No Blood Pressure

[MrsChips]

I have Takayasu Arteritis. Whenever I go to the GP or hospital, where they need to take my blood pressure, they can't find one. Can anyone tell me what they do in this situation? Is there somewhere on your body that makes getting blood pressure easier? The nurses try with the both the machines and manually, with equal problems.

TA is also known as the Pulseless Disease, due to the Brachial stenosis.

[PMRpro]

You mean they can't find a pulse to check the blood pressure - it is an essential factor in using traditional sphygomanometers to measure BP: the cuff is pumped up to a level that stops all blood flow through the artery and then released slowly. The pulse is heard again when the pressure is at the level at which the pressure due to the heart beat is high enough to push blood through the artery and this is the systolic (higher) figure. Then it disappears until the pressure when the heart is at rest is enough to push blood around the system and a normal pulse is heard, the diastolic pressure.

This

emdocs.net/lvad-patients-wh...

describes a way to measure a BP in patients where there is no pulse to be felt - using Doppler ultrasound.

In this article

ahajournals.org/doi/full/10...

they say:

Pulseless Syndromes

Patients with Takayasu arteritis, giant cell arteritis, or severe atherosclerosis and those on long-term hemodialysis with multiple access procedures in the upper extremities may lack detectable brachial pulses, and often neither auscultatory nor oscillometric methods provide accurate BP readings in these circumstances. It may be possible to use an ankle-based BP in the supine position, recognizing that the ankle SBP is usually higher than a simultaneous measurement in the brachial artery as a result of SBP amplification, generally on the order of ≈20 mm Hg. In special circumstances when the carotid artery pressure is known or thought to be normal, retinal arterial pressures can be measured in patients with pulseless syndromes.

(Brachial means arm pulses, SBP is systolic BP, the carotid artery is the artery in the neck)

Have the nurses tried doing ankle pressures - which is done as a standard procedure in patients with peripheral vascular disease and, as far as I know, is even available in some GP practices?

[MrsChips in reply to PMRpro]

This is really interesting. No they haven't tried my ankle but I am now going to suggest it. I'll let you know how I get on. They have used ultrasound to find a pulse in the past.