How does blood pressure cuff size affect measurement accuracy. Why is choosing the right cuff size crucial for diagnosing hypertension. What are the consequences of using an ill-fitting blood pressure cuff. How can patients ensure they receive accurate blood pressure readings.

The Importance of Proper Blood Pressure Cuff Sizing

Blood pressure measurement is a crucial aspect of healthcare, serving as a key indicator of cardiovascular health. However, recent research has highlighted a significant issue that could be affecting the accuracy of these measurements: the size of the blood pressure cuff. A study presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference 2022 has shed light on the potential consequences of using ill-fitting cuffs, particularly in the context of automated blood pressure monitors.

Dr. Tammy Brady, the lead author of the study and medical director of the pediatric hypertension program at Johns Hopkins University, emphasizes, “Accurate blood pressure measurement depends on proper patient preparation, positioning, measurement technique, and individualized selection of cuff size.” This statement underscores the multifaceted nature of obtaining precise blood pressure readings, with cuff size playing a pivotal role.

Understanding Blood Pressure Cuff Sizes and Recommendations

The American Heart Association (AHA) provides guidelines for proper cuff sizing, recommending that the bladder length wrapping around the upper arm should be 75 to 100 percent of the arm circumference. This ensures a snug but not overly tight fit. For instance, a “regular” size adult cuff might be suitable for arm circumferences between 27 to 34 inches. However, using this standard size for individuals with significantly smaller or larger arms can lead to inaccurate readings.

Common Blood Pressure Cuff Sizes:

• Small
• Regular
• Large
• Extra-large

It’s crucial to note that these sizes are not universally standardized, and different manufacturers may have slight variations in their sizing guidelines.

The Impact of Incorrect Cuff Size on Blood Pressure Readings

The study conducted by Dr. Brady and her team involved 165 adults who underwent blood pressure measurements using both a “regular” adult-size cuff and a cuff appropriately sized for their arm circumference. The results were eye-opening, revealing significant discrepancies in readings based on cuff size.

Effects on Individuals with Obesity:

• Systolic pressure increased by an average of 19.7 mmHg
• Diastolic pressure increased by an average of 4.8 mmHg
• 39% were misdiagnosed with hypertension

Effects on Individuals Requiring Smaller Cuffs:

• Systolic pressure decreased by an average of 3.8 mmHg
• Diastolic pressure decreased by an average of 1.5 mmHg
• 22% had undetected hypertension

These findings highlight the potential for both overdiagnosis and underdiagnosis of hypertension due to incorrect cuff sizing. Dr. Jordana Cohen, an assistant professor of medicine and epidemiology at the University of Pennsylvania Perelman School of Medicine, who was not involved in the study, notes, “The degree of under- or overestimation depends on the size discrepancy of the cuff to the size of the arm, and can be substantial.”

Implications for Hypertension Diagnosis and Management

Hypertension, defined by the AHA as a systolic blood pressure of at least 130 mmHg or a diastolic blood pressure of at least 80 mmHg, affects nearly half of U.S. adults. Given the prevalence of this condition and its serious health implications, accurate diagnosis is paramount.

Misdiagnosis due to incorrect cuff sizing can lead to several problems:

1. Unnecessary medication for those falsely diagnosed with hypertension
2. Delayed treatment for those with undetected hypertension
3. Increased healthcare costs due to improper management
4. Heightened anxiety in patients incorrectly labeled as hypertensive
5. Missed opportunities for early intervention in truly hypertensive individuals

These consequences underscore the importance of ensuring proper cuff sizing in both clinical settings and for home blood pressure monitoring.

Ensuring Accurate Blood Pressure Measurements

To address the issue of incorrect cuff sizing, healthcare providers and patients can take several steps:

For Healthcare Providers:

• Measure each patient’s mid-upper arm circumference
• Stock a range of cuff sizes in the clinic
• Train staff on proper cuff selection and application
• Regularly calibrate blood pressure devices
• Consider using validated, automated devices that can adjust for arm size

For Patients:

• Ask your provider to measure your arm circumference
• Ensure the correct cuff size is used during each measurement
• When purchasing a home blood pressure monitor, select one with the appropriate cuff size
• Be aware of signs that might indicate an ill-fitting cuff, such as the cuff popping off during inflation or frequent error messages

Dr. Brady advises, “If a cuff pops off when being inflated or if the device provides multiple error messages while you’re trying to obtain a blood pressure, that might be a sign the cuff is too small.”

The Role of Technology in Improving Blood Pressure Measurements

As awareness of the importance of proper cuff sizing grows, technological advancements are being made to address this issue. Some newer automated blood pressure devices are designed to adjust for arm size, potentially reducing the risk of measurement errors due to incorrect cuff selection.

These advanced devices may incorporate features such as:

• Automatic arm circumference detection
• Adjustable cuff inflation based on arm size
• Error notifications for potential sizing issues
• Integration with electronic health records for consistent tracking

While these technologies show promise, it’s important to note that they are not yet universally available and may not completely eliminate the need for proper cuff selection. Healthcare providers should still be vigilant in ensuring the use of appropriately sized cuffs for each patient.

The Broader Impact on Cardiovascular Health Management

The issue of blood pressure cuff sizing extends beyond individual diagnosis and treatment. It has implications for public health initiatives, clinical research, and the development of treatment guidelines. Consider the following aspects:

Public Health Initiatives:

Inaccurate blood pressure measurements due to improper cuff sizing could skew population-level data on hypertension prevalence. This, in turn, might affect resource allocation and policy decisions related to cardiovascular health programs.

Clinical Research:

Studies investigating hypertension treatments or the relationship between blood pressure and other health outcomes could be compromised if cuff sizing is not carefully controlled. This highlights the need for standardized protocols in research settings.

Treatment Guidelines:

The thresholds for diagnosing and treating hypertension are based on large-scale studies and meta-analyses. If a significant portion of these studies were affected by cuff sizing issues, it could potentially impact the accuracy of current treatment guidelines.

Given these far-reaching implications, addressing the issue of proper blood pressure cuff sizing is crucial not only for individual patient care but also for the broader landscape of cardiovascular health management.

Education and Awareness: Key to Improving Blood Pressure Measurement Accuracy

Improving the accuracy of blood pressure measurements through proper cuff sizing requires a concerted effort to educate both healthcare providers and patients. Several strategies can be employed to raise awareness and promote best practices:

For Healthcare Providers:

• Incorporate cuff sizing education into medical and nursing curricula
• Offer continuing education courses on proper blood pressure measurement techniques
• Develop and disseminate clear guidelines for cuff selection in clinical settings
• Implement quality assurance measures to ensure compliance with proper sizing protocols

For Patients:

• Create educational materials explaining the importance of proper cuff sizing
• Encourage patients to ask questions about the cuff size being used during their measurements
• Provide guidance on selecting appropriate home blood pressure monitors
• Promote regular check-ins with healthcare providers to ensure ongoing accurate measurements

By fostering a culture of awareness and education surrounding blood pressure measurement techniques, we can work towards minimizing errors and improving the overall quality of cardiovascular care.

Future Directions in Blood Pressure Measurement Research

The study highlighting the impact of cuff sizing on blood pressure readings opens up several avenues for future research and development in this field. Some potential areas of focus include:

Advanced Cuff Technologies:

Researchers may explore new materials and designs for blood pressure cuffs that can adapt to a wider range of arm sizes without compromising accuracy. This could potentially reduce the need for multiple cuff sizes in clinical settings.

AI-Assisted Measurements:

Artificial intelligence algorithms could be developed to analyze not only the numerical blood pressure readings but also factors like cuff fit and patient positioning to flag potential measurement errors.

Wearable Technology:

As wearable health devices become more sophisticated, there may be opportunities to develop continuous blood pressure monitoring systems that don’t rely on traditional cuff measurements.

Standardization Efforts:

Further research could inform the development of more precise, universally accepted standards for blood pressure cuff sizing across different populations and age groups.

These research directions hold promise for further improving the accuracy and reliability of blood pressure measurements, ultimately leading to better cardiovascular health outcomes for patients.

The issue of blood pressure cuff sizing serves as a reminder of the complexities involved in medical diagnostics. Even seemingly simple measurements can be influenced by factors that might not be immediately apparent. As our understanding of these nuances grows, so too does our ability to provide more precise and personalized healthcare. The ongoing research and awareness surrounding blood pressure measurement techniques contribute to the broader goal of improving cardiovascular health outcomes and reducing the global burden of hypertension-related diseases.

Why Blood Pressure Cuff Size Matters

People who get their blood pressure checked with a cuff that’s much too tight or too loose on their upper arm won’t get an accurate reading — and may get misdiagnosed as a result.

By Lisa Rapaport

March 11, 2022

Everyday Health Archive

Fact-Checked

Nearly half of U.S. adults have high blood pressure, according to the American Heart Association.Getty Images

Blood pressure cuffs really aren’t one-size-fits-all. To the contrary, a recent study suggests that people who get their blood pressure checked with a cuff that’s the wrong size for their arm circumference may have undetected hypertension or get incorrectly diagnosed with this condition.

Like people, blood pressure cuffs come in many sizes. The American Heart Association (AHA) recommends that the length of the bladder that wraps around patients’ upper arms be 75 to 100 percent of their arm circumference for a snug but not excessively tight fit. Cuffs for a “regular” size adult might get accurate readings for a person with an arm circumference of around 27 to 34 inches, according to the AHA, but it would be inaccurate for somebody with a much smaller or larger size.

Many previous studies have noted inaccurate blood pressure readings made with ill-fitting manual blood pressure cuffs that clinicians pump by hand to compress around the upper arm, but new research presented at the AHA’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference 2022 suggests that inaccuracies also occur with newer, automated blood pressure monitors.

“Accurate blood pressure measurement depends on proper patient preparation, positioning, measurement technique, and individualized selection of cuff size,” says Tammy Brady, MD, PhD, the lead author of the new study and the medical director of the pediatric hypertension program at Johns Hopkins University in Baltimore.

Nearly half of U.S. adults have high blood pressure, according to the AHA. This is defined by the AHA as a systolic blood pressure (the “top number,” which measures the pressure blood exerts against artery walls when the heart beats) of at least 130 mmHg (millimeters of mercury), or a diastolic blood pressure (the “bottom number,” which measures the pressure blood exerts in the arteries when the heart rests between beats) of at least 80 mmHg.

For the study, researchers compared blood pressure readings for 165 adults who had separate measurements done with both a “regular” adult-size cuff and with a cuff appropriately sized for their arm circumference.

Overall, 30 percent of the study participants had hypertension, according to their systolic blood pressure.

Slightly more than two in five people in the study had obesity. When these people who required an extra-large blood pressure cuff had measurements done with a “regular” adult size cuff, this inaccurately increased their systolic blood pressure readings by an average of 19.7 mmHg and their diastolic blood pressure readings by an average of 4. 8 mmHg.

In 39 percent of these cases, people with obesity were misdiagnosed with hypertension as a result.

Similarly, people who needed a “small” blood pressure cuff had hypertension that went undetected in 22 percent of cases when their measurements were done with a “regular” adult size cuff. When these people who needed a smaller cuff had measurements with a “regular” cuff, this inaccurately decreased their systolic blood pressure readings by an average of 3.8 mmHg and their diastolic blood pressure readings by an average 1.5 mmHg.

“The degree of under- or overestimation depends on the size discrepancy of the cuff to the size of the arm, and can be substantial,” says Jordana Cohen, MD, an assistant professor of medicine and epidemiology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, who wasn’t involved in the new study.

To avoid this problem and get your blood pressure checked with a cuff that fits, you should ask your provider to measure the circumference of the middle of your upper arm, Dr. Brady advises. You should also do this yourself before you buy a blood pressure monitor for home use.

“If a cuff pops off when being inflated or if the device provides multiple error messages while you’re trying to obtain a blood pressure, that might be a sign the cuff is too small,” Brady says.

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Blood Pressure Pills Recalled Over Potential Cancer Risk

The recalled tablets may contain nitrosamine, a compound that’s associated with an increased risk of cancer.

By Lisa Rapaport

December 28, 2022

Fact-Checked

The recall involves two lots of quinapril and hydrochlorothiazide tablets.FDA; Canva

Editor’s Note

This story was originally published on Oct. 28, 2022.

On Dec. 21, 2022, the FDA announced another distributor, Lupin Pharmaceuticals, was also recalling four lots of the blood pressure medication quinapril for excessive nitrosamines.

Aurobindo Pharma USA is voluntarily recalling a blood pressure tablet because of a potential cancer risk, according to the U.S. Food and Drug Administration (FDA).

The company is recalling two lots of its quinapril and hydrochlorothiazide tablets, which are prescribed to lower blood pressure in people with hypertension, over concerns that the pills may be contaminated with nitrosamine, the FDA said in a statement.

Nitrosamines are found naturally in many foods including a variety of vegetables, dairy products, and cured or grilled meats. Exposure to high levels of nitrosamines over a long period of time can increase the risk of cancer, the FDA said.

Both lots of recalled blood pressure medicine have an expiration date in January 2023, the FDA said. The tablets are “pink colored, scored, round shaped, biconvex, film-coated tablets, debossed with ‘D’ on the scored side and ‘19’ on the other side.”

There have not been any reports of adverse events related to the tablets covered by the recall, the FDA said.

“Patients should contact their doctor or healthcare provider about whether to continue taking their medication, or whether to consider an alternative treatment prior to returning their medication,” the FDA said.

The recalled tablets contain a combination of two medicines: quinapril hydrochloride, in a family of medicines known as angiotensin-converting enzyme (ACE) inhibitors that lower blood pressure by relaxing blood vessels; and hydrochlorothiazide, in a family of medicines known as diuretics that manage blood pressure by reducing fluid retention.

Some patients may be able to switch to a treatment regimen of two separate tablets — one for each of the medicines contained in the recalled pills.

Consumers with medical questions about the recall can contact Aurobindo Pharma at 866-850-2876 or email the company at [email protected].

Nitrosamines have previously been found in drugs to treat high blood pressure, heartburn, acid reflux, and diabetes, according to the FDA. Some of these drugs from certain manufacturers — including angiotensin II receptor blockers (ARBs), ranitidine, nizatidine, and metformin — have been recalled because of nitrosamine impurities.

Chemical reactions during the drug manufacturing process can cause nitrosamines to form in medicines.

Some previous research has linked exposure to high levels of nitrosamines to several different types of cancer, including pancreatic and gastrointestinal tumors, but because many cancers can form slowly over decades it’s hard to quantify the exact risk. The World Health Organization classifies nitrosamines as probable human carcinogens, but also notes that the cancer risk may be low for nitrosamine impurities found in prescription medicines.

By subscribing you agree to the Terms of Use and Privacy Policy.

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Blood pressure – norm and pathology

from May 14 to 24 within the framework of the Year of the Heart in the MUSIC City Hospital No. G.I. Drobyshev is holding an information and practical campaign

“Learn to control your blood pressure.”

One of the most common health complaints and one of the “favorite” diseases in the elderly is high blood pressure. This pathology can explain any changes in well-being, bad mood and other troubles. Blood pressure can rise and fall several times during one day, and a person’s normal pressure is a purely individual concept.

What is blood pressure and what values ​​are considered normal?

Blood pressure is a general concept that determines the force with which blood presses on the walls of blood vessels, it is more correct to call it blood pressure, because pressure is important not only in arteries, but also in veins and capillaries. But it is possible to measure without the help of special instruments only the pressure in large vessels located on the surface of the body – in the arteries.

Blood pressure – BP – depends on how fast and force the human heart contracts, how much blood it can pump in one minute, on the properties of the blood itself and the resistance of the vessel walls.

Factors affecting the value of blood pressure:

• the ability of the heart to contract with sufficient force and ensure normal blood ejection through the vessels;
• from the rheological properties of blood – the “thicker” the blood, the more difficult it is to move through the vessels, diseases such as diabetes mellitus, increased clotting, greatly impede blood flow and can lead to problems with blood pressure, with thick blood, some doctors prescribe treatment with leeches ;
• elasticity of vessel walls – blood vessels wear out over time and cannot withstand increased stress – this causes the development of hypertension in the elderly,
• atherosclerotic changes – reduce the elasticity of the walls;
• sudden constriction or dilation of blood vessels – as a result of nervous shocks or hormonal changes, a sharp narrowing or expansion of blood vessels is possible – for example, with fear, anger or other strong emotions;
• diseases of the endocrine glands.

Normal pressure is determined by a combination of a large number of parameters, and for each age, gender and for an individual, its indicators can vary greatly. For medical norms, average indicators are taken from healthy people of a certain age. It has long been proven that a pressure of 120/80 cannot and should not be considered the ideal norm for people of different ages.

To find out what normal pressure a person should have at different age periods, you can use the following table.

Adult blood pressure readings:

• Normal blood pressure is considered to be between 110/70 and 130/85 mm. rt. Art.
• Reduced normal pressure – 110\70 – 100\60;
• Low blood pressure – hypotension – below 100/60;
• Increased normal pressure – 130\85-139\89;
• High blood pressure – hypertension – more than 140\90 mm. rt. Art.

Indicators of normal blood pressure for different age periods:

• 16 – 20 years – 100\70 – 120\80 mm. rt. Art.
• 20 – 40 years – 120\70-130\80;
• 40 -60 – up to 140\90;
• over 60 years old – up to 150\90 mm. rt. Art.

From the table above, it can be seen that the greater the age of a person, the higher the normal blood pressure, this is due to age-related changes in blood vessels, in the heart muscle and in other organs. High blood pressure, as well as low blood pressure, can cause various health problems, but in order to determine whether a change in the level of pressure is to blame for feeling unwell, it is necessary to regularly measure it and keep a special diary. For this, several trips to the clinic or visits to the doctor are not enough, only daily regular pressure measurements can give the correct results.

Measurement.

The correctness of the diagnosis and prescription of treatment largely depends on the correctness of blood pressure measurements, because the doctor, prescribing medicine or prescribing treatment, largely focuses on the measurement numbers.

Today there are different ways to measure pressure:

1. The simplest and oldest – with the help of a cuff and a tonometer – here it is of great importance to correctly apply the cuff, the ability to use a tonometer and listen to heart sounds. Such a measurement requires special training and skills, but when used correctly, it gives fairly accurate and reliable results.
2. Electrotonometer – the principle of operation is the same, but the results are visible on a special display. This facilitates self-measurement of pressure and provides more accurate results. But such blood pressure monitors often break down and may show incorrect numbers.

No matter how blood pressure is measured, some general rules must be observed:0034

measurement should be carried out on both hands and it is desirable to carry out a series of measurements with an interval of 5-10 minutes.

If, after a correct measurement of blood pressure, the readings are very different from the norm, it is necessary to repeat the measurements within a few days and, if confirmed, consult a doctor.

High blood pressure.

Considered one of the most dangerous diseases of mankind, about 25% of people worldwide suffer from hypertension, and this figure continues to increase. Hypertension is an increase in blood pressure above 140/90 mm. rt. Art. The causes of hypertension can be:

• overweight,
• genetic predisposition,
• diseases of internal organs,
• lack of physical activity,
• smoking and drinking,
• excessive consumption of table salt,
• nervous strain,
• other factors.

With hypertension, the patient suffers from headaches (and here headache pills will not help), shortness of breath, pain in the heart, increased fatigue, insomnia, poor health and other symptoms. In addition, the risk of developing cardiovascular diseases, brain damage, pathology of the urinary system and eye diseases increases.

The treatment of hypertension is a very complex and time-consuming process, where the outcome of the disease depends on the observance of the doctor’s recommendations. It is important to find the cause of the increase in pressure and act on it. At the same time providing symptomatic treatment. In each case, drugs, doses and their combination should be selected individually by the attending physician.

Without timely treatment or uncontrolled intake of drugs, hypertension can not only severely damage health, but also cause such a life-threatening condition as a hypertensive crisis.

Hypertensive crisis.

Hypertensive crisis is a life-threatening condition caused by a sharp increase in blood pressure and damage to the nervous system and target organs. The blood pressure figures in a hypertensive crisis can vary greatly in different patients – someone normally tolerates 200\150 mm. rt. st, and someone feels bad already at 150 \ 85 mm. rt. Art. The nature of the lesions in GC depends on the organs in which the pathology was previously – if the heart hurt, myocardial infarction may occur, if it was tormented – headaches – then a stroke, and so on.

The causes of GC can be:

• psycho-emotional overstrain,
• physical activity,
• meteorological changes,
• drinking alcohol,
• rich food with high salt content,
• incorrectly selected antihypertensive drugs,
• diseases of the endocrine system and internal organs.

With the development of GC, the patient’s state of health deteriorates sharply, there is a feeling of fear, anxiety, nausea, vomiting, darkness before the eyes, swelling and flushing of the face, chills, tremor of the extremities, fainting, up to coma.

If these symptoms appear, the patient should be placed on any flat surface with a raised headboard and an ambulance should be called immediately. Before her arrival, try to provide the patient with peace, an influx of fresh air, get rid of tight clothing, if the patient has had hypertension for a long time, then most likely he is taking some kind of antihypertensive drug, in this case, you can give the patient the usual dosage before arrival.

Hypotension, low blood pressure.

For many people, especially those suffering from hypertension, it seems that lowering blood pressure may not be a problem, but in fact it is not. Constantly low blood pressure can cause no less inconvenience and cause health problems than hypertension.

The causes of this pathology can be hereditary predisposition, poor nutrition and beriberi, endocrine diseases, nervous strain, general exhaustion of the body and other problems.

A person suffering from hypotension constantly feels tired, overwhelmed, he hardly performs daily duties and is emotionally retarded. In addition, there is a decrease in memory and brain activity, poor thermoregulation, increased sweating, headaches, drowsiness, pain in the joints and muscles, and a general deterioration in well-being.

Although, unlike hypertension, hypotension does not cause serious health problems, it also needs to be treated. And only a doctor can determine the cause of hypotension and prescribe treatment, after a detailed examination. And without medical help, we can advise you to establish a regime of work and rest, eat well, not be nervous and give up bad habits.

Original article http://tibet-medicine.ru/sovrmed/normalnoe-davlenie-cheloveka

Low blood pressure – Hypotension, how to increase blood pressure? – Health World

What is low blood pressure?

Normal blood pressure ranges from 90/60 to 120/80 mmHg. If the pressure readings are less than 90/60, the pressure is considered low. This condition is called hypotension.

Each person has his own normal (working) pressure, so hypotension is usually called pressure, which is 20% lower than the working one. Many (most often thin women) live with hypotension for years and feel great. Doctors believe that these people are lucky – they are less likely to suffer from cardiovascular disease.

Symptoms of low blood pressure

• Headache in the temples, sometimes headache in the back of the head or in the forehead is the most common symptom of low blood pressure. This symptom is directly related to circulatory disorders of the cerebral vessels.
• Dizziness, both sudden and after a sudden change in body position, especially in the morning, are also characteristic symptoms of low blood pressure. Usually dizziness is accompanied by darkening of the eyes, noise in the head, sometimes even fainting. Therefore, people with low blood pressure are not recommended to get out of bed abruptly.
• Feeling of weakness, fatigue, inactivity. Such people get tired very quickly, this is especially acute at the end of the working day – attention and memory decrease, the person becomes absent-minded, irritable, and he has mood swings. It is very difficult for them to be in the same position for a long time, for example, standing in line or washing dishes.
• Hypotension is often accompanied by vegetative disorders – sweating of the palms and feet, violations of thermoregulation – a decrease in temperature to 35.8 – 36 C, sometimes there may be a feeling of incomplete inspiration or shortness of breath during physical exertion.

What to do with low pressure?

If your blood pressure is consistently low but you feel well, there is no need to do anything. If you are concerned about nausea, dizziness or fainting, you need to consult a general practitioner in St. Petersburg.
The frequent occurrence of low blood pressure symptoms may indicate the presence of various diseases. In order to identify the cause, doctors conduct various examinations: ultrasound of the heart, blood vessels, ECG, FGDS. The therapist can refer to narrow specialists: a cardiac surgeon, a gastroenterologist, an endocrinologist, a neurologist. It is important to find out the true cause, because the method of treatment depends on the diagnosis.

General recommendations for hypotension:

• Drink enough fluids and salt. In summer, a person quickly loses water and minerals.
• Drink coffee, tea or cocoa. Drinks with caffeine give a good effect, though short-term.
• Avoid stuffiness, extreme stress or fright.
• Maintain a good mood.
• Perform simple exercises that are useful for hypotension: sit in a cross-legged position, clench and unclench your fists, work with a manual expander.

What to do in case of a sudden drop in pressure?

First, you need to take a supine position. If there is no way to lie down, you must definitely sit down and tilt your head as low as possible, between your knees. This position will ensure the flow of the required amount of blood to the brain and well-being will immediately improve.

Secondly, you should immediately drink a glass of water or, best of all, strong sweet tea. When fainting, you can revive him with a bottle of essential oils or ammonia.