1.2b BP Guidelines

Question 1

When should blood pressure be checked?

Answer 1

When starting the program (check left and right; record highest; check 3x)

If patient has a change in medications (check 3x)

If the patient reports currently or recently not feeling well

If patient has had a recent event and/or hospital visit

Question 2

Should you worry is systolic BP is below 95?

Answer 2

No - remember that a lower BP is healthy, so try to avoid over fixation on lower values when patient is asymptomatic

Question 3

When should you worry about low systolic blood pressure?

Answer 3

when symptomatic - question ability to drive

Question 4

What is the target blood pressure for someone with diabetes or CKD?

Answer 4

130/80

Question 5

What is an emergency situation in terms of blood pressure readings?

Answer 5

systolic BP of 180+
diastolic BP of 110+
symptoms of possible organ damage

Question 6

What are symptoms of possible organ damage?

Answer 6

chest pain
shortness of breath
back pain
numbness/weakness
change in vision, difficulty speaking

Question 7

When would blood pressure present as a contra-indication to exercise?

Answer 7

> 180/110

Question 8

What 3 factors should you consider when deciding what action to take with a patient?

Answer 8

symptoms

patient’s previous history

absolute blood pressure value

Question 9

Is strength or resistance training enough for an individual with hypertension?

Answer 9

No, not recommended as the only form of exercise training because, with the exception of circuit weight training, it has not consistently been shown to lower BP

Question 10

Exercise at what intensity appears to lower resting BP as much as, if not more than exercise at higher intensities?

Answer 10

40-60% of VO2max

Question 11

What should be the initial goal for exercise programming (kcal/week)?

Long-term goal?

Answer 11

700 kcal/wk

long-term goal: >2000kcal/week

Question 12

What is considered mild, moderate, severe, uncontrolled, or dangerous hypertension?

Answer 12

mild: 140/90
moderate: 150/95
severe: 160/100
uncontrolled: 170/100
dangerous/no ex.: >180/110

Question 13

What is the FITTR principle for managing hypertension?

Answer 13

F: daily
I: 40-65% METs
T: aerobic
T: 30-60 min
R: resistance training with BP over 160/100 is not recommended

Question 14

At what BP is resistance training not recommended?

Answer 14

> 160/110

Question 15

What can happen if the blood pressure cuff used on a patient is too small?

Answer 15

BP reading may be artefactually high

may be thought to be hypertensive when they actually are not

Question 16

What can happen if the blood pressure cuff used on a patient is too big?

Answer 16

the BP reading may be artefactually low, so existing hypertension may be missed

Question 17

What is the adult size cuff?

Answer 17

for arm circumference of 27-34 cm

Question 18

How should the blood pressure cuff be placed?

Answer 18

The centre of the sphygomomanometer bladder should be placed over the brachial artery that is situated down the medial aspect of the upper arm.

The lower portion of the cuff should be around 2 cm proximal to the antecubital fossa.

The cuff should be firmly wrapped around the arm.

Question 19

Why should you inflate the sphygmomanometer quickly?

Answer 19

If the cuff is inflated slowly, the korotkoff sounds will become more faint. This may result in a false reading with the systolic value being too low and the diastolic reading being too high. This is because a slow inflation causes venous congestion which can cause the sounds to be faint.

Question 20

What is the issue with rapid deflation of the sphygmomanometer in the presence of bradycardia?

Answer 20

Can result in a falsely low systolic reading and a falsely high diastolic reading. This is because it was deflated too quickly to catch the sounds.

Question 21

What is the true diastolic measurement?

Answer 21

The disappearance of sound represents the diastolic blood pressure. If you get a 10mm/Hg gap between muffling and disappearance, the muffling is probably closer to the true diastolic reading. If you are unsure, it is a good idea to record both.

Question 22

What is an ausculatory gap? What can this result in?

Answer 22

The absence of korotkoff sounds for a brief interval while taking the blood pressure.
One of the errors that can result from an ausculatory gap is the failure to diagnose systolic hypertension.

Question 23

How can you try to prevent an ausculatory gap?

Answer 23

by inflating the sphygmomanometer to at least 220mmHg

Question 24

Why do we check BP in both arms in initial assessment?

Answer 24

because often higher in one arm, usually right