BLOOD PRESSURE •Blood pressure – the most important parameter in cardiovascular system – „high-profile“ parameter •Blood pressure (BP) – pressure of the blood to the wall of the vessels • •Systolic BP, diastolic BP, pulse pressure, mean arterial pressure (MAP) • •BP = CO x R CO – cardiac output, R – resistance • •CO = SV x HR SV – stroke volume, HR – heart rate • ESH AND ESC GUIDELINES 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Authors/Task Force Members: Giuseppe Mancia (Chairperson) (Italy) * , Robert Fagard (Chairperson) Classification BP values category Systolic BP Diastolic BP (mmHg) (mmHg) optimal < 120 < 80 normal 120 – 129 80 – 84 high normal pressure 130 – 139 85 – 89 Hypertension - mild 140 – 159 90 – 99 Hypertension - moderate 160 – 179 100 – 109 Hypertension - severe ≥ 180 ≥ 110 Izolated systolic hypertension ≥ 140 < 90 According the Guidelines of European Society of Cardiology 2013 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) Authors/Task Force Members: Bryan Williams* (ESC Chairperson) (UK), Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands), Enrico Agabiti Rosei (Italy), Michel Azizi (France), Michel Burnier (Switzerland), Denis L. Clement (Belgium), Antonio Coca (Spain), Giovanni de Simone (Italy), Anna Dominiczak (UK), Thomas Kahan (Sweden), Felix Mahfoud (Germany), Josep Redon (Spain), Luis Ruilope (Spain), Alberto Zanchetti† (Italy), Mary Kerins (Ireland), Sverre E. Kjeldsen (Norway), Reinhold Kreutz (Germany), Stephane Laurent (France), Gregory Y. H. Lip (UK), Richard McManus (UK), Krzysztof Narkiewicz (Poland), Frank Ruschitzka (Switzerland), Roland E. Schmieder (Germany), Evgeny Shlyakhto (Russia), Costas Tsioufis (Greece), Victor Aboyans (France), and Ileana Desormais (France) European Heart Journal (2018) 39, 3021–3104 •Classification of BP •It is recommended that BP be classified as •optimal, normal, high–normal, or grades •1–3 hypertension, according to office BP. Classification BP values: „officer BP“ category Systolic BP Diastolic BP (mmHg) (mmHg) optimal < 120 < 80 normal 120 – 129 80 – 84 high normal pressure 130 – 139 85 – 89 Hypertension – mild: grade 1 140 – 159 90 – 99 Hypertension – moderate: grade 2 160 – 179 100 – 109 Hypertension – severe: grade 3 ≥ 180 ≥ 110 Isolated systolic hypertension ≥ 140 < 90 According the Guidelines of European Society of Cardiology 2018 BLOOD PRESSURE MEASUREMENT •Direct invasive method –1726 Stephan Hales – horse –Today – during catetrisation – •Indirect non-invasive measurement -palpation method -Auscultation method -Oscilometric method – – – C:\Documents and Settings\ja2\Dokumenty\DEMONSTRACE\krevní tlak u koně001.jpg An Austrian physician Von Basch „aneroid sfygmomanometr“ Balloon in the wrist 1876 Italian physician Riva Rocci „mercury sfygmomanometr“ The cuff on the arm 1896 Palpatory methods Auskultatory method A Russian army surgeon Nikolai Korotkoff 1904 „mercury sfygmomanometr“ The cuff on the arm Stethoscope at the elbow 03 Špinar, J. a kol. Propedeutika a vyšetřovací metody vnitřních nemocí, 2008 The size of the cuff in adults Small adult Adult Large Tight cuff Noninvasive continuously beat-to-beat measurement of finger arterial pressure •Prof. Jan Peňáz, MD, PhD • •Teacher and researcher on the Department of Physiology, Masaryk university, Brno • •Patent 1969 Finapres (Ohmeda, USA) IMG_0869 P2290051 Finometr (FMS, Nizozemí) •We need than pressure in the cuff corresponded to the pressure of the digital artery •Method: photopletysmography •Recorded photoelectric plethysmogram •The new term: Transmural pressure – Pt (the pressure across the wall of the artery) •BP, Pc (pressure in cuff), Pt •We estimated: BP=Pc - - - Pt=0 - - - photoplethysmogram registered the highest amplitude of oscilation --- we measure the MAP •Step by step increase of Pc, in the moment of the highest amplitude – feed-back loop started for obtained(keeping) the constant volume of the finger Records of circulatory parameters obr11