artery. The reading of the gauge at this point is recorded as the systolic pressure. The sounds continue as the pressure in the cuff is released and the flow of blood through the artery is no longer blocked. At this point, the noises are no longer heard. The reading of the gauge at this point is noted as the diastolic pressure. "Lub-dub" is the sound produced by the normal heart as it beats. Every time this sound is detected, it means that the heart is contracting once. The sounds are created when the heart valves click to close. When one hears "lub," the atrioventricular valves are closing. The "dub" sound is produced by the pulmonic and aortic valves.

With children, the clicking sound does not disappear but changes to a soft muffled sound. Because sounds continue to be heard as the cuff deflates to zero, the reading of the gauge at the point where the sounds change is recorded as the diastolic pressure.

Blood pressure readings are recorded with the systolic pressure first, then the diastolic pressure (e.g. 120/70).

Interpretation

Blood pressure readings must be interpreted in relation to a person's age, physical condition, medical history, and medications being used.

Maintenance

Devices should be checked and calibrated annually by a qualified technician to ensure accurate readings. This is especially important for automatic sphygmomanometers.

Normal results

One elevated reading does not mean that hypertension is present. Repeated measurements may be required if hypertension is suspected. The blood pressure measurement is recorded and compared with normal ranges for an individual's age and medical condition, and a decision is made on whether any further medical intervention is required.

Resources

books

Bickley, L. S., P. G. Szilagyi, and J. G. Stackhouse. Bates' Guide to Physical Examination & History Taking. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Chan, P. D., and P. J. Winkle. History and Physical Examination in Medicine. 10th ed. New York: Current Clinical Strategies, 2002.

Seidel, Henry M. Mosby's Physical Examination Handbook. 4th ed. St. Louis: Mosby-Year Book, 2003.

Swartz, Mark A., and William Schmitt. Textbook of Physical Diagnosis: History and Examination. 4th ed. Philadelphia: Saunders, 2001.

periodicals

Doyle, L. W., B. Faber, C. Callanan, and R. Morley. "Blood Pressure in Late Adolescence and Very Low Birth Weight." Pediatrics 111, no. 2 (2003): 252–257.

Jones, D. W., L. J. Appel, S. G. Sheps, E. J. Roccella, and C. Lenfant. "Measuring Blood Pressure Accurately: New and Persistent Challenges." Journal of the American Medical Association 289, no. 8 (2003): 1027–1030.

O'Brien, E. "Demise of the Mercury Sphygmomanometer and the Dawning of a New Era in Blood Pressure Measurement." Blood Pressure Monitoring 8, no. 1 (2003): 19–21.

Pickering, T. G. "What Will Replace the Mercury Sphygmomanometer?" Blood Pressure Monitoring 8, no. 1 (2003): 23–25.

organizations

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. <fp@aafp.org>. <http://www.aafp.org>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. Fax: (847) 434-8000. <kidsdoc@aap.org>. <http://www.aap.org/default.htm>.

American College of Physicians. 190 N. Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546, x 2600 or (215) 351-2600. <http://www.acponline.org>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. <http://www.ama-assn.org>.

other

"High Blood Pressure." Medline Plus Health Information. [cited March 12, 2003]. <http://www.nlm.nih.gov/medlineplus/highbloodpressure.html>.

"Hypertension." The Franklin Institute Online. [cited March 12, 2003]. <http://sln.fi.edu/biosci/healthy/pressure.html>.

"Your Guide to Lowering High Blood Pressure." National Heart, Lung and Blood Institute (National Institutes of Health). [cited March 12, 2003]. <http://www.nhlbi.nih.gov/hbp>

L. Fleming Fallon, Jr., MD, DrPH