血圧測定、血圧測定法

関: sphygmomanometry

WordNet

the force applied to a unit area of surface; measured in pascals (SI unit) or in dynes (cgs unit); "the compressed gas exerts an increased pressure" (同)pressure level, force per unit area
an oppressive condition of physical or mental or social or economic distress
the somatic sensation that results from applying force to an area of skin; "the sensitivity of his skin to pressure and temperature was normal" (同)pressure_sensation
a force that compels; "the public brought pressure to bear on the government"
smear with blood, as in a hunting initiation rite, where the face of a person is smeared with the blood of the kill
temperament or disposition; "a person of hot blood"
people viewed as members of a group; "we need more young blood in this organization"
the fluid (red in vertebrates) that is pumped through the body by the heart and contains plasma, blood cells, and platelets; "blood carries oxygen and nutrients to the tissues and carries away waste products"; "the ancients believed that blood was the sea
the act of determining the properties of something, usually by research or calculation; "the determination of molecular structures" (同)finding
the quality of being determined to do or achieve something; firmness of purpose; "his determination showed in his every movement"; "he is a man of purpose" (同)purpose
deciding or controlling somethings outcome or nature; "the determination of grammatical inflections"

PrepTutorEJDIC

〈U〉『押すこと』,『押しつけること』,圧搾,圧縮;〈C〉〈U〉『圧力』,圧力の強さ / 〈U〉『圧迫』,『強制』 / 〈U〉(不快な)圧迫感 / 〈C〉〈U〉(精神的な)重荷,苦脳;(時間・金銭的)切迫 / 〈U〉多忙,あわただしさ / 《おもに米》…‘に'圧力をかける,強制する(《英》pressurise)
『血』,『血』液 / 流血(bloodshed);殺人 / 気質,気性,血気,血潮 / 『血統』,血縁(kinship);生まれ,家柄;《the~》王家の血統 / (人種・出身国の)系 / 〈人〉‘に'初めての経験をさせる / 〈猟犬〉‘に'初めて獲物を血を味わわせる
〈U〉『決心』,決意,決断力 / 〈U〉(…の)『決定』,決着《+『of』+『名』》 / 〈C〉(法律上の)(…の)判決,裁決,終結《+『of』+『名』》 / 〈U〉(…の)測定[法]《+『of』+『名』》
純血の,純種の / 《複合語を作って》「…の血(性質)を持った」の意を表す

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/28 22:55:29」(JST)

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[Wiki en表示]

Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels. When used without further specification, "blood pressure" usually refers to the arterial pressure in the systemic circulation. It is usually measured at a person's upper arm. Blood pressure is usually expressed in terms of the systolic (maximum) pressure over diastolic (minimum) pressure and is measured in millimeters of mercury (mm Hg). It is one of the vital signs along with respiratory rate, heart rate, oxygen saturation, and body temperature. Normal resting blood pressure in an adult is approximately 120/80 mm Hg.

Blood pressure varies depending on situation, activity, and disease states. It is regulated by the nervous and endocrine systems. Blood pressure that is low due to a disease state is called hypotension, and pressure that is consistently high is hypertension. Both have many causes which can range from mild to severe. Both may be of sudden onset or of long duration. Long term hypertension is a risk factor for many diseases, including kidney failure, heart disease, and stroke. Long term hypertension is more common than long term hypotension in Western countries. Long term hypertension often goes undetected because of infrequent monitoring and the absence of symptoms.

1 Classification
- 1.1 Systemic arterial pressure
- 1.2 Mean arterial pressure
- 1.3 Pulse pressure
- 1.4 Systemic venous pressure
- 1.5 Pulmonary pressure
2 Disorders
- 2.1 High
- 2.2 Low
- 2.3 Fluctuating blood pressure
3 Physiology
- 3.1 Hemodynamics
- 3.2 Regulation
4 Measurement
- 4.1 Noninvasive
  - 4.1.1 Palpation
  - 4.1.2 Auscultatory
  - 4.1.3 Oscillometric
  - 4.1.4 Continuous noninvasive techniques (CNAP)
  - 4.1.5 Non-occlusive techniques: The Pulse Wave Velocity (PWV) principle
  - 4.1.6 Ambulatory and home monitoring
  - 4.1.7 White-coat hypertension
- 4.2 Invasive
5 Fetal blood pressure
6 References
7 Further reading
8 External links

Classification

Systemic arterial pressure

Classification of blood pressure for adults^[1]^[2]
Category	systolic, mm Hg	diastolic, mm Hg
Hypotension	< 90	< 60
Desired	90–119	60–79
Prehypertension	120–139	80–89
Stage 1 hypertension	140–159	90–99
Stage 2 hypertension	160–179	100–109
Hypertensive urgency	≥ 180	≥ 110
Isolated systolic hypertension	≥ 160	< 90

The table presented here shows the classification of blood pressure adopted by the American Heart Association for adults who are 18 years and older.^[1] It assumes the values are a result of averaging resting blood pressure readings measured at two or more visits to the doctor.^[3]^[4]

In the UK, clinic blood pressures are usually categorised into three groups; low (90/60 or lower), normal (between 90/60 and 139/89), and high (140/90 or higher).^[5]^[6]

Blood pressure fluctuates from minute to minute and normally shows a circadian rhythm over a 24-hour period, with highest readings in the early morning and evenings and lowest readings at night.^[7]^[8] Loss of the normal fall in blood pressure at night is associated with a greater future risk of cardiovascular disease and there is evidence that night-time blood pressure is a stronger predictor of cardiovascular events than day-time blood pressure.^[9]

Various factors, such as age and sex, influence a person's blood pressure and variations in it. In children, the normal ranges are lower than for adults and depend on height.^[10] Reference blood pressure values have been developed for children in different countries, based on the distribution of blood pressure in children of these countries.^[11] As adults age, systolic pressure tends to rise and diastolic tends to fall.^[12] In the elderly, systolic blood pressure tends to be above the normal adult range,^[13] thought to be largely because of reduced flexibility of the arteries. Also, an individual's blood pressure varies with exercise, emotional reactions, sleep, digestion and time of day (circadian rhythm).

Differences between left and right arm blood pressure measurements tend to be random and average to nearly zero if enough measurements are taken. However, in a small percentage of cases there is a consistent difference greater than 10 mm Hg which may need further investigation, e.g. for obstructive arterial disease.^[14]^[15]

The risk of cardiovascular disease increases progressively above 115/75 mm Hg.^[16] In the past, hypertension was only diagnosed if secondary signs of high arterial pressure were present, along with a prolonged high systolic pressure reading over several visits. Regarding hypotension, in practice blood pressure is considered too low only if noticeable symptoms are present.^[2]

Clinical trials demonstrate that people who maintain arterial pressures at the low end of these pressure ranges have much better long term cardiovascular health. The principal medical debate concerns the aggressiveness and relative value of methods used to lower pressures into this range for those who do not maintain such pressure on their own. Elevations, more commonly seen in older people, though often considered normal, are associated with increased morbidity and mortality.

Reference ranges for blood pressure in children^[17]
Stage	Approximate age	Systolic	Diastolic
Infants	1 to 12 months	75–100	50–70
Toddlers and preschoolers	1 to 5 years	80–110	50–80
School age	6 to 12 years	85–120	50–80
Adolescents	13 to 18 years	95–140	60–90

Mean arterial pressure

The mean arterial pressure (MAP) is the average over a cardiac cycle and is determined by the cardiac output (CO), systemic vascular resistance (SVR), and central venous pressure (CVP),^[18]

MAP can be approximately determined from measurements of the systolic pressure and the diastolic pressure ^[18]

Pulse pressure

Curve of the arterial pressure during one cardiac cycle. The closing of the aortic valve causes the notch in the curve.

The pulse pressure is the difference between the measured systolic and diastolic pressures,^[19]

The up and down fluctuation of the arterial pressure results from the pulsatile nature of the cardiac output, i.e. the heartbeat. Pulse pressure is determined by the interaction of the stroke volume of the heart, the compliance (ability to expand) of the arterial system—largely attributable to the aorta and large elastic arteries—and the resistance to flow in the arterial tree. By expanding under pressure, the aorta absorbs some of the force of the blood surge from the heart during a heartbeat. In this way, the pulse pressure is reduced from what it would be if the aorta were not compliant.^[19] The loss of arterial compliance that occurs with aging explains the elevated pulse pressures found in elderly patients.

Systemic venous pressure

Site		Normal pressure range (in mmHg)^[20]
Central venous pressure		3–8
Right ventricular pressure	systolic	15–30
Right ventricular pressure	diastolic	3–8
Pulmonary artery pressure	systolic	15–30
Pulmonary artery pressure	diastolic	4–12
Pulmonary vein/ Pulmonary capillary wedge pressure		2–15
Left ventricular pressure	systolic	100–140
Left ventricular pressure	diastolic	3-12

Blood pressure generally refers to the arterial pressure in the systemic circulation. However, measurement of pressures in the venous system and the pulmonary vessels plays an important role in intensive care medicine but requires invasive measurement of pressure using a catheter.

Venous pressure is the vascular pressure in a vein or in the atria of the heart. It is much less than arterial pressure, with common values of 5 mm Hg in the right atrium and 8 mm Hg in the left atrium.

Variants of venous pressure include:

Central venous pressure, which is a good approximation of right atrial pressure,^[21] which is a major determinant of right ventricular end diastolic volume. (However, there can be exceptions in some cases.)^[22]
The jugular venous pressure (JVP) is the indirectly observed pressure over the venous system. It can be useful in the differentiation of different forms of heart and lung disease.
The portal venous pressure is the blood pressure in the portal vein. It is normally 5–10 mm Hg^[23]

Pulmonary pressure

Normally, the pressure in the pulmonary artery is about 15 mm Hg at rest.^[24]

Increased blood pressure in the capillaries of the lung cause pulmonary hypertension, leading to interstitial edema if the pressure increases to above 20 mm Hg, and to pulmonary edema at pressures above 25 mm Hg.^[25]

Disorders

Disorders of blood pressure control include: high blood pressure, low blood pressure, and blood pressure that shows excessive or maladaptive fluctuation.

High

Overview of main complications of persistent high blood pressure.

Arterial hypertension can be an indicator of other problems and may have long-term adverse effects. Sometimes it can be an acute problem, for example hypertensive emergency.

Levels of arterial pressure put mechanical stress on the arterial walls. Higher pressures increase heart workload and progression of unhealthy tissue growth (atheroma) that develops within the walls of arteries. The higher the pressure, the more stress that is present and the more atheroma tend to progress and the heart muscle tends to thicken, enlarge and become weaker over time.

Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysms, and is the leading cause of chronic kidney failure. Even moderate elevation of arterial pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.^[26]

In the past, most attention was paid to diastolic pressure; but nowadays it is recognised that both high systolic pressure and high pulse pressure (the numerical difference between systolic and diastolic pressures) are also risk factors. In some cases, it appears that a decrease in excessive diastolic pressure can actually increase risk, due probably to the increased difference between systolic and diastolic pressures (see the article on pulse pressure). If systolic blood pressure is elevated (>140) with a normal diastolic blood pressure (<90), it is called "isolated systolic hypertension" and may present a health concern.^[27]^[28]

For those with heart valve regurgitation, a change in its severity may be associated with a change in diastolic pressure. In a study of people with heart valve regurgitation that compared measurements 2 weeks apart for each person, there was an increased severity of aortic and mitral regurgitation when diastolic blood pressure increased, whereas when diastolic blood pressure decreased, there was a decreased severity.^[29]

Low

Blood pressure that is too low is known as hypotension. Hypotension is a medical concern if it causes signs or symptoms, such as dizziness, fainting, or in extreme cases, shock.^[4]

When arterial pressure and blood flow decrease beyond a certain point, the perfusion of the brain becomes critically decreased (i.e., the blood supply is not sufficient), causing lightheadedness, dizziness, weakness or fainting.^[30]

Sometimes the arterial pressure drops significantly when a patient stands up from sitting. This is known as orthostatic hypotension (postural hypotension); gravity reduces the rate of blood return from the body veins below the heart back to the heart, thus reducing stroke volume and cardiac output.^{[citation needed]}

When people are healthy, the veins below their heart quickly constrict and the heart rate increases to minimize and compensate for the gravity effect. This is carried out involuntarily by the autonomic nervous system. The system usually requires a few seconds to fully adjust and if the compensations are too slow or inadequate, the individual will suffer reduced blood flow to the brain, dizziness and potential blackout. Increases in G-loading, such as routinely experienced by aerobatic or combat pilots 'pulling Gs', greatly increases this effect. Repositioning the body perpendicular to gravity largely eliminates the problem.^{[citation needed]}

Other causes of low arterial pressure include:^{[citation needed]}

Sepsis
Hemorrhage – blood loss
Toxins including toxic doses of blood pressure medicine
Hormonal abnormalities, such as Addison's disease
Eating disorders, particularly anorexia nervosa and bulimia

Shock is a complex condition which leads to critically decreased perfusion. The usual mechanisms are loss of blood volume, pooling of blood within the veins reducing adequate return to the heart and/or low effective heart pumping. Low arterial pressure, especially low pulse pressure, is a sign of shock and contributes to and reflects decreased perfusion.^{[citation needed]}

If there is a significant difference in the pressure from one arm to the other, that may indicate a narrowing (for example, due to aortic coarctation, aortic dissection, thrombosis or embolism) of an artery.^{[citation needed]}

Fluctuating blood pressure

Normal fluctuation in blood pressure is adaptive and necessary. Fluctuations in pressure that are significantly greater than the norm are associated with greater white matter hyperintensity, a finding consistent with reduced local cerebral blood flow^[31] and a heightened risk of cerebrovascular disease.^[32] Within both high and low blood pressure groups, a greater degree of fluctuation was found to correlate with an increase in cerebrovascular disease compared to those with less variability, suggesting the consideration of the clinical management of blood pressure fluctuations, even among normotensive older adults.^[32] Older individuals and those who had received blood pressure medications were more likely to exhibit larger fluctuations in pressure.^[32]

Physiology

Systole on the left and diastole on the right

During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure.^[33] The blood pressure in the circulation is principally due to the pumping action of the heart.^[34] Differences in mean blood pressure are responsible for blood flow from one location to another in the circulation. The rate of mean blood flow depends on both blood pressure and the resistance to flow presented by the blood vessels. Mean blood pressure decreases as the circulating blood moves away from the heart through arteries and capillaries due to viscous losses of energy. Mean blood pressure drops over the whole circulation, although most of the fall occurs along the small arteries and arterioles.^[35] Gravity affects blood pressure via hydrostatic forces (e.g., during standing), and valves in veins, breathing, and pumping from contraction of skeletal muscles also influence blood pressure in veins.^[34]

Hemodynamics

There are many physical factors that influence arterial pressure. Each of these may in turn be influenced by physiological factors, such as: diet, exercise, disease, drugs or alcohol, stress, and obesity.^[36]

Some physical factors are:

Volume of fluid or blood volume, the amount of blood that is present in the body. The more blood present in the body, the higher the rate of blood return to the heart and the resulting cardiac output. There is some relationship between dietary salt intake and increased blood volume, potentially resulting in higher arterial pressure, though this varies with the individual and is highly dependent on autonomic nervous system response and the renin–angiotensin system.^[37]^[38]^[39]
Resistance. In the circulatory system, this is the resistance of the blood vessels. The higher the resistance, the higher the arterial pressure upstream from the resistance to blood flow. Resistance is related to vessel radius (the larger the radius, the lower the resistance), vessel length (the longer the vessel, the higher the resistance), blood viscosity, as well as the smoothness of the blood vessel walls. Smoothness is reduced by the buildup of fatty deposits on the arterial walls. Substances called vasoconstrictors can reduce the size of blood vessels, thereby increasing blood pressure. Vasodilators (such as nitroglycerin) increase the size of blood vessels, thereby decreasing arterial pressure. Resistance, and its relation to volumetric flow rate (Q) and pressure difference between the two ends of a vessel are described by Poiseuille's Law.
Viscosity, or thickness of the fluid. If the blood gets thicker, the result is an increase in arterial pressure. Certain medical conditions can change the viscosity of the blood. For instance, anemia (low red blood cell concentration), reduces viscosity, whereas increased red blood cell concentration increases viscosity. It had been thought that aspirin and related "blood thinner" drugs decreased the viscosity of blood, but instead studies found^[40] that they act by reducing the tendency of the blood to clot.

In practice, each individual's autonomic nervous system responds to and regulates all these interacting factors so that, although the above issues are important, the actual arterial pressure response of a given individual varies widely because of both split-second and slow-moving responses of the nervous system and end organs. These responses are very effective in changing the variables and resulting blood pressure from moment to moment.

Moreover, blood pressure is the result of cardiac output increased by peripheral resistance: blood pressure = cardiac output X peripheral resistance. As a result, an abnormal change in blood pressure is often an indication of a problem affecting the heart's output, the blood vessels' resistance, or both. Thus, knowing the patient's blood pressure is critical to assess any pathology related to output and resistance.

Regulation

The endogenous regulation of arterial pressure is not completely understood, but the following mechanisms of regulating arterial pressure have been well-characterized:

Baroreceptor reflex: Baroreceptors in the high pressure receptor zones detect changes in arterial pressure. These baroreceptors send signals ultimately to the medulla of the brain stem, specifically to the rostral ventrolateral medulla (RVLM). The medulla, by way of the autonomic nervous system, adjusts the mean arterial pressure by altering both the force and speed of the heart's contractions, as well as the total peripheral resistance. The most important arterial baroreceptors are located in the left and right carotid sinuses and in the aortic arch.^[41]
Renin-angiotensin system (RAS): This system is generally known for its long-term adjustment of arterial pressure. This system allows the kidney to compensate for loss in blood volume or drops in arterial pressure by activating an endogenous vasoconstrictor known as angiotensin II.
Aldosterone release: This steroid hormone is released from the adrenal cortex in response to angiotensin II or high serum potassium levels. Aldosterone stimulates sodium retention and potassium excretion by the kidneys. Since sodium is the main ion that determines the amount of fluid in the blood vessels by osmosis, aldosterone will increase fluid retention, and indirectly, arterial pressure.
Baroreceptors in low pressure receptor zones (mainly in the venae cavae and the pulmonary veins, and in the atria) result in feedback by regulating the secretion of antidiuretic hormone (ADH/Vasopressin), renin and aldosterone. The resultant increase in blood volume results in an increased cardiac output by the Frank–Starling law of the heart, in turn increasing arterial blood pressure.

These different mechanisms are not necessarily independent of each other, as indicated by the link between the RAS and aldosterone release. When blood pressure falls many physiological cascades commence in order to return the blood pressure to a more appropriate level.

The blood pressure fall is detected by a decrease in blood flow and thus a decrease in Glomerular filtration rate (GFR).
Decrease in GFR is sensed as a decrease in Na⁺ levels by the macula densa.
The macula densa cause an increase in Na⁺ reabsorption, which causes water to follow in via osmosis and leads to an ultimate increase in plasma volume. Further, the macula densa releases adenosine which causes constriction of the afferent arterioles.
At the same time, the juxtaglomerular cells sense the decrease in blood pressure and release renin.
Renin converts angiotensinogen (inactive form) to angiotensin I (active form).
Angiotensin I flows in the bloodstream until it reaches the capillaries of the lungs where angiotensin converting enzyme (ACE) acts on it to convert it into angiotensin II.
Angiotensin II is a vasoconstrictor which will increase bloodflow to the heart and subsequently the preload, ultimately increasing the cardiac output.
Angiotensin II also causes an increase in the release of aldosterone from the adrenal glands.
Aldosterone further increases the Na⁺ and H₂O reabsorption in the distal convoluted tubule of the nephron.

Currently, the RAS is targeted pharmacologically by ACE inhibitors and angiotensin II receptor antagonists. The aldosterone system is directly targeted by spironolactone, an aldosterone antagonist. The fluid retention may be targeted by diuretics; the antihypertensive effect of diuretics is due to its effect on blood volume. Generally, the baroreceptor reflex is not targeted in hypertension because if blocked, individuals may suffer from orthostatic hypotension and fainting.

Measurement

A medical student checking blood pressure using a sphygmomanometer and stethoscope.

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Right position for taking blood pressure

Arterial pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure.^[42] Blood pressure values are generally reported in millimetres of mercury (mm Hg), though aneroid and electronic devices do not contain mercury.

For each heartbeat, blood pressure varies between systolic and diastolic pressures. Systolic pressure is peak pressure in the arteries, which occurs near the end of the cardiac cycle when the ventricles are contracting. Diastolic pressure is minimum pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood. An example of normal measured values for a resting, healthy adult human is 120 mm Hg systolic and 80 mm Hg diastolic (written as 120/80 mm Hg, and spoken as "one-twenty over eighty").

Systolic and diastolic arterial blood pressures are not static but undergo natural variations from one heartbeat to another and throughout the day (in a circadian rhythm). They also change in response to stress, nutritional factors, drugs, disease, exercise, and momentarily from standing up. Sometimes the variations are large. Hypertension refers to arterial pressure being abnormally high, as opposed to hypotension, when it is abnormally low. Along with body temperature, respiratory rate, and pulse rate, blood pressure is one of the four main vital signs routinely monitored by medical professionals and healthcare providers.^[43]

Measuring pressure invasively, by penetrating the arterial wall to take the measurement, is much less common and usually restricted to a hospital setting.

Noninvasive

The noninvasive auscultatory and oscillometric measurements are simpler and quicker than invasive measurements, require less expertise, have virtually no complications, are less unpleasant and less painful for the patient. However, noninvasive methods may yield somewhat lower accuracy and small systematic differences in numerical results. Noninvasive measurement methods are more commonly used for routine examinations and monitoring.

Palpation

A minimum systolic value can be roughly estimated by palpation, most often used in emergency situations, but should be used with caution.^[44] It has been estimated that, using 50% percentiles, carotid, femoral and radial pulses are present in patients with a systolic blood pressure > 70 mm Hg, carotid and femoral pulses alone in patients with systolic blood pressure of > 50 mm Hg, and only a carotid pulse in patients with a systolic blood pressure of > 40 mm Hg.^[44]

A more accurate value of systolic blood pressure can be obtained with a sphygmomanometer and palpating the radial pulse.^[45] The diastolic blood pressure cannot be estimated by this method. The American Heart Association recommends that palpation be used to get an estimate before using the auscultatory method.

Auscultatory

Auscultatory method aneroid sphygmomanometer with stethoscope

Mercury manometer

The auscultatory method (from the Latin word for "listening") uses a stethoscope and a sphygmomanometer. This comprises an inflatable (Riva-Rocci) cuff placed around the upper arm at roughly the same vertical height as the heart, attached to a mercury or aneroid manometer. The mercury manometer, considered the gold standard, measures the height of a column of mercury, giving an absolute result without need for calibration and, consequently, not subject to the errors and drift of calibration which affect other methods. The use of mercury manometers is often required in clinical trials and for the clinical measurement of hypertension in high-risk patients, such as pregnant women.

A cuff of appropriate size^[46] is fitted smoothly and also snugly, then inflated manually by repeatedly squeezing a rubber bulb until the artery is completely occluded. It is important that the cuff size is correct: undersized cuffs record too high a pressure; oversized cuffs may yield too low a pressure.^[47] Usually three or four cuff sizes should be available to allow measurements in arms of different size.^[47] Listening with the stethoscope to the brachial artery at the antecubital area of the elbow, the examiner slowly releases the pressure in the cuff. When blood just starts to flow in the artery, the turbulent flow creates a "whooshing" or pounding (first Korotkoff sound). The pressure at which this sound is first heard is the systolic blood pressure. The cuff pressure is further released until no sound can be heard (fifth Korotkoff sound), at the diastolic arterial pressure.

The auscultatory method is the predominant method of clinical measurement.^[48]

Oscillometric

The oscillometric method was first demonstrated in 1876 and involves the observation of oscillations in the sphygmomanometer cuff pressure^[49] which are caused by the oscillations of blood flow, i.e., the pulse.^[50] The electronic version of this method is sometimes used in long-term measurements and general practice. It uses a sphygmomanometer cuff, like the auscultatory method, but with an electronic pressure sensor (transducer) to observe cuff pressure oscillations, electronics to automatically interpret them, and automatic inflation and deflation of the cuff. The pressure sensor should be calibrated periodically to maintain accuracy.

Oscillometric measurement requires less skill than the auscultatory technique and may be suitable for use by untrained staff and for automated patient home monitoring. As for the auscultatory technique it is important that the cuff size is appropriate for the arm. There are some single cuff devices that may be used for arms of differing sizes, although experience with these is limited.^[47]

The cuff is inflated to a pressure initially in excess of the systolic arterial pressure and then reduced to below diastolic pressure over a period of about 30 seconds. When blood flow is nil (cuff pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic pressure), cuff pressure will be essentially constant. When blood flow is present, but restricted, the cuff pressure, which is monitored by the pressure sensor, will vary periodically in synchrony with the cyclic expansion and contraction of the brachial artery, i.e., it will oscillate.

Over the deflation period, the recorded pressure waveform forms a signal known as the cuff deflation curve. A bandpass filter is utilized to extract the oscillometric pulses from the cuff deflation curve. Over the deflation period, the extracted oscillometric pulses form a signal known as the oscillometric waveform (OMW). The amplitude of the oscillometric pulses increases to a maximum and then decreases with further deflation. A variety of analysis algorithms can be employed in order to estimate the systolic, diastolic, and mean arterial pressure.

Oscillometric monitors may produce inaccurate readings in patients with heart and circulation problems, which include arteriosclerosis, arrhythmia, preeclampsia, pulsus alternans, and pulsus paradoxus.^[47]^[51]

In practice the different methods do not give identical results; an algorithm and experimentally obtained coefficients are used to adjust the oscillometric results to give readings which match the auscultatory results as well as possible. Some equipment uses computer-aided analysis of the instantaneous arterial pressure waveform to determine the systolic, mean, and diastolic points. Since many oscillometric devices have not been validated, caution must be given as most are not suitable in clinical and acute care settings.

Recently, several coefficient-free oscillometric algorithms have developed for estimation of blood pressure. These algorithms do not rely on experimentally obtained coefficients and have been shown to provide more accurate and robust estimation of blood pressure. These algorithms are based on finding the fundamental relationship between the oscillometric waveform and the BP using modeling ^[52]^[53] and learning ^[54] approaches.

The term NIBP, for non-invasive blood pressure, is often used to describe oscillometric monitoring equipment.

Continuous noninvasive techniques (CNAP)

Continuous Noninvasive Arterial Pressure (CNAP) is the method of measuring arterial blood pressure in real-time without any interruptions and without cannulating the human body. CNAP combines the advantages of the following two clinical “gold standards”: it measures blood pressure continuously in real-time like the invasive arterial catheter system and it is noninvasive like the standard upper arm sphygmomanometer. Latest developments in this field show promising results in terms of accuracy, ease of use and clinical acceptance.

Non-occlusive techniques: The Pulse Wave Velocity (PWV) principle

Since the 1990s a novel family of techniques based on the so-called pulse wave velocity (PWV) principle have been developed. These techniques rely on the fact that the velocity at which an arterial pressure pulse travels along the arterial tree depends, among others, on the underlying blood pressure.^[55] Accordingly, after a calibration maneuver, these techniques provide indirect estimates of blood pressure by translating PWV values into blood pressure values.^[56]

The main advantage of these techniques is that it is possible to measure PWV values of a subject continuously (beat-by-beat), without medical supervision, and without the need of inflating brachial cuffs. PWV-based techniques are still in the research domain and are not adapted to clinical settings.

Ambulatory and home monitoring

Ambulatory blood pressure devices take readings regularly (e.g. every half hour throughout the day and night). They have been used to exclude measurement problems like white-coat hypertension and provide more reliable estimates of usual blood pressure and cardiovascular risk. Blood pressure readings outside of a clinical setting are usually slightly lower in the majority of people; however studies that quantified the risks from hypertension and the benefits of lowering blood pressure have mostly been based on readings in a clinical environment. Use of ambulatory measurements is not widespread but guidelines developed by the UK National Institute for Health and Care Excellence and the British Hypertension Society recommended that 24-hour ambulatory blood pressure monitoring should be used for diagnosis of hypertension.^[57] Health economic analysis suggested that this approach would be cost effective compared with repeated clinic measurements.^[58]

Home monitoring is a cheap and simple alternative to ambulatory blood pressure monitoring, although it does not usually allow assessment of blood pressure during sleep which may be a disadvantage.^[59]^[60] Automatic self-contained blood pressure monitors are available at reasonable prices, however measurements may not be accurate in patients with atrial fibrillation or other arrhythmias such as frequent ectopic beats.^[59]^[60] Home monitoring may be used to improve hypertension management and to monitor the effects of lifestyle changes and medication related to blood pressure.^[3] Compared to ambulatory blood pressure measurements, home monitoring has been found to be an effective and lower cost alternative,^[59]^[61]^[62] but ambulatory monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension.

When measuring blood pressure in the home, an accurate reading requires that one not drink coffee, smoke cigarettes, or engage in strenuous exercise for 30 minutes before taking the reading. A full bladder may have a small effect on blood pressure readings; if the urge to urinate arises, one should do so before the reading. For 5 minutes before the reading, one should sit upright in a chair with one's feet flat on the floor and with limbs uncrossed. The blood pressure cuff should always be against bare skin, as readings taken over a shirt sleeve are less accurate. The same arm should be used for all measurements. During the reading, the arm that is used should be relaxed and kept at heart level, for example by resting it on a table.^[63]

Since blood pressure varies throughout the day, home measurements should be taken at the same time of day. A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association on home monitoring in 2008^[60] recommended that 2 to 3 readings should be taken in the morning (after awakening, before washing/dressing, taking breakfast/drink or taking medication) and another 2 to 3 readings at night, each day over a period of 1 week. It was also recommended that the readings from the first day should be discarded and that a total of ≥12 readings (i.e. at least two readings per day for the remaining 6 days of the week) should be used for making clinical decisions.

White-coat hypertension

For some patients, blood pressure measurements taken in a doctor's office may not correctly characterize their typical blood pressure.^[64] In up to 25% of patients, the office measurement is higher than their typical blood pressure. This type of error is called white-coat hypertension (WCH) and can result from anxiety related to an examination by a health care professional.^[65] White coat hypertension can also occur because, in a clinical setting, patients are seldom given the opportunity to rest for five minutes before blood pressure readings are taken. The misdiagnosis of hypertension for these patients can result in needless and possibly harmful medication. WCH can be reduced (but not eliminated) with automated blood pressure measurements over 15 to 20 minutes in a quiet part of the office or clinic.^[66] In some cases a lower blood pressure reading occurs at the doctor's - this has been termed 'masked hypertension'.^[67]

Blood Pressure - Take another person.
Blood Pressure - Take your own.

Invasive

Arterial blood pressure (BP) is most accurately measured invasively through an arterial line. Invasive arterial pressure measurement with intravascular cannulae involves direct measurement of arterial pressure by placing a cannula needle in an artery (usually radial, femoral, dorsalis pedis or brachial).

The cannula must be connected to a sterile, fluid-filled system, which is connected to an electronic pressure transducer. The advantage of this system is that pressure is constantly monitored beat-by-beat, and a waveform (a graph of pressure against time) can be displayed. This invasive technique is regularly employed in human and veterinary intensive care medicine, anesthesiology, and for research purposes.

Cannulation for invasive vascular pressure monitoring is infrequently associated with complications such as thrombosis, infection, and bleeding. Patients with invasive arterial monitoring require very close supervision, as there is a danger of severe bleeding if the line becomes disconnected. It is generally reserved for patients where rapid variations in arterial pressure are anticipated.

Invasive vascular pressure monitors are pressure monitoring systems designed to acquire pressure information for display and processing. There are a variety of invasive vascular pressure monitors for trauma, critical care, and operating room applications. These include single pressure, dual pressure, and multi-parameter (i.e. pressure / temperature). The monitors can be used for measurement and follow-up of arterial, central venous, pulmonary arterial, left atrial, right atrial, femoral arterial, umbilical venous, umbilical arterial, and intracranial pressures.

Fetal blood pressure

In pregnancy, it is the fetal heart and not the mother's heart that builds up the fetal blood pressure to drive its blood through the fetal circulation.

The blood pressure in the fetal aorta is approximately 30 mm Hg at 20 weeks of gestation, and increases to approximately 45 mm Hg at 40 weeks of gestation.^[68]
The average blood pressure for full-term infants:
Systolic 65–95 mm Hg
Diastolic 30–60 mm Hg^[69]

References

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^ Klabunde, RE (2007). "Cardiovascular Physiology Concepts – Arterial Baroreceptors". Retrieved 2008-09-09. Archived version 2009-10-03
^ Booth J (1977). "A short history of blood pressure measurement". Proceedings of the Royal Society of Medicine 70 (11): 793–9. PMC 1543468. PMID 341169.
^ "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". OHSU Health Information. Oregon Health & Science University. Retrieved 2010-04-16. ^{[dead link]}
^ ^a ^b Deakin CD, Low JL (September 2000). "Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study". BMJ 321 (7262): 673–4. doi:10.1136/bmj.321.7262.673. PMC 27481. PMID 10987771.
^ Interpretation – Blood Pressure – Vitals, University of Florida. Retrieved 2008-03-18.
^ M.M. Chiappa, Y. Ostchega (2013). "Mean mid-arm circumference and blood pressure cuff sizes for U.S. adults: National Health and Nutrition Examination Survey, 1999-2010". Blood Press Monitoring 18 (3): 138–143. doi:10.1097/MBP.0b013e3283617606. PMID 23604196.
^ ^a ^b ^c ^d O'Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G, et al. (2003). "European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement". J. Hypertens. 21 (5): 821–48. doi:10.1097/01.hjh.0000059016.82022.ca. PMID 12714851.
^ (Pickering et al. 2005, p. 146) See Blood Pressure Measurement Methods.
^ (Pickering et al. 2005, p. 147) See The Oscillometric Technique.
^ Laurent, P (2003-09-28). "Blood Pressure & Hypertension". Retrieved 2009-10-05.
^ Hamzaoui O, Monnet X, Teboul JL (2013). "Pulsus paradoxus". Eur. Respir. J. 42 (6): 1696–705. doi:10.1183/09031936.00138912. PMID 23222878.
^ Forouzanfar M (2014). "Ratio-independent blood pressure estimation by modeling the oscillometric waveform envelope". IEEE Trans. Instrum. Meas. 63: 2501–2503. doi:10.1109/tim.2014.2332239.
^ Forouzanfar M (2013). "Coefficient-free blood pressure estimation based on pulse transit time–cuff pressure dependence". IEEE Trans. Biomed. Eng. 60: 1814–1824. doi:10.1109/tbme.2013.2243148.
^ M. Forouzanfar, H. R. Dajani, V. Z. Groza, M. Bolic, and S. Rajan, "Feature-based neural network approach for oscillometric blood pressure estimation," IEEE Trans. Instrum. Meas., vol. 60, pp. 2786–2796, Aug. 2011.
^ Asmar, Roland (1999). Arterial Stiffness and Pulse Wave Velocity. Paris: Elsevier. ISBN 2-84299-148-6.
^ Solà, Josep (2011). Continuous non-invasive blood pressure estimation (PDF). Zurich: ETHZ PhD dissertation.
^ Hypertension Guideline 2011 [CG127] Produced in a collaboration between the British Hypertension Society and NICE. http://guidance.nice.org.uk/CG127/NICEGuidance/pdf/English
^ Lovibond K, Jowett S, Barton P, Caulfield M, Heneghan C, Hobbs FD, et al. (2011). "Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study". Lancet 378 (9798): 1219–30. doi:10.1016/S0140-6736(11)61184-7. PMID 21868086.
^ ^a ^b ^c Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Kjeldsen SE, Erdine S, Narkiewicz K, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Cifkova R, Dominiczak A, Fagard R, Heagerty AM, Laurent S, Lindholm LH, Mancia G, Manolis A, Nilsson PM, Redon J, Schmieder RE, Struijker-Boudier HA, Viigimaa M, Filippatos G, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Kiowski W, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL (June 2007). "2007 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)". Eur Heart J 28 (12): 1462–536. doi:10.1093/eurheartj/ehm236. PMID 17562668.
^ ^a ^b ^c Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D (2008). "Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society Of Hypertension, and Preventive Cardiovascular Nurses Association". Hypertension 52 (1): 1–9. doi:10.1161/HYPERTENSIONAHA.107.189011. PMID 18497371.
^ Niiranen TJ, Kantola IM, Vesalainen R, Johansson J, Ruuska MJ (2006). "A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment". Am J Hypertens 19 (5): 468–74. doi:10.1016/j.amjhyper.2005.10.017. PMID 16647616.
^ Shimbo D, Pickering TG, Spruill TM, Abraham D, Schwartz JE, Gerin W (2007). "The Relative Utility of Home, Ambulatory, and Office Blood Pressures in the Prediction of End-Organ Damage". Am J Hypertens 20 (5): 476–82. doi:10.1016/j.amjhyper.2006.12.011. PMC 1931502. PMID 17485006. Archived from the original on May 25, 2014.
^ National Heart, Lung and Blood Institute. "Tips for having your blood pressure taken".
^ Elliot, Victoria Stagg (2007-06-11). "Blood pressure readings often unreliable". American Medical News (American Medical Association). Retrieved 2008-08-16.
^ Jhalani J, Goyal T, Clemow L, Schwartz JE, Pickering TG, Gerin W (2005). "Anxiety and outcome expectations predict the white-coat effect". Blood Pressure Monitoring 10 (6): 317–9. doi:10.1097/00126097-200512000-00006. PMID 16496447.
^ (Pickering et al. 2005, p. 145) See White Coat Hypertension or Isolated Office Hypertension.
^ (Pickering et al. 2005, p. 146) See Masked Hypertension or Isolated Ambulatory Hypertension.
^ Struijk PC, Mathews VJ, Loupas T, Stewart PA, Clark EB, Steegers EA, Wladimiroff JW; Mathews; Loupas; Stewart; Clark; Steegers; Wladimiroff (October 2008). "Blood pressure estimation in the human fetal descending aorta". Ultrasound Obstet Gynecol 32 (5): 673–81. doi:10.1002/uog.6137. PMID 18816497.
^ Sharon, S. M. & Emily, S. M. (2006). Foundations of Maternal-Newborn Nursing. (4th ed p.476). Philadelphia:Elsevier.

External links

Blood Pressure Association (UK)
About High Blood Pressure, American Heart Association
Control of Blood Pressure, Toronto General Hospital
Blood Pressure Chart, Vaughn's Summaries

UpToDate Contents

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1. 高血圧の診断における血圧測定手技 technique of blood pressure measurement in the diagnosis of hypertension
2. 成人における24時間携帯血圧測定および白衣高血圧症 ambulatory blood pressure monitoring and white coat hypertension in adults
3. 小児における携帯型血圧モニター ambulatory blood pressure monitoring in children
4. 高血圧治療における目標血圧 what is goal blood pressure in the treatment of hypertension
5. 小児および思春期における高血圧の定義および診断 definition and diagnosis of hypertension in children and adolescents

English Journal

The mechanism of increased blood flow in the brain and spinal cord during hemodilution.

Crystal GJ1, Czinn EA, Salem MR.Author information 1From the *Department of Anesthesiology, Advocate Illinois Masonic Medical Center; †Departments of Anesthesiology and of Physiology and Biophysics, University of Illinois College of Medicine; and ‡Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois. Edward A. Czinn, MD, is currently affiliated with Broward Health Medical Center, Fort Lauderdale, Florida and Florida International University, Miami, Florida.AbstractBACKGROUND: Hemodilution is accompanied by an increase in cerebral blood flow, but whether this is due to vasodilation in response to reduced arterial oxygen content, reduced blood viscosity, or a combination of these mechanisms is a matter of debate. We performed the current study to gain insight into this question by evaluating the effect of hemodilution on (1) vasodilator reserve and (2) the level of blood flow during hypercapnia-induced vasodilation in regions of the brain and spinal cord.
Anesthesia and analgesia.Anesth Analg.2014 Mar;118(3):637-43. doi: 10.1213/ANE.0000000000000078.
BACKGROUND: Hemodilution is accompanied by an increase in cerebral blood flow, but whether this is due to vasodilation in response to reduced arterial oxygen content, reduced blood viscosity, or a combination of these mechanisms is a matter of debate. We performed the current study to gain insight i
PMID 24557108

Identification of anaerobic threshold by analysis of heart rate variability during discontinuous dynamic and resistance exercise protocols in healthy older men.

Simões RP1, Castello-Simões V, Mendes RG, Archiza B, Dos Santos DA, Bonjorno JC Jr, de Oliveira CR, Catai AM, Arena R, Borghi-Silva A.Author information 1Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise of Federal University of Sao Carlos, Sao Carlos, SP, Brazil.AbstractThe purposes of this study were to determine anaerobic threshold (AT) during discontinuous dynamic and resistive exercise protocols by analysing of heart rate variability (HRV) and blood lactate (BL) in healthy elderly subjects and compare the cardiovascular, metabolic and autonomic variables obtained from these two forms of exercise. Fourteen elderly (70 ± 4 years) apparently healthy males underwent the following tests: (i) incremental ramp test on cycle ergometer, (ii) one repetition maximum (1RM) leg press at 45°, (iii) a discontinuous exercise test on a cycle ergometer (DET-C) protocol and (iv) a resistance exercise leg press (DET-L) protocol. Heart rate, blood pressure and BL were obtained during each increment of exercise intensity. No significant differences (P>0·05) were found between methods of AT determination (BL and HRV) nor the relative intensity corresponding to AT (30% of maximum intensity) between the types of exercise (DET-C and DET-L). Furthermore, no significant differences (P>0·05) were found between the DET-C and DET-L in relation to HRV, however, the DET-L provided higher values of systolic blood pressure and BL (P<0·05) from the intensity corresponding to AT. We conclude that HRV was effective in determination of AT, and the parasympathetic modulation responses obtained during dynamic and resistive exercise protocols were similar when compared at the same relative intensity. However, DET-L resulted in higher values of blood pressure and BL at workloads beyond AT.
Clinical physiology and functional imaging.Clin Physiol Funct Imaging.2014 Mar;34(2):98-108. doi: 10.1111/cpf.12070. Epub 2013 Jul 23.
The purposes of this study were to determine anaerobic threshold (AT) during discontinuous dynamic and resistive exercise protocols by analysing of heart rate variability (HRV) and blood lactate (BL) in healthy elderly subjects and compare the cardiovascular, metabolic and autonomic variables obtain
PMID 23879324

Refractory hypertension: determination of prevalence, risk factors, and comorbidities in a large, population-based cohort.

Calhoun DA1, Booth JN 3rd, Oparil S, Irvin MR, Shimbo D, Lackland DT, Howard G, Safford MM, Muntner P.Author information 1Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 430 BMR3, 1530 3rd Ave South, Birmingham, AL 35242. dcalhoun@uab.edu.AbstractRefractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic, ≥140/90 mm Hg) on ≥5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic, ≥140/90 mm Hg on ≥3 or <140/90 mm Hg on ≥4 antihypertensive classes) and all participants treated for hypertension served as comparator groups. Of 14 809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension (n=2144) and 41.7% among participants on ≥5 antihypertensive drug classes. Among all participants with hypertension, black race, male sex, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes mellitus, and history of stroke and coronary heart disease were associated with refractory hypertension. Compared with resistant hypertension, prevalence ratios for refractory hypertension were increased for blacks (3.00; 95% confidence interval, 1.68-5.37) and those with albuminuria (2.22; 95% confidence interval, 1.40-3.52) and diabetes mellitus (2.09; 95% confidence interval, 1.32-3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension when compared with those with either comparator group. These data indicate that although resistant hypertension is relatively common among treated patients with hypertension, true antihypertensive treatment failure is rare.
Hypertension.Hypertension.2014 Mar;63(3):451-8. doi: 10.1161/HYPERTENSIONAHA.113.02026. Epub 2013 Dec 9.
Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and as
PMID 24324035

Japanese Journal

肺年齢と喫煙、生活習慣病の関係

市川由理,深草元紀,服部加奈子,武田京子,石田也寸志
総合健診 42(2), 253-260, 2015
【背景】近年、慢性閉塞性肺疾患（COPD）の罹患者が増え、COPD発症の好発要因となる喫煙を指摘し禁煙支援する目的で日本呼吸器学会が提唱した「肺年齢」の有用性が期待される。当院でも肺機能検査にてこの肺年齢を提示し、受診者にとって身近なものとなりつつある。そこで禁煙支援を目的の一つとするのであれば、当院の人間ドック受診者を喫煙状況の差で肺年齢の差が明確に表されることが期待できなければならない。また肺 …
NAID 130005068523

重症下肢虚血患者における下肢血管内治療後の皮膚灌流圧の時間的変動

石田泰久,辻依子,中山真紀,寺師浩人
創傷 6(2), 54-58, 2015
… 　重症下肢虚血患者に末梢血行再建術が施行された後どれくらいの期間で皮膚灌流圧 (skin perfusion pressure，以下 SPP) 値が上昇するかということは，創傷治療にとって重要である。 …
NAID 130005064125

性差を考慮した各身体計測指標とCT測定内臓脂肪面積との相関性:─男性の内臓脂肪、女性の内臓脂肪─

佐藤友美,中山佳津代,柳樂和美,高尾俊弘
総合健診 41(6), 644-652, 2014
【目的】内臓脂肪型肥満の評価判定として最も有用な身体計測の指標を調査し、性差を考慮して関連性を検討した。【対象および方法】当院の職員定期健康診断で同意を得た128名（男性44名、女性84名）を対象とした。本研究では職員検診時に既往歴、現病歴、内服歴、身体計測指標（腹囲、BMI、腹囲身長比、ウエストヒップ比）、血圧、血液検査（総コレステロール：TC、中性脂肪:TG、HDLコレステロール：HDL、LD …
NAID 130004936248

Related Pictures

★リンクテーブル★

リンク元	「sphygmomanometry」
関連記事	「determination」「pressure」「blood」

「sphygmomanometry」

Blood pressure
	Diagnostics
	A sphygmomanometer, a device used for measuring arterial pressure
MeSH	D001795
	[edit on Wikidata]

　　[★]

血圧測定

関: blood pressure determination

「determination」

　　[★]

n.

決定、判定、定量

関: assay、assessment、decide、decision、decisional、definition、determine、quantitative determination

「pressure」

　　[★]

n.

圧力

「blood」

　　[★] 血液

[Heartorg-1] "Understanding blood pressure readings". American Heart Association. 11 January 2011. Retrieved 30 March 2011.

[Mayo2009causes-2] Mayo Clinic staff (2009-05-23). "Low blood pressure (hypotension) — Causes". MayoClinic.com. Mayo Foundation for Medical Education and Research. Retrieved 2010-10-19.

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[Pickering2005p146-48] (Pickering et al. 2005, p. 146) See Blood Pressure Measurement Methods.

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[Pickering2005p145-66] (Pickering et al. 2005, p. 145) See White Coat Hypertension or Isolated Office Hypertension.

[Pickering2005p146a-67] (Pickering et al. 2005, p. 146) See Masked Hypertension or Isolated Ambulatory Hypertension.

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Blood pressure
Diagnostics
A sphygmomanometer, a device used for measuring arterial pressure
MeSH	D001795
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blood pressure determination