Blood pressure Essay Example for Free (#2)

Blood pressure Essay Blood pressure (BP), sometimes referred to as arterial blood pressure, is the pressureexerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, â€Å"blood pressure† usually refers to thearterial pressure of the systemic circulation. During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure.[1] The blood pressure in the circulation is principally due to the pumping action of the heart.[2] Differences in mean blood pressure are responsible for blood flow from one location to another in the circulation. The rate of mean blood flow depends on the resistance to flow presented by the blood vessels. Mean blood pressure decreases as the circulating blood moves away from the heart through arteries and capillaries due to viscous losses of energy. Mean blood pressure drops over the whole circulation, although most of the fall occurs along the small arteries and arterioles.[3] Gravity affects blood pressure via hydrostatic forces (e.g., during standing) and valves in veins, breathing, and pumping from contraction of skeletal muscles also influence blood pressure in veins.[2] The measurement blood pressure without further specification usually refers to the systemic arterial pressure measured at a person’s upper arm and is a measure of the pressure in the brachial artery, major artery in the upper arm. A person’s blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure and is measured in millimetres of mercury (mmHg), for example 120/80. The table on the right shows the classification of blood pressure adopted by the American Heart Association for adults who are 18 years and older.[4] It assumes the values are a result of averaging blood pressure readings measured at two or more visits to the doctor.[6][7] In the UK, blood pressures are usually categorised into three groups: low (90/60 or lower), high (140/90 or higher), and normal (values above 90/60 and below 130/80).[8][9] While average values for arterial pressure could be computed for any given population, there is often a large variation from person to person; arterial pressure also varies in individuals from moment to moment. Additionally, the average of any given population may have a questionable correlation with its general health; thus the relevance of such average values is equally questionable. However, in a study of 100 human subjects with no known history of hypertension, an average blood pressure of 112/64 mmHg was found,[10] which are currently classified as desirable or â€Å"normal† values. Normal values fluctuate through the 24-hour cycle, with highest readings in the afternoons and lowest readings at night.[11][12] Various factors, such as age and sex influence average values, influence a person’s average blood pressure and variations. In children, the normal ranges are lower than for adults and depend on height.[13] As adults age, systolic pressure tends to rise and diastolic tends to fall.[14] In the elderly, blood pressure tends to be above the normal adult range,[15] largely because of reduced flexibility of the arteries. Also, an individual’s blood pressure varies with exercise, emotional reactions, sleep, digestion and time of day. Differences between left and right arm blood pressure measurements tend to be random and average to nearly zero if enough measurements are taken. However, in a small percentage of cases there is a consistent difference greater than 10 mmHg which may need further investigation, e.g. for obstructive arterial disease.[16][17] The risk of cardiovascular disease increases progressively above 115/75 mmHg.[18] In the past, hypertension was only diagnosed if secondary signs of high arterial pressure were present, along with a prolonged high systolic pressure reading over several visits. Regarding hypotension, in practice blood pressure is considered too low only if noticeable symptoms are present.[5] Clinical trials demonstrate that people who maintain arterial pressures at the low end of these pressure ranges have much better long term cardiovascular health. The principal medical debate concerns the aggressiveness and relative value of methods used to lower pressures into this range for those who do not maintain such pressure on their own. Elevations, more commonly seen in older people, though often considered normal, are associated with increased morbidity and mortality. There are many physical factors that influence arterial pressure. Each of these may in turn be influenced by physiological factors, such as diet, exercise, disease, drugs or alcohol, stress, obesity, and so-forth.[20] †¢ Volume of fluid or blood volume, the amount of blood that is present in the body. The more blood present in the body, the higher the rate of blood return to the heart and the resulting cardiac output. There is some relationship between dietary salt intake and increased blood volume, potentially resulting in higher arterial pressure, though this varies with the individual and is highly dependent on autonomic nervous system response and the renin-angiotensin system.[21][22][23] †¢ Resistance. In the circulatory system, this is the resistance of the blood vessels. The higher the resistance, the higher the arterial pressure upstream from the resistance to blood flow. Resistance is related to vessel radius (the larger the radius, the lower the resistance), vessel length (the longer the vessel, the higher the resistance), blood viscosity, as well as the smoothness of the blood vessel walls. Smoothness is reduced by the build up of fatty deposits on the arterial walls. Substances called vasoconstrictors can reduce the size of blood vessels, thereby increasing blood pressure. Vasodilators (such as nitroglycerin) increase the size of blood vessels, thereby decreasing arterial pressure. Resistance, and its relation to volumetric flow rate (Q) and pressure difference between the two ends of a vessel are described by Poiseuille’s Law. †¢ Viscosity, or thickness of the fluid. If the blood gets thicker, the result is an increase in arterial pressure. Certain medical conditionscan change the viscosity of the blood. For instance, anemia (low red blood cell concentration), reduces viscosity, whereas increased red blood cell concentration increases viscosity. It had been thought that aspirin and related â€Å"blood thinner† drugs decreased the viscosity of blood, but instead studies found[24] that they act by reducing the tendency of the blood to clot. In practice, each individual’s autonomic nervous system responds to and regulates all these interacting factors so that, although the above issues are important, the actual arterial pressure response of a given individual varies widely because of both split-second and slow-moving responses of the nervous system and end organs. These responses are very effective in changing the variables and resulting blood pressure from moment to moment. Moreover, blood pressure is the result of cardiac output increased by peripheral resistance: blood pressure = cardiac output Xperipheral resistance. As a result, an abnormal change in blood pressure is often an indication of a problem affecting the heart’s output, the blood vessels’ resistance, or both. Thus, knowing the patient’s blood pressure is critical to assess any pathology related to output and resistance. The mean arterial pressure (MAP) is the average over a cardiac cycle and is determined by the cardiac output (CO), systemic vascular resistance (SVR), and central venous pressure (CVP),[25] Curve of the arterial pressure during one cardiac cycle The up and down fluctuation of the arterial pressure results from the pulsatile nature of thecardiac output, i.e. the heartbeat. The pulse pressure is determined by the interaction of thestroke volume of the heart, compliance (ability to expand) of the aorta, and the resistance to flow in the arterial tree. By expanding under pressure, the aorta absorbs some of the force of the blood surge from the heart during a heartbeat. In this way, the pulse pressure is reduced from what it would be if the aorta wasn’t compliant.[26] The loss of arterial compliance that occurs with aging explains the elevated pulse pressures found in elderly patients. The pulse pressure can be simply calculated from the difference of the measured systolic and diastolic pressures,[26] The arm–leg (blood pressure) gradient is the difference between the blood pressure measured in the arms and that measured in the legs. It is normally less than 10 mmHg,[27] but may be increased in e.g. coarctation of the aorta.[27] The larger arteries, including all large enough to see without magnification, are conduits with low vascular resistance (assuming no advanced atherosclerotic changes) with high flow rates that generate only small drops in pressure. The smaller arteries and arterioles have higher resistance, and confer the main drop in blood pressure along the circulatory system. Modern physiology developed the concept of the vascular pressure wave (VPW). This wave is created by the heart during the systoleand originates in the ascending aorta. Much faster than the stream of blood itself, it is then transported through the vessel walls to the peripheral arteries. There the pressure wave can be palpated as the peripheral pulse. As the wave is reflected at the peripheral veins, it runs back in a centripetal fashion. When the reflected wave meets the next outbound pressure wave, the pressure inside the vessel rises higher than the pressure in the aorta. This concept explains why the arterial pressure inside the peripheral arteries of the legs and arms is higher than the arterial pressure in the aorta,[28][29][30] and in turn for the higher pressures seen at the ankle compared to the arm with normal ankle brachial pressure index values. The endogenous regulation of arterial pressure is not completely understood, but the following mechanisms of regulating arterial pressure have been well-characterized: †¢ Baroreceptor reflex: Baroreceptors in the high pressure receptor zones detect changes in arterial pressure. These baroreceptors send signals ultimately to the medulla of the brain stem, specifically to the Rostral ventrolateral medulla (RVLM). The medulla, by way of the autonomic nervous system, adjusts the mean arterial pressure by altering both the force and speed of the heart’s contractions, as well as the total peripheral resistance. The most important arterial baroreceptors are located in the left and rightcarotid sinuses and in the aortic arch.[31] †¢ Renin-angiotensin system (RAS): This system is generally known for its long-term adjustment of arterial pressure. This system allows the kidney to compensate for loss in blood volume or drops in arterial pressure by activating an endogenous vasoconstrictorknown as angiotensin II. †¢ Aldosterone release: This steroid hormone is released from the adrenal cortex in response to angiotensin II or high serum potassiumlevels. Aldosterone stimulates sodium retention and potassium excretion by the kidneys. Since sodium is the main ion that determines the amount of fluid in the blood vessels by osmosis, aldosterone will increase fluid retention, and indirectly, arterial pressure. †¢ Baroreceptors in low pressure receptor zones (mainly in the venae cavae and the pulmonary veins, and in the atria) result in feedback by regulating the secretion of antidiuretic hormone (ADH/Vasopressin), renin and aldosterone. The resultant increase inblood volume results an increased cardiac output by the Frank–Starling law of the heart, in turn increasing arterial blood pressure. These different mechanisms are not necessarily independent of each other, as indicated by the link between the RAS and aldosterone release. Currently, the RAS is targeted pharmacologically by ACE inhibitors and angiotensin II receptor antagonists. The aldosterone system is directly targeted by spironolactone, an aldosterone antagonist. The fluid retention may be targeted by diuretics; the antihypertensive effect of diuretics is due to its effect on blood volume. Generally, the baroreceptor reflex is not targeted in hypertensionbecause if blocked, individuals may suffer from orthostatic hypotension and fainting. A medical student checking blood pressure using a sphygmomanometer and stethoscope. Arterial pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure.[32] Blood pressure values are generally reported in millimetres of mercury (mmHg), though aneroid and electronic devices do not use mercury. For each heartbeat, blood pressure varies between systolic and diastolic pressures. Systolic pressure is peak pressure in the arteries, which occurs near the end of the cardiac cyclewhen the ventricles are contracting. Diastolic pressure is minimum pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood. An example of normal measured values for a resting, healthy adult human is 120 mmHgsystolic and 80 mmHg diastolic (written as 120/80 mmHg, and spoken [in the US and UK] as â€Å"one-twenty over eighty†). Systolic and diastolic arterial blood pressures are not static but undergo natural variations from one heartbeat to another and throughout the day (in a circadian rhythm). They also change in response to stress, nutritional factors, drugs, disease, exercise, and momentarily from standing up. Sometimes the variations are large. Hypertension refers to arterial pressure being abnormally high, as opposed to hypotension, when it is abnormally low. Along with body temperature, respiratory rate, and pulse rate, blood pressure is one of the four main vital signs routinely monitored by medical professionals and healthcare providers.[33] Measuring pressure invasively, by penetrating the arterial wall to take the measurement, is much less common and usually restricted to a hospital setting. The noninvasive auscultatory and oscillometric measurements are simpler and quicker than invasive measurements, require less expertise, have virtually no complications, are less unpleasant and less painful for the patient. However, noninvasive methods may yield somewhat lower accuracy and small systematic differences in numerical results. Noninvasive measurement methods are more commonly used for routine examinations and monitoring. A minimum systolic value can be roughly estimated by palpation, most often used in emergency situations, but should be used with caution.[34] It has been estimated that, using 50% percentiles, carotid, femoral and radial pulses are present in patients with a systolic blood pressure > 70 mmHg, carotid and femoral pulses alone in patients with systolic blood pressure of > 50 mmHg, and only a carotid pulse in patients with a systolic blood pressure of > 40 mmHg.[34] A more accurate value of systolic blood pressure can be obtained with a sphygmomanometer and palpating the radial pulse.[35] The diastolic blood pressure cannot be estimated by this method.[36] The American Heart Association recommends that palpation be used to get an estimate before using the auscultatory method. Auscultatory method aneroid sphygmomanometer with stethoscope Mercury manometer The auscultatory method (from the Latin word for â€Å"listening†) uses a stethoscope and asphygmomanometer. This comprises an inflatable (Riva-Rocci) cuff placed around the upperarm at roughly the same vertical height as the heart, attached to a mercury or aneroidmanometer. The mercury manometer, considered the gold standard, measures the height of a column of mercury, giving an absolute result without need for calibration and, consequently, not subject to the errors and drift of calibration which affect other methods. The use of mercury manometers is often required in clinical trials and for the clinical measurement of hypertension in high-risk patients, such as pregnant women. A cuff of appropriate size is fitted smoothly and snugly, then inflated manually by repeatedly squeezing a rubber bulb until the artery is completely occluded. Listening with the stethoscope to the brachial artery at the elbow, the examiner slowly releases the pressure in the cuff. When blood just starts to flow in the artery, the turbulent flow creates a â€Å"whooshing† or pounding (first Korotkoff sound). The pressure at which this sound is first heard is the systolic blood pressure. The cuff pressure is further released until no sound can be heard (fifth Korotkoff sound), at the diastolic arterial pressure. The auscultatory method is the predominant method of clinical measurement.[37] The oscillometric method was first demonstrated in 1876 and involves the observation of oscillations in the sphygmomanometer cuff pressure[38] which are caused by the oscillations of blood flow, i.e., the pulse.[39] The electronic version of this method is sometimes used in long-term measurements and general practice. It uses a sphygmomanometer cuff, like the auscultatory method, but with an electronic pressure sensor (transducer) to observe cuff pressure oscillations, electronics to automatically interpret them, and automatic inflation and deflation of the cuff. The pressure sensor should be calibrated periodically to maintain accuracy. Oscillometric measurement requires less skill than the auscultatory technique and may be suitable for use by untrained staff and for automated patient home monitoring. The cuff is inflated to a pressure initially in excess of the systolic arterial pressure and then reduced to below diastolic pressure over a period of about 30 seconds. When blood flow is nil (cuff pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic pressure), cuff pressure will be essentially constant. It is essential that the cuff size is correct: undersized cuffs may yield too high a pressure; oversized cuffs yield too low a pressure. When blood flow is present, but restricted, the cuff pressure, which is monitored by the pressure sensor, will vary periodically in synchrony with the cyclic expansion and contraction of the brachial artery, i.e., it will oscillate. The values of systolic and diastolic pressure are computed, not actually measured from the raw data, using an algorithm; the computed results are displayed. Oscillometric monitors may produce inaccurate readings in patients with heart and circulation problems, which include arterial sclerosis, arrhythmia, preeclampsia, pulsus alternans, and pulsus paradoxus. In practice the different methods do not give identical results; an algorithm and experimentally obtained coefficients are used to adjust the oscillometric results to give readings which match the auscultatory results as well as possible. Some equipment uses computer-aided analysis of the instantaneous arterial pressure waveform to determine the systolic, mean, and diastolic points. Since many oscillometric devices have not been validated, caution must be given as most are not suitable in clinical and acute care settings. The term NIBP, for non-invasive blood pressure, is often used to describe oscillometric monitoring equipment. Continuous noninvasive techniques (CNAP) Continuous Noninvasive Arterial Pressure (CNAP) is the method of measuring arterial blood pressure in real-time without any interruptions and without cannulating the human body. CNAP combines the advantages of the following two clinical â€Å"gold standards†: it measures blood pressure continuously in real-time like the invasive arterial catheter system and it is noninvasive like the standard upper arm sphygmomanometer. Latest developments in this field show promising results in terms of accuracy, ease of use and clinical acceptance. Non-occlusive techniques: the Pulse Wave Velocity (PWV) principle Since the 90s a novel family of techniques based on the so-called Pulse wave velocity (PWV) principle have been developed. These techniques rely on the fact that the velocity at which an arterial pressure pulse travels along the arterial tree depends, among others, on the underlying blood pressure.[40] Accordingly, after a calibration maneuver, these techniques provide indirect estimates of blood pressure by translating PWV values into blood pressure values.[41] The main advantage of these techniques is that it is possible to measure PWV values of a subject continuously (beat-by-beat), without medical supervision, and without the need of inflating brachial cuffs. PWV-based techniques are still in the research domain and are not adapted to clinical settings. For some patients, blood pressure measurements taken in a doctor’s office may not correctly characterize their typical blood pressure.[42] In up to 25% of patients, the office measurement is higher than their typical blood pressure. This type of error is calledwhite-coat hypertension (WCH) and can result from anxiety related to an examination by a health care professional.[43] The misdiagnosis of hypertension for these patients can result in needless and possibly harmful medication. WCH can be reduced (but not eliminated) with automated blood pressure measurements over 15 to 20 minutes in a quiet part of the office or clinic.[44] Debate continues regarding the significance of this effect.[citation needed] Some reactive patients will react to many other stimuli throughout their daily lives and require treatment. In some cases a lower blood pressure reading occurs at the doctor’s office.[45] Ambulatory blood pressure devices that take readings every half hour throughout the day and night have been used for identifying and mitigating measurement problems like white-coat hypertension. Except for sleep, home monitoring could be used for these purposes instead of ambulatory blood pressure monitoring.[46] Home monitoring may be used to improve hypertension management and to monitor the effects of lifestyle changes and medication related to blood pressure.[6] Compared to ambulatory blood pressure measurements, home monitoring has been found to be an effective and lower cost alternative,[46][47][48] but ambulatory monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension. Ambulatory monitoring is recommended for most patients before the start of antihypertensive drugs.[49] Aside from the white-coat effect, blood pressure readings outside of a clinical setting are usually slightly lower in the majority of people. The studies that looked into the risks from hypertension and the benefits of lowering blood pressure in affected patients were based on readings in a clinical environment. When measuring blood pressure, an accurate reading requires that one not drink coffee, smoke cigarettes, or engage in strenuous exercise for 30 minutes before taking the reading. A full bladder may have a small effect on blood pressure readings; if the urge to urinate arises, one should do so before the reading. For 5 minutes before the reading, one should sit upright in a chair with one’s feet flat on the floor and with limbs uncrossed. The blood pressure cuff should always be against bare skin, as readings taken over a shirt sleeve are less accurate. During the reading, the arm that is used should be relaxed and kept at heart level, for example by resting it on a table.[50] Since blood pressure varies throughout the day, measurements intended to monitor changes over longer time frames should be taken at the same time of day to ensure that the readings are comparable. Suitable times are: †¢ immediately after awakening (before washing/dressing and taking breakfast/drink), while the body is still resting, †¢ immediately after finishing work. Automatic self-contained blood pressure monitors are available at reasonable prices, some of which are capable of Korotkoff’s measurement in addition to oscillometric methods, enabling irregular heartbeat patients to accurately measure their blood pressure at home. Arterial blood pressure (BP) is most accurately measured invasively through an arterial line. Invasive arterial pressure measurement with intravascular cannulae involves direct measurement of arterial pressure by placing a cannula needle in an artery (usually radial, femoral,dorsalis pedis or brachial). The cannula must be connected to a sterile, fluid-filled system, which is connected to an electronic pressure transducer. The advantage of this system is that pressure is constantly monitored beat-by-beat, and a waveform (a graph of pressure against time) can be displayed. This invasive technique is regularly employed in human and veterinary intensive care medicine, anesthesiology, and for research purposes. Cannulation for invasive vascular pressure monitoring is infrequently associated with complications such as thrombosis, infection, andbleeding. Patients with invasive arterial monitoring require very close supervision, as there is a danger of severe bleeding if the line becomes disconnected. It is generally reserved for patients where rapid variations in arterial pressure are anticipated. Invasive vascular pressure monitors are pressure monitoring systems designed to acquire pressure information for display and processing. There are a variety of invasive vascular pressure monitors for trauma, critical care, and operating room applications. These include single pressure, dual pressure, and multi-parameter (i.e. pressure / temperature). The monitors can be used for measurement and follow-up of arterial, central venous, pulmonary arterial, left atrial, right atrial, femoral arterial, umbilical venous, umbilical arterial, and intracranial pressures. Further information: Fetal circulation#Blood pressure In pregnancy, it is the fetal heart and not the mother’s heart that builds up the fetal blood pressure to drive its blood through the fetal circulation. The blood pressure in the fetal aorta is approximately 30 mmHg at 20 weeks of gestation, and increases to approximately 45 mmHg at 40 weeks of gestation.[51] The average blood pressure for full-term infants: Systolic 65–95 mm Hg Diastolic 30–60 mm Hg[52] Blood pressure is the measurement of force that is applied to the walls of the blood vessels as the heart pumps blood throughout the body.[53] The human circulatory system is 400,000 miles long, and the magnitude of blood pressure is not uniform in all the blood vessels in the human body. The blood pressure is determined by the diameter, flexibility and the amount of blood being pumped through the blood vessel.[53] Blood pressure is also affected by other factors including exercise, stress level, diet and sleep. The average normal blood pressure in the brachial artery, which is the next direct artery from the aorta after the subclavian artery, is 120mmHg/80mmHg. Blood pressure readings are measured in millimeters of mercury (mmHg) using sphygmomanometer. Two pressures are measured and recorded namely as systolic and diastolic pressures. Systolic pressure reading is the first reading, which represents the maximum exerted pressure on the vessels when the heart contracts, while the diastolic pressure, the second reading, represents the minimum pressure in the vessels when the heart relaxes.[54] Other major arteries have similar levels of blood pressure recordings indicating very low disparities among major arteries. The innominate artery, the average reading is 110/70mmHg, the right subclavian artery averages 120/80 and the abdominal aorta is 110/70mmHg.[55] The relatively uniform pressure in the arteries indicate that these blood vessels act as a pressure reservoir for fluids that are transported within them. Pressure drops gradually as blood flows from the major arteries, through the arterioles, the capillaries until blood is pushed up back into the heart via the venules, the veins through the vena cava with the help of the muscles. At any given pressure drop, the flow rate is determined by the resistance to the blood flow. In the arteries, with the absence of diseases, there is very little or no resistance to blood. The vessel diameter is the most principal determinant to control resistance. Compared to other smaller vessels in the body, the artery has a much bigger diameter (4mm), therefore the resistance is low.[55] In addition, flow rate (Q) is also the product of the cross-sectional area of the vessel and the average velocity (Q = AV). Flow rate is directly proportional to the pressure drop in a tube or in this case a vessel. ∆P ÃŽ ± Q. The relationship is further described by Poisseulle’s equation ∆P = 8 µlQ/Ï€r4.[56] As evident in the Poisseulle’s equation, although flow rate is proportional to the pressure drop, there are other factors of blood vessels that contribute towards the difference in pressure drop in bifurcations of blood vessels. These include viscosity, length of the vessel, and radius of the vessel. Factors that determine the flow’s resistance as described by Poiseuille’s relationship: †¢ ∆P: pressure drop/gradient †¢  µ: viscosity †¢ l: length of tube. In the case of vessels with infinitely long lengths, l is replaced with diameter of the vessel. †¢ Q: flow rate of the blood in the vessel †¢ r: radius of the vessel Assuming steady, laminar flow in the vessel, the blood vessels behavior is similar to that of a pipe. For instance if p1 and p2 are pressures are at the ends of the tube, the pressure drop/gradient is:[57] In the arterioles blood pressure is lower than in the major arteries. This is due to bifurcations, which cause a drop in pressure. The more bifurcations, the higher the total cross-sectional area, therefore the pressure across the surface drops. This is why the arterioles have the highest pressure-drop. The pressure drop of the arterioles is the product of flow rate and resistance: ∆P=Q xresistance. The high resistance observed in the arterioles, which factor largely in the ∆P is a result of a smaller radius of about 30  µm.[58] The smaller the radius of a tube, the larger the resistance to fluid flow. Immediately following the arterioles are the capillaries. Following the logic obvserved in the arterioles, we expect the blood pressure to be lower in the capillaries compared to the arterioles. Since pressure is a function of force per unit area, (P = F/A), the larger the surface area, the lesser the pressure when an external force acts on it. Though the radii of the capillaries are very small, the network of capillaries have the largest surface area in the vascular network. They are known to have the largest surface area (485mm) in the human vascular network. The larger the total cross-sectional area, the lower the mean velocity as well as the pressure.[55] Reynold’s number also affects the blood flow in capillaries. Due to its smaller radius and lowest velocity compared to other vessels, the Reynold’s number at the capillaries is very low, resulting in laminar instead of turbulent flow.[59] The Reynold’s number (denoted NR or Re) is a relationship that helps determine the behavior of a fluid in a tube, in this case blood in the vessel. The equation for this dimensionless relationship is written as:[56] †¢ Ï : density of the blood †¢ v: mean velocity of the blood †¢ L: characteristic dimension of the vessel, in this case diameter †¢ ÃŽ ¼: viscosity of blood The Reynold’s number is directly proportional to the velocity and diameter of the tube. Note that NR is directly proportional to the mean velocity as well as the diameter. A Reynold’s number of less than 2300 is laminar fluid flow, which is characterized by constant flow motion, whereas a value of over 4000, is represented as turbulent flow. Turbulent flow is characterized as chaotic and irregular flow.[56] Disregulation disorders of blood pressure control include high blood pressure, blood pressure that is too low, and blood pressure that shows excessive or maladaptive fluctuation. Overview of main complications of persistent high blood pressure. Arterial hypertension can be an indicator of other problems and may have long-term adverse effects. Sometimes it can be an acute problem, for examplehypertensive emergency. All levels of arterial pressure put mechanical stress on the arterial walls. Higher pressures increase heart workload and progression of unhealthy tissue growth (atheroma) that develops within the walls of arteries. The higher the pressure, the more stress that is present and the more atheroma tend to progress and the heart muscle tends to thicken, enlarge and become weaker over time. Persistent hypertension is one of the risk factors for strokes, heart attacks,heart failure and arterial aneurysms, and is the leading cause of chronic renal failure. Even moderate elevation of arterial pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.[60] In the past, most attention was paid to diastolic pressure; but nowadays it is recognised that both high systolic pressure and high pulse pressure (the numerical difference between systolic and diastolic pressures) are also risk factors. In some cases, it appears that a decrease in excessive diastolic pressure can actually increase risk, due probably to the increased difference between systolic and diastolic pressures (see the article on pulse pressure). If systolic blood pressure is elevated (>140) with a normal diastolic blood pressure ( Blood pressure. (2017, Feb 22).

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THE LEGAL ENVIRONMENT OF BUSINESS - Essay Example A Brief History of Monopoly Law in the United States Monopolies came into being in the United States during the colonial administration. The public sector wanted to make some new world and old immigrants changes. Most companies were provided with exclusive contracts by the colonial administrations. Even after the colonial handovers, the American nation functioned effectively to ensure that the contracts and the land were held. Since then, the federal Government usually implements the antitrust laws. The laws seek to protect consumers from companies that tend to become monopolies and abuse the market. These laws include the Sherman Antitrust Act, which prevents the formation of a monopoly. If a company decides to operate in a monopolistic manner, the Act seeks to remove it from the market. In case there are any antitrust laws, the government takes charge through the office of the U.S or through the respective Attorney in the States. In this case, the United States Government and the 1 9 States filed a suit against Microsoft for operating as a monopoly. The Sherman Act forms the basis of modern-day Anti-trust legislations whose mandate is to protect consumers from wayward corporate practices that aim to exploit them. In essence, the Act tries to promote integrity in the market and for companies to operate in a competitive environment. Monopolies together with their subsidiaries or acquired companies can lead to great developments though the only downside is their control on the market. Unless monopolies prove a threat to national security, they can be embraced for the provision of certain products and services (Yao and Loo 34). Monopolization has a downside, since it is the sole supplier of certain goods and can decide to produce substandard and low quality goods (Boldrin and David 36). Monopolies create barriers to entry in the market due to large economies of scale among other factors (Yao and Loo 34). This reduces the marginal costs in producing additional unit s since the price is increased. Therefore, it is better to remove monopolies and promote competition, which will ensure good quality goods at affordable prices. This eliminates price fixing and the exploitation of end users (Boldrin and David 33). Firms may collude to operate as one in distribution of products. This is possible where the companies are involved in a similar business operate producing related products. Collusions lead to the formation of oligopolies, which reduces competition in the market. The firms can be involved in the price fixing that disadvantages the buyer. If the large firms collude, they gain the market and result in imperfect competition between the large and small firms. The firms obtain market power and thus determine prices to the disadvantage of the smaller firms. An example of oligopoly is the internet where few firm control the internet. These are shaw, Telus, Bel and Rogers. Government monopolies are usually involving in distribution of products, whi ch if left to the private sector would undergo exploitation. An example is the armed forces and the military (Lynn 22). In my opinion, Google is a monopoly company facing many criticisms most of the prompted by Microsoft. The main question has been whether Google is abusing its monopolistic position. Studies reveal that the company has been encrypting traffic for many years, and the recent changes were prompted by the USA over Kerfuffle as they attempt to force people to

Research paper Example | Topics and Well Written Essays - 1250 words - 3

Research Paper Example In the last work by Langston Hughes that is I, too were identified varied themes, symbols and metaphors. This paper intends to unravel the commonality of those themes, symbols and metaphors in the two short stories by the author, which are Father and Son and Cora Unashamed. As was traced in the poem I, too by Langston Hughes, the short story Father and Son by the same writer delineates the atrociousness and brutality of the Jim Crow rules, but in a more detailed and intricate manner. Father and Son is a story about a Georgia white man Colonel Thomas Norwood who keeps a black woman Nora for a mistress and fathers five children by her. The story reveals the psychological and social might of the Jim Crow laws. In the story, Colonel Tom is showed to harbor feelings of constrained affection and liking for his sons from Cora, as is natural for any man. However, his allegiance to the Jim Crow system is evinced to be more doughty and mightier than his commitment to the voice of human feeling s within him. He not only tends to publically deny his children from his black maid Cora, but considers an open profession of affection by his son Brat to be a mark of dishonor and disgrace. As in I, too, in Father and Son, Hughes exposes the absurdity and fickleness of Jim Crow laws, which allow a white man to get into the most intimate of relationships with a black girl and to father sons by her, yet, do not allow one to socially and legally recognize the relationships that such intimacies and acts entail. As in other works of Hughes, the register attributed to the black characters further exposes the bestial and subhuman level to which the blacks character are supposed to stoop in Jim Crow America, replete with invectives like nigger, darkie and yard-nigger. In Father and Son, Hughes elaborately shows the decorum and mannerisms which the black dependants were expected to follow in subservience to Jim Crow norms that he alludes to in I, too. The black slaves owned by Colonel Tom a re never allowed to enter his home from the front door or to roam about in his inner chambers, irrespective of their long service to him or their relationship to him. The blacks were always to approach his home from the backdoor and allowed to gather only in the kitchen. Like a dog, they were expected to maintain a respectable distance from and decorum with their white master. The story also reinforces the social status attributed to black characters in Hughes’ other works. All the black characters are shown to be serving in menial positions. Colonel Tom do tries to be good to his children by extending to them educational and other opportunities and facilities. However, the magnanimity of his concern for his children never dares to cross the boundaries marked by Jim Crow laws. The story also reveals the fear of marginalization of the whites, as in Hughes’ other works. When Brat, the youngest son of Colonel tries to rebel against the constraints of segregation and recla im his relationship with his father, the system comes crashing down on him and his brother. Cora Unashamed is one of the masterpieces of Langston Hughes. Though the writer predominantly repeats the themes, symbols and metaphors in the story with which he deals with in his

Consumer Buyer Behaviour and Organisational Buyer Behaviour Essay

Consumer Buyer Behaviour and Organisational Buyer Behaviour - Essay Example The researcher of this essay aims to analyze the buying process of the consumers which entails few different stages while arriving at a final purchase decision. The ‘consumer buying behavior’ is explained to be the buying of the products for the reason of personal or even household use but is not indulged in for any kind of business intentions. In a similar way, organizational buying is referred to be a multifaceted process related to decision making as well as communication. This multifaceted process is learned to occur over time entailing numerous organizational members along with their association with the other existing organizations as well as institutions. The process of organizational buying behavior is observed to be a definite behavior that involves more than just an easy process related to placing of orders with regard to the suppliers. ‘Organisational buying behavior’ is referred as the course of action related to decision making with the help of which the official organizations create the requirement for the purchased services as well as products.The official organizations are also believed to recognize, assess and select among the other suppliers and brands. Thus, this complete process is known as the ‘organisational buying behavior’ (Ferrell & Hartline, 2010). ... It needs to be mentioned and comprehended in this respect that the widely explained practice of organisational buying is believed to differ from the process related to consumer buying in certain significant ways. The innate challenges witnessed in the process of organisational buying compared to the consumer purchases are taken into concern from the external as well as internal viewpoints. To be specific, the external associations with regard to the buyer as well as the seller in case of organisational buying are believed to be reliant on the aspect of derived demand. This particular facet of derived demand is referred as an increasingly difficult buying as well as selling process along with involving an increasingly intense customer base. In comparison, the consumers are observed to indulge in purchases for the reason of their respective personal as well as household use along with involving a comparatively less difficult procedure and symbolising an assorted consumers group (Sheth, 1973). Internally, the organisational purchasers entail a tendency to provide increasing focus compared to the final consumers on the aspect of technology as well as superior performance. Greater emphasis is also learnt to be laid on the factor of customisation for the reason of catering to the definite necessities along with the guiding principle related to order-fulfilment. This factor of order-fulfilment is believed to involve manufacturing to ordering in comparison to just filling of a particular order related to finished products with regard to an accessible inventory (Oxford University Press, 2011). In comparison to the final consumers the organisational purchasers are also believed to entail a tendency of

Assess why government intervention to ensure equlity of opportunity Thesis

Assess why government intervention to ensure equlity of opportunity was historically necessary to correct tremendous injustices - Thesis Example The policy of slavery could only be cured by the policy of civil rights to rectify the injustice of what it is to live in a country without having the rights of citizenship. Where social structures fail, it is the responsibility of the government to lead the people out of the darkness of immoral and unethical behavior. According to Spalding (2007) â€Å"John Adams opposed slavery his entire life as a "foul contagion in the human character" and "an evil of colossal magnitude." James Madison called it "the most oppressive dominion ever exercised by man over man†. Many of those in the beginnings of the country who helped to shape its ideology did not agree with the idea of oppressing people. The idea of breaking from European structures of law that denied some while allowing corruption to flourish and enhance the lives of the elite was a defining element of creating the New World. The idea that slavery was a part of this New World was incongruous to the ideas upon which the nation was being built. This is not an opinion that is universal and there are those that believe that the practice of slavery in the United States was merely a continuation of economic policies that had existed since ancient times. There is some truth to this assertion, but the opinion asserted by D’Souza takes the argument too far. D’Souza (1995) suggests that the idea that grew within the United States was subversive and expresses an undeserved disgust with the concept of slavery suggests that slavery should still be an accepted idea. What should be recognized is that a heinous practice that had been a part of many cultures across the world was finally identified for its inhumanity as the ideologies of the United States began to influence it and other cultures to change the perception of slavery. Whether we turn to the declarations of the past, or to the professions of the present, the conduct of the nation seems equally hideous and revolting. America is false to the

Research paper Example | Topics and Well Written Essays - 1250 words - 3

Research Paper Example In the last work by Langston Hughes that is I, too were identified varied themes, symbols and metaphors. This paper intends to unravel the commonality of those themes, symbols and metaphors in the two short stories by the author, which are Father and Son and Cora Unashamed. As was traced in the poem I, too by Langston Hughes, the short story Father and Son by the same writer delineates the atrociousness and brutality of the Jim Crow rules, but in a more detailed and intricate manner. Father and Son is a story about a Georgia white man Colonel Thomas Norwood who keeps a black woman Nora for a mistress and fathers five children by her. The story reveals the psychological and social might of the Jim Crow laws. In the story, Colonel Tom is showed to harbor feelings of constrained affection and liking for his sons from Cora, as is natural for any man. However, his allegiance to the Jim Crow system is evinced to be more doughty and mightier than his commitment to the voice of human feeling s within him. He not only tends to publically deny his children from his black maid Cora, but considers an open profession of affection by his son Brat to be a mark of dishonor and disgrace. As in I, too, in Father and Son, Hughes exposes the absurdity and fickleness of Jim Crow laws, which allow a white man to get into the most intimate of relationships with a black girl and to father sons by her, yet, do not allow one to socially and legally recognize the relationships that such intimacies and acts entail. As in other works of Hughes, the register attributed to the black characters further exposes the bestial and subhuman level to which the blacks character are supposed to stoop in Jim Crow America, replete with invectives like nigger, darkie and yard-nigger. In Father and Son, Hughes elaborately shows the decorum and mannerisms which the black dependants were expected to follow in subservience to Jim Crow norms that he alludes to in I, too. The black slaves owned by Colonel Tom a re never allowed to enter his home from the front door or to roam about in his inner chambers, irrespective of their long service to him or their relationship to him. The blacks were always to approach his home from the backdoor and allowed to gather only in the kitchen. Like a dog, they were expected to maintain a respectable distance from and decorum with their white master. The story also reinforces the social status attributed to black characters in Hughes’ other works. All the black characters are shown to be serving in menial positions. Colonel Tom do tries to be good to his children by extending to them educational and other opportunities and facilities. However, the magnanimity of his concern for his children never dares to cross the boundaries marked by Jim Crow laws. The story also reveals the fear of marginalization of the whites, as in Hughes’ other works. When Brat, the youngest son of Colonel tries to rebel against the constraints of segregation and recla im his relationship with his father, the system comes crashing down on him and his brother. Cora Unashamed is one of the masterpieces of Langston Hughes. Though the writer predominantly repeats the themes, symbols and metaphors in the story with which he deals with in his