What is the best way to measure blood pressure?
In the course of the blood pressure measurement different methods are used. First of all, one should pay attention to the quality of the pulse (e.g. Pulsus durus as a hard, difficult to squeeze pulse in arterial hypertension). Manual blood pressure measurement according to Riva-Rocci is gradually being replaced by an oscillometric measurement method in everyday clinical practice.
Here, pressure sensors in a blood pressure cuff register and measure the pressure fluctuations caused by the blood flow. The Riva-Rocci method requires attention to important details: The cuff should be placed approximately at the level of the heart with the upper body as upright as possible. The width of the cuff should be about half the circumference of the upper arm.
Too wide or narrow cuffs falsify the blood pressure values considerably. A strong extension of the arm also reduces the accuracy of the measurement. It is recommended to perform the measurement in a slightly bent arm position.
Regular pressure measurements are an important support for the physician and the patient in order to be able to present a profile. Individual blood pressure peaks in the practice/clinic can occur as so-called nervousness hypertension. A 24-hour blood pressure measurement with continuous pressure measurement is suitable for unmasking this.
However, the best method for therapy monitoring combined with an increase in compliance is the patient’s own blood pressure measurement. In order to be able to guarantee a continuous recording of blood pressure values under everyday conditions, one can fall back on the risk-free 24-hour long-term blood pressure measurement. Indication is mainly the suspicion of a dysbalance of the day-night rhythm of blood pressure.
This is understood to mean, for example, a lack of lowering of blood pressure during sleep. Also the white coat syndrome with occasional blood pressure peaks during the measurement in the clinic can be avoided. With this method, the patient wears a cuff on the upper arm for 24 hours, which inflates every 15 minutes during the day and every 30 minutes at night and stores the measured values on a recording device.
The long-term blood pressure measurement allows a meaningful representation of a pressure profile. Possibly conspicuous peaks or drops can be indications of a temporary dysfunction of the cardiovascular system during evaluation. This can be achieved by recording the patient’s activities within these 24 hours while wearing the measuring device. Standard values are a 24-hour mean value of 130 mmHg (systolic) and 80 mmHg (diastolic) or a daily mean value of 135 mmHg (systolic) and 85 mmHg (diastolic).
Which of the two blood pressure values is more important?
Based on the scientific fact that the systolic blood pressure value represents the time of ejection, one could assume that this is the more important value. After all, it supplies the entire body with oxygen-carrying blood. However, if the heart does not sufficiently fill the chambers with blood during diastole, there will not be sufficient blood ejection.
For this reason, both systole and diastole must be regarded as vital cardiac actions. Also the own supply of the heart muscle cells via the perfusion of the coronary arteries (“coronary arteries”) takes place mainly during diastole. If this heart muscle supply is reduced due to insufficient diastolic filling of the chambers, the overall performance of the heart is reduced. Even with an increased heart rate, for example, the time of diastole decreases relatively more than that of systole, and the heart’s self-sufficiency dwindles.
