Wearing a Blood Pressure Monitor Assignment Sample

Wearing a Blood Pressure Monitor Assignment

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Introduction - Wearing a Blood Pressure Monitor

A blood pressure monitor is a tool for measuring the blood pressure levels of an individual. It measures the systolic, diastolic, and average pressure of the arteries. The importance of using blood pressure monitors is in the prevention of hypertension or high blood pressure levels and the prevention of hypotension or low blood pressure levels. Early detection of high blood pressure should be done and treatment of that disease should be done at the early stages. Sometimes, there are no visible symptoms for inspecting the high or low blood pressure levels which are also called silent killers. A blood pressure monitor can be measured by both invasive and non-invasive processes. The invasive process deals with the piercing method and hence it is easy to use. The non-invasive process possesses a pressure sensor instead of mercury level to measure the blood pressure level and is called a Sphygmomanometer.

Objective
The objective for using a blood pressure monitor is
? To get the measurement of blood pressure levels of a body
? To prevent an individual from facing any kinds of health care complications.
? To measure the systolic, diastolic, and arterial pressures
? To prevent an individual from facing low blood pressure that can further lead to dangerous diseases like Down’s syndrome.
? To keep the balance of the blood pressures of a body

This blood pressure monitor makes use of certain parameters such as cardiac output, vascular resistance of the system, and critical pressure for closing at the arteriole level.
Discussion
Initial Concept
A blood pressure monitor gives a clear-cut idea about the conditions or risks of an individual's heart. It varies from person to person. This analysis will help an individual to keep their pressure in a stable condition (Arakawa, et al. 2018). If a patient's high blood pressure or hypertension is left untreated then there may be a severe health problem in the body leading to dangerous outcomes like stroke, heart attack, etc. Conversely, if a patient's low blood pressure or hypotension is left untreated then it may lead to outcomes like dizziness, weakness, fainting, etc. when the brain, heart, and other organs of the body don't get enough blood supply and they don't work properly.


Figure 1: Blood Pressure Range
(Source: https://www.heart.org)

Blood pressure can be measured while a person is awake or in sleep. A sphygmomanometer acts as the "gold standard" for measuring blood pressure. But their use in offices or hospitals has diminished as there is a ban on the use of mercury devices. So, instead of using mercury devices, alternative methods like automated electronic devices are used. It uses the oscillometric method for measuring (Connolly, et al. 2020). The blood pressure is measured from the upper arm. The unit for measuring blood pressure is millimeters of mercury (mm Hg). The readings are determined in pairs with the upper (systolic) value, followed by the lower (diastolic) value.

For example, if any person is having a reading of 128/80 mm Hg (often spoken as “128 over 80”)
? Systolic Blood Pressure of 128 mm Hg and
? Diastolic Blood Pressure of 80 mm Hg

The normal blood pressure for male and female are hereby notified in a tabular format below.

Table 1: Normal Blood Pressure Level (Age-wise)
(Source: MS-Word)
Engineering Features
A digital blood pressure monitor, a battery-generated air pump, an inflatable rubber cuff, and a pressure sensor to sense the vibrations in the walls of the artery to measure arterial blood pressure. They are of two types - the upper arm model and the wrist model. The measurement procedure is the same for both models (Dixon, et al. 2020). In the upper-arm model, the cuff is connected to the monitor that should be rested on a nearby platform of the upper arm through a tube. In the wrist model, the whole unit envelopes around the wrist and is smaller in size than the upper-arm model. The blood pressure monitor is surrounded in the upper arm or wrist of a person with an inflatable cuff which is inflated using an air pump to give enough pressure to prevent the flow of blood in the principal artery. Then the given pressure is released using a solenoid valve which is digitally controlled till the beginning of flowing of the blood through the artery.

Figure 2: Functional diagram of Blood Pressure Monitor
(Source: https://techblog.livongo.net)

Figure 3: Blood Pressure Monitor Module comprising of an air pump, air valve, and pressure sensor
(Source: https://techblog.livongo.net)
Measurement System
The pressure sensor at this point measures the systolic pressure. At this time, the pulse rates are also determined. When the blood flow is no longer restricted, then the reading of diastolic pressure is taken. This whole process of measurement is automatically controlled by the microcontroller (Golbus, et al. 2021). Before the conversion of data through an analog-to-digital converter (ADC), the signal emitted from the pressure sensor is conditioned with an instrumental amplifier. Depending on the type of monitor and sensor used, the systolic pressure, diastolic pressure, and pulse rate are calculated using a proper algorithm in the digital domain. Then all the calculations are displayed in a Liquid Crystal Display (LCD), marked with time and date, and are kept in non-volatile memory.
User Interface (UI)
Blood pressure monitors use a plain monochromatic LCD with a maximum of 100 segments and can be driven by the driver which is integrated within the micro-controller. By using one or more white LEDs backlighting can be appended (Kario, et al. 2020). One or multiple numbers of physical pushbuttons are used to switch on or off and start taking the measurement. A hi-tech blood pressure monitor may use a color LCD with a touch screen to enable UIs like touchable menus, virtual buttons on-screen, graphics, animation, etc. The use of simple beepers can add audible power to a BP monitor by using one or two-port pins of a microcontroller with the ability of pulse-width modulation (PWM). Digital-to-analog converters and amplified speakers can be used for the advancement of audible notifications.
Connection
Nowadays, among young users, connectivity, data aggregation of health, and sharing are the latest trends in the digital health space of consumers. To track measurements over time, connected BP monitors are used with the ability to upload data to a PC or Smartphone (Tomitani, et al. 2021). This can be done using the Universal Serial Bus (USB) interface or Bluetooth Low Energy (BLE) link of the radio. Without making use of any type of device the advanced technology uses WiFi or cellular wireless networking for uploading data.
Management of Power
Four AA or AAA (1.5 V) alkaline batteries are used for an upper-arm BP monitor and two AAA alkaline batteries are used for wrist BP monitors. A rechargeable Li-Ion battery and a plug-in charger can be used for hi-tech BP monitors. Depending on the used technology, the air pump of the monitor and analog circuit needs a 5V or 3.3V supply and the digital circuit needs a 3.3V or 1.8V power supply (Khaddage, et al. 2021). BP monitor requires a switching regulator for regulating the air pump or analog supply voltage to 5V and for the 3.3V or 1.8V digital requirement, a low-drop linear regulator (LDO) is used. An automatic power shut down after a certain inactivity period may be implemented to extend the battery life. To inspect the current time when the monitor is turned off, a real-time clock (RTC) may be switched on.
Exp¬ected Behavior
The usage of hi-end technologies to make an efficient blood pressure monitor tremendously helps in being aware of the risks related to a person's heart and helps the patients to further control the low and high blood pressure levels (Eom, et al. 2020). Factors that can affect blood pressure measurements are -
Exercise - Through exercise, there may be a high rise in the level of blood pressure. So, it is advised to avoid measuring after exercise. One can take measurements before exercising to get a proper reading. One can take measurements before exercising to get a proper reading. Studies have shown that it can increase the blood pressure reading 10-20 mm Hg.
Meals - A person should take measurements before having breakfast or 30 minutes after having breakfast. Digestion of food can lower down the blood pressure level. It can impact the systolic blood pressure 10-20 mm Hg.
Latrine - There can be an elevation in the blood pressure reading if the urinary bladder is full. It is advised to take measurements after peeing. On the other hand, when the bladder is empty the blood pressure level is low. The blood pressure reading rises up gradually when the bladder starts to fill. When a person is having a full bladder then according to the studies it has been seen that the blood pressure measurement will have an increment of 10-15 mm Hg. It is advised to take measurements after peeing.
Cuff Size - Knowing the position of the cuff in the upper arm or wrist is the most important thing before using the kit (Kim, et al. 2018). If the cuff is not properly fitted to the upper arm or wrist then there may be a chance of getting the inappropriate measurement. The doctor can advise a person how to fit the cuff properly and set it in the proper place to get the best results. It is advised to take enough time to check whether the circumference of the patient’s arm falls within the indicators of range on the cuff. This may cause a temporary increase in the systolic blood pressure level from 10-40 mm Hg.
Clothing - There may be an inappropriate reading when a person wraps the cuff over the clothing. It is required to put the kit on bare skin to get proper results. Either a person can take off the shirt or can pull his arms from the sleeves by rolling them back. It can impact the systolic pressure from 10-50 mm Hg.
Temperature - If the temperature of a person is very low then the monitor will give an unexpected higher reading. It is advised not to keep the room temperature of the pathology, clinic or home chilly.
Position - For getting appropriate and compatible results, a person should maintain the same arm position. The upper arm should be rested on a table or a chair-arm at the level of the heart (Patil, et al. 2019, June). The backbone should be straight and supported on a chair and the legs should not be crossed. An increment of diastolic blood pressure of 6 mm Hg can be seen if the backbone is not supported. Leg crossing has shown an increment of 2-8 mm Hg. The positioning of the upper arm lower to the heart level will show higher measurements and positioning of the upper arm higher to the heart level will show lower measurements. The differences in the positioning of the upper arm may increase or decrease the level by 2 mm Hg for every inch displacement.
Stress - The person needs to avoid thoughts that are stressful and should rest in a comfortable position for 5 minutes before taking measurements (Zhang, et al. 2017). This will help to get an accurate reading for the blood pressure measurement. This happens if the person is in the emotional state of stress or anxiety.
Talking - While taking blood pressure readings, it is advised not to have any conversation with the person next to them. It can increase the blood pressure level. The systolic blood pressure may increase up to 10-15 mm Hg.
Smoking - Cigarettes, cigars, etc. all of these tobacco items cause temporary increases in blood pressure level. The person who is a smoker should hold back for 30 minutes without smoking and then take the reading for blood pressure measurement.
Alcohol or Caffeine - Consumption of alcohol and Caffeine products such as tea, coffee, soda etc. put an end to the blood pressure levels. So, it is advised by all the physicians to avoid alcohol or caffeine 30 minutes before measurement.
Most people are unaware of the fact that the blood pressure reading changes from time to time responding to mood, action, environment, position of the body etc. These types of simple changes can bring fluctuation in reading of 5 mm Hg and 40 mm Hg.

Societal Implications
In society, blood pressure monitoring helps to evaluate the general health conditions of a person. It is not only a tool to necessarily indicate whether a person will have heart disease or not but it helps the doctors to manage a patient's health. Blood pressure monitoring is very important in a person’s life because without blood pressure the tissues and organs will not be pushed with the oxygen and nutrients for nourishment (Melville, et al. 2018). It is a vital activity to monitor blood pressure as it transports the White Blood Cells (WBC) and antibodies for gaining immunity. It also delivers hormones like insulin. The normal guideline for blood pressure is less than 120/80 mm Hg in adults. The response in blood pressure measurement changes with situations (Tian, et al. 2020). There is a temporary rise in response to exhausting activities or a temporary fall in the response during sleeping or relaxing. Blood pressure monitoring can take place at home on a regular basis, at a doctor's appointment, and in hospital continuously if there are any critical health care complications.
During invasive blood pressure monitoring, the person will feel pressure as the cuff inflates but pressure vanishes while the cuff deflates. This monitoring is not painful. But during Intra Arterial Pressure (IAP), the doctors insert a catheter or tube in the artery to take the blood pressure readings from the arteries. This is a procedure to take readings from critical patients by using a local anesthetic to insensible the area where the catheter is placed in the artery (Undiyaundeye, et al. 2021). As a treatment, sedative medications are provided to comfort the patient from pain. Blood pressure monitoring plays an immense important role in society.

Literature Review
Literature review gives a brief description of the research and investigation of the literature available in the topic given. This is a survey of successful scholarly sources, books etc. which helps to provide the overview of the topic (Hui, et al. 2019). Literature review discusses the goals and purposes of a study of the statement of thesis papers that are published in journals or books or any other scholarly articles and gives a summary of the critical evaluation in the context of the research problem provided. This literature review describes the different published works related to the wearing of different types of blood pressure monitors.
According to the author, Mitsuo Kuwabara PhD, 24th May 2020, the research aimed at the validation of the accuracy of Omron HEM - 9601T. It is a device with a function of timer for measuring nocturnal blood pressure automatically and can be worn on the wrist. This research is according to the “American National Standards Institute / Association for the Advancement of Medical Instrumentation / International Organization for Standardization (ANSI/AAMI/ISO) 81060 - 2:2013 guidelines”. The performance of the blood pressure monitor is examined while a person is in the supine position by applying the same method for the position of sitting (Kuwabara, et al. 2020). It has been concluded that the criteria for validation of ANSI/AAMI/ISO 81060-2:2013 guidelines were fulfilled by the blood pressure monitor model Omron HEM - 9601T. It worked properly when it was used on a person with the wrist placed at the level of the heart and was sitting in a position and the accuracy of the reading taken in supine position was almost equivalent to that of the reading taken in sitting position. Hence it has been seen from the study that it is more suitable to make use of wrist models for measuring blood pressure rather than using upper-arm models. It will help to improve the surety of diagnosis and manage the night time hypertension of a patient.
According to the author, Takeshi Otsuki, March 2017, increase in blood pressure while exercising will lead to cardiovascular diseases in future. In spite of having dissimilarities outdoor exercise which are practical and the test of exercise through lab setting, there is minimum knowledge about the changes in Systolic Blood Pressure while doing outdoor exercises. It has been found that during outdoor walking which is own paced and temperature relationship can change the systolic blood pressure reading. The concerned subjects were set to walk randomly at own pace outdoor, having a wearable blood pressure wrist monitor. Systolic Blood Pressure increases while walking than at rest and was higher on the mark of 1 kilometer than both the marks of 2 kilometers and 3 kilometers. Systolic blood pressure at the mark of 1 km was greater for the group with lower temperature than the groups with higher and intermediate temperatures which are not dependent on the systolic blood pressure at rest, intensity of walking, and body mass index. From the studies it can be concluded that elevation in systolic blood pressure shows a rise in days having low temperature and for mark of 1 kilometer than for marks of 2 kilometers and 3 kilometers, it is higher. A doctor advises not to take the readings of blood pressure on days with low temperature to diminish the systolic blood pressure response while the subject is on the onset of walking.

Conclusion
To conclude that measurement of blood pressure is the most commonly performed task in the clinics and it should be done with utmost care. The causes of misleading readings are stated in the above discussions. Special care should be taken while using mercury sphygmomanometers as mercury is a toxic substance. Automatic blood pressure monitors will replace mercury over time. While taking the measurements from different age groups such as children, an obese, elderly and pregnant woman special consideration needs to be taken. Blood pressuring monitoring should be done continuously to prevent any person from facing healthcare complications.

 
References
Journals
Arakawa, T., 2018. Recent research and developing trends of wearable sensors for detecting blood pressure. Sensors, 18(9), p.2772.

Connolly, E.L., Bodoni, C.P., Sim, M., Radavelli-Bagatini, S., Croft, K.D., Boyce, M.C., James, A.P., Clark, K., Anomy, R., Bodoni, N.P. and Woodman, R.J., 2020. A randomized controlled crossover trial investigating the short-term effects of different types of vegetables on vascular and metabolic function in middle-aged and older adults with mildly elevated blood pressure: the Vegetables for vascular health (VESSEL) study protocol. Nutrition journal, 19, pp.1-11.

Dixon, D.L., Patterson, J.A., Gate wood, S., Kefir, T., Abdallah, J., Curtis, M., Hawkeye, L., Grigsby, J., Salgado, T.M. and Hold ford, D.A., 2020. Development and feasibility of a community pharmacy–driven 24-hour ambulatory blood pressure monitoring service. Journal of the American Pharmacists Association, 60(6), pp.e332-e340.

Globus, J.R., Pescadores, N.A., Nallamothu, B.K., Shah, N. and Kheterpal, S., 2021. Wearable device signals and home blood pressure data across age, sex, race, ethnicity, and clinical phenotypes in the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) study: a prospective, community-based observational study. The Lancet Digital Health, 3(11), pp.e707-e715.

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Kari, K., Titian, N., Morimoto, T., Kanga, H., Lacy, P. and Williams, B., 2021. Relationship between blood pressure repeatedly measured by a wrist-cuff oscillometric wearable blood pressure monitoring device and left ventricular mass index in working hypertensive patients. Hypertension Research, pp.1-10.

Khaddage, S.J., Patterson, J.A., Sargent, L.J., Price, E.T. and Dixon, D.L., 2021. Sex and age differences in ambulatory blood pressure monitoring tolerability. American Journal of Hypertension, 34(4), pp.335-338.

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