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BLOOD PRESSURE IN MALES
ABSTRACT
A survey of
blood pressure measurements for 674 male subjects in University of Port
Harcourt was carried out in this work. Measured blood pressure (systolic and
diastolic) was found to be associated with weight, status and age. Blood
pressure increased with increases in weight and age, while the influence of
status on blood pressure was such that mean blood pressure was highest for the
academic staff, followed in decreasing order by that measured for non-academic
staff, Technicians/Laborers, University Students and Secondary School Students.
TABLE
OF CONTENTS
Title
Page - - - - - - - - - - i
Declaration - - - - - - - - - ii
Dedication - - - - - - - - - iii
Acknowledgement - - - - - - - - iv
Abstract - - - - - - - - - - v
Table
of Contents - - - - - - - - vi
CHAPTER
ONE: GENERAL INTRODUCTION
1.1
Direct Method of Blood Pressure
Measurement
1.2
Indirect Method of Blood Pressure
Measurement
1.3
Variability in Systemic Arterial
Pressure
1.3.1Diurnal
Variation
1.3.2Exercise
1.3.3Weight
1.3.4Pressure under
Stress and Excitement
1.3.5Age
1.3.6Eating
1.3.7Temperature
1.3.8Inheritance
1.3.9Racial
Influence
1.3.10
Sex
1.4
Hypertension
1.4.1Causes of
Secondary Hypertension
1.4.1.1
Organic Diseases
1.4.1.2
Drugs and Chemicals
1.4.1.3
Hypertensive
1.4.2 Primary
(Essential) Hypertension
1.4.2.1
Body Weight
1.4.2.2
Alcohol
1.4.2.3
Intake of Salt
1.4.2.4
Psychosocial Factors
1.4.2.5
Smoking
1.4.2.6
Exercise
1.4.3Management of
Hypertension
1.4.3.1
Surgery
1.4.3.2
Drug Therapy
1.4.3.3
Non-Pharmacological Measures
CHAPTER
TWO: MATERIAL AND METHOD
2.1 Materials
2.1.1 Mercury Sphygmomanometer
2.1.2 Stethoscope
2.1.3 Weighing Machine
2.2 Method
2.2.1 Blood Pressure Measurement
2.2.2 Weight Measurement
2.2.3 Questioning of Subject
CHAPTER
THREE: RESULT
3.1 Blood Pressure as Related to Weight
3.1.1 Systolic Blood Pressure and Weight
3.1.2 Diastolic Blood Pressure and Weight
3.2 Blood Pressure as Related to Status
3.2.1 Systolic Blood Pressure and Status
3.2.2 Diastolic Blood Pressure and Status
3.3 Blood Pressure as Related to Age
3.3.1 Systolic Blood Pressure and Age
3.3.2 Diastolic Blood Pressure and Age
3.4 Mean Blood Pressure for Total Population
Studied
CHAPTER
FOUR: DISCUSSION, CONCLUSION AND
REFERENCES
4.1 Discussion
4.1.1 Blood
Pressure and Weight
4.1.2 Blood
Pressure and Status
4.1.3 Blood
Pressure and Age
4.1.4 Blood
Pressure and others
4.2 Conclusion
References
CHAPTER ONE
GENERAL INTRODUCTION
Blood pressure is the pressure exerted
by blood on the vessel wall (7).
It can be measured directly or indirectly.
1.1 DIRECT METHOD OF MEASURING BLOOD
PRESSURE
By
direct method measuring blood pressure, a cannula is inserted directly into an
artery, the pressure can then be measured directly with a mercury monometer or
a suitably calibrated strain gauge and an oscillograph arranged to write
directly on a moving strip of paper (2, 4, and 9).
It
was reverend Stephen Hales, an English Clergyman, who demonstrated in 1933 that
blood in arteries is under a relatively high pressure by inserting a cannula in
the trachea of a goose to a glass tube (6).
Ponselle,
a French Physicist, in 1828 improved on Hales method by introducing a U-tube
filled with mercury. The height of the column rose only a few inches, since
mercury has a weight of about thirteen times that of blood. It has been
customary since Ponselle introduced the mercury manometer to express the blood
pressure in millimeters of mercury (mm.Hg) (7).
A
few years later, Ludwig a German Physiologist, improved Ponselle’s method by
placing a float fastened to a wire bearing writing point so that the
fluctuations in blood pressure could be recorded on a rotating drum (kymograph)
(7).
1.2 INDIRECT METHOD OF MEASURING
BLOOD PRESSURE
By
indirect method of blood pressure measurement, arterial annulation is not
required; rather the use of sphygmomanometer and stethoscope is employed. This
indirect method could be by auscultator method is the most popular and widely
employed method in clinical practice.
The
dynamics of the auscultator method is based on the fact that the streamline
flow in the un-constricted artery is silent, but when the artery in narrowed,
the velocity of flow through the constricted vessel exceeds the critical
velocity (which is the velocity at or above which flow is turbulent). It is
this turbulent flow that produces the korotkor (2,4,
and 9).
1.3 VARIABILITY IN SYSTEMIC ARTERIAL
PRESSURE
Blood
pressure is never constant; it varies according to needs and requirements of
the body, and it does so frequently in the course of everyday. Whether it goes
up or down depends on a wide variety of different factors (7).
1.3.1
DIURNAL
VARIATION
The
lowest pressure readings normally occur while sleeping. During the day with its
physical and psychological demands and strains, pressure usually goes up from
early morning until dinner time, the blood pressure tend to rise progressively
by about 15mmHg to 20mm Hg (3, 5, and 8).
1.3.2
EXERCISE
During
exercise blood pressure increases because of the cardiovascular adjustments
which is set into action to handle the situation. These increases in pressure
may persist for varying periods after the termination of the exercise (2,
4, 4, and 8).
1.3.3
WEIGHT
Blood
pressure and body weight are significantly associated in individuals and in
populations. Blood pressure increases with increasing weight and falls again
when weight is lost by dieting (3, 5, 8, and 9).
The relationship between blood pressure and weight tends to be less impressive (5,
8, and 9).
1.3.4
PRESSURE
UNDER STRESS AND EXCITEMENT
It
is a known fact that excitement can affect blood pressure. “pounding heart beat”,
accompanied by a definite increase in blood pressure holds true regardless of
the cause, whether pain or pleasure, shame or fear, the thought of one’s blood
pressure being measured or simple irritation over being caught in a traffic jam
when in a hurry or feel pressured on your job (2,
4, 5, and 8).
1.3.5
AGE
With
increasing age, there is also increase in both systolic and diastolic pressure,
such that different standards must be established for the various age groups (5,
8).
1.3.6
EATING
Ingestion
of a large meal is usually followed by a significant systemic blood pressure (5,
8).
1.3.7
TEMPERATURE
Blood
pressure tend to diminish in warm weather and increase in cold weather, hence
blood pressure of inhabitants of the cold region are usually higher than those
of the hot tropical region inhabitations (8).
1.3.8
INHERITANCE
The
blood pressure of first – degree relatives is positively correlated, so that
there is a tendency for the incidence of either hypertension or hypotension to
be higher in such relatives of hypertensive subjects (9).
This is sometimes referred to as ‘familial aggregation of blood pressure’. (9)
1.3.9
RACIAL
INFLUENCE
Both
systolic and diastolic blood pressure is slightly higher in Negroes the whites.
The difference can be demonstrated in both sexes and in all age groups (9).
Also the Chinese, Philippines, Puerto Ricans, East Africans, Indians, Arabs and
Aboriginal Australians seem to have lower blood pressure than do North American
or West European people (8).
1.3.10
SEX
A
lot of other factors some known others unknown lead to the recorded variability
in blood pressure, some of these include diet, smoking, alcohol, drug etc. and
the magnitude of their effect depends more on individual susceptibility to arterial
blood pressure change induced by these factors. (2,
3, 4, 5, and 8)
1.4 HYPERTENSION
In
96 – 99% cases of hypertension the cause or causes of hypertension (elevation
of blood pressure) is not clearly identifiable and this condition is referred
to as primary or essential hypertension. In some cases, the cause can easily be
removed once it has been recognized. This hypertension whose cause is
identifiable is termed secondary hypertension.
1.4.1
CAUSES
OF SECONDARY HYPERTENSION
1.4.4.1 ORGANIC DISEASES (2,
3, 4, 5, 8, AND 9)
Organic diseases which cause secondary
hypertension include diseases of the adrenal cortex (primary
hyperaldosteronism; Cushing’s syndrome; tumors producing excess of other
cortico – steroids such as desoxycortone and corticosterone; inborn errors of
cortisteroid biosynthesis).
§ Coarctation
of the cortex
§ Diseases
of the adrenal medulla (pheochromocytoma)
§ Renal
diseases (renal tuberculosis; renal
artery stenosis; pyelonephritis; glomerulonephritis; radiation nephritis, renal
failure; hydronephrosis, renal tumors, including renin – secreting tumors;
renal cyst).
1.4.1.2 DRUGS AND CHEMICALS (2,
3, 4, 5, 8, AND 9)
§ Corticosteroids
and corticotrophin (ACTH)
§ Hormonal
contraceptive (containing estrogen)
§ Non-steroidal
antirhaumatic agents such as indomethacin
§ Liquorice
and carbenoxolone
§ Others
1.4.1.3 There could also be hypertensive diseases
of pregnancy (2, 3, 4, 5, 8, AND
9)
1.4.2 PRIMARY HYPERTENSION (ESSENTIAL)
The
tendency to develop primary hypertension is inherited probably in a polygenic
fashion. However, in addition a number of environmental factors play an
important role by contributing to the full expression of hypertension, and
these are of predominant concern in exploring the possibilities of
hypertension, since obviously nothing can be done to influence the genetic
factor (3, 5, and 9).
The
following factors are of importance in primary hypertension.
1.4.2.1 BODY WEIGHT
There
is close relationship between blood pressure and weight that is individuals who
gain more weight with advancing age will have a rapid blood pressure rise and
vise vasa for weight reduction (3).
1.4.2.2 ALCOHOL
Although
excessive ethanol consumption and high risk of hypertension are associated, the
mechanism of this association remains unclear (3).
1.4.2.3 INTAKE OF SALT
A
very high salt intake (more than 14g/day) will cause a detectable increase in
blood pressure, while a very low salt intake (less than 1g/day) reduces
arterial pressure (3).
This offers one of the most made means preventing hypertension (3).
1.4.2.4 PSYCHOSOCIAL FACTORS
There
is little evidence that harm can result from short-term blood pressure increase
due to acute psychosocial factors (3),
but then there are reports that factory workers, machines etc. have higher
blood pressure due to the nature of their job. Also in migrant population,
long-term exposure to adverse psychosocial circumstances could lead to
hypertension (3).
Those who work in less noisy environment tend to have lower blood pressure (3).
1.4.2.5 SMOKING
There
has not been an established causal relationship existing between smoking and
hypertension, smoking combined with the consumption of coffee has a short-term
pressure effect (3).
1.4.2.6 EXERCISE
Although
a number of studies have reported on the effect of physical training or hard
job on blood pressure, there is as yet no clear cut changes in blood pressure
demonstrated (3).
1.4.4
MANAGEMENT
OF HYPERTENSION
Management
of hypertension involves diverse measures since hypertension has a wide
ethology.
1.4.3.1 SURGERY
Use
of surgical measures to remove tumors such as tumors of the adrenal medulla
which secrete principally moropinephrene in pheochromocytoma and tumor of the
renal system which secrete renin (6).
1.4.3.2 DRUG THERAPY
Drug
therapy could be employed. In this case drugs like Diuretics (e.g. Furosemide
and thiazide) 
– adrenoceptor blockers (e.g. propranolol)
vasodilators (e.g. hydralazine) and adrenergic neuron blocking drugs (e.g.
guanethidine) or a centrally acting drug (e.g. methyldopa) are administered in
various regimens (6).
– adrenoceptor blockers (e.g. propranolol)
vasodilators (e.g. hydralazine) and adrenergic neuron blocking drugs (e.g.
guanethidine) or a centrally acting drug (e.g. methyldopa) are administered in
various regimens (6).
1.4.3.3 NON-PHARMACOLOGICAL MEASURES
The
non-pharmacological measures include weight reduction, salt intake restriction,
controlled exercise, vigorous anti-smoking and anti-ethanol advice and
psychotherapy (which include relaxation, yoga, musicotherapy, “autogenic
training” etc.,) (3, 5, 6, and 10).
The successful management of hypertension therefore will depend on co-operation
between the patient, doctor or nurse and others.
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