Systolic/diastolic blood pressures

Sildenafil and vardenafil decrease systolic/diastolic blood pressure by 8 to 10/5 to 6 mm Hg for 1 to 4 hours after a dose. Although most patients are asymptomatic, multiple antihypertensives, nitrates, and baseline hypotension increase the risk of developing adverse effects. Although tadalafil does not decrease blood pressure, it should be used with caution in patients with cardiovascular disease because of the inherent risk associated with sexual activity. 

Mechanism of Action An alpha-adrenergic agonist that stimulates alphaj-adrenergic receptors. Inhibits sympatheticcardioaccelerat or and vasoconstrictor center to heart, kidneys, peripheral vasculature. Therapeutic Effect Decreases systolic, diastolic blood pressure (BP). Chronic use decreases peripheral vascular resistance. Pharmacohinetics Well absorbed from gastrointestinal (GI) tract. Widely distributed. Protein binding 90%. Metabolized in liver. Excreted in urine and feces. Not removed by hemodialysis. Half-life 6 hr. 

A sphygmomanometer placed around the upper arm is inflated at mid systolic-diastolic blood pressure level. After baseline blood sampling a hand manometer is squeezed for 2 min in a frequency of 1 per sec. Immediately after exercise the cuff is released. 

High levels of potassium intake are associated with reduced blood pressure. Observational data have been reasonably consistent in documenting this inverse relationship, whereas data from individual trials have been less consistent. However, three meta-analyses of these trials have each documented a significant inverse relationship between potassium intake and blood pressure in nonhypertensive and hypertensive individuals. In one meta-analysis, average net systolic/diastolic blood pressure reductions associated with a net increase in urinary potassium excretion of 2g/day (50 mmol/day) were 4.4/2.4mmHg. Typically, greater... 

As a result of such studies hypertension has been operationally defined as the blood pressure level above which therapeutic intervention has clinical benefit. As increasingly aggressive intervention has continued to demonstrate benefits, this level has gradually reduced over time and is commonly defined as systolic blood pressure>l40 mmHg and/or diastolic blood pressure >90 mmHg (Table 1). Isolated systolic hypertension is defined as systolic blood pressure >140 mmHg and diastolic blood pressure <90 mmHg. 

The higher category applies, if systolic and diastolic blood pressure values of a patient fall into different categories. 

Systolic and Diastolic Blood Pressure and Pulse Pressure 1175... 

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. 

Antihypertensive agents should be avoided unless the systolic blood pressure is >220 mmHg or the diastolic blood pressure is >120 mmHg (see Table 3.2 for management)... 

Systolic blood pressure (SBP) <220 mmHg or diastolic blood pressure (DBP) <120 mmHg... 

BP, blood pressure CCB, calcium channel blocker agent DBP, diastolic blood pressure SBP, systolic blood pressure. (Adapted from JNC 7 Modified from Saseen JJ, Carter BL. Hypertension. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 194, with permission.)... 

The selection of blood pressure cuff size based on a patient s arm circumference is crucial for the accurate measurement of blood pressure. Systolic and diastolic blood pressure tend to increase when the cuff size is too small relative to the patient s arm circumference. This circumstance is important due to the increasing prevalence of obesity in developed nations. Currently, the guidelines of the American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Measurement in Humans recommends cuff sizes for small, standard, and large adults with an optimal 2 1 ratio of cuff length/width based on arm circumference.18... 

CHD, coronary heart disease DBP, diastolic blood pressure HDL, high-density lipoprotein SBP, systolic blood pressure. 

Hypotension (systolic blood pressure less than 90 mm Hg or diastolic blood pressure less than 60 mm Hg)... 

Mean arterial blood pressure A calculated measure of arterial blood pressure mean arterial blood pressure = (2 x diastolic blood pressure + systolic blood pressure)/3. 

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. 

Simple correlational analysis of the NHANES II data by Harlan (1988) and Harlan et al. (1985) revealed statistically significant associations between PbB levels and systolic and diastolic blood pressure for both men and women, aged 12-74 years. Statistical analyses controlling for a number of other potentially confounding factors (e.g., age, race, and body mass index), however, indicated significant associations between PbB level and blood pressure only for the men. Based on these analyses, the effect of PbB concentration on blood pressure was estimated to be an increase in blood pressure of 7 mm Hg at PbB levels between 14 and 30 pg/dL. 

Rat (Sprague-Dawtey) 18 mo 7 d/wk 1x/d (W) Cardio 1.4 M 2.8 M (increased systolic and diastolic blood pressure) Carmignani et al. 1988a PbAc... 

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