Kan Basıncı Ölçümünde Gözden Kaçan Faktörler: Sırt, Ayak ve Kol Desteğinin Etkisi

Yıl 2023, Cilt: 12 Sayı: 4, 1896 - 1903, 26.12.2023

Metin Tuncer , Leyla Khorshid

https://doi.org/10.37989/gumussagbil.1366509

Öz

Kılavuzlarda hastanın sırtının desteklenmesi, kolun alt kısmının kalp hizasında desteklenmesi ve ayakların yere düz basması önerilmektedir. Ancak bu konuda yapılan çalışma sayısı sınırlı olduğundan, bu önerilerin dikkate alınmamasından kaynaklanan hataların etkileri bilinmemektedir. Bu çalışmada sağlıklı bireylerde kan basıncı ölçümü sırasında kol, sırt ve ayak desteğinin kan basıncı değerlerine etkisinin araştırılması amaçlandı.
Araştırmaya 111 kişi dahil edildi. Katılımcıların ortalama yaşları 21.95±1.57 idi. Sistolik ve diyastolik kan basınçları, üçü hatalı ölçüm (desteksiz ayaklar, desteksiz sırt ve desteksiz kol) ve biri kılavuzların önerdiği standart prosedür olan dört ölçüm prosedürü kullanılarak ölçüldü. Prosedürler randomize edildi ve katılımcıların kan basınçları her prosedür için üç kez ölçüldü.
Ayak desteği ve sırt desteği olmadan yapılan ölçümlerde belirlenen ortalama sistolik değerler, standart ölçümlerle belirlenenlerden daha yüksek olduğu belirlendi (sırasıyla t=-4.872, p<0.001 ve t=-2.152, p=0.034). Ayrıca ayak desteği olmadan yapılan ölçümde belirlenen diyastolik değer, standart ölçüme göre yüksek bulundu (t=-5.635, p<0.001). Araştırma sonuçlarına göre ayaklar ve sırt desteksiz bırakıldığında ölçülen ortalama sistolik/diyastolik kan basıncı değerleri standart prosedürle ölçülenlerden daha yüksekti.

Anahtar Kelimeler

Desteksiz ayak, Desteksiz kol, Desteksiz sırt, Kan basıncı ölçümü.

Factors Overlooked in Blood Pressure Measurement: The Effect of Back, Feet and Arm Support

Öz

In the guidelines, it is recommended that the patient's back should be supported, that the lower part of the arm should be supported at the heart level, and the feet should be kept flat on the floor. However, the effects of errors stemming from ignoring these recommendations are unknown because the number of studies conducted on this issue is limited. In this study, the authors aimed to investigate the effect of arm, back and feet support on blood pressure values during blood pressure measurement in healthy individuals.
In the study, 111 individuals were included. Their mean age was 21.95±1.57 years. Their systolic and diastolic blood pressures were measured using four measurement procedures, three of which were erroneous measurements (feet without support, back without support, and arm without support) and one of which was the standard procedure recommended by the guidelines. Procedures were randomized and the participants' blood pressures were measured three times for each procedure.
While the mean systolic values determined with the measurements performed without feet support and back support were higher than were those determined with the standard measurements (t=-4.872, p<0.001 and t=-2.152, p=0.034, respectively), the mean diastolic value determined with the measurement performed without feet support was higher than was that determined with the standard measurement (t=-5.635, p<0.001). According to the results of the study, the mean systolic/diastolic blood pressure values measured when the feet and the back were left unsupported were higher than were those measured by the standard procedure.

Anahtar Kelimeler

Blood pressure, Blood pressure measurement, Unsupported arm, Unsupported back, Unsupported feet

Kaynakça

• 1. Ringrose, J.S, Wong, J, Yousefi, F. and Padwal, R. (2017). “The Effect of Back and Feet Support on Oscillometric Blood Pressure Measurements”. Blood Pressure Monitoring, 22 (4), 213-216. https://doi.org/10.1097/MBP.0000000000000265
• 2. Burgess, S.E, MacLaughlin, E.J, Smith, P.A, Salcido, A. and Benton, T.J. (2011). “Blood Pressure Rising: Differences Between Current Clinical and Recommended Measurement Techniques”. Journal of the American Society of Hypertension,5 (6), 484-488. https://doi.org/10.1016/j.jash.2011.08.007
• 3. Kallioinen, N, Hill, A, Horswill, M.S, Ward, H.E. and Watson, M.O. (2017). “Sources of Inaccuracy in the Measurement of Adult Patients” resting blood pressure in clinical settings: a systematic review. Journal of hypertension, 35 (3), 421-444. https://doi.org/10.1097/HJH.0000000000001197
• 4. Stergiou, G.S, Parati, G, McManus, R.J, Head, G.A, Myers, M.G. and Whelton, P.K. (2018). “Guidelines for Blood Pressure Measurement: Development Over 30 Years. The Journal of Clinical Hypertension, 20(7), 1089-1091. https://doi.org/10.1111/jch.13295
• 5. Turner, M.J, Baker, A.B, and Kam, P.C. (2004). “Effects of Systematic Errors in Blood Pressure Measurements on the Diagnosis of Hypertension”. Blood pressure monitoring, 9(5), 249-253.
• 6. Wan, T.X, Wu, Y.H, Wu, Y.Q, Hu, W. and Su, H. (2021). “Differences in Oscillometric Blood Pressure Readings Between Unsupported and Supported Back Conditions”. Hypertension Research, 44 (5), 528-532.
• 7. Ramtahal, R. (2015). Common Errors in the Measurement of Blood Pressure. Int Arch Nurs Health Care, 1 (004).
• 8. Eşer, I, Khorshid, L, Yapucu Güneş, Ü. and Demir, Y. (2007). “The Effect of Different Body Positions on Blood Pressure”. Journal of Clinical Nursing, 16 (1), 137-140. https://doi.org/10.1111/j.1365-2702.2005.01494.x
• 9. Adiyaman, A. (2009). “Blood Pressure Management in Cardiovascular Risk Stratification: Procedure, Progression, Process”. Doctoral Dissertation. Radboud Universiteit. Netherlands.
• 10. Matheson, E, Kremer, M, Fogg, L. and Crisanti, G. (2020). “Ensuring Accurate BP Measurements. Nursing2022, 50 (4), 63-69. https://doi.org/10.1097/01.NURSE.0000657040.45768.02
• 11. Watson, K. E, Al Hamarneh, Y.N, Rabi, D, Daskalopoulou, S. S. and Tsuyuki, R.T. (2021). “Hypertension Canada’s 2020 Hypertension Guidelines for Pharmacists: An Update”. Canadian Pharmacists Journal/Revue Des Pharmaciens Du Canada, 154 (1), 19-25. https://doi.org/10.1177/1715163520975809
• 12. Whelton, P.K, Carey, R.M and Aronow, W.S. (2018). Acc/aha/aapa/abc/acpm/ags/APhA/ASH/ASPC/nma/pcna guideline for the prevention, Detection, evaluation, and management of high blood pressure in adults: a Report of the American College of Cardiology/American heart Association. Task force on clinical practice guidelines//J. Am. Coll. Cardiol.-2017.-Nov 13. Почки, 7 (1), 68-74.
• 13. Familoni, O. B. and Olunuga, T. O. (2005). Comparison of the effects of arm position and support on blood pressure in hypertensive and normotensive subjects: cardiovascular topic. Cardiovascular Journal of South Africa, 16 (2), 85-88.
• 14. Beck, F. M, Weaver, J. M, Blozis, G. G. and Unverferth, D. V. (1983). Effect of arm position and arm support on indirect blood pressure measurements made in a dental chair. The Journal of the American Dental Association, 106 (5), 645-647. https://doi.org/10.14219/jada.archive.1983.0146
• 15. Silverberg, D.S, Shemesh, E. and Iaina, A. (1977). The unsupported arm: a cause of falsely raised blood pressure readings. British Medical Journal, 2 (6098), 1331-1334. https://doi.org/10.1136%2Fbmj.2.6098.1331
• 16. Güneş, Ü.Y. and Efteli, E.Ü. (2016). Does Errors Made during Indirect Blood Pressure Measurement affect the Results?. International Journal of Caring Sciences, 9 (2), 520-525.
• 17. Cushman, W. C, Cooper, K. M, Horne, R. A. and Meydrech, E. F. (1990). Effect of back support and stethoscope head on seated blood pressure determinations. American journal of hypertension, 3 (3), 240-241. https://doi.org/10.1093/ajh/3.3.240
• 18. Myers, M. G, Valdivieso, M. and Kiss, A. (2009). Consistent relationship between automated office blood pressure recorded in different settings. Blood pressure monitoring, 14 (3), 108-111. https://doi.org/10.1097/MBP.0b013e32832c5167
• 19. Bateman, B. T, Shaw, K. M, Kuklina, E. V, Callaghan, W. M, Seely, E. W. and Hernández-Díaz, S. (2012). Hypertension in women of reproductive age in the United States: NHANES 1999-2008. PloS one, 7 (4), e36171. https://doi.org/10.1371/journal.pone.0036171
• 20. Janssen, I, Heymsfield, S. B, Wang, Z. and Ross, R. (2000). Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. Journal of applied physiology. https://doi.org/10.1152/jappl.2000.89.1.81
• 21. Tykarski, A, Filipiak, K.J, Januszewicz, A, Litwin, M, Narkiewicz, K, Prejbisz, A. and Kostka-Jeziorny, K. (2019). 2019 Guidelines for the management of hypertension—part 1–7. Arterial Hypertension, 23 (2), 41-87. 10.5603/AH.a2019.0008
• 22. de Souza Nery, S, Gomides, R.S, da Silva, G.V, de Moraes Forjaz, CL, Mion Jr, D. and Tinucci, T. (2010). Intra-arterial blood pressure response in hypertensive subjects during low-and high-intensity resistance exercise. Clinics, 65 (3), 271-277. https://doi.org/10.1590/S1807-59322010000300006
• 23. Halley, S.L, Marshall, P. and Siegler, J.C. (2018). The effect of ischaemic preconditioning on central and peripheral fatiguing mechanisms in humans following sustained maximal isometric exercise. Experimental Physiology, 103 (7), 976-984. https://doi.org/10.1113/EP086981
• 24. Molatore, T.L. (1979). A comparison of the effects of biofeedback and meditation treatment on essential hypertension. https://doi.org/10.15760/etd.2930
• 25. Valic, Z, Buckwalter, J.B. and Clifford, P.S. (2005). Muscle blood flow response to contraction: influence of venous pressure. Journal of Applied Physiology, 98 (1), 72-76. https://doi.org/10.1152/japplphysiol.00151.2004