Basic Blood Pressure Question

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Specializes in ER, Medicine.

My patient has been having diastolic pressures in the 50s and 40s throughout her stay. She gets very anxious about this low reading. Last time I checked she was 121/40. Prior to that she was 120/43. She's asymptomatic. Is this anything I should be especially concerned about?

Just a brief note, she's here for pneumonia and has history of ESRD and DM. She's in her late 60s early 70s.

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Specializes in Adult Cardiac surgical.

There are numerous reasons why one would have low diastolic pressures. A common reason is being fluid depleted. Often giving volume will increase the diastolic pressure.

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sometimes, in the elderly, the DBP seems to drop r/t the rigidity of the blood vessels....do you, perhaps have very good hearing?

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Specializes in CTICU.

Explain mean blood pressure to her. Hers is 66 which is fine.

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Specializes in Aged Care.

Hi there. Sorry to butt in but I'm also curious. What about her pulse pressure?

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Specializes in Emergency Room, Step-down Unit.
Hi there. Sorry to butt in but I'm also curious. What about her pulse pressure?

Her pulse pressure was 81 at the first reading (121 systolic - 40 diastolic = 81). This tells you that her left ventricle is doing a very good job. Her MAP was 67 at that reading. Well within limits to provide normal perfusion, although 70-110 is considered a "normal" value.

As one of the other posters stated, she could be a little fluid depleted though.

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Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.

Evidently, let's start some IV's STAT:cool:

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Specializes in chemical / ETOH dependence.

I used to work with a doc who would tell his patients to drink tomato juice to increase diastolic. Seen it help many times.

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Specializes in CTICU.

Yes, it's got a lot of sodium in it, which leads to increased fluid volume.

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Specializes in critical care, home health.

You said she has ESRD; is she on dialysis? HD can do whonky things to your blood pressure.

Since she's a renal patient and she's asymptomatic, reassure her (over and over again, if necessary) that this reading is fine for her. Blood pressure is a highly personal thing. I have patients on whom, if I were to get a "normal" blood pressure reading, would cause me to be extremely concerned! It all depends on the patient.

Like ghillbert pointed out, the MAP is the most important thing anyway. Giving fluids is definitely NOT recommended for a renal patient, generally. What's important is that her pressure is adequate to keep her perfusing. And if she's awake and able to express her concern about it, she's perfusing.

If this was my patient, I'd address the anxiety issue. So often, patients (and families!) cling to the "numbers" and totally freak out about the numbers. We've all had families who fixate on some number- usually the temperature- and just panic out if it's not 98.6. Some reassurance and honest communication can go a very long way.

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Specializes in ER, Medicine.

Thank you guys for your responses and input. It gave me some more perspective on the situation. Since I have this lady again tonight, I feel more prepared this time! Thanks!:yeah:

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