# Pulse Pressure and Mean Arterial Pressure

When someone "takes a pulse," he or she palpates an artery (for example, the radial artery) and feels the expansion of the artery occur in response to the beating of the heart; the pulse rate is thus a measure of the cardiac rate. The expansion of the artery with each pulse occurs as a result of the rise in blood pressure within the artery as the artery receives the volume of blood ejected by a stroke of the left ventricle.

Since the pulse is produced by the rise in pressure from dia-stolic to systolic levels, the difference between these two pressures is known as the pulse pressure. A person with a blood pressure of 120/80 (systolic/diastolic) would therefore have a pulse pressure of 40 mmHg.

Pulse pressure = systolic pressure - diastolic pressure

No sounds

Cuff pressure = 140

First Korotkoff sounds

Cuff pressure = 120

Systolic pressure = 120 mmHg

Sounds at every systole

Cuff pressure = 100

Last Korotkoff sounds

Cuff pressure = 80

Diastolic pressure = 80 mmHg

Blood pressure = 120/80

■ Figure 14.29 The blood flow and Korotkoff sounds during a blood pressure measurement. When the cuff pressure is above the systolic pressure, the artery is constricted. When the cuff pressure is below the diastolic pressure, the artery is open and flow is laminar. When the cuff pressure is between the diastolic and systolic pressure, blood flow is turbulent and the Korotkoff sounds are heard with each systole.

Cuff pressure

No flow

Turbulent flow

Laminar flow

Systole

Blood pressure

Diastole

■ Figure 14.30 The indirect, or auscultatory, method of blood pressure measurement. The first Korotkoff sound is heard when the cuff pressure is equal to the systolic blood pressure, and the last sound is heard when the cuff pressure is equal to the diastolic pressure. The dashed line indicates the cuff pressure.

Cardiac Output, Blood Flow, and Blood Pressure

Blood flows during systole only (turbulent flow)

14 mmHg

20 mmHg

Snapping sounds

Murmurs

Relative intensity of sounds

t ol led

5 mmHg

5 mmHg

■ Figure 14.31 The five phases of blood pressure measurement.

Not all phases are heard in all people. The cuff pressure is indicated by the falling dashed line.

At diastole in this example, the aortic pressure equals 80 mmHg. When the left ventricle contracts, the intraventricular pressure rises above 80 mmHg and ejection begins. As a result, the amount of blood in the aorta increases by the amount ejected from the left ventricle (the stroke volume). Due to the increase in volume, there is an increase in blood pressure. The pressure in the brachial artery, where blood pressure measurements are commonly taken, therefore increases to 120 mmHg in this example. The rise in pressure from diastolic to systolic levels (pulse pressure) is thus a reflection of the stroke volume.

Clinical Investigation Clue

Remember that Charlie's pulse was weak.

What is the sequence of effects that caused Charlie's pulse to be weak?

The mean arterial pressure represents the average arterial pressure during the cardiac cycle. This value is significant because it is the difference between this pressure and the venous pressure that drives blood through the capillary beds of organs. The mean arterial pressure is not a simple arithmetic average because the pe-

nod of diastole is longer than the period of systole. Mean arterial pressure can be approximated by adding one-third of the pulse pressure to the diastolic pressure. For a person with a blood pressure of 120/80, for example, the mean arterial pressure would be approximately 80 + 1/3 (40) = 93 mmHg.

Mean arterial pressure = diastolic pressure + 1/3 pulse pressure

A rise in total peripheral resistance and cardiac rate increases the diastolic pressure more than it increases the systolic pressure. When the baroreceptor reflex is activated by going from a lying to a standing position, for example, the diastolic pressure usually increases by 5 to 10 mmHg, whereas the systolic pressure either remains unchanged or is slightly reduced (as a result of decreased venous return). People with hypertension (high blood pressure), who usually have elevated total peripheral resistance and cardiac rates, likewise have a greater increase in diastolic than in systolic pressure. Dehydration or blood loss results in decreased cardiac output, and thus also produces a decrease in pulse pressure.

An increase in cardiac output, by contrast, raises the systolic pressure more than it raises the diastolic pressure (although both pressures do rise). This occurs during exercise, for example, when the blood pressure may rise to values as high as 200/100 (yielding a pulse pressure of 100 mmHg).

### Test Yourself Before You Continue

1. Describe the relationship between blood pressure and the total cross-sectional area of arteries, arterioles, and capillaries. Describe how arterioles influence blood flow through capillaries and arterial blood pressure.

Explain how the baroreceptor reflex helps to compensate for a fall in blood pressure. Why will a person who is severely dehydrated have a rapid pulse?

Describe how the sounds of Korotkoff are produced and explain how these sounds are used to measure blood pressure. Define pulse pressure and explain the physiological significance of this measurement.