Blood pressure – Wikipedia, the free encyclopedia

Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation, usually measured at a person's upper arm. A persons blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure and is measured in millimeters of mercury (mm Hg). Normal resting blood pressure for an adult is approximately 120/80mm Hg.

Blood pressure varies depending on situation, activity, and disease states, and is regulated by the nervous and endocrine systems. Blood pressure that is pathologically low is called hypotension, and pressure that is pathologically high is hypertension. Both have many causes and can range from mild to severe, with both acute and chronic forms. Chronic hypertension is a risk factor for many complications, including peripheral vascular disease, heart attack, and stroke. Hypertension is generally more common, also due to the demands of modern lifestyles. Hypertension and hypotension go often undetected because of infrequent monitoring.

The table on the right shows the classification of blood pressure adopted by the American Heart Association for adults who are 18 years and older.[1] It assumes the values are a result of averaging blood pressure readings measured at two or more visits to the doctor.[3][4]

In the UK, clinic blood pressures are usually categorised into three groups; low (90/60 or lower), normal (between 90/60 and 139/80), and high (140/90 or higher).[5][6]

Blood pressure fluctuates from minute to minute and normally shows a circadian rhythm over a 24-hour period, with highest readings in the afternoons and lowest readings at night.[7][8] Loss of the normal fall in blood pressure at night is associated with a greater future risk of cardiovascular disease and there is evidence that night-time blood pressure is a stronger predictor of cardiovascular events than day-time blood pressure.[9]

Various factors, such as age and sex, influence a person's blood pressure and variations in it. In children, the normal ranges are lower than for adults and depend on height.[10] Reference blood pressure values have been developed for children in different countries, based on the distribution of blood pressure in children of these countries.[11] As adults age, systolic pressure tends to rise and diastolic tends to fall.[12] In the elderly, blood pressure tends to be above the normal adult range,[13] largely because of reduced flexibility of the arteries. Also, an individual's blood pressure varies with exercise, emotional reactions, sleep, digestion, time of day and circadian rhythm.

Differences between left and right arm blood pressure measurements tend to be random and average to nearly zero if enough measurements are taken. However, in a small percentage of cases there is a consistent difference greater than 10mm Hg which may need further investigation, e.g. for obstructive arterial disease.[14][15]

The risk of cardiovascular disease increases progressively above 115/75mm Hg.[16] In the past, hypertension was only diagnosed if secondary signs of high arterial pressure were present, along with a prolonged high systolic pressure reading over several visits. Regarding hypotension, in practice blood pressure is considered too low only if noticeable symptoms are present.[2]

Clinical trials demonstrate that people who maintain arterial pressures at the low end of these pressure ranges have much better long term cardiovascular health. The principal medical debate concerns the aggressiveness and relative value of methods used to lower pressures into this range for those who do not maintain such pressure on their own. Elevations, more commonly seen in older people, though often considered normal, are associated with increased morbidity and mortality.

The mean arterial pressure (MAP) is the average over a cardiac cycle and is determined by the cardiac output (CO), systemic vascular resistance (SVR), and central venous pressure (CVP),[18]

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Blood pressure - Wikipedia, the free encyclopedia