vey of lite haemoglobin le94-t. By

MATERIALS AND METHODS

sterol, cholesterol esters• Exper. Bioi. Med , 62: 2 fHE PATTERN OF BLOOD PRESSuRE OSCILLATIONS AND THEIR RELATION TO

y"'TuL~C \. D D1ASTOUC BLOOD PRESSURES IN HEALTHY ADULTS*

Am. J. Obst. GYIIl'C., 95; 3 V. K. MULGAONKER AND M.G. Go GATE

Department of Physiology, Goa Medical College, Panaji-Goae, M. E. Haggard, H. Davlood serum lipids in pregnan

INTRODUCTION

lipid studies in pregnancy,

Notwithstanding the fact that auscultatory method is most ideal for determining thesystolic and diastolic blood pressures, the palpatory and oscillatory methods are often taughtto the students. Oscillatory method is particularly valuable in conditions of shock witharterial spasm and in healthy infants, where the Korotkov sounds are not distinctly heard (5).In adults in which the diastolic pressure cannot be determined by the change in character ofthe sounds the oscillatory method is often used for this purpose.

g the menstrual cycle. Clin;

in Coronary sclerosis and

in levels during pregnancy.It has however been observed that there is no uniformity in descriptions regarding the

pattern of blood pressure oscillations and its utility in determining systolic and diastolicpressures in an individual. As different patterns were observed in the course of teaching itwas felt necessary to record such manometric oscillations. during the determination of bloodpressure in healthy human adults.

The study was performed in 67 healthy male and female medical students of the agegroup varying from 18 to 23 years. The subjects were allowed to rest in the recumbent posi-tion for 15 minutes. The systolic pressures were first roughly estimated by palpatory methodin every subject. Then three readings of systolic and diastolic pressures were taken by auscul-tatory methods at an interval of about 5 minutes. The sudden muffling of the sound wastaken as a criterion of the diastolic pressure (7). The mean ystolic and diastolic readingswere found out. Ludwig's mercury manometer was used for the recordings. The oscillationsof the mercury column were then recoi ded with the help of iloat on the slow moving kymograph.The pressure in the cuff was raised 20 mm of mercury above the systolic reading. It wasslowly reduced and the oscillations recorded throughout. Systolic and diastolic pressureswere marked on the drum paper during the course 0[' oscillations. In every case the tracings wererecorded till the level of mercury column reached about 20 mm below the diastolic pressureas determined by auscultatory method. The readings were taken in both the arms separatelyin every su bject.

"Received 3-9-]970

"0,

.'

276 Mulgaonker and Gogate October 1970Ind, J. Physiol. & Pharmac.

As the manometric oscillations have been found to be influenced by deep breathing(Fig 2) the subjects were specially asked to avoid the same.

RESULTS

In alll34 recordings were studied in 67 subjects. The various patterns of oscillationsobtained are shown in Fig. 1.

I'. r1;0 -

100

A

80

1> IQ st.ol',

140 [

120

100

1fO

60

Fig. 1It is observed that the blood pressure oscillations show a spindle-shaped pattern in all

the subjects irrespective of the level of systolic and diastolic pressures as determined by the aus-cu tatory method. In many subjects it was further observed that the patterns on the rightand left arms were not identical. This was confirmed on repeated readings. For this reasonreadings on both the sides were treated separately. Table 1 records the incidence of patternsin the readings thus studied.

TABLE I

Patterns 0/ manometric oscillations in 134 readings obtained in right and left arms in 67 subjects

Pattern No. of readings obtained.

Approximate percentage reading

ABC

771443

57.4610.4532.09

Fig. 2 records variations in oscillations during the respiratory phases when the subject was asked to takeslow and deep breaths.

Volume 14Nurnber'4

a.p, i

IItO

120

100

80

60

Variations ill blood pressure man

It is observed that themetric method as an index 0

ly at the level of systolic presdiastolic pressure had been tshowing a sudden increaseby palpation was taken as alations as detected by an os(5,8). It was however notmany subjects when the blooshow only a little changediastolic level at which theyoscillatory waves reach asize as the armlet pressure Cfurther influenced by respir

•

DISCUSSION

Pattern of Blood Pressure Oscillations in Healthy Adults 277

B

patterns of oscillations

FJg.2Variations ill blood press lire manometric oscillations during deep respirations-inspirations downward.

57.4610.4532.09

It is observed that there is no uniformity in statements regarding the validity of oscillo-metric method as an index of diastolic pressure. That the oscillations appear more prominent-ly at the level of systolic pressure and progressively increase reaching their maximum at thediastolic pressure had been the standard description (2,4,8). The blood pressure oscillationsshowing a sudden increase in amplitude together with appearance of radial pulse as detectedby palpation was taken as a criterion of systolic blood pressure. The first appearance of oscil-lations as detected by an oscillometer has also been considered as an index of systolic pressure(5,8). It was however noted in the present series that minute oscillations were observed inmany subjects when the blood pressure was kept above the systolic level. The oscillationsshow only a little change in magnitude as the pressure is slowly lowered till it reaches thediastolic level at which they suddenly become smaller (3,8). It is further documented that theoscillatory waves reach a maximum near the mean pressure and show a sudden reduction insize as the armlet pressure falls below the diastolic level (1,5,6). The size of fluctuations isfurther influenced by respirations (1). This has been confirmed during our studies (Fig. 2).

spindle-shaped pa ttern in allres as determined by the au

hat the patterns on the rightd readings. For this reasonds the incidence of patterns

pproximate percentage reading

278 Mulgaonker and Gogate October 1970Ind. J. Physiol. & Pl1armac.

Present study indicates that the oscillometric method cannot be treated as a reliable onefor determining the systolic or diastolic pressures. This is contrary to what is described insome of the standard text books. fn addition the influence of respiration on the oscillationsof the mercury column cannot be overlooked in drawing any conclusions.

SUMMARY AND CONCLUSIONS

The blood pressure manometric oscillations were recorded in 67 subjects during thedetermination of systolic and diastolic pressure in both arms saparately. Three main patternswere observed in the subjects studied. Many subjects showed different patterns in two arms.The oscillations were also observed to vary with respiratory phases. It is concluded that theos illatory method is not a good index of systolic or diastolic blood pressures.

ACK OWLEDGEMENT

Wc are grateful to the Dean, Goa Medical College for 'his encouragement andDr. (Mrs.) Jolly Mascarenhas for going through the manuscript.

REFERENCES

1. Bard Philip, Medical Physiology; St. Louis. The c.r, Mosby Company; 1961; 153.

2. Bell, G.H., J.N. Davidson and H. Scareborough. Textbook of Physiology andBiochemistry, Edinburgh; E. and S. Livingstone Ltd., 1963.480.

3. Best, C.H., and N.B.Tailor. The Physiological Basis of Medical Practice;Calcutta; Scientific Book Agency, 1966; 727.

4. Davson, H. and M.G. Eggleton. Principles of Human Physiology, London; J. and A.Churchill Ltd., 1962; 195.

5. Guy ton. A.C. Textbook of lcdical Physiology. Philadelphia; WB. Sounders COlI/-

pally. 1965; 362.6. Houssay, B.A. Human Physiology. New York; Me Grow-Hill Book Companyi lnc;

1955, 183.7. Moss. A.J. and F. Adarns. Muffling Versus Complete Cessation of Vascular sounds

as an index of c1iastolic blood pre me. Circulation. 28. 773; 1963.

8. Sodernan, W.A. Paiholog ic Physiology-Mechanism of Disease, Philadelphia;11'.n. Sounders Company; 1%3, 365.

Department of Physiology,

GROWTH PATTERNS ANGRA

The attainable body mOyama and Platt (1) to begravity environment by centriSo far experimental studies ofvarious physiological responexposed to simulated changes

The present studies weand reproduction characterist

Male and female alibtaken for the study. Only 0

28 cm radius centrifuge at aouter cages and 12 cm. frocages (inner and outer onetime to be kept. The animalrespectively as shown in Tablonly scheduled times as shosingle rat were suspended byassumed a final position suevertical to the cage floor. Nday light. Water and feedperiod of six months. Thethe potential changes in thecentrifugation.

A t the end of the exfollowing organs: ovaries (riadrenals (right and left) were--------------------~*Received 22.9.1970.*·Present Address: Department

Ludhiana.