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41 PRACTICAL QUESTIONS AND ANSWERS ABOUT HYPERTENSION AND HYPERCHOLESTEROLEMIA - 2008

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General information

  • The diagnosis of hypertension is based exclusively on blood pressure measurement. There is not any other method or test for the detection of hypertensive persons.
  • Blood pressure measurement is a simple procedure. Nevertheless, education, practice and meticulousness are required for its proper measurement.
  • Both in healthy and in hypertensive people, blood pressure continually fluctuates. Therefore for the exact blood pressure level determination, many measurements are usually required. These measurements must be performed only when the patient is relaxed. If he is in a nervous state or in a state of fear, panic or during exercise (i.e. running, weight lifting etc) blood pressure may increase too much: in fact systolic pressure may exceed even 200 mmHg. This is not the "true" blood pressure. This blood pressure does not need any management and subsides a little later.
  • The measurement of blood pressure may be performed either with an automatic electronic device or with a sphygmomanometer (mercury or aneroid sphygmomanometer) that requires the use of a stethoscope (see "Which devices are the most appropriate for blood pressure measurement", figures 3 and 4).
  • All devices read blood pressure in millimeters on a column of mercury (for example 140/90 mmHg).

Instructions for correct blood pressure measurement (figure 1)

  • At least half an hour before the measurement, you must avoid drinking coffee and smoking (of course you should always avoid smoking).
  • The measurement must be performed in a sitting position. If you take antihypertensive pills your doctor may also ask you to perform some measurements also in a standing position in order to determine if your blood pressure lowers in this position (orthostatic hypotension).
  • Before the measurement you must remain in a sitting position for about 5 minutes.
  • During the measurement your back must be supported by the back of a chair and your arm must be supported on a firm surface (for example a table).
  • The cuff (i.e. the cloth that is wrapped around the arm) must fit well around the naked arm.
  • The sleeve must be loosened if it is too tight.
  • The cuff must be at the level of the heart (figure 1).
  • The end of the stethoscope must be placed on the inner surface of the elbow without being completely covered by the cuff (figure 1).
  • Be sure that your blood pressure device indicates 0 before you start the measurement.
  • Inflate the cuff to 200-220 mmHg. Deflate slowly (about 10 mmHg every 5 seconds).
  • Systolic blood pressure is the point when the first rhythmic sound is heard.
  • The diastolic blood pressure is read from the mercury column when this sound disappears.
  • Blood pressure must be recorded in millimeters, for instance systolic pressure 160 and diastolic 90 mmHg and not "16 and 9".
  • Your device has marks for every 2 millimeters of pressure i.e. 90, 92, 94, 96 etc. The pressure value must not be rounded as for example 160/95 but must be recorded in detail with the final even (not odd) digit, i.e. 162/94 mmHg.
  • In most cases, two measurements are enough with an interval of 1 or 2 minutes in between. The second measurement usually shows lower blood pressure than the first one. If there is a large difference between the two measurements (more than 10 mmHg), a third one must be performed. All measurements must be recorded on paper.

WRITING GROUP
G. Stergiou, Chairman
A. Achimastos
E. Andreadis
I. Avramopoulos
M. Elissaf
N. Karatzas
T. Mountokalakis
D. Papadogiannis
K. Siamopoulos
E. Varsamis
K. Vemmos
D. Vlahakos