How do flavonoids impact blood pressure. What role does gut bacteria play in blood pressure regulation. Can dietary changes significantly affect cardiovascular health. Which foods are rich in flavonoids and how much should we consume. What is the connection between gut microbiome diversity and blood pressure.

The Link Between Flavonoids, Gut Bacteria, and Blood Pressure

Recent research has unveiled a fascinating connection between flavonoid-rich foods, gut bacteria, and blood pressure regulation. A study published in Hypertension in August 2021 suggests that consuming more flavonoid-packed foods may help lower systolic blood pressure, particularly when combined with a diverse gut microbiome.

Aedín Cassidu, PhD, the senior study author and professor at Queen’s University in Belfast, emphasizes the importance of this discovery: “Our gut microbiome plays a key role in metabolizing flavonoids to enhance their cardioprotective effects, and this study provides evidence to suggest these blood pressure-lowering effects are achievable with simple changes to the daily diet.”

Understanding the Study: Flavonoids and Blood Pressure

The research examined data from 904 adult participants in the German PopGen biobank network. By analyzing food intake, gut microbiome composition, and blood pressure measurements, researchers uncovered some intriguing findings:

• Participants with the highest flavonoid intake had significantly lower average systolic blood pressure – 2.9 millimeters of mercury (mmHg) lower than those with the lowest flavonoid intake.
• Up to 15% of the association between certain flavonoid-rich foods and lower blood pressure could be explained by greater diversity in the gut microbiome.
• Consuming 1.6 servings of berries daily (1 cup per serving) was linked to an average reduction in systolic blood pressure of 4.1 mmHg.
• Drinking 2.8 glasses of wine (about 4 ounces per glass) weekly was associated with an average reduction of 3.7 mmHg in systolic blood pressure.

The Role of Gut Bacteria in Flavonoid Metabolism

Dr. Cassidy explains the unique relationship between flavonoids and gut bacteria: “Unlike many other food constituents, the flavonoids are predominantly metabolized in the gut – suggesting that the gut microbiome may be more important in enhancing their biological activity than for other things we eat.”

This insight highlights the potential synergistic effect between flavonoid consumption and a diverse gut microbiome in promoting cardiovascular health. But how exactly do gut bacteria interact with flavonoids to influence blood pressure?

The Gut-Heart Connection

The gut microbiome, comprising trillions of microorganisms, plays a crucial role in various aspects of human health, including cardiovascular function. When it comes to flavonoids, gut bacteria appear to enhance their bioavailability and effectiveness in several ways:

1. Metabolic conversion: Gut bacteria can transform flavonoids into more bioactive compounds, increasing their potential health benefits.
2. Absorption enhancement: Some gut bacteria may improve the absorption of flavonoids in the intestines, allowing more of these beneficial compounds to enter the bloodstream.
3. Anti-inflammatory effects: The interaction between flavonoids and gut bacteria may promote an anti-inflammatory environment, which can contribute to better cardiovascular health.
4. Production of beneficial metabolites: Gut bacteria may produce secondary metabolites from flavonoids that have additional health-promoting properties.

Flavonoid-Rich Foods: Nature’s Blood Pressure Regulators

Flavonoids are naturally occurring compounds found in various plant-based foods. But which foods are particularly rich in these beneficial substances? Here’s a list of some top flavonoid sources:

• Berries (strawberries, blueberries, raspberries)
• Citrus fruits (oranges, lemons, grapefruits)
• Apples and pears
• Dark chocolate
• Red wine
• Tea (particularly green and black tea)
• Onions
• Kale and other leafy greens

Incorporating these foods into your diet may help support healthy blood pressure levels. But how much should you consume to see potential benefits?

Recommended Intake for Potential Blood Pressure Benefits

While individual needs may vary, the study suggests some general guidelines:

• Berries: Aim for about 1.6 servings (approximately 1.6 cups) daily
• Red wine: If you choose to drink alcohol, limit intake to about 2.8 glasses (4 ounces each) per week

It’s important to note that these recommendations should be considered in the context of an overall healthy diet and lifestyle. Consulting with a healthcare professional or registered dietitian can help you determine the best approach for your individual needs.

Beyond Blood Pressure: Additional Benefits of Flavonoids

While the focus of this study was on blood pressure, flavonoids have been associated with numerous other health benefits. What are some of the additional advantages of incorporating flavonoid-rich foods into your diet?

• Antioxidant properties: Flavonoids are powerful antioxidants that can help protect cells from oxidative stress and damage.
• Anti-inflammatory effects: Many flavonoids have demonstrated anti-inflammatory properties, which may help reduce the risk of chronic diseases.
• Improved cognitive function: Some studies suggest that flavonoids may support brain health and cognitive performance.
• Cancer prevention: Certain flavonoids have shown potential in inhibiting the growth of cancer cells in laboratory studies.
• Cardiovascular health: Beyond blood pressure regulation, flavonoids may help improve overall heart health by supporting healthy cholesterol levels and vascular function.

The Importance of Gut Microbiome Diversity

The study’s findings underscore the significance of maintaining a diverse gut microbiome. But why is microbial diversity so crucial for our health, and how can we promote it?

Benefits of a Diverse Gut Microbiome

A rich and varied gut microbiome offers several advantages:

• Enhanced nutrient absorption
• Improved immune function
• Better digestive health
• Potential protection against various diseases
• Support for mental health and cognitive function

Strategies to Enhance Gut Microbiome Diversity

To promote a diverse and healthy gut microbiome, consider the following approaches:

1. Eat a varied diet rich in fruits, vegetables, and whole grains
2. Include fermented foods like yogurt, kefir, and sauerkraut in your diet
3. Consume prebiotic foods such as garlic, onions, and leeks
4. Limit processed foods and artificial sweeteners
5. Stay hydrated
6. Exercise regularly
7. Manage stress through relaxation techniques or meditation
8. Consider probiotic supplements under the guidance of a healthcare professional

Flavonoids and Cardiovascular Health: A Broader Perspective

The connection between flavonoids and blood pressure is just one aspect of their potential cardiovascular benefits. Previous research has also highlighted the positive impact of flavonoids on heart health.

Long-Term Effects on Hypertension Risk

A study published in the American Journal of Clinical Nutrition followed over 110,000 participants for more than a decade. The findings were compelling:

• Individuals with the highest flavonoid intake, primarily from blueberries and strawberries, were 8% less likely to develop high blood pressure.
• This suggests that consistent, long-term consumption of flavonoid-rich foods may have a protective effect against hypertension.

Impact on Arterial Health

Another study, also published in the American Journal of Clinical Nutrition, examined the relationship between flavonoid intake and arterial health in nearly 1,900 women. The results were equally intriguing:

• Women with the lowest flavonoid intake, particularly from berries and tea, showed significantly more arterial stiffness.
• Arterial stiffness is a known risk factor for cardiovascular events such as heart attacks and strokes.
• Higher intake of flavonoids found in berries was associated with a 3.0 mmHg lower average systolic blood pressure.

These findings further reinforce the potential of flavonoids as a dietary approach to supporting cardiovascular health.

The Future of Flavonoid Research and Cardiovascular Health

While the current research is promising, there’s still much to learn about the intricate relationships between flavonoids, gut bacteria, and cardiovascular health. Dr. Penny Kris-Etherton, a nutrition professor at The Pennsylvania State University, emphasizes the need for further investigation:

“We are in the early stages of learning about how different foods affect specific gut bacteria and how changes in the gut microbiota affect cardiovascular risk factors and other health measures. It could be the specific flavonoids present in berries and red wine affected specific gut bacteria, which in turn, affected systolic blood pressure, but more research is needed to understand how certain foods and their flavonoids affect the gut microbiome and how this, in turn, affects blood pressure and other cardiovascular disease risk factors.”

Potential Areas for Future Research

As scientists continue to explore the relationship between flavonoids, gut bacteria, and cardiovascular health, several key questions emerge:

• Which specific flavonoids are most effective in promoting cardiovascular health?
• How do different gut bacteria species interact with various flavonoids?
• Can targeted probiotic interventions enhance the cardiovascular benefits of flavonoid consumption?
• Are there synergistic effects between different flavonoid-rich foods?
• How do factors like age, genetics, and overall diet influence the relationship between flavonoids and cardiovascular health?

Addressing these questions could lead to more personalized and effective dietary recommendations for cardiovascular health.

Implications for Public Health and Dietary Guidelines

The growing body of evidence supporting the cardiovascular benefits of flavonoids may have significant implications for public health policies and dietary guidelines. As research progresses, we may see:

1. Increased emphasis on flavonoid-rich foods in national dietary guidelines
2. Development of functional foods or supplements targeting specific flavonoid-gut bacteria interactions
3. More nuanced recommendations for individuals based on their gut microbiome composition
4. Greater integration of flavonoid intake and gut health considerations in cardiovascular disease prevention strategies

Practical Tips for Incorporating Flavonoids into Your Diet

Given the potential health benefits of flavonoids, you might be wondering how to increase your intake. Here are some practical strategies to boost your flavonoid consumption:

Simple Dietary Changes

• Start your day with a berry smoothie or add berries to your morning cereal
• Snack on apple slices with a small piece of dark chocolate
• Include a colorful salad with mixed greens and citrus fruits at lunch
• Swap your afternoon coffee for green tea
• Add sautéed onions to your dinner dishes
• Enjoy a glass of red wine with dinner (if you choose to consume alcohol)

Cooking and Preparation Tips

To maximize the flavonoid content in your meals, consider these preparation methods:

1. Eat fruits and vegetables raw when possible, as some flavonoids can be lost during cooking
2. If cooking, opt for steaming or light sautéing rather than boiling
3. Leave the skin on fruits and vegetables when appropriate, as flavonoids are often concentrated in the outer layers
4. Choose darker varieties of leafy greens, as they tend to have higher flavonoid content
5. Store fruits and vegetables properly to maintain their flavonoid content

Balancing Flavonoid Intake with Overall Diet

While increasing flavonoid intake can be beneficial, it’s important to maintain a balanced approach to nutrition. Here are some considerations:

• Focus on whole food sources of flavonoids rather than relying on supplements
• Incorporate a variety of flavonoid-rich foods to ensure a diverse intake of different flavonoid types
• Remember that flavonoids are just one component of a heart-healthy diet – continue to follow general guidelines for a balanced, nutritious eating plan
• Be mindful of calories and sugar content, especially when consuming fruit juices or sweetened flavonoid-rich foods

By thoughtfully incorporating flavonoid-rich foods into your diet and supporting a healthy gut microbiome, you may be taking important steps toward better cardiovascular health. As research in this field continues to evolve, we can look forward to even more insights into the powerful connection between what we eat, our gut bacteria, and our heart health.

Gut Bacteria and Flavonoid-Rich Foods Linked to Lower Blood Pressure

Eating more foods packed with flavonoids may help lower your systolic blood pressure — the “top number” that reflects the pressure blood exerts against artery walls when the heart beats — especially when you also have a greater diversity of bacteria in your gut, according to a study published in August 2021 in Hypertension.

“Our gut microbiome plays a key role in metabolizing flavonoids to enhance their cardioprotective effects, and this study provides evidence to suggest these blood pressure-lowering effects are achievable with simple changes to the daily diet,” says senior study author Aedín Cassidu, PhD, a professor of nutrition and preventive medicine at the Institute for Global Food Security at Queen’s University in Belfast, Northern Ireland.

For the study, researchers examined data on 904 adult participants from the German PopGen biobank network, including information on food intake, gut microbiome, and blood pressure. Participants reported how often they ate 112 different foods, and researchers then used data from the U.S. Department of Agriculture (USDA) to identify flavonoid-rich foods and calculate total daily flavonoid intake.

People who had the highest total flavonoid intake had significantly lower average systolic blood pressure — 2.9 millimeters of mercury (mmHg) lower — than people with the smallest amount of flavonoids in their diets, the study found.

Participants also provided stool samples, allowing researchers to examine each person’s gut microbiome — the bacteria, microorganisms, fungi, and viruses that are present in the gastrointestinal tract. Up to about 15 percent of the association between certain flavonoid-rich foods, including berries, red wine, apples, and pears, could be explained by greater diversity in the gut microbiome, the study found.

In particular, eating 1.6 servings of berries each day (service size 1 cup) was associated with an average reduction in systolic blood pressure of 4. 1 mmHg. About 12 percent of this association could be explained by the gut microbiome.

And drinking 2.8 glasses of wine (about 4 ounces per glass) each week was associated with an average reduction in systolic blood pressure of 3.7 mmHg. Roughly 15 percent of this connection could be explained by the gut microbiome.

“Unlike many other food constituents, the flavonoids are predominantly metabolized in the gut — suggesting that the gut microbiome may be more important in enhancing their biological activity than for other things we eat,” says Dr. Cassidy.

The study wasn’t a controlled experiment designed to prove that flavonoids directly cause lower blood pressure. Researchers also limited their analysis to specific flavonoid-rich foods and beverages, and it’s possible that the results might have been influenced by other foods that weren’t examined in the study.

Flavonoids Promote Gut Health

Flavonoids are found naturally in a variety of fruits and vegetables as well as in dark chocolate, tea, and wine. Earlier research has linked flavonoids to lower blood pressure and other markers of cardiovascular health.

One study published in the American Journal of Clinical Nutrition examined data on eating habits and blood pressure followed 87,242 women and 23,018 men for more than a decade. None of them had hypertension at the start of the study. By the end, people who had the most flavonoids in their diets — mostly from blueberries and strawberries — were 8 percent less likely to develop high blood pressure.

Another study published in the American Journal of Clinical Nutrition examined eating habits, blood pressure, and arterial stiffness for 1,898 women. This study found that women whose diets had the least flavonoids — primarily from berries and tea — had much more arterial stiffness, a risk factor for events like heart attacks and strokes. Higher intake of flavonoids found in berries was also associated with 3.0 mmHg lower average systolic blood pressure.

“We are in the early stages of learning about how different foods affect specific gut bacteria and how changes in the gut microbiota affect cardiovascular risk factors and other health measures,” says Penny Kris-Ethertom PHD, RDN, a former chairperson of the American Heart Association’s Lifestyle and Cardiometabolic Health Council Leadership Committee and a nutrition professor at The Pennsylvania State University in University Park, Pennsylvania.

“It could be the specific flavonoids present in berries and red wine affected specific gut bacteria, which in turn, affected systolic blood pressure, but more research is needed to understand how certain foods and their flavonoids affect the gut microbiome and how this, in turn, affects blood pressure and other cardiovascular disease risk factors,” says Dr. Kris-Etherton, who wasn’t involved in the new study.

Adding more plants to your diet is a good way to consume more flavonoid-rich foods and also promote a healthy, more diverse gut microbiome, says Samantha Heller, RDN, a nutritionist at New York University Langone Medical Center in New York City.

“While this study highlights certain foods such as pears, apples, and tea, there is no one magical food that will work miracles,” says Heller, who wasn’t involved in the new study. “All edible plant foods are good and each provides a variety of health benefits.”

Pediatric Vital Signs Normal Ranges

Pediatric Vital Signs Normal Ranges Summary Table: 

(Flynn, Kaelber et al. 2017, National High Blood Pressure Education Program Working Group on High Blood Pressure in and Adolescents 2004, Xi, Zong et al. 2016, Morgan & Mikhail’s Clinical Anesthesiology,  Chapter 42. Pediatric Anesthesia)

* For Newborn infants, BP values vary considerably during the first few weeks of life and the definition of HTN in preterm and term neonates also varies. Data have been compiled on neonatal BP values and the summary table is available. Please note that no alternative data have been developed recently. For further information, please see the following articles:

Dionne, J. M., et al. (2012). “Hypertension in infancy: diagnosis, management, and outcome.” Pediatr Nephrol 27(1): 17-32.

Dionne, J. M., et al. (2017). “Hypertension Canada’s 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension.” Can J Cardiol 33(5): 577-585.

“Report of the Second Task Force on Blood Pressure Control in Children–1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland.” Pediatrics 79(1): 1-25.

When to start screening for high BP and how often?

(National High Blood Pressure Education Program Working Group on High Blood Pressure in and Adolescents 2004)

• Guidelines suggest that the blood pressure of children should be assessed starting at 3 years of age. (Grade C, moderate recommendation)
• Children less than 3 years of age should have their BP checked under special conditions including a history of prematurity, congenital heart disease malignancy and other systemic illnesses (Grade C, moderate recommendation)

Hypertension (HTN) or High Blood Pressure

(Chen and Wang 2008, Chiolero, Cachat et al. 2007, McNiece, Poffenbarger et al. 2007, National High Blood Pressure Education Program Working Group on High Blood Pressure in and Adolescents 2004, Weaver 2019)

• What is the definition of HTN?
  • High blood pressure is defined as average systolic BP and/or diastolic BP >/= 95^th percentile for age, gender and height on more than 3 occasions.
  • Pre-hypertension is defined as SBP and/or DBP between 90^th and 95^th percentile.
  • For adolescents, BP readings >/= 120/80 are considered to be pre-hypertensive. 
• How prevalent is HTN in Children?
  • The prevalence of clinical HTN in children and adolescent is ~3. 5%
  • The prevalence of persistent HTN is ~2.2% to 3.5%
    • Higher rates are present among overweight and obese children and adolescents.
• Does HTN in children track into HTN in adulthood?
  • Data on BP tracking suggest that higher BP in childhood correlates with higher BP in adulthood

A Summary of Pediatric BP Categories, Stages and Follow-Up

• The table was recreated from the articles listed below. Given that there were slight variations in BP values, we elected to include both percentiles and BP ranges.

(National High Blood Pressure Education Program Working Group on High Blood Pressure in and Adolescents 2004, Chen and Wang 2008, Banker, Bell et al. 2016, Flynn, Kaelber et al. 2017, Weaver 2017, Weaver 2019)

Obtaining Accurate Blood Pressure Measurements:

(Scott, Rocchini et al. 1988, Pickering, Hall, et al. 2005)

• Different methods to measure Blood pressure: The mercury sphygmomanometer is the gold standard device for in-office blood pressure measurement
  • The Auscultatory method 
    •  The most widely used noninvasive method for measuring blood pressure.
    • The preferred method for BP measurement in children
    • Korotkoff technique
      • Discovered by Dr. Nikolai Korotkov over 100 years ago.
      • It involves blocking the brachial artery by inflating a cuff to above systolic blood pressure and gradually deflate to re-establish blood flow.
      • The sounds detected by the stethoscope are known as Korotkoff sounds and are generally classified as phases I -V.
        • Phase I appears as a tapping sound and corresponds to systolic blood pressure
        • Phase V (disappearance of sound) corresponds to diastolic blood pressure (Pickering, Hall et al. 2005).
  • The oscillometric method:
    • The SBP and DBP are estimated indirectly by measuring the mean arterial pressure.
    • Not commonly used as ambulatory blood pressure monitors.
    • Advantages:
      •  No transducer is needed and therefore, the placement of the cuff is not critical
      • Convenient and minimize observer error
    • Current guidelines suggest that if blood pressure reading exceeds the 90^th percentile, it should be confirmed by the auscultatory method.
• Location of measurement:
  • The upper arm is the standard location for blood pressure measurement. Wrist monitors can be used in obese patients because wrist diameter is not significantly affected by obesity
• Subject preparation: For most accurate blood pressure measurements, the American Heart Association recommends the following:
  • Sitting quietly for at least 5 minutes.
  • The child should be seated comfortably in a chair with back supported and legs uncrossed.  
    • An unsupported back may result in an increase in diastolic blood pressure
    • Crossing the legs may increase systolic blood pressure.
  • Remove all clothing that covers the location of cuff placement
  • child’s arm should be supported at heart level
    • the right arm is preferred due to the possibility of coarctation of the aorta, which may result in a falsely low reading (Scott, Rocchini et al. 1988)
• Cuff size:
  • The ideal cuff size is one with a bladder length of 80% and a width that is at least 40% of arm circumference
  • Using a cuff that is too narrow will result in inappropriately high blood pressure. whereas a cuff that is too wide will result in an inappropriately low blood pressure reading.
  • Below are recommended BP cuff sizes for children and adolescents for a range of arm circumference.
    • The table recreated from numerous sources listed below. Slight variations were noted.
    • (Mattoo 2002, National High Blood Pressure Education Program Working Group on High Blood Pressure in and Adolescents 2004, Pickering, Hall et al. 2005, Prineas, Ostchega et al. 2007, Palatini and Frick 2012, Ostchega, Hughes, et al. 2014, Weaver 2017, Ostchega, Hughes, et al. 2018)

Childhood Obesity and its Effects on Blood Pressure

• It is noteworthy that the increasing prevalence of obesity in the United States has not only affected adults but also children. As a result, population-based studies of pediatric weight will vary according to the period to time sampled – and will also affect (as per Keefe 2019) – the prevalence of sleep apnea with its related impact on hypertension.
• The prevalence of childhood obesity has significantly increased since 1980 with approximately 30% of children who are overweight/obese (Ogden, Carroll et al. 2015).
  • Children with high BMI are more likely to develop hypertension later in life compared to children with lower BMI (Parker, Sinaiko et al. 2016)
• With the unfortunate rising rates of childhood obesity, obtaining an accurate measurement has proven to be challenging due to an abnormally large arm circumference:
  • Arm circumference can be large enough which requires the use of adult size BP cuff
  • NHANES data from 2007-2010 showed that boys and girls as young as 9 years of age required a standard adult-sized cuff. Additionally, of obese participants, one third required a large adult BP cuff (Palatini and Frick 2012)
    • Disproportionately short arm compared to the cuff required for a given arm circumference
  • Conically shaped arms resulting in an average difference of 8. 7 cm between the proximal and distal upper arm circumference (Palatini and Frick 2012)

• Pathophysiology: (Stefan, Vozarova et al. 2002, Rasouli and Kern 2008, do Carmo, da Silva et al. 2011, Kalil and Haynes 2012, Brambilla, Antolini et al. 2013, Vecchiola, Lagos et al. 2016, Brady 2017)
  • Increased adiposity leads to dysfunctional activation of the sympathetic nervous system:
    • Increased adipose tissue results in an increased production of adipokines (pro- and anti-inflammatory hormones and cytokines) to maintain homeostasis
      • Recent research has been focused on the role of adiponectin (AD) due to its anti-inflammatory and anti-atherogenic effects as well as its role in increasing insulin sensitivity
    • Over time, the disproportionate increase in pro-inflammatory adipokines (IL-6, leptin, etc.) leads to a chronic inflammatory state
      • For example, Leptin’s activation of SNS is mediated via leptin receptors present on POMC neurons in the brain
  • The activation of SNS leads to increased norepinephrine production resulting in elevated BP via the following mechanisms
    •  Increased activity of RAAS and release of renin.
    • Direct vasoconstricting effects
  • Chronic inflammation and increased oxidative stress lead to endothelial damage and vascular dysfunction which manifests clinically as hypertension.

References: 

Banker, A., C. Bell, M. Gupta-Malhotra and J. Samuels (2016). “Blood pressure percentile charts to identify high or low blood pressure in children.” BMC Pediatr 16: 98.

Brady, T. M. (2017). “Obesity-Related Hypertension in Children.” Front Pediatr 5: 197.

Brambilla, P., L. Antolini, M. E. Street, M. Giussani, S. Galbiati, M. G. Valsecchi, A. Stella, G. V. Zuccotti, S. Bernasconi and S. Genovesi (2013). “Adiponectin and hypertension in normal-weight and obese children.” Am J Hypertens 26(2): 257-264.

Chen, X. and Y. Wang (2008). “Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis.” Circulation 117(25): 3171-3180.

Chiolero, A., F. Cachat, M. Burnier, F. Paccaud and P. Bovet (2007). “Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight.” Journal of hypertension 25(11): 2209-2217.

Coulthard, M. G. (2020). “Single blood pressure chart for children up to 13 years to improve the recognition of hypertension based on existing normative data.” Arch Dis Child.

do Carmo, J. M., A. A. da Silva, Z. Cai, S. Lin, J. H. Dubinion and J. E. Hall (2011). “Control of blood pressure, appetite, and glucose by leptin in mice lacking leptin receptors in proopiomelanocortin neurons.” Hypertension 57(5): 918-926.

Flynn, J. T., D. C. Kaelber, C. M. Baker-Smith, D. Blowey, A. E. Carroll, S. R. Daniels, S. D. de Ferranti, J. M. Dionne, B. Falkner, S. K. Flinn, S. S. Gidding, C. Goodwin, M. G. Leu, M. E. Powers, C. Rea, J. Samuels, M. Simasek, V. V. Thaker, E. M. Urbina, S. Subcommittee On and C. Management Of High Blood Pressure In (2017). “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.” Pediatrics 140(3).

Kalil, G. Z. and W. G. Haynes (2012). “Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications.” Hypertens Res 35(1): 4-16.

Mattoo, T. K. (2002). “Arm cuff in the measurement of blood pressure.” Am J Hypertens 15(2 Pt 2): 67S-68S.

McNiece, K. L., T. S. Poffenbarger, J. L. Turner, K. D. Franco, J. M. Sorof and R. J. Portman (2007). “Prevalence of hypertension and pre-hypertension among adolescents.” The Journal of pediatrics 150(6): 640-644. e641.

National High Blood Pressure Education Program Working Group on High Blood Pressure in, C. and Adolescents (2004). “The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.” Pediatrics 114(2 Suppl 4th Report): 555-576.

Ogden, C. L., M. D. Carroll, C. D. Fryar and K. M. Flegal (2015). “Prevalence of Obesity Among Adults and Youth: United States, 2011-2014.” NCHS Data Brief(219): 1-8.

Ostchega, Y., J. P. Hughes, T. Nwankwo and G. Zhang (2018). “Mean mid-arm circumference and blood pressure cuff sizes for US children, adolescents and adults: National Health and Nutrition Examination Survey, 2011-2016.” Blood Press Monit 23(6): 305-311.

Ostchega, Y., J. P. Hughes, R. J. Prineas, G. Zhang, T. Nwankwo and M. M. Chiappa (2014). “Mid-arm circumference and recommended blood pressure cuffs for children and adolescents aged between 3 and 19 years: data from the National Health and Nutrition Examination Survey, 1999-2010.” Blood Press Monit 19(1): 26-31.

Palatini, P. and G. N. Frick (2012). “Cuff and bladder: overlooked components of BP measurement devices in the modern era?” Am J Hypertens 25(2): 136-138.

Parker, E. D., A. R. Sinaiko, E. O. Kharbanda, K. L. Margolis, M. F. Daley, N. K. Trower, N. E. Sherwood, L. C. Greenspan, J. C. Lo, D. J. Magid and P. J. O’Connor (2016). “Change in Weight Status and Development of Hypertension.” Pediatrics 137(3): e20151662.

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Rasouli, N. and P. A. Kern (2008). “Adipocytokines and the metabolic complications of obesity.” J Clin Endocrinol Metab 93(11 Suppl 1): S64-73.

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Low Blood Pressure During Pregnancy and Poor Perinatal Outcomes: An Obstetric Paradox | American Journal of Epidemiology

Abstract

Low blood pressure during pregnancy has been associated with poor perinatal outcomes. However, whether this association is causal or is due to confounding has never been carefully assessed. The authors used data from the Collaborative Perinatal Project, a large prospective cohort study in 12 hospitals in the United States from 1959 to 1966. A total of 28,095 subjects were included. At first glance, it appeared that the lower the baseline blood pressure during pregnancy, the higher the incidence of very premature birth (<34 weeks) and severe small for gestational age (<5th percentile) in a consistent dose-response pattern. However, women with low blood pressure were generally younger, shorter, lighter, leaner, poorer, and more often a minority, and they gained less weight. After the authors controlled for these factors, low blood pressure was not associated with preterm birth (adjusted relative risks ranging from 0.86 to 0.93, p > 0.05) or small for gestational age (relative risks ranging from 0.45 to 2.0). Therefore, the association between low blood pressure during pregnancy and poor perinatal outcomes is largely due to confounding by other risk factors. Low blood pressure by itself does not increase risk of poor perinatal outcomes at a population level. However, this conclusion may not apply to individual patients who also have a compromised plasma volume expansion or pathologic homeostasis.

While hypertension in pregnancy has been extensively studied, little attention has been paid to the other end of the spectrum, namely low blood pressure during pregnancy. Friedman and Neff (1) demonstrated that approximately 10 percent of pregnant women had a maximum diastolic blood pressure (DBP) of 60 mmHg or lower. More importantly, low systolic blood pressure and low DBP were associated with a higher risk of low birth weight, fetal death, and defective intelligence quotient scores at age 4 years in a consistent dose-response pattern. However, no further analysis was conducted. These findings have been cited repeatedly in the literature and were consistent with more recent data (2). Because blood pressure declines in early pregnancy and rises later, maximum blood pressure can be influenced by the level of baseline blood pressure, the degree of rise in late gestation, and the gestational age at delivery, in addition to other factors. Further, from the point of view of prevention, baseline and rise in blood pressure appear to be more useful than the maximum blood pressure. The purpose of this study is to look at this issue in-depth and answer the following specific questions: 1) Is low baseline DBP in early pregnancy associated with poor perinatal outcomes? 2) Does low blood pressure cause poor perinatal outcomes, or does it merely reflect other risk factors? 3) How might a rise in DBP in late pregnancy modify the effect of baseline DBP on fetal growth?

MATERIALS AND METHODS

We used data from the Collaborative Perinatal Project. Details of the study have been described elsewhere (3). Briefly, women who attended prenatal care at 12 hospitals from 1959 to 1966 were invited to participate in this prospective observational study. At entry, detailed demographic, socioeconomic, and behavioral information was collected by in-person interview. A medical history was obtained, and a physical examination was also given. Women were interviewed, and physical findings were recorded in all following prenatal visits. Detailed findings in labor/delivery and postpartum were also collected.

Blood pressure was recorded at entry, during each prenatal visit, during labor and delivery, and postpartum. Either Korotkoff phase 4 (muffling) or phase 5 (disappearance) was used for DBP (1). A validation study in which the information on blood pressure was checked against that in the original medical records showed remarkable accuracy (1). In that study, the authors selected 772 recordings suspected of error because of wide deviations from the sequence of blood pressures recorded in that patient during the course of pregnancy. The percent error for these blood pressure readings was 1.8 percent. Furthermore, since assessment of blood pressure has not changed substantially in the last 40 years, the current data are suitable and reliable for the purpose of our study.

A total of 58,760 pregnancies were included in the Project. We restricted our analyses to singleton pregnancies with a first prenatal visit before 25 weeks, at least three prenatal visits, and birth between 25 and 45 weeks inclusive. Since it is well established that high blood pressure during pregnancy causes poor perinatal outcomes, we limited our analysis to women with baseline DBP less than 80 mmHg. A total of 28,095 subjects were eligible. The baseline DBP is defined as the average of all the DBP measures from 15 to 24 weeks of gestation (83 percent of subjects had at least two measures). Rise in DBP was calculated by subtracting the baseline DBP from the highest DBP, defined as the last antepartum DBP within 3 weeks from delivery (85 percent were less than 2 weeks). Since blood pressure progressively rises in the second half of pregnancy and intrapartum blood pressure is affected by other factors, we considered the last antepartum DBP to be more likely to reflect true DBP and, therefore, preferable to the actual highest recording. Postpartum blood pressure was defined as blood pressure at least 5 weeks after delivery. Mean arterial pressure (MAP) was calculated as: DBP + (systolic blood pressure − DBP)/3. Main outcomes include preterm births less than 34 weeks (based on the last menstrual period) and severe small for gestational age (SGA) less than the 5th percentile (4). To reduce potential misclassification owing to erroneous gestational age, infants with birth weights of 3,100 g or more were considered to have a gestational age of 34 weeks or more (4).

Univariate analysis was conducted first. Analysis of covariance and χ² test were used for continuous and categorical variables, respectively. We used multiple logistic regression for preterm birth and SGA to adjust for potential confounders. Appropriate transformation of the variables was made before they were incorporated into the statistical models.

RESULTS

Figure 1 illustrates that at a baseline DBP value of less than 80 mmHg, the lower the baseline DBP the higher the incidence of very premature birth among women with a rise in DBP of less than 15 mmHg (χ² test, p < 0.001). Similarly, incidence of severe SGA increased with decreasing baseline DBP. However, this trend was reversed among those with excessive rise in DBP. The striking and consistent pattern prompted us to ask who these subjects with low baseline DBP were. Table 1 indicates that these women were generally younger, shorter, lighter, leaner, poorer, and more often minority and that they gained less weight. These are well-known risk factors for poor perinatal outcomes. After we had controlled for race, socioeconomic status, prepregnancy body mass index, and smoking during pregnancy, low blood pressure was no longer associated with very preterm birth. The adjusted relative risks were 1.0 (reference), 0.93 (95 percent confidence interval: 0.83, 1.05), 0.86 (95 percent confidence interval: 0.71, 1.03), and 0.88 (95 percent confidence interval: 0.55, 1.42) for baseline DBPs of 70–79, 60–69, 50–59, and less than 50 mmHg, respectively. Likewise, low blood pressure was not associated with severe SGA (figure 2). We reran the logistic regression for severe SGA without net weight gain. The results were similar. Figure 2 further suggests that rise in DBP in late pregnancy does not seem to influence the risk of SGA in most women. However, women with relatively high baseline and excessive rise in DBP had twice the risk of having a baby with severe SGA.

FIGURE 1.

Incidence of very premature birth (<34 weeks) and severe small for gestational age (SGA) (<5th percentile) in association with baseline diastolic blood pressure and rise in late pregnancy, Collaborative Perinatal Project, 1959–1966.

FIGURE 1.

Incidence of very premature birth (<34 weeks) and severe small for gestational age (SGA) (<5th percentile) in association with baseline diastolic blood pressure and rise in late pregnancy, Collaborative Perinatal Project, 1959–1966.

FIGURE 2.

Adjusted relative risks and 95% confidence intervals (CI) for severe small for gestational age by diastolic blood pressure in pregnancy (logistic regression, adjusting for maternal height, prepregnancy body mass index, smoking, and net maternal weight gain), Collaborative Perinatal Project, 1959–1966.

FIGURE 2.

Adjusted relative risks and 95% confidence intervals (CI) for severe small for gestational age by diastolic blood pressure in pregnancy (logistic regression, adjusting for maternal height, prepregnancy body mass index, smoking, and net maternal weight gain), Collaborative Perinatal Project, 1959–1966.

TABLE 1.

Characteristics of women with a low diastolic blood pressure at the baseline, Collaborative Perinatal Project, 1959–1966

.	Baseline diastolic pressure (mmHg) .
.	<50 (n = 294) .	50–59 (n = 3,064) .	60–69 (n = 12,671) .	70–79 (n = 12,066) .
Maternal age (years) .	22 ± 5 .	23 ± 5 .	24 ± 6 .	25 ± 6 .
Height (inches) *	62.8 ± 2.5	63.0 ± 2.7	63.2 ± 2.7	63.5 ± 2.7
Prepregnancy weight (pounds) *	116 ± 18	121 ± 9	125 ± 21	132 ± 25
Body mass index (kg/m2)	20.2 ± 2.5	21.0 ± 3.1	21.6 ± 3.6	22.6 ± 4.1
Net weight gain (kg)†	6.7 ± 3. 3	6.9 ± 3.7	7.2 ± 3.9	7.3 ± 4.3
Race/ethnicity (%)
White	31	42	50	53
Black	62	48	41	41
Other	7	10	9	6
Socioeconomic status (%)
1 (lowest)	12	89	6	5
2	37	32	27	25
3	35	31	30	30
4	11	20	23	24
5 (highest)	5	9	14	15
Nulliparous (%)	34	32	32	32
Smoking during pregnancy  (cigarettes/day) (%)
0	54	50	55	59
1–9	18	20	17	15
10–19	12	14	13	12
≥20	15	16	15	14
Baseline MAP‡ (mmHg)	63	71	79	87
Last antepartum MAP‡ (mmHg)	77	81	85	89
Postpartum MAP‡ (mmHg)	83	86	89	93

.	Baseline diastolic pressure (mmHg) .
.	<50 (n = 294) .	50–59 (n = 3,064) .	60–69 (n = 12,671) .	70–79 (n = 12,066) .
Maternal age (years) .	22 ± 5 .	23 ± 5 .	24 ± 6 .	25 ± 6 .
Height (inches) *	62.8 ± 2.5	63.0 ± 2.7	63.2 ± 2.7	63.5 ± 2.7
Prepregnancy weight (pounds) *	116 ± 18	121 ± 9	125 ± 21	132 ± 25
Body mass index (kg/m2)	20.2 ± 2.5	21.0 ± 3.1	21.6 ± 3.6	22.6 ± 4.1
Net weight gain (kg)†	6.7 ± 3. 3	6.9 ± 3.7	7.2 ± 3.9	7.3 ± 4.3
Race/ethnicity (%)
White	31	42	50	53
Black	62	48	41	41
Other	7	10	9	6
Socioeconomic status (%)
1 (lowest)	12	89	6	5
2	37	32	27	25
3	35	31	30	30
4	11	20	23	24
5 (highest)	5	9	14	15
Nulliparous (%)	34	32	32	32
Smoking during pregnancy  (cigarettes/day) (%)
0	54	50	55	59
1–9	18	20	17	15
10–19	12	14	13	12
≥20	15	16	15	14
Baseline MAP‡ (mmHg)	63	71	79	87
Last antepartum MAP‡ (mmHg)	77	81	85	89
Postpartum MAP‡ (mmHg)	83	86	89	93

TABLE 1.

Characteristics of women with a low diastolic blood pressure at the baseline, Collaborative Perinatal Project, 1959–1966

.	Baseline diastolic pressure (mmHg) .
.	<50 (n = 294) .	50–59 (n = 3,064) .	60–69 (n = 12,671) .	70–79 (n = 12,066) .
Maternal age (years) .	22 ± 5 .	23 ± 5 .	24 ± 6 .	25 ± 6 .
Height (inches) *	62.8 ± 2.5	63.0 ± 2.7	63.2 ± 2.7	63.5 ± 2.7
Prepregnancy weight (pounds) *	116 ± 18	121 ± 9	125 ± 21	132 ± 25
Body mass index (kg/m2)	20. 2 ± 2.5	21.0 ± 3.1	21.6 ± 3.6	22.6 ± 4.1
Net weight gain (kg)†	6.7 ± 3.3	6.9 ± 3.7	7.2 ± 3.9	7.3 ± 4.3
Race/ethnicity (%)
White	31	42	50	53
Black	62	48	41	41
Other	7	10	9	6
Socioeconomic status (%)
1 (lowest)	12	89	6	5
2	37	32	27	25
3	35	31	30	30
4	11	20	23	24
5 (highest)	5	9	14	15
Nulliparous (%)	34	32	32	32
Smoking during pregnancy  (cigarettes/day) (%)
0	54	50	55	59
1–9	18	20	17	15
10–19	12	14	13	12
≥20	15	16	15	14
Baseline MAP‡ (mmHg)	63	71	79	87
Last antepartum MAP‡ (mmHg)	77	81	85	89
Postpartum MAP‡ (mmHg)	83	86	89	93

.	Baseline diastolic pressure (mmHg) .
.	<50 (n = 294) .	50–59 (n = 3,064) .	60–69 (n = 12,671) .	70–79 (n = 12,066) .
Maternal age (years) .	22 ± 5 .	23 ± 5 .	24 ± 6 .	25 ± 6 .
Height (inches) *	62.8 ± 2.5	63.0 ± 2.7	63.2 ± 2.7	63.5 ± 2.7
Prepregnancy weight (pounds) *	116 ± 18	121 ± 9	125 ± 21	132 ± 25
Body mass index (kg/m2)	20.2 ± 2.5	21.0 ± 3.1	21.6 ± 3.6	22.6 ± 4.1
Net weight gain (kg)†	6.7 ± 3. 3	6.9 ± 3.7	7.2 ± 3.9	7.3 ± 4.3
Race/ethnicity (%)
White	31	42	50	53
Black	62	48	41	41
Other	7	10	9	6
Socioeconomic status (%)
1 (lowest)	12	89	6	5
2	37	32	27	25
3	35	31	30	30
4	11	20	23	24
5 (highest)	5	9	14	15
Nulliparous (%)	34	32	32	32
Smoking during pregnancy  (cigarettes/day) (%)
0	54	50	55	59
1–9	18	20	17	15
10–19	12	14	13	12
≥20	15	16	15	14
Baseline MAP‡ (mmHg)	63	71	79	87
Last antepartum MAP‡ (mmHg)	77	81	85	89
Postpartum MAP‡ (mmHg)	83	86	89	93

DISCUSSION

Our study indicates that the association between low blood pressure during pregnancy and poor perinatal outcomes is due to confounding by other risk factors. After multiple factors are adjusted for, low DBP in early pregnancy is no longer associated with poor perinatal outcomes. Literature on this association is not only scarce but is also inconsistent. Steer (2) found from his database of more than 22,000 term births that the incidence of having a small-for-gestational age baby (<10th percentile) was 3.7, 2.6, 3.2, and 6.9 percent for a maternal maximum DBP of 60 or less, 61–70, 71–89, and 90 or more mmHg, respectively. Ng and Walters (5) compared 134 patients with a blood pressure of 110/70 mmHg or less at all antenatal visits with 134 patients with a blood pressure of greater than 110/70 mmHg on at least three antenatal visits. Incidence of preterm birth, low birth weight, significant meconium staining of the amniotic fluid, and maternal postpartum complications was about twice as high in the former group as in the latter. However, the hypotensive group was significantly younger (26 vs. 28 years) and weighed much less at the first prenatal visit (56. 5 vs. 64.7 kg). No confounders were controlled in their analysis.

Accurate blood pressure measurement is difficult to achieve. In the best conducted study so far, Churchill et al. (6) used ambulatory blood pressure monitors on 209 low-risk, nulliparous women. Twenty-four-hour recordings of blood pressure were obtained at around 18, 28, and 36 weeks’ gestation. After adjustment for maternal age, height, weight, cigarette smoking, alcohol intake, ethnic origin, gestational age, and pregnancy hypertension syndromes, maternal mean 24-hour DBP at 28 weeks’ gestation was inversely associated with birth weight. A 1-mmHg decrease in DBP was associated with 13.5-g increase in birth weight (95 percent confidence interval: 0.6, 26.4). This association persisted at 36 weeks’ gestation.

Despite the inconsistent findings on whether low blood pressure in midpregnancy is actually beneficial to fetal growth, careful analyses suggest that low blood pressure at least does not impose an additional risk to fetal growth. Paradoxically, such an epidemiologic observation seems contradictory to limited evidence from clinical studies. For instance, Grünberger et al. (7) followed 70 pregnant women with a blood pressure of 110/65 mmHg or less, 36 percent of whom had a history of miscarriage. Placental perfusion at 28 weeks’ gestation and onward was measured by radioisotopes. More than 80 percent of the patients were considered to have uteroplacental underperfusion. Thirty patients reported only slight discomfort (i.e., fatigue and occasional dizziness), while the other 40 women had severe dizziness, nausea, headache, and the propensity to collapse. The latter were then given mineralocorticoids intramuscularly. Blood pressure was able to be raised to above 110/65 mmHg in 27 patients. Overall, placental perfusion rate improved significantly after treatment. Compared with the untreated women, those who were treated had a lower incidence of preterm birth (5 vs. 20 percent, p = 0.06), moderate-to-severe neonatal dystrophy (5 vs. 60 percent, p < 0.001), and substantially higher mean birth weight (3,308 g vs. 2,800 g; no test was performed). These findings were confirmed in a prospective study by the same authors (8), which involved 60 women with hypotension in pregnancy. Half of the women were treated and compared with the other, untreated half. Placental blood flow was significantly higher in the treated group, as was the birth weight (by 600 g). However, the authors did not mention in either study whether these patients had preexisting homeostatic, renal, or endocrinologic disorders or whether the low blood pressure developed during pregnancy. Such a distinction might determine the possible mechanism(s) of how blood pressure may affect fetal growth.

A more recent study examined changes in MAP induced by a transition from a lying to a standing position in 53 and 41 normal singleton women in early (12–18 weeks) and late pregnancy (34–40 weeks), respectively (9). A linear relation was observed between the change in MAP and birth weight in late pregnancy; i. e., the greater drop in MAP, the lower the birth weight (r = 0.57, p < 0.001). However, this relation was not found in early pregnancy. Further, there was no relation between blood pressure at rest and birth weight among all the women. These findings indicate that it is the orthostatic hypotension rather than low blood pressure per se that is associated with poor fetal growth.

In a normal pregnancy, systemic vascular resistance drops substantially (10). Despite an marked increase in cardiac output, overall MAP declines significantly in early gestation. Lower baseline MAP might be caused by greater loss of vascular tone and reactivity, by vascular underfill due to insufficient plasma volume expansion, or by both. Table 1 shows that despite large differences in baseline MAP, the difference in postpartum MAP, which reflects nonpregnant MAP, was much smaller among these women. (Some of the postpartum difference might be accounted for by difference in weight and body mass. ) Among women who had a baseline DBP of less than 50 mmHg, MAP dropped approximately 20 mmHg compared with a 6-mmHg drop in women whose baseline DBP was 70–79 mmHg. Furthermore, those who had a lower baseline MAP tended to have a substantially greater rise in MAP in late pregnancy (14, 10, 6, and 2 mmHg for women with a baseline DBP of less than 50, 50–59, 60–69, and 70–79 mmHg, respectively). These findings suggest that lower baseline blood pressure in midpregnancy is more likely because of greater vascular relaxation rather than because of blood underfill. On the other hand, failure to drop in vascular tone in early pregnancy coupled with greater rise in blood pressure in late pregnancy, more likely due to vasospasm rather than to greater volume expansion, restricts fetal growth.

Given the limited knowledge about low blood pressure in pregnancy, it is difficult to reconcile the discrepancy between clinical and epidemiologic observations. We can only speculate that since a substantial proportion of pregnant women have a relatively low baseline DBP (19 percent had a baseline DBP of 60 mmHg or lower in our study population), one would assume that most cases are probably physiologic, which may not affect fetal growth. On the other hand, our study showed that several risk factors appear to aggregate in women who were already at high risk for poor fetal growth. If a clinical intervention does improve perinatal outcomes in this group, this might become another option to reduce preterm birth and SGA. Given the scarcity and inconsistency of the literature, more investigations are warranted.

To sum up, low blood pressure during pregnancy is a common phenomenon. However, insufficient attention has been paid to the group of women with this condition. Although several studies reported a significant association between low blood pressure during pregnancy and poor perinatal outcomes, our analysis indicates that this association was largely due to confounding. Low blood pressure by itself does not increase the risk of poor perinatal outcomes at a population level. However, this conclusion may not apply to individual patients who also have a compromised plasma volume expansion or pathologic homeostasis.

The authors are indebted to Dr. Cassandra Henderson for consultation regarding the clinical perspectives.

REFERENCES

1.

Friedman EA, Neff RK. Pregnancy hypertension: a systematic evaluation of clinical diagnostic criteria. Littleton, MA: PSG Publishing Co., 1977.

2.

Steer P. Factors influencing relative weights of placenta and newborn infant. (Letter).

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Niswander KR, Gordon M, eds. The Collaborative Perinatal Study of the National Institute of Neurological Diseases and Stroke: the women and their pregnancies. Philadelphia, PA: W. B. Saunders, 1972.

4.

Zhang J, Harville E. Birth-weight-for-gestational-age patterns by race, sex, and parity in the United States population: the 5th percentile.

Paediatr Perinatal Epidemiol

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12

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352

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Ng PH, Walters WA. The effects of chronic maternal hypotension during pregnancy.

Aust N Z J Obstet Gynaecol

1992

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32

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14

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Churchill D, Perry IJ, Beevers DG. Ambulatory blood pressure in pregnancy and fetal growth.

Lancet

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349

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7

–10.7.

Grünberger W, Leodolter S, Parschalk O. Maternal hypotension: fetal outcome in treated and untreated cases.

Gynecol Obstet Invest

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32

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Grünberger W, Parschalk O, Fishchl F. Treatment of hypotension complicating pregnancy improves fetal outcomes. (In German).

Med Klin

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76

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257

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Hohmann M, Kunzel W. Orthostatic hypotension and birthweight.

Arch Gynecol Obstet

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248

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181

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Lindheimer MD, ed. Cardiovascular adaptation to normal pregnancy. In: Lindheimer MD, Roberts JM, Cunningham FG, eds. Chesley’s hypertensive disorders in pregnancy. 2nd ed. Stamford, CT: Appleton & Lange, 1999:67–166.

Blood pressure of adults, 2012 to 2015

Release date: October 13, 2016

On this page

Blood pressure has many implications for health. High systolic blood pressure (SBP) and/or high diastolic blood pressure (DBP) can cause damage to blood vessels and can result in cardiovascular disease or events, such as heart attack or stroke, which are among the leading causes of hospitalization and death in Canada.^{Note 1Note 2}

Results from the 2012 to 2015^Note 3 Canadian Health Measures Survey (CHMS) indicate that Canadian adults aged 20 to 79 had a measured average resting blood pressure of 113/72 mmHg. For both males and females, average resting blood pressure increased significantly with age (Chart 1). The average resting blood pressure for males aged 20 to 29 was 107/69 mmHg, compared with 123/70 mmHg for males aged 70 to 79. The average resting blood pressure for females aged 20 to 29 was 101/66 mmHg, compared with 128/70 mmHg for females aged 70 to 79. Average resting systolic blood pressure tended to be significantly higher for males in younger age groups (aged 20 to 49) but significantly lower for males in the oldest age group (aged 70 to 79) compared with females in those same age groups. Average resting diastolic blood pressure was higher among middle aged males 50 to 59 compared with females of the same age group.

Data table for Chart 1

Hypertension

Hypertension is defined as a measured systolic blood pressure greater than or equal to 140 mmHg, a measured diastolic blood pressure greater than or equal to 90 mmHg, a self-reported diagnosis of high blood pressure, or the self-reported use of anti-hypertensive medication. Hypertension was prevalent in 24% of Canadian adults aged 20 to 79 in 2012 to 2015. The prevalence of hypertension increased significantly with age, such that 53% of Canadians aged 60 to 79 self-reported that they had been diagnosed with hypertension by a health-care professional, were taking anti-hypertensive medication, or had high measured blood pressure. Meanwhile, 24% of adults aged 40 to 59 and less than 5% of adults aged 20 to 39 were considered to be hypertensive (data not shown).

Approximately 18% of Canadian adults with measured hypertension were unaware of their condition (chart 2). Fourteen percent were aware of their condition and treated by medication but the condition was not controlled (i.e. reported taking medication for high blood pressure yet had a measured blood pressure greater than or equal to 140/90 mmHg), and another 4% were aware of their condition but were not treated. Sixty-five percent of Canadian adults with hypertension were aware of their condition and were controlling it through medication use.  

Data table for Chart 2

An important risk factor for hypertension is being overweight or obese. ^Note 4 Results from the CHMS show that measured hypertension was more than twice as likely to occur among adults who were overweight or obese, compared with their normal-weight counterparts (Chart 3). Hypertension was prevalent in 30% of Canadian adults who were classified as being overweight or obese, compared with 12% of those who were normal weight. Overweight or obese adults aged 60 to 79 had the highest prevalence of hypertension (57%), while adults aged 20 to 39 had the lowest, regardless of weight status (no significant difference between normal weight or overweight/obese for 20-to-39-year olds).

Data table for Chart 3

Data table for chart 3

Table summary

This table displays the results of Data table for chart 3 Normal weight and Overweight/obese, calculated using percent units of measure (appearing as column headers).

		Normal weight	Overweight/obese
		percent
Sex	Total	12.1	30.0
	Males	13.0	30.4
	Females	11.5	29.6
Age group	20 to 39	Note F: too unreliable to be published	7. 3
	40 to 59	13.6	29.2
	60 to 79	39.8	57.3

Start of text box

About blood pressure

Blood pressure (BP) is a measure of the force of blood against the artery walls, and is expressed as systolic blood pressure (SBP)/diastolic blood pressure (DBP) in millimetres of mercury (e.g., 120/80 mmHg). The systolic pressure (top number) is the pressure when the heart contracts and pushes the blood out, and the diastolic pressure (bottom number) is the lowest pressure when the heart relaxes between beats.

The CHMS measured resting blood pressure using an automated device (BPTru™) following a five minute rest period. The BPTru™ recorded six measurements, one minute apart. The average SBP and DBP were calculated using the last five of the six measurements. Respondents were also asked to report if they have ever been diagnosed with high blood pressure by a health care professional or if they have taken medication for high blood pressure in the past month.

The criteria for blood pressure classification in adults are as follows:

Criteria for blood pressure classification in adults

Table summary

This table displays the results of Criteria for blood pressure classification in adults . The information is grouped by Category (appearing as row headers), Description (appearing as column headers).

Category	Description
Normal	Mean SBP/DBP < 120/80 mmHg
Pre-hypertension	Mean SBP of 120-139 mmHg and mean DBP of 80-89 mmHg OR Mean SBP of 120-139 mmHg and mean DBP < 80 mmHg OR Mean SBP < 120 mmHg and mean DBP of 80-89 mmHg
Hypertension	Mean SBP ≥ 140 mmHg OR Mean DBP ≥ 90 mmHg OR Self-reported use of medication for high blood pressure within the past month OR Self-reported having been diagnosed with hypertension by a health-care professional

Data

Canadian Health Measures Survey data related to this fact sheet are available in CANSIM tables 117-0001, 117-0005, 117-0008 and 117-0009.

For more information on the Canadian Health Measures Survey, please contact Statistics Canada’s Statistical Information Service (toll-free 1-800-263-1136; 514-283-8300; [email protected]).

Notes

Footnote 1.

Statistics Canada. 2015. “Trends in mortality rates, 2000 to 2012.” Health Fact Sheets. Statistics Canada Catalogue no. 82-625-X. http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14297-eng.htm. (accessed: September 7, 2016).

Return to note 1 referrer

Footnote 2.

Public Health Agency of Canada. 2013. Leading causes of hospitalizations, Canada, 2009/10, males and females combined, counts (age-specific hospitalization rate per 100,000). http://www.phac-aspc.gc.ca/publicat/lcd-pcd97/table2-eng.php. (accessed: September 7, 2016).

Return to note 2 referrer

Footnote 3.

Blood pressure data from Cycle 3 (2012 and 2013) and Cycle 4 (2014 and 2015) of the Canadian Health Measures Survey were combined for this fact sheet.

Return to note 3 referrer

Footnote 4.

Chobanian, A.V., Bakris, G.L., Black, H.R., et al. 2003. “Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.” Hypertension; 42: 1206-52. (accessed: September 7, 2016).

Return to note 4 referrer

ISSN: 1920-9118

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Statistics Canada is committed to serving its clients in a prompt, reliable and courteous manner. To this end, the Agency has developed standards of service which its employees observe in serving its clients.

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Published by authority of the Minister responsible for Statistics Canada.

© Minister of Industry, 2016

All rights reserved. Use of this publication is governed by the Statistics Canada Open Licence Agreement.

Catalogue no. 82-625-X

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Ottawa

Normal Blood Pressure Levels for Men

Ideal blood pressure levels are the same for all adults.

Image Credit: Moyo Studio/E+/GettyImages

People are all different — so does that mean that your blood pressure goals differ from someone else’s because of age or height or gender? The quick answer: No matter your size or age or gender, a “normal” blood pressure definition is the same for all adults. Of course, it’s not quite that simple.

Read more: What Is Blood Pressure, Exactly?

Blood Pressure Diagnoses

Blood pressure is a measure of the force of blood as it’s pushed through blood vessels. In 2017, 11 health organizations — including the American Heart Association (AHA) — agreed on new definitions for normal and abnormal blood pressure levels. They’re the same for both men and women, and they don’t differ by weight, height or age.

Experts agree that “normal” blood pressure for all adults is less than 120 millimeters of mercury, or mm Hg, (the unit used in medicine to denote this pressure).

That means the first or upper number in the reading, called the systolic pressure, should be lower than 120. The second or lower number, known as the diastolic reading, should be lower than 80. (The systolic number represents the force used by your heart to push blood through your body by beating, and the diastolic number measures the force when your heart contracts between beats. The AHA further details each blood pressure category as follows:

• If the upper reading is between 120 and 129, while
  the lower reading is under 80, you’re considered to have “elevated” blood
  pressure.
• If your upper reading is between 130 and 139 and the
  lower reading is between 80 and 89, you’re in Stage 1 of high blood pressure.
• The next level, Stage 2, is defined as upper
  readings of 140 or higher or lower readings of 90 or higher.

“Hypertensive crisis,” though rare, occurs when the upper reading is higher than 180 and/or the lower reading is higher than 120. In such an instance, emergency support should be contacted right away.

Men
and High Blood Pressure

Both high and low blood pressure are potential signs that the cardiovascular system isn’t working properly. High blood pressure (hypertension, in medical terminology) is common. It often indicates that the heart is working harder because blood vessels are clogged, according to the AHA.

An estimated 47 percent of men in the U.S. have high blood pressure, according to the Centers for Disease Control and Prevention, compared with 43 percent of women.

“In general, men are at greater risk of hypertension than women, but only until women reach menopause … when women begin to catch up,” says cardiologist Michael Miller, MD, a professor of cardiovascular medicine, epidemiology and public health at the University of Maryland School of Medicine in Baltimore.

Read more: Blood Pressure Readings When You’re Over 70

According to Dr. Miller, he has seen that men are more likely than women to ignore high blood pressure and fail to follow through with recommended treatment. However, he notes, “The good news is that men’s blood pressure is commonly well-controlled when they follow lifestyle instructions and take their blood-pressure-lowering medications.”

Common strategies to reduce high blood pressure include weight loss, exercise and medication, according to the AHA. Work with your doctor to develop an individualized plan to alleviate hypertension.

Read more: The Best, Science-Backed Tips to Prevent High Blood Pressure — the ‘Silent Killer’

What
About Low Blood Pressure?

In some cases, medications designed to lower blood pressure can bring it down to an unhealthy range. However, there’s no universally defined level for abnormally low blood pressure. According to the AHA, the important factor in determining whether your blood pressure is too low is whether you have symptoms of low blood pressure, which could include fainting, dizziness, nausea and dehydration (which may cause low blood pressure itself).

According to Dr. Miller, it’s important to understand that older people can experience symptoms of low blood pressure at higher levels than when they were younger.

“We need to be careful in men and women who are around 80 or older and have been living at a systolic blood pressure of 150 to 160 mm Hg,” Dr. Miller says. “If we drop blood pressure too low for that person, that might compromise blood flow to the brain and cause a stroke. In these situations, the goal would be a more modest reduction, to around 130 to 140 mm Hg.”

Therefore, although the ideal or “normal” BP level is the same for all, older individuals may feel differently at different levels. Always see your doctor for individualized monitoring and treatment.

Correlation
of palpable carotid, femoral and radial pulses with systolic blood pressure
 

Dr Charles D. Deakin MA MD MRCP FRCA
Department of Anaesthetics
Southampton General Hospital
Tremona Road
Southampton
SO16 6YD
UK

Tel: 01703-796135
Fax: 01703-794348
E-mail: [email protected]
 

Abstract

Objectives: To establish the relationship
between palpable carotid, femoral and radial pulses and systolic blood
pressure.

Design: A sequential, single blinded,
observational study.

Setting: Southampton General Hospital
N.H.S. Trust.

Subjects: Patients withhypotension
secondary to hypovolaemia in whom invasive arterial blood pressure monitoring
had been established.

Interventions: Palpation of carotid,
femoral and radial pulses.

Main outcome measures: Presence/absence
of a pulse as blood pressure increased/decreased.

Results: Using 50% centiles, carotid,
femoral and radial pulses are present in patients with a systolic > 70
mmHg, carotid and femoral pulses alone in patients with a systolic > 52
mmHg and only a carotid pulse in patients with a systolic > 42 mmHg.

Conclusions: The Advanced Trauma Life
Support (ATLS) course teaching of the relationship between palpable pulses
and systolic blood pressure is therefore not supported by this study. ATLS
methodology will overestimate the patient’s systolic blood pressure and
underestimate the degree of hypovolaemia.
 

Introduction

Hypovolaemic shock is a major cause of morbidity
and mortality in trauma patients. Early assessment and appropriate treatment
of the hypovolaemia can improve outcome. Assessment of the circulatory
state during the primary survey is based on blood pressure, pulse, capillary
refill and level of consciousness. Blood pressure may not be immediately
available because of delays in attaching monitoring and even when this
is established, due to failure to non-invasive blood pressure monitors
to detect a weak pulse in hypovolaemic states. As an alternative to sphygnomanometry,
assessment of palpable pulses in major vessels has been used as a quick
but approximate guide to the systolic blood pressure. The Advanced Trauma
Life Support (ATLS) course taught that if only the patient’s carotid pulse
is palpable, the systolic blood pressure is between 60-70 mmHg ¹.
If both carotid and femoral pulses are palpable, the systolic blood pressure
is between 70-80 mmHg and if the radial pulse is also palpable, the systolic
blood pressure in above 80 mmHg. The only study to examine the accuracy
of this model used non-invasive blood pressure measurements which have
a tendency to underestimate systemic arterial BP during hypotension ².
No reliable data is therefore available to support the ATLS guidelines
upon which clinical decisions are made. A study was therefore undertaken
to assess the correlation of palpable radial, femoral and carotid pulses
with invasive systolic blood pressure in hypovolaemic patients.
 

Material and Methods

Following Ethics Committee approval, patients
who were hypotensive due to hypovolaemia and in whom invasive arterial
blood pressure monitoring had been established were studied. An observer
blinded to the blood pressure palpated the radial, femoral and carotid
pulses at which time the invasive systolic blood pressure was recorded.
The presence or absence of each pulse was recorded.

Patients were assessed as hypovolaemic if
they were hypotensive with either major blood loss (> 15% estimated blood
volume) or if the heart appeared relatively empty on direct inspection.
Patients in vasodilated states (e.g. sepsis) were excluded. It was assumed
that when a pulse was palpable at a given blood pressure, it remained palpable
at higher pressures and when a pulse was not palpable at a given blood
pressure, it remained not palpable at lower pressures.
 

Results

Twenty patients were studied. Age ranged from
18-79 years. All patients had been admitted to the intensive care unit
or were in the operating theatre at the time of measurement. Not all pulses
were palpable when a reading was taken because of impaired patient access
secondary to a sterile operating field. Results are shown graphically in
figure 1. Data is given in table 1. The radial pulse always disappeared
before the femoral pulse which always disappeared before the carotid pulse.

Radial pulse: A palpable radial
pulse was present in all patients with a systolic blood pressure of > 79
mmHg. Only 50% patients had a palpable pulse between 70-71 mmHg. No palpable
radial pulse was present in patients with a systolic blood pressure of
< 51 mmHg.

Femoral pulse: A palpable femoral
pulse was present in all patients with a systolic blood pressure of > 76
mmHg. Only 50% patients had a palpable pulse between 52-54 mmHg. No palpable
femoral pulse was present in patients with a systolic blood pressure of
< 47 mmHg.

Carotid pulse: A palpable carotid
pulse was present in all patients with a systolic blood pressure of > 76
mmHg. Only 50% patients had a palpable pulse at 42-47 mmHg. No palpable
carotid pulse was present in any patient with a systolic blood pressure
of < 37 mmHg.
 

Discussion

In hypovolaemic states, palpable pulses in
the radial, femoral and carotid arteries disappear as blood pressure falls.
This study confirms that as systolic blood pressure decreases, the palpable
radial pulse disappears before the femoral pulse which in turn disappears
before the carotid pulse. Using 50% centiles, carotid, femoral and radial
pulses are present in patients with a systolic > 70 mmHg, carotid and femoral
pulses alone in patients with a systolic > 52 mmHg and only a carotid pulse
in patients with a systolic > 42 mmHg. The Advanced Trauma Life Support
(ATLS) course teaching of the relationship between palpable pulses and
systolic blood pressure is therefore not supported by this study. ATLS
methodology will generally overestimate the patient’s systolic blood pressure
and therefore underestimate the degree of hypovolaemia.

Use of palpable pulses has been used as a
quick and easy method of assessing blood pressure in hypovolaemic patients
both in hospital and in pre-hospital settings where direct blood pressure
measurement may not be possible. It is also a technique used in triaging
mass casualties. This study shows that there is a wide variability between
patients using a technique that may underestimate the degree of hypovolaemia.
The presence or absence of palpable pulses must therefore be used with
caution when using their presence as an estimate of systolic blood pressure.
 

References

1. Collicott PE. Advanced Trauma Life Support
course for physicians. Chicago, American College of Surgeons, 1985,
p141.
2. Poulton TJ. ATLS paradigm fails. Ann
Emerg Med 1988; 17: 107.
 

Funding: None

Conflict of interest: None
 

 

What Your Blood Pressure Says About You

Is your blood pressure healthy, borderline or risky? Find out the BP basics and how you can help you keep your numbers in the healthy column.

Unless your family has a history of high blood pressure or your doctor has warned you about your own reading, chances are you haven’t given this potentially serious and far-reaching medical condition much thought.

“People don’t usually know they have high blood pressure unless they get it measured,” explains Dr. Chris Simpson, a cardiologist and Vice-Dean (Clinical) at Queen’s University’s School of Medicine in Kingston, Ontario. In fact, you can have high blood pressure for years without symptoms. “When people are diagnosed in their 40s or 50s, they’ve often had high blood pressure for a while.”

This is a shame, because early detection can be the key to maintaining the health and proper function of your heart, kidneys, vision and more.

The following guide will walk you through the basics of blood pressure and offer tips on how to keep yours within a healthy range.

Systolic and diastolic blood pressure: What do they mean?

When your doctor talks about blood pressure, she’s actually talking about two numbers: systolic and diastolic.

Systolic blood pressure is the top number in your reading. It measures the pressure when your heart pumps blood through your vessels.

Diastolic blood pressure — the bottom number — measures the pressure when your heart is resting between beats.

So, for example, if you have a reading of 116/78, that indicates a systolic blood pressure of 116 and a diastolic blood pressure of 78. It would also fall squarely within the healthy range. A reading below 120/80 is considered a low risk to your health, according to the Heart and

Unless your family has a history of high blood pressure or your doctor has warned you about your own reading, chances are you haven’t given this potentially serious and far-reaching medical condition much thought.

“People don’t usually know they have high blood pressure unless they get it measured,” explains Dr. Chris Simpson, a cardiologist and Vice-Dean (Clinical) at Queen’s University’s School of Medicine in Kingston, Ontario. In fact, you can have high blood pressure for years without symptoms. “When people are diagnosed in their 40s or 50s, they’ve often had high blood pressure for a while.”

This is a shame, because early detection can be the key to maintaining the health and proper function of your heart, kidneys, vision and more.

The following guide will walk you through the basics of blood pressure and offer tips on how to keep yours within a healthy range.

Systolic and diastolic blood pressure: What do they mean?

When your doctor talks about blood pressure, she’s actually talking about two numbers: systolic and diastolic.

Systolic blood pressure is the top number in your reading. It measures the pressure when your heart pumps blood through your vessels.

Diastolic blood pressure — the bottom number — measures the pressure when your heart is resting between beats.

So, for example, if you have a reading of 116/78, that indicates a systolic blood pressure of 116 and a diastolic blood pressure of 78. It would also fall squarely within the healthy range. A reading below 120/80 is considered a low risk to your health, according to the Heart and Stroke Foundation of Canada.

A reading between 121/80 and 139/89 — sometimes described as pre-high blood pressure or pre-hypertension — is considered a moderate risk. And a reading of 140/90+, also called high blood pressure or hypertension, constitutes a high health risk. If you have diabetes, the high-risk category starts lower, at 130/80.

While you may have heard that your systolic reading (the top number) is more important in predicting your heart attack and stroke risk, that isn’t always true. High systolic or diastolic pressure can damage your blood vessels over time and put your health at risk.

What factors affect your blood pressure?

You’re probably aware of some of the causes of high blood pressure: A sedentary lifestyle, a diet high in sodium and a lack of access to health care all contribute to your risk. But other factors also affect your hypertension risk. A family history of high blood pressure means you’re also more likely to develop it, and people of African, South Asian and Indigenous heritage face an increased risk of developing high blood pressure, explains the Heart and Stroke Foundation. And you’ll face a higher chance of developing hypertension as you age.

Understanding the risk of high blood pressure is also especially important for women. Conditions that can occur during pregnancy, like pre-eclampsia or gestational diabetes, can contribute to the risk of high blood pressure both during pregnancy and later on. And the age-related risk of hypertension is compounded for women, since menopausal hormonal changes also contribute to high blood pressure.

How elevated blood pressure affects your health

Though it’s likely no surprise that elevated blood pressure puts your health at risk, some of its effects on your health might surprise you. Not only does elevated blood pressure increase your risk of heart disease and stroke, it also places you at a higher risk of kidney failure, blindness and other health issues related to your blood vessels, Dr. Simpson explains. On top of that, high blood pressure is the most common cause of a rapid, irregular heartbeat, he says, which is an increasingly common heart problem for many Canadians.

If your blood pressure is in the pre-high blood pressure range, you could also face an increased risk of health complications, Dr. Simpson explains, but you are still in a stage that frequently responds well to lifestyle changes.

How to keep your blood pressure in a healthy range

When it comes to managing your blood pressure, the simple fixes often cited for many maladies — that is, a healthy diet and regular exercise — work best, says Dr. Simpson. Aim for at least 150 minutes of brisk walking per week to help manage your blood pressure, he advises, and follow a healthy diet that keeps your salt consumption in check.

If you have elevated blood pressure that’s not responding to lifestyle changes, ask your doctor about medication to protect your health.

Keep in mind that other factors such as high levels of stress may also increase your blood pressure and raise your risk of other blood vessel-related problems. So make stress management a part of your daily routine. And if you’re struggling with financial stress, find an advisor near you to help put your mind — and your heart — at ease.

Stroke Foundation of Canada.

A reading between 121/80 and 139/89 — sometimes described as pre-high blood pressure or pre-hypertension — is considered a moderate risk. And a reading of 140/90+, also called high blood pressure or hypertension, constitutes a high health risk. If you have diabetes, the high-risk category starts lower, at 130/80.

While you may have heard that your systolic reading (the top number) is more important in predicting your heart attack and stroke risk, that isn’t always true. High systolic or diastolic pressure can damage your blood vessels over time and put your health at risk.

What factors affect your blood pressure?

You’re probably aware of some of the causes of high blood pressure: A sedentary lifestyle, a diet high in sodium and a lack of access to health care all contribute to your risk. But other factors also affect your hypertension risk. A family history of high blood pressure means you’re also more likely to develop it, and people of African, South Asian and Indigenous heritage face an increased risk of developing high blood pressure, explains the Heart and Stroke Foundation. And you’ll face a higher chance of developing hypertension as you age.

Understanding the risk of high blood pressure is also especially important for women. Conditions that can occur during pregnancy, like pre-eclampsia or gestational diabetes, can contribute to the risk of high blood pressure both during pregnancy and later on. And the age-related risk of hypertension is compounded for women, since menopausal hormonal changes also contribute to high blood pressure.

How elevated blood pressure affects your health

Though it’s likely no surprise that elevated blood pressure puts your health at risk, some of its effects on your health might surprise you. Not only does elevated blood pressure increase your risk of heart disease and stroke, it also places you at a higher risk of kidney failure, blindness and other health issues related to your blood vessels, Dr. Simpson explains. On top of that, high blood pressure is the most common cause of a rapid, irregular heartbeat, he says, which is an increasingly common heart problem for many Canadians.

If your blood pressure is in the pre-high blood pressure range, you could also face an increased risk of health complications, Dr. Simpson explains, but you are still in a stage that frequently responds well to lifestyle changes.

How to keep your blood pressure in a healthy range

When it comes to managing your blood pressure, the simple fixes often cited for many maladies — that is, a healthy diet and regular exercise — work best, says Dr. Simpson. Aim for at least 150 minutes of brisk walking per week to help manage your blood pressure, he advises, and follow a healthy diet that keeps your salt consumption in check.

If you have elevated blood pressure that’s not responding to lifestyle changes, ask your doctor about medication to protect your health.

Keep in mind that other factors such as high levels of stress may also increase your blood pressure and raise your risk of other blood vessel-related problems. So make stress management a part of your daily routine. And if you’re struggling with financial stress, find an advisor near you to help put your mind — and your heart — at ease.

Rules for measuring blood pressure | City hospital №9

There are a number of rules that must be followed to get true blood pressure (BP) numbers. These rules are independent of the type of instrument being measured.
Hell can differ on the left and right hands by 10 mm or more. rt. Art. Therefore, once you need to measure blood pressure on both hands, set it on which one is higher, and then measure blood pressure only on the arm where the indicators are higher.
For an hour before measuring blood pressure, you must not smoke and drink coffee; after the last meal, at least 1-2 hours should pass. Blood pressure is measured in calm conditions after a 5-minute rest. It is necessary to avoid additional external influences (noise, vibration, etc.), which can distort the BP numbers and prevent clearly hearing the beats (“Korotkov tones”).
Optimal posture for measuring blood pressure: sitting on a chair, leaning back, with relaxed and not crossed legs.
The size of the tonometer cuff should correspond to the shoulder circumference: cover at least 80% of the circumference and at least 40% of the shoulder length.

The arm, on which the blood pressure is measured, is freed from clothing and placed on a support.The cuff of the tonometer is located approximately at the level of the heart (the middle of the cuff at chest level), the lower edge is 2-3 cm above the elbow bend, the tube entrance into the cuff is located above the elbow bend. A finger should pass between the cuff and the surface of the shoulder.
The membrane of the stethoscope fits snugly against the surface of the shoulder in the middle of the cubital fossa (at the point of maximum pulsation of the brachial artery). The head of the stethoscope should not touch the cuff or tubing.
Do not talk while measuring blood pressure.
Check the position of the pressure gauge pointer relative to the zero mark on the scale.
Close the valve on the pear and pump air into the cuff: pump air until the pressure in the cuff, according to the manometer readings, exceeds the level at which the arterial pulsation is no longer detected by 25-30 mm Hg. The inflation of the cuff should be fast. Open the valve and slowly (2 mmHg per second) release air from the cuff. At the same time, listen to the tones with the phonendoscope and observe the readings on the pressure gauge scale.

90,000 Blood pressure in children. Or how to measure blood pressure for a child

Measurement of blood pressure is necessary not only for adults, but also for children. Of course, blood pressure problems are much less common in children than in adults, but they are not uncommon. Therefore, it is necessary to recognize the violation and take timely measures so that it does not affect the child’s health in the future. But how to correctly measure the pressure of a child?

It is worth remembering that many factors affect blood pressure indicators in both adults and children.This is the mood, the weather, the diet, the state of health, the level of physical activity and even the atmosphere in the family. And of course, pressure cannot be constant, it always changes. But if the pressure rises to certain levels and remains at this level for a long time, then you need to consult a doctor.

It is in order to identify such violations that children, as well as adults, are recommended to periodically measure blood pressure and keep a control diary. A family that looks after their health probably has a tonometer at home – a device for measuring blood pressure.And it is great for diagnosing pressure in a child, but a standard cuff will be great for a small child’s hand. Therefore, in the line of health devices, the world manufacturer of the company’s equipment – OMRON has a special cuff that is suitable for a child’s hand – the OMRON CS2 Small Cuff (HEM-CS24). It can be used both for automatic OMRON blood pressure monitors and for semi-automatic ones.

Before you start measuring the pressure, put the child on a chair, let him rest calmly for 5 minutes.Place the baby cuff on the baby’s shoulder (do not over clothing). Make sure the cuff fits snugly around your arm. During the measurement, do not talk or move, lean on the back of the chair, and put your hand with the cuff on the table.

Tonometer OMRON M2 Classic with universal fan-shaped cuff (22 – 42 cm)

More details

Optimal blood pressure – Federal State Budgetary Institution “NMITs TPM” of the Ministry of Health of Russia

The English Longitudinal Study of Aging (ELSA) is published in Hypertension ~ .

The study carried out long-term follow-up (> 10 years) of patients in order to assess the prevalence of hypertension, awareness, treatment and control of blood pressure parameters, the relationship between systolic blood pressure (SBP) and mortality.

Participants (about 25 thousand) were divided into 8 categories depending on the SBP indicators: <110, 110-119, 120-129, 130-139, 140-149, 150-159, 160-169 and> 169 mm Hg . st.; then 2 age groups 50-79 years old and over 80 years old and 2 subgroups depending on whether hypertension was treated or not.

The prevalence of hypertension (higher than 140/90) was significantly lower in 1998 (35% among 50-79 year olds and 56% among eighty years old) than in 2012 (54% and 71%, respectively). Among patients who were eighty years old at the time of enrollment in the study, the mean SBP decreased from 147 mm Hg. in 1998/2000 up to 134 mm Hg. st in 2012/2013. During the same period, the proportion of those who took antihypertensive drugs increased significantly.

Against the background of hypertension treatment, SBP values ​​<150/90 in 1998 were observed in 51% of eighty-year-olds and 46% in the age group 50 to 79 years old; in 2012 59% and 64%. SBP rates <140/90 were noted at 37% and 42% in 1998 and 47% and 50% in 2012, respectively.

Among eighty-year-olds, no statistically significant differences were found in the risks of death at any BP values ​​compared to the reference group with AH 120-129 mm Hg. Art. (both in the group “hypertension treatment” and “without treatment”).

Among younger people, there were also no statistically significant differences, but there was a tendency to a J-shaped curve (the lowest indicators were recorded in the reference group and in the groups with SBP below 160 mm Hg.Art.) both in the group taking and not taking antihypertensive drugs.

Results do not support the notion that more stringent BP targets may be associated with lower mortality.

Longitudinal Trends in Hypertension Management and Mortality Among Octogenarians: Prospective Cohort Study

Hypertension 2016 May 09; [EPub Ahead of Print], A Dregan, R Ravindrarajah, N Hazra, S Hamada, SH Jackson, MC Gulliford

Comments d.MD, professor Samorodskaya I.V .: The study, although it includes a significant number of participants, is complex-organized, with a division into 32 subgroups. With this study design, the incidence of the events considered in each subgroup is low, which is probably the reason why there were no statistically significant differences in the risks of adverse events when compared across subgroups. At the same time, in the article itself, the graphs clearly show a tendency towards a J-shaped dependence of mortality from all causes and CVS on the level of blood pressure.The results of this study should probably be regarded as support for the emerging paradigm of individual correction of blood pressure levels, especially in the elderly, depending on comorbid pathology, tolerance of antihypertensive therapy, and an emphasis on a healthy lifestyle.

90,000 COVID-19 treatment guidelines include oxygen quality standards

The Ministry of Health has released an updated version of the guidelines for the prevention, diagnosis and treatment of COVID-19.The department has clarified the rules for the use of medical oxygen for severe patients and the standards for its quality, as well as the dosage of some drugs. In addition, the innovations affected the section on the diagnosis of invasive aspergillosis and invasive candidiasis in patients with coronavirus.

The new version of the manual includes explanations about the saturation of the patient’s body with oxygen (oxygenation). In particular, the requirements for the quality of medical oxygen have been clarified. For oxygenation of patients on mechanical ventilation and under anesthesia, medical pure oxygen of at least 99.5% concentration should be used.Recommendations for the safety of oxygen therapy, supplemental oxygenation of patients, and optimal oxygen consumption have also been improved.

The document changed the dosing instructions for the anti-inflammatory drug baricitinib for patients with mild disease who are treated in a hospital. Clarifications have been made to the section on diagnostics of invasive aspergillosis in coronavirus infected (affects the respiratory system, usually proceeds acutely and rapidly progresses, causes shortness of breath, cough, fever, chest pain) and invasive candidiasis (one of the complex forms of fungal infection that can affect the entire body ).

As noted in the recommendations, on average, 50% of those infected with coronavirus are asymptomatic. In 80% of patients with clinical symptoms, the disease proceeds in a mild form of ARVI. Elderly patients may have an atypical presentation without fever and cough. At the same time, the absence of symptoms of COVID-19 is dangerous, since it can be accompanied by a severe development of the disease. Atypical symptoms of COVID-19 in elderly patients include confusion and delirium.

“The new version of the guidelines has been sent to the regions for use in practical work,” the press service of the Ministry of Health said.

The ministry last updated the recommendations on 15 November. Then the sections were clarified about drug therapy and the use of monoclonal antibodies, which can neutralize the virus at an early stage and prevent a severe course of COVID.

In September, the Ministry of Health included in the recommendations new outpatient treatment regimens, including the drug budesonide for patients with mild disease.Information on the rational use of oxygen in the respiratory support of patients has been added to the section on the management of emergency conditions. The section on specific prophylaxis of COVID-19 was also updated – information on indications for vaccine prophylaxis in pregnant women was added to it. The ministry also excluded umifenovir (Arbidol) from the recommendations for the treatment of COVID. It is no longer required for patients with mild disease. The criteria and terms of prescribing genetically engineered biological preparations and anticoagulants have been clarified.

Director of the National Research Center for Epidemiology and Microbiology. N.F. Gamalei Alexander Gunzburg said in November that seriously ill COVID-19 drugs are usually administered through injections. Patients in a state of mild to moderate severity are given tablets.

Read also

90,000 Minsk is depressed, Gomel is sick. WHO and the Ministry of Health conducted a large-scale study – what did they learn?

Mizdrav and the WHO Regional Office for Europe have published STEPS 2020 Supplement to the Prevalence of Risk Factors for Noncommunicable Diseases (NCDs).This is the result of a large-scale study by organizations of the potential causes of the development of circulatory system diseases, diabetes mellitus, chronic respiratory diseases, oncological and other health problems in Belarusians. What is important, this year, for the first time, a comparative analysis was carried out for the regions of Belarus (all regions and separately for Minsk). We studied the document and chose the most interesting from it.

Photo: TUT.BY

What kind of research is this?

STEPS is a WHO approved research methodology for the surveillance of noncommunicable diseases.The purpose of such an event is to assess the risk factors that exist in different regions of the country, identify problem areas and then plan a policy in the health sector for the coming years.

For this, the organizers of the study in 2020 compiled a sample of 5760 people aged 18 to 69 years, living in different regions of Belarus. At the first stage, these people filled out questionnaires with many questions about their health and lifestyle, at the second stage, they took a number of physical measurements (blood pressure, heart rate, height, weight), at the third stage, they carried out a blood test (measured, for example, the level of cholesterol and glucose).

Most smokers are in Minsk, and they are young

In total, over a quarter of the population in the country turned out to be smokers – 26.7%. The “leader” here is Minsk – 33.6% of its residents are now smoking. The best indicators are in the Vitebsk region – 20.3%. The average age of smoking initiation in Belarus is 18.2 years; it differs insignificantly by regions.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

The Gomel region is the leader in terms of smoking duration – here the average indicator reaches 26.5 years, and the lowest indicator is in Minsk (16.4 years).From this, the authors make an indirect conclusion that more young people smoke in Minsk.

Manufactured cigarettes are smoked by 96.1% of Belarusians, hand-rolled cigarettes – 4.9%, pipes – 0.7%, heated tobacco products (STI, for example, IQOS) – 3% (some people smoke 2 or more types of products, so the amount is more 100%). Most of the users of NTI are in Minsk – 10.5%. E-cigarettes were also studied separately: most of the users of “vapes” are in the Mogilev region (10.7%) and Minsk (8.9%). All in all, 6.1% of the population “vapes” in the country.

As for those who quit smoking, there are most of them in the Vitebsk region (41.4%), and in total there are 36.7% of them in the country. Most of the unsuccessful attempts to quit smoking were among the residents of the Mogilev region – 42%.

Minsk is among the “leaders” in alcohol again

If smokers in the country – more than a quarter of the population, then drinkers – more than half. According to the study, 54.4% of respondents at the time of the survey had consumed spirits within the previous 30 days. Minsk is again the leader here – in the capital this indicator is at the level of 58.9%.However, the authors of the study emphasize that the difference between the regions is small, and the indicators themselves may not be completely reliable due to the possible statistical error. The bottom line does not change from this – the Belarusians still drink a lot. According to the study, there are only 6.3% of those who do not drink throughout their lives, and 10.1% have not drunk during the last year.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

In terms of the number of cases of alcohol consumption by drinkers over the last month, the capital is again among the leaders – 4.2 cases.The Mogilev region is not far behind – 4.1 cases. In the most favorable in this regard, the Brest region, the indicator is 2.6 cases, followed by the Gomel region (2.8 cases). The national average is 3.4 cases.

However, the biggest problem is probably not the fact of drinking, or even the frequency of drinking, but the quantity. The worst situation in this regard is in the Gomel region – here, for one case of alcohol consumption, people on average drink 5.5 standard doses (according to the WHO methodology, this is a dose of any alcoholic drink with a pure alcohol content of 10 grams; this is approximately equal to 25 grams of vodka, 100 grams dry wine or 200 grams of beer; men are advised to consume no more than three standard doses per day, women – no more than two).The Brest and Vitebsk regions were not far behind (5.2 standard doses each). And best of all for this indicator is Minsk – 3.1. On average in the country, 4.3 standard doses of alcohol are consumed in one “sitting”.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

In addition, Belarusians often “drink”: 25.2% of all residents of the Vitebsk region, 22.1% of residents of the Brest region drank more than six standard doses at once in the last month. The Gomel region looks better than others – only 11.2% of respondents from this region drank heavily with alcohol during the month.In the country, this indicator is at the level of 17.4%.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

The study even studied the consumption of “unregistered alcohol” – in other words, moonshine. The Mogilev region is by far the leader here – 19.9% ​​of its residents drink homemade drinks. This indicator is also high in Minsk (9.5%) and Minsk region (7.1%), and the lowest – in the Grodno region (1.1%). In the country as a whole, 6.5% of the population drink moonshine.

What’s wrong with the nutrition of Belarusians?

The study examined the consumption of fruits and vegetables by the inhabitants of the country.WHO recommends that your daily diet includes 400 g of vegetables and fruits, divided into five servings (approximately 80 g each). At the same time, starchy roots, such as potatoes or sweet potatoes, are not included in this number. For example, 90.4% of Brest residents eat less than this amount per day. In Minsk, the indicator is 80.2%, and the best of all is the situation in the Mogilev region – there is a lack of fruits and vegetables in the diet of only half of the residents (49.9%). For the country as a whole, the indicator is at the level of 78.2%.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

There is a problem with the use of salt – more precisely, with oversalting of food.38.5% of Minsk residents add food before or during meals – this is the worst indicator. The best one is in the Vitebsk region, where 7.1% of residents take up the salt shaker. But with processed foods with a high salt content, the situation is even worse, and here again Minsk is among the “leaders”: 58.2% of city residents have salted foods in their diet, the indicator is not particularly better in the Minsk region (57.4%). Residents of the Brest region look the best (30.8%), but the overall figure for the country is depressing – 44.3% constantly eat salty.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

A similar situation with sugar, in particular with sugary drinks.Here, the worst situation is in Grodno and the region – 14.2% of residents drink them once a day or more often, 9.7% – 4-6 times a week. At the same time, 42.6% of the residents of the Gomel region stated that they do not drink sugary drinks at all.

A sports nation? Yes and no

The largest proportion of people whose average number of minutes of physical activity per day does not meet the WHO recommendations is in the Minsk region, and here this figure is only 21.3%. Best of all in physical education – Minsk, here only 5% of residents do not reach the required indicator.On average, in the country, it is at the level of 11.6%.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

True, it is difficult to call this sport in the full sense – for the majority, the activity figure turned out to be high due to the corresponding work. For example, in Minsk, physical activity at work takes 112.3 minutes on average, and only 27.9 minutes during leisure time. The best region in terms of “leisure” physical activity is the Gomel region, here it takes residents on average 35.9 minutes a day.Most of the “sloths” live in the Grodno region – 62.5% of the region’s residents do not have active leisure, least of all – in the Brest region (34.3%). In general, 45.8% of residents in the country do not have active rest.

In general, among Belarusians, 46% of activity falls on banal movement, 29.5% – on physical labor and only 24.5% – on physically active leisure.

Everything is bad in Gomel: what about Belarusians with “sores”?

A large block of research is devoted to the diagnosis of selected non-communicable diseases.

For a start – hypertension. In total, 26% of the population in the country has been diagnosed with such a diagnosis, of which 11.6% – during the last year. Residents of the Gomel region (40.3%) suffer the most from high blood pressure, the least – Vitebsk and Minsk (21.9% and 22%, respectively). The share of those who are diagnosed with hypertension taking medications for hypertension in the country is 66%. In many regions, people are trying to solve pressure problems using folk methods, most of all such people are in the Mogilev region – 17.3%.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

Diabetes patients in the country 6.5%. The Gomel region is again “in the lead” – here 12.2% of residents have such a diagnosis. The best situation is in the Mogilev region (5.2%).

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

More people suffer from high blood cholesterol levels, 9.4% of the country’s inhabitants have been diagnosed with hypercholesterolemia. And again the most problematic region is the Gomel region: here the disease was diagnosed in 19.4% of residents.The best situation is in the Minsk region (7.7%) and the Brest region (8%). And here, many respondents spoke about treatment with folk remedies, and the Mogilev region was again among the leaders – 13.2% of patients are treated with herbs.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

Patients with heart disease (who had a heart attack or chest pain due to heart disease or stroke) in the country 8.9%. And again, most of them are in the Gomel region – 16.2%. Residents of the Vitebsk region suffer the least from these problems (4.5%).It is not surprising that residents of the Gomel region take aspirin more often than others – 18.9% of the population do it.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

Are Belarusians getting fat?

In terms of body mass index (BMI), Belarus has already become one of the “fattening” countries – the national average is 26.2 (the WHO considers a BMI up to 24.9 to be the norm, after which overweight begins, after 30 – obesity). The worst of all is in the Gomel region – here the average BMI of residents is 27.9.The only region with an average BMI below 25 is the Vitebsk region (24.7).

In the country as a whole, the normal body weight (BMI 18.5-24.9) in 45.1% of residents, 34.1% – overweight, 18.9% – obesity. You cannot call Belarusians malnourished – only 1.9% of the country’s inhabitants are underweight. Most obese people are in the Gomel region (33.1%), the least – in the Vitebsk region (5.7%).

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

The worst teeth are also in the Gomel region

Another section of the study is devoted to oral health.Poor or very poor condition of teeth among those who do not wear dentures – in 13.4% of the country’s inhabitants, diseased gums – in 5.3%.

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

As usual, the situation is worse than everyone else in the Gomel region – 23.3% of residents complain about the condition of the teeth here, 11.8% of the gums. Most residents of Vitebsk region may not be ashamed of their smile: 4.8% of the population have bad teeth, 2.1% have gums. Dentures are worn by 7.2% of Belarusians, the leaders are Mogilev region (10.3%) and Grodno region (10.2%).Almost the entire population of the country (99.4%) uses a toothbrush, while less than a third of the population (29.3%) uses dental floss. Most often floss is used by Minsk dwellers, there are 46% of them in the capital.

Minsk – depressed

The proportion of the population with depressive symptoms in the 12 months prior to the survey in the country is 12.4%. Minsk is by far the leader here – in the capital, more than a quarter of the population (25.9%) suffers from depression. The Minsk region (6.5%) looks contrasting against this background, and the most “relaxed” region is Vitebsk (6.3%).

Infographics: STEPS 2020 study, WHO and the Ministry of Health of Belarus

What problems in the regions have the specialists identified?

In the results of the study, the authors emphasize that risk factors for NCDs are highly prevalent in the country and, as a result, a high level of morbidity, disability and mortality caused by these diseases. “As a hazard in and of themselves, NCDs carry additional burdens as aggravating factors in infectious diseases. The COVID-19 epidemic has shown that the highest risk of mortality from coronavirus is observed in people with certain NCDs and their risk factors, ”the conclusion says.

For each of the regions, the authors identified the following problems:

• Minsk – smoking; alcohol consumption; salt intake; low motivation to take antihypertensive drugs, aspirin; insufficient number of recommendations for a healthy lifestyle; long waiting time for an appointment at the office of a medical worker; depressive conditions;
• Brest region – low level of consumption of vegetables and fruits; high proportion of the population with three or more risk factors for NCDs;
• Gomel region – high blood pressure, overweight, high levels of glucose and cholesterol in the blood; a high proportion of the population aged 40–69 years with a 10-year risk of circulatory system diseases (CVD) ≥30% or with the presence of CVD; a high proportion of respondents who consider the condition of their teeth and gums to be bad or very bad;
• Grodno region – lack of physically active leisure; low motivation to take medications against high blood cholesterol; low proportion of the population without risk factors for NCDs;
• Minsk region – low level of physical activity; low motivation to take statins for the treatment of diseases of the circulatory system; low screening coverage for cervical and breast cancer; high proportion of people requiring treatment and counseling but not receiving drug therapy and counseling to prevent heart attacks and strokes; a high proportion of people who missed a medical consultation, medical tests, treatment or follow-up and did not use a prescription or missed a dose of a drug because they had to pay for it; long waiting time for reception by appointment;
• Mogilev region – consumption of unregistered alcohol;
• Vitebsk region – a high proportion of the population consuming more than 6 standard doses of alcohol in one case; high salt intake; low level of physical activity; insufficient number of recommendations for a healthy lifestyle; low subjective assessment of the quality of medical care.

90,426 90,000 On the consumer price index in October 2021

On the consumer price index in October 2021

On the consumer price index

in October 2021

In October 2021, compared to September 2021, the consumer price index was 101.11%, compared to December 2020 – 106.49% (in October 2020 – 100.43%, compared to December 2019 – 103.32%).

Consumer price indices

in percent

	October 2021to			January – October 2021 to January – October 2020	For reference
					October 2020 to			January – October 2020 to January – October 2019
	Sep – Timber 2021	December 2020	October 2020		Sep – February 2020	December 2019	October 2019
Consumer Price Index	101.11	106.49	108.13 9000	106.34	100.43	103.32	103.99	103.12
including on:
goods	101.50	109.59	107.42	100.65	103.73 900 12	104.51	103.26
food goods1)	102.17	107.77	110.89	107, 94	100.62	103.69	104.83	103.44
food goods without fruit and vegetable products	101.37	107.62	109.25	107.42	100.73	103.87	104.41	103.36
fruits and vegetables products	108.65	109.27	125.60 90 007	111.88	99.63	102.14	108.96	103.83
non-food non-food products	9000 100.78	107.12	108.17	106.84	100.68	103.77	104.15	103 , 05
services	100.01	103.87	104.36	103.57	99.87	102, 22	102.58	102.74
Basic consumer price index	100.85	106.99 9 0012	108.03	106.26	100.46	103.21	103.58	102.92
1) Including alcoholic drinks.

An increase in consumer prices by 1.2% or more was recorded in 49 constituent entities of the Russian Federation. To the greatest extent – in the Republic of North Ossetia-Alania (by 2.1%) due to the rise in food prices by 4.1%.

In Moscow, prices for the month increased by 0.7%, in St. Petersburg – by 1.2% (since the beginning of the year – the increase in prices was 5.3% and 6.4%, respectively).

Price indices for certain groups and types
food products

in percent

108.70

2 9000 9000

90 011

139.81

9000to	January – October 2021 to January – October 2020	For reference
		October 2020 to			January – October 2020 to January – October 2019
		Sep – Timber 2021	December 2020	October 2020		Sep – February 2020	December 2019	October 2019
Food	102.42	108.57	112.09	100.70	103.84	105.12	103.62
of which
bread and baked goods	101.42	108.67	107.95	100.73	105.37 9 0012	105.97	105.09
cereals and legumes	102.16	108.89	110.26	112.10	101.23	118.63	122.32	120.57
pasta	101.93	108.68	111.74	110.22	100.02	109.01	109.38	107.72
meat and bird	102.48	116.33	117.69	110.82	100.28	101.54	101.12	100.31
of which:
chilled chickens and frozen	105.47	126.27	130.89	118.56	10012 9000	99.19	98.12	97.01
fish and sea – food products	100.84	108.02	110.25	108.39	100.58	103.05	103.87 9001 2	103.95
of which: frozen fish uncut	100.33	106.19	110.31	111.65	101.26	102.53	104.18	105.58
milk and dairy products	101.51	106 , 12	107.20	104.27	100.36	102.51	103.78	105.12
butter	101.34	106.09	107.39	104.91	100.21	102.8 9	104.94	107.74
sunflower oil	100.58	106.43	116.31	125, 63	107.43	115.21	114.54	102.35
chicken eggs	112.74	105, 59	128.04	124.24	106.33	94.95	104.51	100.49
sugar -sand	102.03	106.53	111.32	140.15	118.29	157.46	89.76
fruits and vegetables products	108.65	109.27	125.60	111.88	99.63	102.14	108.96	103.83
Alcoholic drinks	100.33	102.25	102.46	102.40	100.02	102.59	102.72	102.13

In October continued growth in prices for fruits and vegetables, including cucumbers – by 48.7%, tomatoes – by 43.8%, potatoes – by 15.5%, oranges – by 10.7%, bananas – by 5.8% …

Prices for cucumbers in 5 constituent entities of the Russian Federation increased by 3.1-20.0%, in 24 constituent entities – by 20.1-45.0%, in 31 constituent entities – by 45.1-60.0%, in 25 subjects – by 60.1-93.9%.

Tomato prices in 9 constituent entities of the Russian Federation increased by 1.2-20.0%, in 36 constituent entities – by 20.1-50.0%, in 27 constituent entities – by 50.1-70.0%, in 9 regions – by 70.1-83.0%, in 3 regions – by 1.9-2.1 times. In the Kamchatka Territory, tomatoes became cheaper by 1.0%.

At the same time, prices fell: lemons – by 14.9%, apples – by 5.0%, onions – by 2.4%, grapes – by 1.9%, carrots – by 1.8%, cabbage white cabbage – by 0.2%.

Chicken eggs on average in Russia have risen in price by 12.7%, including in 20 constituent entities of the Russian Federation – by 0.6-10.0%, in 47 constituent entities – by 10.1-20.0%, in 16 subjects – by 20.1-31.4%. In the Chukotka Autonomous Okrug, prices have not changed. In the Magadan region, prices for chicken eggs fell by 0.4%.

Prices for chicken meat in Russia on average increased by 5.5%, including in 44 constituent entities of the Russian Federation – by 1.0-6.0%, in 38 constituent entities – by 6.1-9.8%. In the Chukotka and Nenets Autonomous Okrugs, prices have not changed.In the Magadan region, prices for chicken meat fell by 1.3%.

Prices for sugar in Russia on average increased by 2.0%, including in 69 constituent entities of the Russian Federation – by 0.1-4.0%, in 11 constituent entities – by 4.1-16.5%. In the Chukotka Autonomous Okrug, prices have not changed. In 4 regions, sugar prices fell by 0.1-1.6%.

Sunflower oil on average in Russia has become more expensive by 0.6%, including in 56 constituent entities of the Russian Federation – by 0.1-2.0%, in 8 constituent entities – by 2.1-3.6%. In 5 regions, prices have not changed.In 16 subjects, sunflower oil fell in price by 0.1-2.7%.

Among other food products, prices increased: frozen squid – by 4.2%, buckwheat – by 3.2%, chicken legs – by 2.8%, salted herring and culinary products from poultry – by 2.2%, flour wheat – by 2.1%, pasta – by 1.9%, frozen uncut shrimps, sour cream, drinking milk, rice, peas and beans – by 1.8%, minced meat – by 1.7%, oatmeal ” Hercules “, pork, smoked meat and poultry products, bread and bakery products from wheat flour – by 1.6%.

At the same time, lamb (except for boneless meat) and black tea fell in price – by 0.1%.

Price indices for selected groups
non-food products

in percent

9001 0

9000 – October 2021 to January – October 2020	For reference
	October 2020 to			January – October 2020 to January – October 2019
	Sep – Timber 2021	December 2020	October 2020		Sep – Timber 2020	December 2019	October 2019
Fabrics	100.38	102.22	102.76	102.77	100.26	101.48	101.71	101.30
Clothes and underwear	100.54	102.60	102.85	102.33	100.39	101.33	101.73	101.75
Jerseys	100.70	103.19	103.69	102.89	100.51	101.51	102.07	101.92
Shoes	100.64	102.18	102.38	101.80	100.47	101.00	101.03	101.02
Washing and cleaning agents	100.70	105.61	106.53	106.55	101.06	105.10	106.07	104.89
Tobacco products	100.45	115.37	116.86	113.50	100.59	106.77	108.91	110.27
Electrical goods and other household appliances	100.60	103.29	104.46	104.47	100.75	105 , 20	104.75	102.34
TV and radio equipment	101.25	110.14	110.01	, 88	99.70	99.52	98.38	96.14
Construction materials	99.28	123 , 75	125.80	118.96	100.75	103.62	103.66	102.40
Motor gasoline	100.62	106.88	107.09	105.74	100.12	102.33	102.37	101.88
Medicines	100.88	103.86	105.70	106 , 98	100.93	107.85	109.29	108.31

by 3.9%.

Among medical goods and dressings, prices increased: for bandages – by 1.2%, domestic cotton wool – by 1.1%, electronic blood pressure monitors – by 0.6%, corrective glasses, disposable syringes – by 0 , 3%. At the same time, medical electronic and mercury-free thermometers (galinstanovye) fell in price – by 0.3%.

Medicines not related to vital and essential medicines (VED) have become more expensive by 1.5%, including motherwort tincture – by 3.3%, bromhexine – by 2.6%, sulfacetamide – by 2 , 4%, allochol – by 2.1%, metamizole sodium (domestic analgin), fluocinolone acetonide, oftan katachrom, corvalol, validol, domestic multivitamins without minerals – by 1.6-2.0%.

Prices for drugs related to VED increased by 0.3%, including acetylsalicylic acid (domestic aspirin) – by 3.5%, glycine – by 1.5%, nitroglycerin, pancreatin, indapamide, xylometazoline, vinpocetine, hypothiazide, ibuprofen – by 0.7-1.0%, loperamide, ambroxol, ceftriaxone, amlodipine, drotaverine, verospiron, umifenovir (arbidol), colecalciferol (vitamin D3), omeprazole – by 0.4-0.6% … At the same time, prices fell: amoxicillin with clavulanic acid – by 4.7%, enalapril – by 2.4%, apixaban (eliquis), suprastin, chlorhexidine, oseltamivir (nomides) – by 0.1-0.9%.

Of the observed goods included in the recommended list of non-food essential goods, prices increased: matches – by 2.5%, toilet soap – by 1.7%, laundry soap, wet wipes – by 1.2%, toilet paper , paper table napkins – by 1.0%, disinfectants for surfaces – by 0.9%, baby diapers – by 0.8%, automobile gasoline, diesel fuel, diapers for newborns, hygienic pads, liquid toilet soap, pastes and toothbrushes, washing powders, antiseptics for hands, dry food for pets – by 0.2-0.7%.At the same time, prices for gas motor fuel fell by 3.3%, and sanitary and hygienic masks – by 0.6%.

Prices increased: for coal – by 3.1%, domestic new and imported second-hand cars, desktop computer monitors, televisions, electric vacuum cleaners, children’s plastic constructors, genuine leather gloves, paper handkerchiefs, garden shovels, freshly cut flowers, certain types of clothing, footwear, knitwear, furniture, dishes, perfumery and cosmetic products – by 1.0-1.9%.

Prices for building materials decreased on average by 0.7%, including chipboards, oriented strand boards and metal tiles – by 4.9%, edged boards – by 0.1%. At the same time, prices went up: sheet glass – by 3.6%, red brick – by 2.1%, oil paints, domestic enamels – by 1.2%, tared cement – by 1.0%, roofing material – by 0.9 %, laminate – by 0.8%, linoleum – by 0.7%.

Prices decreased: for landline telephones – by 0.8%, electric trimmers – by 0.4%, cameras, bicycles for preschoolers, blouses and dresses for girls, women’s shoes – by 0.1-0.3%.

Price and tariff indices for certain groups and types of services

in percent

5

to

1

9000

, 900 28

900 11

102.77

9 0011

utilities

0

9 0011

100.00

9 0011

100.27

January – October 2021 to January – October 2020	For reference
	October 2020to			January – October 2020 to January – October 2019
	Sep – February 2021	December 2020	October 2020		Sep – Timber 2020	December 2019	October 2019
Housing Utility 10012	, 16	104.10	104.30	103.90	100.04	103.35	103.40	102, 92
housing	100.26	103.95	104.22	103.28	100.05	103.06	103.19	103.32
of which:
payment for housing in houses state and municipal housing funds	100.05	103.17 105	105.16	100.02	102.61	102.72	102.83
maintenance and repair housing for citizens homeowners	100.07	102.71	102.58	100.04	102.29	102.50	102.71
operation and execution of works on the operation of houses of residential complex, ZhKK, HOA	100.05	102.64	102.70	102.26	100.13	101.61	101.66	101.83
hotels and other places of residence	101.42	118.99	118.26	113.82	99.43	102.79	102.29	101.60
100.04	103.52	103.70	103.75	100.05	103.55	103 , 58	102.77
of which:						0
water supply cold	100.00	103.73	103.77	103.87	100.01	103 84	103.86	103.50
water disposal	103.80	103.82	104.32	100.05	104.76	104.75	104.43
hot water	100.00	103.61	104.53	104.43	100.08	103.40	103.41	102.53
Heating	100.01	103.12	103.15	103.28	100.02	103.33	103.39	102.65
Gas supply	103.01	103.07	103.33	100.14	103.16	103.16	102.15
Power supply	100.00	104.41	104.43	104.21	100.00	103.94	103.94	103.05
Medical	100.45	105.23	105.80	104 , 93	100.24	103.77	104.20	104.00
Passenger transport	99.64	105.01	107.75	104.88	97.77	98.49	99.95	102.45
Communications	100.21	100.24	99.98	100.21	99.75	103.33	104.30	105.26
Organizations cultures	101.06	105.59	106.11	104.94	100.52	101.52	102.85	103.58
Sanatorium Wellness	98.21	105.53	105.52	106.01	98.68	103.77	103.55	102.93
Preschool	100.39	103.84	104.01	102.73	100.22 900	102.05	102.43	102.96
Education	100.14	105.31	105.48	103.20	100.19	101.73	101.84	104.48
Household	100.63	105.17	105.76	104.55	100.25	102.68	103.16	102 , 76
Foreign tourism	97.44	102.96	102.96	103.60	100.00	99 , 54	99.82	99.29
Physical culture and sports	100.30	103.44	103.65	102.79	100.02	101.38	101.51	101.86
Insurance	100.10 9000 7	104.96	106.12	105.62	101.31	102.12	102.44	100.51

In October, prices for tourism and recreation services increased: for accommodation in hostels and hotels 2 * -3 * – from 0.4% to 5.5%, tickets to museums and exhibitions – by 1.8 %, theaters – by 1.6%, cinemas – by 0.4%.Vacation vouchers to Turkey dropped in price – by 13.5%, in the UAE – by 3.9%, sanatoriums and rest houses, boarding houses – by 2.3% and 1.4%, respectively, as well as excursion tours in Russia – by 2 , 1%, bus tours – by 0.5%, accommodation in hotels 1 *, 4 * -5 *, motels – by 0.4-0.5%.

Among consumer services, prices increased: for the installation of plastic windows – by 2.5%, wheel alignment of a passenger car – by 1.5%, tire fitting for a passenger car – by 1.2%, trouser repair – by 1.1 %, installation of a stretch ceiling, replacement of batteries in wristwatches – by 0.9%, setting headers, photo studio services, making a coffin – by 0.7%.

Prices for renting one- and two-room apartments increased by 0.8% and 1.0%, respectively, accommodation in a student hostel – by 0.6%.

Of the other monitored services, prices increased: sending a simple parcel within Russia – by 2.3%, caries treatment – by 1.1%, tooth extraction – by 1.0%, oral consultation of a lawyer on family issues, photocopying of a document – by 0 , 9%, additional classes in state and municipal educational organizations – by 0.8%, initial consultation with a specialist doctor, animal vaccination – by 0.7%.

There was a decrease in tariffs for railway transport – by 5.2%, including for travel in various types of cars on long-distance trains – from 4.6% to 7.3%.

Car rental prices fell by 0.2%.

At the same time, travel in a fixed-route taxi increased by 2.2%, air travel in economy class – by 0.8%, travel in a city bus – by 0.4%, an intercity bus – by 0.3%, a trolleybus – by 0.1 %.

Rules and technique for measuring blood pressure

Rules and technique for measuring blood pressure.Tonometers for home use.

It should be remembered that at present, special attention is paid to the measurement of blood pressure (BP) at home. It has been proven that self-monitoring of blood pressure and keeping a diary of hypertensive patients increase the patient’s motivation to treat hypertension, increase the effectiveness of treatment by 15-20%. When visiting your attending physician, specialist consultant, you must bring your diary entries with you.

When measuring blood pressure with any tonometer in order to improve the accuracy of the results, a number of conditions must be observed.

• Measurement of blood pressure must be carried out in a sitting position.
• It is necessary to provide support on the back of the chair, relax the legs
• Measurement is taken after 5 minutes rest
• The hand on which the measurement is taken must lie on the table and be at the level of the heart.
• the measurement is carried out on the hand on which the pressure is higher than
• during blood pressure measurement you should not talk,
• for 1-1.5 hours it is necessary to exclude food intake and smoking.
• it is necessary to have a cuff of the correct size, which must be applied to the naked shoulder;
• The lower edge of the cuff is 1–2 cm above the elbow bend.
• it is recommended to measure blood pressure twice with a break of 3-5 minutes

Measurement of blood pressure by the auscultatory method (Korotkov’s method) using a phonendoscope and listening to pulsation tones requires compliance with additional rules:

• Install the stethophonendoscope head in the center of the cubital fossa
• quickly enough to pump air into the cuff; at the same time, the inflation level should be 20-30 mm Hg higher than the “normal” blood pressure
• after opening the tap, the air should be vented at a speed of 2-3 mm Hg per second
• to fix the appearance of the first Korotkoff tone, which indicates systolic blood pressure
• to fix the disappearance of Korotkov’s tones, which indicates diastolic blood pressure

Which tonometer is it recommended to measure blood pressure at home?

European guidelines for the treatment of hypertension and the Recommendations of the Russian Society of Physicians “Prevention of Chronic Non-Communicable Diseases” (2013) recommend “… to measure blood pressure to patients with an automatic method using various models of tonometers.” Firstly, these are the instruments that provide high measurement accuracy. Secondly, due to the convenience and simplicity of the procedure for measuring blood pressure, only automatic blood pressure monitors contribute to high motivation and patient commitment to constant blood pressure measurement and keeping a diary of hypertensive patients.

So, in particular, measuring blood pressure by the auscultatory method (Korotkov’s method) using a phonendoscope and listening to pulsation tones requires good hearing, experience and coordination of the “hand-eye-ears” system.In addition, the observance of the technique of pumping air into the cuff and releasing it, which is required for high accuracy of the results, makes the procedure difficult for a person who does not have the skills to do this. Failure to comply with these rules leads to errors in the results when using mechanical blood pressure monitors of 10-15 mm Hg. Such an error is significant and can affect the treatment and prognosis of the disease. The use of a pear for self-pumping of air is undoubtedly associated with muscle tension in the arm, which also leads to an overestimation of blood pressure values.Therefore, the use of semi-automatic blood pressure monitors with an oscillometric sensor, but retaining the bulb for self-inflating air, is unjustified.

Over the past decades, the accuracy of automatic blood pressure monitors has been repeatedly evaluated in accordance with stringent international criteria for the standardization of medical devices. This served as the basis for recommending the use of automatic blood pressure monitors at home.

Tonometer OMRON – tonometer No. 1 for measuring blood pressure at home.

Tonometers OMRON have all the necessary characteristics that make them the number 1 device for measuring blood pressure at home. The fan-shaped cuff of the universal size of 22-42 cm, following the natural contour of the hand, evenly distributes air, making the measurement painless and accurate. The intelligent Intellisense system inflates air immediately, adjusting to the patient – 20-30 mm above systolic blood pressure, making measurement convenient, fast and accurate.

It should be emphasized that many models of automatic OMRON blood pressure monitors have sensors for cuff position, hand movement, and arrhythmia indicators.At the same time, only the OMRON tonometer model M6 can most accurately measure blood pressure in atrial fibrillation, which is a significant difference between this model and other tonometers, including other manufacturers.

OMRON, which manufactures high-sensitivity sensors used in a wide variety of equipment, has been producing tonometers for 40 years that are used in medicine in different countries. These characteristics make OMRON blood pressure monitors the leader in sales in Russia over the past few years.

Based on the studies carried out by American and European experts, OMRON automatic blood pressure monitors have been assigned a high accuracy class (A) (European Society of Hypertension, 2013).

OMRON wrist tonometers are also recommended for use. These devices are primarily indicated for people with a large shoulder volume, as well as for those who often take a tonometer on the road. Currently, there is no age limit for the use of wrist blood pressure monitors. Important! For accurate measurement of blood pressure, it is necessary to position the cuff sensor as correctly as possible at the level of the patient’s heart.

Important to know!

When measuring blood pressure with any tonometer, sequential blood pressure measurement with an interval of 2-3 minutes will give different values. The value of blood pressure, like all other parameters of the organism, are not constant and are within the limits of physiological fluctuations. Differences in tonometer readings should not be regarded as manifestations of inaccuracies or malfunctions of instruments.

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