Pressure diastolic

Systolic pressure, or maximum blood pressure, occurs during left ventricular systole. Diastolic pressure, or minimum blood pressure, occurs during ventricular diastole. The difference between systolic and diastolic pressure is the pulse pressure. While diastolic blood pressure has been historically been used as the most relevant clinical blood pressure phenotype, it has now been clearly established that systolic blood pressure is the more important clinical predictor for cardiovascular morbidity and mortality. More recently, additional attention is focussed on the importance of pulse pressure, i.e. the blood pressure amplitude, as a predictive factor for cardiovascular disease. 

Once essential hypertension develops, management of this disorder becomes a lifetime task. When a direct cause of the hypertension can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks first, with tumors or other abnormalities of the adrenal glands following. In malignant hypertension the diastolic pressure usually exceeds 130 mm Hg. In secondary hypertension,... 

In most individuals, the systolic pressure increases sharply with age, whereas the diastolic pressure increases until about age 55 years and then declines. Older individuals with an elevated systolic pressure have a condition known as isolated systolic hypertension (ISH). When the systolic pressure is high, blood vessels become less flexible and stiffen, leading to cardiovascular disease and kidney damage. Research indicates that treating ISH saves lives and reduces illness. The treatment is the same for ISH as for other forms of hypertension. 

Notify the primary care provider if the diastolic pressure suddenly increases to 130 mm Hg or higher you may have malignant hypertension. 

If a stroke patient receives intravenous (IV) thrombolysis, care often continues in the ED until the patient arrives in the ICU. Close monitoring must continue during this time, with special attention to the blood pressure. The blood pressure is most commonly checked via an arm cuff, since the placement of invasive lines (e.g., arterial catheterization) is relatively contraindicated once the patient has received intravenous thrombolysis (unless the situation is emergent and mandates such treatment). The systolic pressure must not exceed 185 mm Hg, and the diastolic pressure limit should be 110 mm Hg. Should the blood pressure exceed these limits, IV antihypertensive agents should be administered. IV pushes of labetolol (10-20 mg over 1-2 minutes) may be effective, but if patients are refractory to these initial measures then a continuous infusion of labetolol (0.5-2.0 mg/minute), nicardipine (5-15 mg/hour), or nitro-prusside (0.25-10 mg/kg/minute) may be necessary to keep the patient s blood pressure within the range. There will be a more detailed discussion of these antihypertensive agents, including their side effect profiles, later in this chapter. 

Essential hypertension, whose prevalence is increased nearly two-fold in the diabetic population, may be another source of free-radical activity. The vascular lesions of hypertension can be produced by free-radical reactions (Selwign, 1983). In the recent Kuopio Ischaemic Heart Risk Factor Study in Finnish men, a marked elevation of blood pressure was associated with low levels of both plasma ascorbate and serum selenium (Salonen etal., 1988). A few studies report a hypotensive effect of supplementary ascorbate in patients with hypertension, but the actual changes in both systolic and diastolic pressure after ascorbate were not statistically significant in comparison with placebo (Trout, 1991). 

To reduce deviations in blood pressure measurement in the clinic, the patient and clinician should not talk during blood pressure readings. The measurement arm is supported and positioned at heart level with the blood pressure cuff encircling at least 80% of arm circumference. If a mercury or aneroid device is used, then the palpatory method must be used first to estimate the systolic blood pressure.18 If an automated device is used, this is not necessary. After the patient s cuff is inflated above the systolic pressure, the mercury column should drop at a rate of 2 to 3 mm per second. A stethoscope placed over the brachial artery in the antecubital fossa identifies the first and last audible Korotkoff sounds, which should be taken as systolic and diastolic pressure, respectively. A minimum of two readings at least 1 minute apart are then averaged. If measurements... 

The treatment of elderly patients with hypertension, as well as those with isolated systolic hypertension, should follow the same approach as with other populations with the exception that lower starting doses may be warranted to avoid symptoms and with special attention paid to postural hypotension. This should include a careful assessment of orthostatic symptoms, measurement of blood pressure in the upright position, and caution to avoid volume depletion and rapid titration of antihypertensive therapy.2 In individuals with isolated systolic hypertension, the optimal level of diastolic pressure is not known, and although treated patients who achieve diastolic pressures less than 60 to 70 mm Hg had poorer outcomes in a landmark trial, their cardiovascular event rate was still lower than those receiving placebo.69... 

NS (general population) Cardiovascular Increased systolic pressure by 1-2 mm Hg and increased diastolic pressure by 1.4 mm Hg with every doubling in blood lead level effect most prominent in middle-aged white men 7-38 Coate and Fowles 1989 Harlan 1988 Harlan et al. 1988 Landis and Flegal 1988 Pirkle et al. 1985 Schwartz 1988 Proctor et al. 1996... 

The relationship of PbB level to systolic and diastolic blood pressure was determined in a study of 89 Boston policemen (race not specified) (Weiss et al. 1986, 1988). These policemen were under observation for health outcomes related to environmental work exposures (i.e., they had traffic exposure histories). After statistically adjusting for previous systolic blood pressure, body mass index, age, and cigarette smoking, high PbB level ( 30 pg/dL) was a significant (p=0.01) predictor of subsequent elevation in systolic blood pressure of 1.5-11 mm Hg in the working policemen with normal blood pressure. Low PbB level (20-29 pg/dL) was not a predictor of subsequent systolic blood pressure elevations. Diastolic pressure was unrelated to PbB levels. 

Distinguish among diastolic pressure, systolic pressure, and pulse pressure... 

At rest, the MAP is closer to the diastolic pressure because the diastolic phase of the cardiac cycle lasts almost twice as long as the systolic phase. During exercise when heart rate increases and the length of diastole decreases, systolic pressure contributes more to the MAP. 

Notes CO cardiac output VR venous return HR heart rate SV stroke volume EDV end-diastolic volume ESV end-systolic volume O blood flow AP pressure gradient R resistance r vessel radius P systolic pressure Piiastoik- diastolic pressure MAP mean arterial pressure TPR total peripheral resistance, P venous pressure Era- right atrial pressure Rv venous resistance. 

Hypertension is the most common cardiovascular disease in fact, nearly 25% of adults in the U.S. are considered hypertensive. Hypertension is defined as a consistent elevation in blood pressure such that systolic/diastolic pressures are >140/90 mmHg. Over time, chronic hypertension can cause pathological changes in the vasculature and in the heart. As a result, hypertensive patients are at increased risk for atherosclerosis, aneurysm, stroke, myocardial infarction, heart failure, and kidney failure. There are several categories of antihypertensive agents ... 

The answer is d. (Katzung, p 130J Epinephrine has a positive ionotropic and chronotropic effect on the heart because of its pradrenergic activity It also has a-adrenergic activity that causes vasoconstriction in the vascular beds. These actions result in a rise in systolic blood pressure. Epinephrine also has p2-adrenergic activity, which causes vasodilation in skeletal muscle. Because of this latter effect, total peripheral resistance can fall, resulting in a drop in diastolic pressure, particularly at low doses of epinephrine. 

Fig. 6.3 Hemodynamic profile of CAS 1609 on anesthetised dog (0.3mgkg 1 i.v.) systolic blood pressure (BPs), diastolic blood pressure (BPd), left ventricular end diastolic pressure (LVEDP), diastolic pulmonary artery pressure (PAPd), heart rate (HR), left ventricular...

The sudden deaths of workers in the explosives industry have been attributed to a series of cardiovascular events that occur after repeated occupational exposures (Carmichael and Lieben 1963). Acute exposures result in a depression of both the systolic and diastolic blood pressure. Continued exposure to low concentrations of nitrate esters produces a progressive rise in the diastolic blood pressure from the previously depressed level without a comparable rise in the systolic blood pressure. This narrowing of the pulse pressure combined with an increased diastolic pressure and high pulse rate, which occurs following cessation of exposure, may contribute to acute myocardial ischemia. 

Hypertension Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systohe and 90 mm Hg diastolic pressure. [NIH]... 

The pressure difference between the aortic diastolic pressure and the LVEDP (mmHg). 

CPP is coronary perfusion pressure and ADP is aortic diastolic pressure. 

Pulmonary atery (PA) As the catheter moves into the PA, the diastolic pressure will increase owing to the presence of the pulmonary valve. Normal PA systolic pressure is the same as the RV systolic pressure but the diastolic pressure rises to 10-15 mmHg. 

PAOP This must be lower than the PA diastolic pressure to ensure forward flow. It is drawn as an undulating waveform similar to the CVP trace. The normal value is 6-12 mmHg. The values vary with the respiratory cycle and are read at the end of expiration. In spontaneously ventilating patients, this will be the highest reading and in mechanically ventilated patients, it will be the lowest. The PAOP is found at an insertion length of around 45 cm. 

The line plotted on a pressure-volume graph that describes the relationship between filling status and diastolic pressure for an individual ventricle (EDPVR). 

A-F This straight line represents the ESPVR. If a ventricle is taken and filled to volume a , it will generate pressure A at the end of systole. When filled to volume b it will generate pressure B and so on. Each ventricle will have a curve specific to its overall function but a standard example is shown below. Changes in contractility can alter the gradient of the line, a-f This curve represents the ED PVR. When the ventricle is filled to volume a it will, by definition, have an end-diastolic pressure a . When filled to volume b it will have a pressure b and so on. The line offers some information about diastolic function and is altered by changes in compliance, distensibility and relaxation of the ventricle. 

The integrated function of the vasculature and heart, as a closed circulatory system, supplies nutrients and oxygen to critical organs and removes metabolic wastes and carbon dioxide. This integrated system results from the careful control of cardiac output, arterial blood pressure (systolic and diastolic pressures integrated to derive mean arterial pressure), and systemic vascular resistance, thereby maintaining blood perfusion through... 

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