International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(11), June, 2012

Pages: 52-58

Date of Publication: 18-Jun-2012


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COMPARISON OF MEAN ARTERIAL BLOOD PRESSURE IN FOUR DIFFERENT BODY POSITIONS BETWEEN HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS

Author: Prakash J. Patel, Dhaval Patel

Category: Healthcare

Abstract:Objectives: It is known that changes in the body positions leads to the various changes in the cardio vascular system. It is also known that many factors influence on individuals BP measurement, however BP is constantly changes from one position to another. Change in positions well known to cause change in intravascular and intra cardiac volumes and pressures, and in neurohumoral activity. Surprisingly there is little information available on the BP changes in various positions between hypertensive and normotensive individuals. Purpose of the study to compare mean arterial blood pressure response between supine, sitting, standing and supine with crossed leg positions. Methods: 100 volunteers,50 hypertensive
and 50 normotensive, male \? 49, Female \? 51, age range 18 \? 35 years, with mean age of normotensive individuals 22.74\? 2.90 and mean age of hypertensive individuals were 27.70 \? 3.19 . Four different positions were used in this study: Sitting, Standing, Supine and supine with cross leg. Blood pressure measured by standardized mercury sphygmomanometer and MABP value was calculated as per formula. Results: Comparison of changes in MABP scores in different positions between hypertensive and normotensive individuals shows p \? value < 0.01 which were statistically significant. Conclusion: The study shows that there is significant difference of positions on MABP response between hypertensive and normotensive individuals. The study concluded that in standing position MABP is lower than other positions and supine position has higher MABP values.

Keywords: Hypertensive, Normotensive, Positions, MABP (mean arterial blood pressure)

Full Text:

INTRODUCTION
Blood pressure is the lateral pressure exerted on the wall of the vessels by the column of blood present in it. The maximum pressure, which occurs during systole, is called systolic pressure and the minimal pressure produced during diastole is called diastolic pressure. The difference between two pressures is called pulse pressure. The average of pressure produced during a cardiac cycle is known as mean pressure. It is calculated by taking the diastolic pressure and adding one third of pulse pressure. Systolic pressure ranges from 100 to 140 mm of Hg. With the average pressure of 120 mm of Hg. In adults, diastolic pressure ranges from 70 to 90 mm of Hg and the average is 80 mm of Hg. Pulse pressure is the difference between systolic and diastolic pressures and is 40 mm of Hg. The mean arterial blood pressure is 100 mm of Hg.1 The concept of stages of hypertension has been applied to define levels of blood pressure. Many clinicians have continued to use more descriptive terms such as ?mild,? ?moderate,? or ?severe? hypertension.

Therefore, to avoid confusion between physicians and patients regarding the risk associated with hypertension, it is best to describe the degree of blood pressure elevation using a staging system. When systolic and diastolic blood pressure fall into different categories, the higher stage should be used to classify the patient's blood pressure because both are independent risk factors for subsequent cardiovascular events.2 Hypertension is the most common diseasespecific reason for which Americans visit a physician. It is currently among the leading causes of morbidity and mortality in the world and is expected to have an even greater impact on the health of the public as more of the world becomes developed.3 In addition to the morbidity and mortality directly attributable to hypertension, high blood pressure is a powerful risk factor that in this case increases the likelihood that an individual or population will develop a wide variety of cardiovascular diseases 4,5,6,7,8 Movement from a supine or sitting position to standing causes a rapid loss of blood from the thoracic and abdominal cavities and pulling in extremities, reducing venous return and cardiac stroke volume.

Under normal conditions, this stimulates baroreceptors to active the sympathetic nervous system, leading to vasoconstriction and increased heart rate to maintain a stable blood pressure as parasympathetic nerve signals to the heart are withdrawn, thus causing short term blood pressure changes, although up regulation of sympathetic activity is necessary for regulation of blood pressure, hyper reactivity is associated with harmful effects, including the development of hypertension.9 A change in the body position from upright to the supine increases left ventricular blood filling with simultaneous stroke volume and cardiac output increases but decreases heart rate and arterial blood pressure.10 Orthostatic stresses are common daily events in humans. In the upright position, a gravitational displacement of blood from the thorax to the venous vascular beds of the legs, buttock and abdomen occurs. During orthostasis, approx. 600–700 ml of blood is transferred to the regions below the diaphragm 11, 12. Which is known as ?venous pooling‘ This results in a reduced venous return to the heart and a fall in central venous pressure with a consequent decrease in cardiac filling, stroke volume and cardiac output 13 . Gravity imposes numerous cardiovascular and neurohumoral adjustments on the human body in the standing position. Physiological adaptations mainly due to the effect of gravity occur during changes of position and can influence the symptoms of various diseases involving not only the circulatory system but also other systems (respiratory, digestive, osteoarticular etc).14 Posture affects blood pressure, with a general tendency for it to increase from the lying to the sitting or standing position.

However, in most people posture is unlikely to lead to significant error in blood pressure measurement provided the arm is supported at heart level. None the less, it is advisable to standardize posture for individual patients and in practice blood pressure is usually measured in the sitting position. 15 The indirect blood pressure measurement is perhaps the most frequently performed clinical procedure and important therapeutic decisions rely on its accuracy. However, its accuracy strongly depends both on the number of measurement and the circumstances during the procedure. Unfortunately, it is perhaps one of the most inaccurately performed procedures done by healthcare providers. 16 The position of the patient during the measurement is often neglected. The reference point for the measurement of the blood pressure is the right atrium, the so called ?heart level?.17 A change in posture is well known to cause changes in intravascular and intracardiac volumes and pressures, and in neurohumoral activity.18, 19, 20, 21 Thus, the impact of body positioning needs to be verified as significant heamodynamic variations may lead to different interpretation of the study.22, 23 Some of the identified sources of error included inappropriate cuff size, wrong arm position, failure to allow a rest period before taking blood pressure, deflating the cuff too rapidly, not measuring the BP in both arms, and failure to palpate for maximal- systolic pressure before auscultation. 24 It is known that failure to support the arm, even when the arm is in slightly flexed at the elbow and at heart level position‘ 25 can raise the blood pressure by as much as 10% this effect is even greater in hypertensive‘s and the patients taking b- blocker .26 By understanding how MABP varies in different body positions between the hypertensive and normotensive individual, physiotherapist can better advice on positional changes that may help in improve the stability of cardiovascular response in hypertensive patient. Keeping in view the above this study intended to examine the comparison of Mean arterial blood pressure in four different body positions between hypertensive and normotensive individuals and to find out the changes in MABP scores in various positions between hypertensive and normotensive individuals.

METHODOLOGY
In Observational study, A total of 100 individuals, 50 hypertensive and 50 normotensive. With age of 18 to 35 years were obtained. Before they enter into the study protocol, they were explained about the procedure. A written consent form obtained from those subjects who were willing to participate in the study after screening for the inclusion and exclusion criteria. Purposive sampling technique used to collect 100 subjects of both sexes in the age group of 18 – 35 years.

Inclusion Criteria:
(1) 50 hypertensives and 50 normotensive subjects in age group of 18 to 35 years (both male and female) (2) Person scoring 100 in 36 – SF questionnaire.28 (3) Hypertensive individual with mild grade (140/90 mm of Hg). (4) BMI 18.5 – 29 kg/m2

Exclusion Criteria:
(1) Individual with any cardiovascular problems or under medication, (2) Hypertensive individual with SBP≥140 mm of hg, and DBP ≥ 90 mm of hg. 3) Acute systemic illness (4) Recent history of postural hypotension. (5)Renal hepatic disease, severe anemia, hypothyroidism and cerebro vascular accident (6) After any abdominal surgery, hernia, (7) Pregnant women, (8) Smokers.

Procedure:
Subjects were instructed to wear loosen and comfortable clothing and not to eat food or do any exercise 1 hour before they start their procedure. Prior instructions about the procedure were given to each enrolled subject as explained below.

Positioning:
BP was taken in each of four different postures: supine, sitting, standing and supine with crossed leg.

Sitting:
Subjects sat on chair with arm and back support. The height of the seat was adjusted so that the angle of hip and knee joint was 90

Standing:
Subjects were instructed to stand free with feet slightly apart, aiming for an equal weight distribution between left and right feet.

Supine:
The subjects resting comfortably on their backs in horizontal position on a couch. A pillow was placed under the head.

Supine with crossed leg:
The subjects resting comfortably on their backs in horizontal position on a couch. A pillow was placed under the head. The subjects were instructed to cross the right leg in front of left leg at thigh level and relaxed.

Technique:-
Patient‘s profile was recorded and arm circumference was measured midway between the shoulder acromian and elbow. Systolic and diastolic blood pressure were recorded by using standardize sphygmomanometer and stethoscope from brachial artery at elbow as the appearance of the korotkoff sounds (phase 1 and 5). Firstly, sitting BP was taken from the left arm, which was flexed at the elbow and supported at the heart level on the chair. After 1 minute of standing BP was measured in standing with arm supported on desk or table. After 1 minute of rest in supine BP was measured. Finally, after 1 minute BP was again taken in the supine with crossed leg position. In all the position BP was measured 3 times and mean of 3 readings taken for calculate MABP. All the measurements were recorded separately in an evaluation chart for each subject. The Mean arterial Blood Pressure was obtaining by using this formula: MABP = DBP + (1/3 SBP – DBP)

RESULTS
Among the 100 subjects, 50 hypertensive and 50 normotensive individuals and their data were taken up for statistical Analysis. Analysis result shows that, among the normotensive individuals mean and standard deviation of MABP in sitting position is 88.14 ± 7.25, in standing position 86.00 ± 7.28, in supine position 90.76 ± 7.15, in supine with cross leg position 89.96 ± 7.12, by ANOVA and multiple comparison shows that, there is significant difference among the positions. Further value is less in standing position compare to sitting position compare to supine with cross leg position and compare to supine position. So supine position has higher value then other positions. Result shows that, among the hypertensive individuals mean and standard deviation of MABP in sitting position is 102.32 ± 3.95, in standing position 100.60 ± 4.07, in supine position 104.74 ± 3.84, in supine with cross leg position 103.96 ± 3.71, by ANOVA and multiple comparison shows that, there is significant difference among the positions. Further value is less in standing position compare to sitting position compare to supine with cross leg position and compare to supine position. So supine position has higher value then other positions. Result shows that, in sitting position hypertensive individual have significantly higher value with mean difference 14.48 compare to normotensive as p < 0.01, in standing position hypertensive individual has significantly higher value with mean difference 14.60 compare to normotensive as p < 0.01, in supine position hypertensive individual has significantly higher value with mean difference 13.98 compare to normotensive as p < 0.01, in supine with cross leg position hypertensive individual has significantly higher value with mean difference 14.00 compare to normotensive as p < 0.01. DISCUSSION Result of this study shows that in the supine position, a significantly higher MABP was observed compared to other positions in both hypertensive and normotensive individuals. Similarly lower MABP was observed in the standing position compared to other positions in hypertensive and normotensive individuals. The position of the body is known to affect the BP readings with BP increases successively from the supine to sitting and standing and standing position. One study shows that SBP and DBP were significantly higher in the supine position than in the sitting position.29 Results of this study supports the result of the present study. There is a theoretical basis and studies that suggest crossing leg may increase the blood pressure30, 31

The slowed pulse rate in the horizontal posture as compared with sitting, and quicker rate in standing as compared with sitting, squatting, depend on wholly different mechanisms and may vary independently. Variation in the cardiovascular parameter in sitting, standing and supine posture is associated with hydrostatic influence acting on the altered position of the thighs, horizontal or vertical in these postures. 32 A significant fall in BP can be prevented by a complex regulatory system comprising a series of neurohumoral mechanisms and cardiovascular reflexes that regulate peripheral vascular resistance and capacitance, stroke volume and HR, with BP as the controlled variable. This baroreceptor reflex plays a key role in this. 33 In present study blood pressure fluctuations more seen in the normotensive individuals then in the hypertensive individuals. Also hand placement for measuring blood pressure has major factor for error or fluctuations in various positions. As per world health organization and international society of hypertension guidelines on BP measurement recommend that BP should be measured routinely with patient‘s arm supported at heart level.34 so in this study also, hand position was kept at the heart level to avoid errors.

CONCLUSION:

The study shows that there is significant effect of positions on MABP between hypertensive and normotensive individuals. ? From the results obtained it concluded that standing posture having low MABP value than other positions and also supine has higher value in both normotensive and hypertensive individuals. Also sitting is the optimal position to measure the blood pressure in clinical practice. ? Thus, the study concluded that there are higher fluctuations in blood pressure in normotensive then in the hypertensive individuals.

ACKNOWLEDGEMENT
I acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. I am also grateful to authors/ editors/ publishers of all those articles, journal and books from where the literature for this article has been reviewed and discussed. A study in all its sense certainly can be accomplished by the guidance and assistance of many people. I take this opportunity to express my gratitude to all those who have helped me for completing this study successfully.

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A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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