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Measurement of blood pressure

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Abstract

The time-averaged systemic blood pressure (over 24 hours) is maintained in healthy individuals within a relatively narrow physiological range, which is necessary for adequate tissue perfusion. Blood pressure provides the driving force for blood flow and, without it, circulation and perfusion would cease. This chapter explains Underlying causes of hypertension; Selection of patients for blood pressure evaluation; Principles of blood pressure measurement; Interpretation of blood pressure measurements; and Management of hypertension.

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Figures

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15.1 An algorithm for screening and treating dogs and cats at risk for hypertension. BP = blood pressure; TOD = target-organ damage.
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15.3 Multifocal retinal oedema with an early sign of hypertensive retinopathy in a 17-year-old female cat with blood pressure of 215/132 mmHg. (Courtesy of N Kahane)
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15.4 Doppler blood pressure measurement. (a) Equipment required for Doppler sphygmomanometric measurement of blood pressure in dogs and cats. The signal amplifier (upper left) is attached to a piezoelectric crystal (lower centre). An inflatable bulb syringe attached to a manometer (upper centre) is used to inflate an appropriately sized cuff. Coupling gel and isopropyl alcohol (upper centre-right) are used to dampen the fur. (b) The cat is held gently in position and a flexible measuring tape is used to measure the circumference of the limb at the level of cuff placement. The cuff size is noted in the patient’s record. (c) Coupling gel is applied to the Doppler crystal just before application to the ventral portion of the metacarpal arch of the cat. The patient is held comfortably with the cuff at the level of the right atrium. (d) A bulb syringe attached to the manometer is used to inflate the blood pressure cuff positioned on the distal forelimb of a dog. During measurement, the leg is held gently so that the cuff is at the level of the right atrium.
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15.5 Blood pressure measurement using an oscillometric blood pressure device. Small dogs and cats may feel more comfortable in their owner’s laps, minimizing stress and ‘white coat hypertension’. (a) Equipment required for oscillometric blood pressure measurement. A flexible measuring tape (lower right) is used to measure the circumference of the cuff site. A previously devised ‘cuff size chart’ (upper right) may be useful for rapid choice of cuff size. An automated oscillometric monitor is attached to the appropriately sized cuff, and light tape may be used to secure the cuff in position once it is wrapped around the extremity to be used for measurement. (b) Oscillometric blood pressure measurement. A forelimb cuff is used to measure blood pressure with an automated oscillometric device. Note that, during such measurement, the limb is supported comfortably such that the cuff is at the level of the right atrium (thoracic inlet). The monitor displays systolic/diastolic pressure (e.g. 190/127 mmHg) with mean pressure (144 mmHg) beneath. Heart rate is displayed at the bottom (93 bpm). (c) A hindlimb cuff is positioned distal to the hock, with the dog in lateral recumbency. The limb is gently supported during readings so that the cuff is at the level of the right atrium (the sternum in lateral recumbency). A reading has not yet been obtained for this dog.

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