Blood pressure measurement

Summary

Arterial blood pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure. Blood pressure values are generally reported in millimetres of mercury (mmHg), though aneroid and electronic devices do not contain 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 cycle when 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 mmHg systolic and 80 mmHg diastolic (written as 120/80 mmHg, and spoken as "one-twenty over eighty"). Systolic and diastolic arterial blood pressures are not static but undergo natural variations from one heartbeat to a

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Brachial artery waveforms for automatic blood pressure measurement

Nikolaos Stergiopulos

Theoretically the auscultatory method using Korotkoff sounds is more related to the maximum artery closure status, while the oscillometric method is more related to the overall artery closure status under the cuff. Therefore, the latter is less accurate than the former. This work introduces a new method, which is more accurate than the oscillometric method and suitable for automatic devices. To monitor the maximum artery closure status, a piezoelectric film sensor is attached to the skin just above the brachial artery and under the central section of the cuff where maximum cuff pressure is transferred to the arm. Using the waveform features obtained by this sensor, measurement errors of 0.7 +/- 2.5 and 1.27 +/- 4.53 mmHg were obtained for the systolic and diastolic pressure, respectively. These reflect small deviations from auscultatory clinical data. (C) 2012 Elsevier Ltd. All rights reserved.

Elsevier2013

Contribution of the Arterial System and the Heart to Blood Pressure during Normal Aging - A Simulation Study

Elira Maksuti, Nikolaos Stergiopulos, Nico Westerhof

During aging, systolic blood pressure continuously increases over time, whereas diastolic pressure first increases and then slightly decreases after middle age. These pressure changes are usually explained by changes of the arterial system alone (increase in arterial stiffness and vascular resistance). However, we hypothesise that the heart contributes to the age-related blood pressure progression as well. In the present study we quantified the blood pressure changes in normal aging by using a Windkessel model for the arterial system and the time-varying elastance model for the heart, and compared the simulation results with data from the Framingham Heart Study. Parameters representing arterial changes (resistance and stiffness) during aging were based on literature values, whereas parameters representing cardiac changes were computed through physiological rules (compensated hypertrophy and preservation of end-diastolic volume). When taking into account arterial changes only, the systolic and diastolic pressure did not agree well with the population data. Between 20 and 80 years, systolic pressure increased from 100 to 122 mmHg, and diastolic pressure decreased from 76 to 55 mmHg. When taking cardiac adaptations into account as well, systolic and diastolic pressure increased from 100 to 151 mmHg and decreased from 76 to 69 mmHg, respectively. Our results show that not only the arterial system, but also the heart, contributes to the changes in blood pressure during aging. The changes in arterial properties initiate a systolic pressure increase, which in turn initiates a cardiac remodelling process that further augments systolic pressure and mitigates the decrease in diastolic pressure.

Public Library of Science2016

Although hemodynamic parameters can be assessed non-invasively, state-of-the-art non-invasive systems generally require an expert operator and are not applicable for ambulatory measurements. These limitations have restricted our understanding of the continuous behavior of hemodynamic parameters. In this manuscript, we introduce a novel wrist-mounted device that incorporates an array of pressure sensors which can be used to extract arterial waveforms and relevant pulse wave analysis biomarkers. In vivo evaluation is performed with Bland-Altman analysis to compare the novel sensor to a gold-standard hand-held tonometer by assessing their reproducibility and agreement in peripheral augmentation index (AIx) estimation at the radial artery. Arterial waves from 28 randomly selected participants were recorded in a controlled environment. Initially we assess the reproducibility of AIx results for both devices. The intra-class correlation coefficient (ICC) and mean difference +/- SD were [0.913, 0.033 +/- 0.048] and [0.859, 0.039 +/- 0.076] for the hand-held and the wrist-mounted tonometer respectively. We then show that the AIx values derived from the novel tonometer have good agreement, accuracy, and precision when compared against the AIx values derived from the reference hand-held tonometer (ICC 0.927, mean difference 0.026 +/- 0.049). In conclusion, we have presented evidence that the new wrist-mounted arterial pressure sensor records arterial waveforms that can be processed to yield AIx values that are in good agreement with its traditional hand-held counterpart. (C) 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

Elsevier Sci Ltd2016