The impact of sphygmomanometer placement and cuff placement on blood pressure measurements.

Background: Hypertension is the most significant global risk factor for mortality and morbidity, making standardized blood pressure measurement crucial. Objectives: To investigate whether the location of blood pressure monitors and the positioning of cuffs yield differing results in blood pressure measurements. Methods: Patients admitted to the Affiliated Hospital of Jiujiang College between 1 January 2022 and 30 June 2023 were enrolled in this study and randomly allocated into four groups. These groups were defined based on the positioning of monitoring equipment as follows: varied placements of cuffs on automatic blood pressure monitors, different heights for mercury column blood pressure monitors, varied heights for automatic blood pressure monitors, and different orientations for the cuff airbag tubes on electrocardiogram monitors. Blood pressure was measured and recorded for each group, followed by an analysis of the variations in readings across the different setups. Results: In the first cohort of 763 individuals, mean systolic blood pressure measured at the standard upper arm site was 128.8 ± 10.5 mmHg, compared to 125.3 ± 10.4 mmHg at the elbow fossa. The corresponding diastolic pressures were 79.2 ± 10.7 and 75.0 ± 10.6 mmHg, respectively. The difference in systolic pressure between these positions was significant at 3.48 ± 3.22 mmHg (t1 = 29.91, p1 < 0.001) and for diastolic pressure at 4.23 ± 1.31 mmHg (t2 = 88.98, p2 < 0.001). For the subsequent groups, involving 253, 312, and 225 individuals, respectively, blood pressure measurements were analyzed and compared across different methods within each group. All p-values exceeded 0.05, indicating no statistically significant differences. Conclusions: Blood pressure values measured at the elbow fossa position using an upper arm-type automatic sphygmomanometer were found to be lower than those measured at the upper arm position, with a difference of 3.48 mmHg for systolic and 4.23 mmHg for diastolic pressures. It is therefore essential to position the cuff correctly, specifically 2-3 cm above the elbow fossa, when utilizing an upper arm-type automatic sphygmomanometer for blood pressure monitoring. Conversely, the placement of the mercury column sphygmomanometer and the automated sphygmomanometer at varying heights had no significant effect on blood pressure readings. Similarly, the orientation of the electrocardiogram's cuffed balloon tube, whether facing upward or downward, did not influence blood pressure measurement outcomes.

Normative value of deep neck flexors muscle strength measurement using pressure biofeedback unit and sphygmomanometer: An observational study.

PURPOSE: To find out the normative value of deep neck flexor muscles strength using pressure biofeedback unit and sphygmomanometer. METHODS: The healthy individuals both male and female aged between 18 and 25 years were recruited by stratified random sampling method from a tertiary hospital. The procedure is performed with the patient in supine lying with the neck in a neutral position. To check strength, pressure biofeedback unit and sphygmomanometer were placed under occiput and ask the individual to do the movement is genteelly and slowly as a head nodding action (chin tuck). The performance was scored via the pressure level that patient achieves 3 repetitions for 10 s hold and interval timing for 10 s. And the pressure biofeedback unit and sphygmomanometer inflated with 40 mmHg and took three reading respectively. RESULT: Our result shows, in decreased of deep neck cervical flexor muscle Strength with age group 21 (20-22) in normal adult and underweight with age group 21 (19-23) and with BMI 21 (20.1-22.4) and 16.6 (16.1-17.6) respectively. In our study, the deep neck flexor strength of overweight adults with age group 22 (21-23) and with BMI 27.8 (25.9-29.4) is stronger is than the normal and underweight adults. CONCLUSION: The study concluded that the maximal Deep neck cervical flexor strength of overweight Adults is stronger than normal and underweight Adults. The difference is maintained in all age groups. The maximal Deep neck cervical flexor strength, for flexion is developed at neutral position of neck.

Predictors of muscle strength assessed with the modified sphygmomanometer test.

OBJECTIVES: To investigate the best predictor of muscle strength assessed with both Modified Sphygmomanometer Test (MST) methods (bag adaptation and non-adapted) and to provide normative values for these two MST methods for the strength assessment of the trunk, upper, and lower limb muscles. DESIGN: Cross-sectional study. METHODS: The strength of 42 muscle groups were assessed with the MST in the bag adaptation and non-adapted methods in 120 healthy individuals, 50 % males, divided into three age groups (20-39, 40-59, 60-79) with 40 subjects per group. Stepwise multiple regression analysis was performed to investigate which independent variables (sex, age, and limb dominance) is the best predictor of muscle strength (α = 5 %). RESULTS: Sex was the best independent predictor for all muscle groups for both MST methods (8.8 % < R2<57.8 %, p < 0.0001), except for the ankle plantar flexors assed with the non-adapted sphygmomanometer, in which age was the best independent predictor (R2 = 25.6 %; p < 0.0001). The normative values of muscle strength were reported for both MST methods considering the subgroups (sex, age, and limb dominance). Ceiling effect was observed when the MST bag adaptation was used to assess some muscles (8.8 %). CONCLUSION: Sex was the best predictor of muscle strength, as commonly found for muscle strength assessment with the dynamometer. The normative values provided have high clinical utility and can be used to interpret results of muscle strength assessment using both MST methods. For the MST in the bag adaptation method, caution is advised for the assessment of some muscles.

The Effect of Clothes on Blood Pressure Measurement in Normotensive and Hypertensive Subjects in a Real-Life Setting.

INTRODUCTION: The effect of clothing on the recording of blood pressure in a normotensive and hypertensive population remains essential to diagnosing and managing. METHODS: This is a cross-sectional study to measure blood pressure using a validated oscillometric sphygmomanometer in two populations. The records were made over the thicker sleeve arm and non-sleeved arm (either on bare arm or indicating the removal of the outermost garment). Clothing was categorized according to how patients attended the outpatient clinic based on the real world. RESULTS: A total of 75 patients were included with a diagnosis of hypertension whose mean age was 67.1 years (SD ± 16.3). The group of normotension included 63 patients whose mean age was 21.1 years (SD ± 2.2). There was not variability related to technique or inherent to the condition of the subject on the first and second measurements of blood pressure. In the comparative analysis, the group with normotension did not report a significant difference in systolic or diastolic blood pressure due to the effect of clothing during the first or second measurement (p > 0.05). In the group with hypertension, a significant difference was observed in the first measurement, between the group over-the-sleeve and non-sleeved arm (systolic blood pressure, p: 0.021 and diastolic, p: 0.001). However, when the variable order of measurement was analyzed by randomizing the initial registry with or without clothing was not found a statistical difference. CONCLUSION: Clothing does not a significant difference in the measure of blood pressure in a normotensive or hypertensive population.

Oscillometric and Doppler techniques can provide continuous noninvasive blood pressure readings in cats and dogs: an instructional video.

OBJECTIVE: To provide a video tutorial detailing how to perform continuous noninvasive blood pressure monitoring in dogs and cats. ANIMALS: Any size dog or cat. METHODS: To measure blood pressure noninvasively, a blood pressure cuff is selected on the basis of the circumference of the limb and placed at the level of the right atrium. For oscillometric blood pressure measurement, the cuff is connected to an oscillometric unit that will automatically inflate and deflate the cuff in order to measure the patient's blood pressure using an internal algorithm. For Doppler blood pressure measurement, a sphygmomanometer is used to manually inflate the pressure cuff 30 to 40 mm Hg above the point where the audible arterial sounds disappear. Then, the cuff is gradually deflated until the audible arterial sounds return; the pressure at the first sound is recorded as the blood pressure. To generate continuous readings, the oscillometric machine is set to measure blood pressure as often as every minute. Alternatively, the Doppler crystal is taped to the patient's leg to facilitate repeated cuff inflation/deflation and collection of blood pressure values as often as every minute. RESULTS: Continuous blood pressure readings can be obtained by both the oscillometric and Doppler techniques. CLINICAL RELEVANCE: Continuous blood pressure readings identify trends in a patient's cardiovascular status. The most reliable oscillometric blood pressure reading is the mean arterial pressure. Doppler blood pressure values are considered systolic in dogs. Doppler values in cats underestimate systolic and overestimate mean blood pressure.

A smartwatch sphygmomanometer-based model for predicting short-term new-onset hypertension in individuals with high-normal blood pressure: a cohort study.

OBJECTIVES: The objective was to utilize a smartwatch sphygmomanometer to predict new-onset hypertension within a short-term follow-up among individuals with high-normal blood pressure (HNBP). METHODS: This study consisted of 3180 participants in the training set and 1000 participants in the validation set. Participants underwent both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) using a smartwatch sphygmomanometer. Multivariable Cox regressions were used to analyze cumulative events. A nomogram was constructed to predict new-onset hypertension. Discrimination and calibration were assessed using the C-index and calibration curve, respectively. RESULTS: Among the 3180 individuals with HNBP in the training set, 693 (21.8%) developed new-onset hypertension within a 6-month period. The nomogram for predicting new-onset hypertension had a C-index of 0.854 (95% CI, 0.843-0.867). The calibration curve demonstrated good agreement between the nomogram's predicted probabilities and actual observations for short-term new-onset hypertension. In the validate dataset, during the 6-month follow-up, the nomogram had a good C-index of 0.917 (95% CI, 0.904-0.930) and a good calibration curve. As the score increased, the risk of new-onset hypertension significantly increased, with an HR of 8.415 (95% CI: 5.153-13.744, p = .000) for the middle-score vs. low-score groups and 86.824 (95% CI: 55.071-136.885, p = .000) for the high-score vs. low-score group. CONCLUSIONS: This study provides evidence for the use of smartwatch sphygmomanometer to monitor blood pressure in individuals at high risk of developing new-onset hypertension in the near future. TRIAL REGISTRATION: ChiCTR2200057354.

Diagnosis of kidney insufficiency by using the pressure waveforms of wrist-type sphygmomanometers: toward a convenient point-of-care device.

OBJECTIVES: Digital sphygmomanometers have been used for more than 40 years in Western medicine for accurately measuring systolic and diastolic blood pressures, which are vital signs observed for the diagnosis of different diseases. Similarly, traditional Chinese medicine (TCM) has been using wrist pulse diagnosis for thousands of years. Some studies have combined digital wrist pulse signals and the diagnosis method of TCM to quantify pulse waves and identify diseases. However, the effectiveness of this approach is limited because of scattered methods and complex pathological features. Moreover, the literature on TCM does not provide quantitative data or objective indicators. METHODS: In this prospective study, we developed a diagnostic system that contains a modified sphygmomanometer. In addition, we designed a procedure for analyzing pulse waves with 156 features of harmonic modes and a decision tree method for diagnosing kidney insufficiency. RESULTS: In the decision tree method, at least three features of harmonic modes can achieve an accuracy of 0.86, a specificity of 0.91, and a Cohen's kappa coefficient of 0.72. By comparison, the random forest method can achieve an accuracy of 0.99, a specificity of 0.99, and a Cohen's kappa coefficient of 0.94 within 200 trees. The results of this study indicated that even in patients with kidney insufficiency and complex etiology, common features can be distinguished by identifying changes in pulse waveforms. CONCLUSION: By using the modified sphygmomanometer to measure blood pressure, people can monitor their health status and take care of it in advance by simply measuring their blood pressure.

Reference blood pressure values obtained using the auscultation method for 2-year-old Japanese children: from the Japan Environment and Children's Study.

BACKGROUND: Reference blood pressure (BP) values for Japanese children based on a large number of measurements by auscultation have not yet been established. METHODS: This was a cross-sectional analysis of data from a birth-cohort study. The data from the sub-cohort study conducted for children at the age of 2 years in the Japan Environment and Children's Study from April 2015 to January 2017 were analyzed. BP was measured via auscultation using an aneroid sphygmomanometer. Each participant was measured in triplicate, and the average value of two consecutive measurements with a difference of less than 5 mmHg was recorded. The reference BP values were estimated using the lambda-mu-sigma (LMS) method and compared with those obtained via the polynomial regression model. RESULTS: Data from 3361 participants were analyzed. Although the difference between the estimated BP values by the LMS and the polynomial regression model was small, the LMS model was more valid based on the results of the fit curve of the observed values and regression models for each model. For 2-year-old children with heights in the 50th percentile, the 50th, 90th, 95th, and 99th percentile reference values of systolic BP (mmHg) for boys were 91, 102, 106, and 112, and that for girls were 90, 101, 103, and 109, respectively, and those of diastolic BP for boys were 52, 62, 65, and 71, and that for girls were 52, 62, 65, and 71, respectively. CONCLUSION: The reference BP values for 2-year-old Japanese children were determined based on auscultation and were made available.

Comparison of Blood Pressure Measurements by Currently Available Multiparameter Monitors and Mercury Column Sphygmomanometer in Patients Admitted in Pediatric Intensive Care Unit.

Background: The multiparameter monitor (MPM) is replacing mercury column sphygmomanometers (MCS) in acute care settings. However, data on the former's accuracy in critically ill children are scarce and mostly extrapolated from adults. We compared non-invasive blood pressure (NIBP) measurements by MPMs with MCS in pediatric intensive care unit (PICU). Patients: Adequately sedated and hemodynamically stabilized children (age, 1-144 months) were prospectively enrolled. Materials and methods: Three NIBP measurements were obtained from MCS (Diamond®, India) and MPM (Intellivue MX800® or Ultraview SL®) in rapid succession in the upper limb resting in supine position. Respective three measurements were averaged to obtain a paired set of NIBP readings, one each from MCS and MPM. Such readings were obtained thrice a day. NIBP readings were then compared, and agreement was assessed. Results: From 39 children [median age (IQR), 30 (10-72) months], 1,690 sets of NIBP readings were obtained. A-third of readings were from infants and children >96 months, while 383 (22.6%) readings were from patients on inotropes. Multiparameter monitors gave significantly higher NIBP readings compared to MCS [median systolic blood pressure (SBP), 6.5 (6.4-6.7 mm Hg); diastolic blood pressure (DBP), 4.5 (4.3-4.6 mm Hg); mean arterial pressure (MAP), 5.3 (5.1-5.4 mm Hg); p < 0.05]. It was consistent across age, gender, and critical care characteristics. Multiparameter monitors overestimated SBP in 80% of readings beyond the maximal clinically acceptable difference (MCAD). Conclusions: Non-invasive blood pressure readings from MCS and MPMs are not interchangeable; SBP was 6-7 mm Hg higher with the latter. Overestimation beyond MCAD was overwhelming. Caution is required while classifying systolic hypotension with MPMs. Confirmation with auscultatory methods is advisable. More studies are required to evaluate currently available MPMs in different pediatric age groups. How to cite this article: Khan AA, Gupta PK, Baranwal AK, Jayashree M, Sahoo T. Comparison of Blood Pressure Measurements by Currently Available Multiparameter Monitors and Mercury Column Sphygmomanometer in Patients Admitted in Pediatric Intensive Care Unit. Indian J Crit Care Med 2023;27(3):212-221.

Long-term stability of over-the-counter cuffless blood pressure monitors: a proposal.

Blood pressure is an important cardiovascular parameter. Currently, the cuff-based sphygmomanometer is a popular, reliable, measurement method, but blood pressure monitors without cuffs have become popular and are now available without a prescription. Blood pressure monitors must be approved by regulatory authorities. Current cuffless blood pressure (CL-BP) monitors are not suitable for at-home management and prevention of hypertension. This paper proposes simple criteria for over-the-counter CL-BP monitoring. First, the history of the sphygmomanometer and current standard blood pressure protocol are reviewed. The main components of CL-BP monitoring are accuracy during the resting condition, accuracy during dynamic blood pressure changes, and long-term stability. In this proposal we recommend intermittent measurement to ensure that active measurement accuracy mirrors resting condition accuracy. A new experimental protocol is proposed to maintain long-term stability. A medically approved automated sphygmomanometer was used as the standard device in this study. The long-term accuracy of the test device is based on the definition of propagation error, i.e., for an oscillometric automated sphygmomanometer (5 ± 8 mmHg) ± the error for the test device static accuracy (-0.12 ± 5.49 mmHg for systolic blood pressure and - 1.17 ± 5.06 mmHg for diastolic blood pressure). Thus, the long-term stabilities were - 3.38 ± 7.1 mmHg and - 1.38 ± 5.4 mmHg, which satisfied propagation error. Further research and discussion are necessary to create standards for use by manufacturers; such standards should be readily evaluated and ensure high-quality evidence. Supplementary information: The online version contains supplementary material available at 10.1007/s12553-023-00726-6.

Blood pressure measurement in the elderly with atrial fibrillation: an observational study comparing different noninvasive sphygmomanometers.

Background: Atrial fibrillation (AF) has affected millions of adults in the world. It is important to monitor and manage blood pressure (BP) in AF patients. The accuracy of BP monitoring in AF patients with noninvasive methods remains questionable, however. Objectives: To compare the accuracy of different noninvasive BP devices (oscillographic sphygmomanometer and pulse wave device) for BP measurement in elderly patients with AF, with a mercury sphygmomanometer as a reference. Design: This study was an observational study. Methods: Patients with AF from the inpatient department of cardiology were included from 1 January to 31 December 2020. BP measurements were performed by two trained nurses using a tee junction connection on the cuff to connect three sphygmomanometers. The Bland-Altman plot analysis was conducted to compare the agreement of BP measurements. We also compared the agreement of BP measurements through metrics such as accuracy, bias, and precision. Results: A total of 202 patients (54.5% female) were included. The Bland-Altman plot analysis showed that the lower and upper limits of agreement (LoAs) of pulse wave/reference were similar to the predefined acceptable clinical limits (10/5 mmHg). The bias and precision in both systolic and diastolic BP were significantly less in pulse wave/reference (a bias of 1.8 and 0.77 mmHg and a precision of 5.20 and 4.66 mmHg, respectively), with corresponding higher accuracy readings (98.51% for P10 in systolic BP and 85.64% for P5 in diastolic BP). Conclusion: A novel noninvasive sphygmomanometer - pulse wave device has a good concordance with a mercury sphygmomanometer in BP monitoring, and may be applicable to perform BP measurements in the elderly with AF.

[Miniature Non-invasive Blood Pressure Measurement and Verification System].

Mercury sphygmomanometer based on traditional auscultation method is widely used in primary medical institutions in China, but a large amount of blood pressure data can not be directly recorded and applied in scientific research analysis, meanwhile auscultation data is the clinical standard to verify the accuracy of non-invasive electronic sphygmomanometer. Focusing on this, we designed a miniature non-invasive blood pressure measurement and verification system, which can assist doctors to record blood pressure data automatically during the process of auscultation. Through the data playback function,the software of this system can evaluate and verify the blood pressure algorithm of oscillographic method, and then continuously modify the algorithm to improve the measurement accuracy. This study introduces the hardware selection and software design process in detail. The test results show that the system meets the requirements of relevant standards and has a good application prospect.

Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial.

BACKGROUND: Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN. METHODS: From the randomized, sham-controlled SPYRAL HTN-OFF MED Pivotal trial, we performed a post hoc analysis of BP waveforms from 111 RDN patients and 111 sham controls, obtained with a brachial cuff-based sphygmomanometer. Waveforms were acquired during ambulatory BP monitoring at diastolic BP level and processed with validated ARCSolver algorithms to derive hemodynamic parameters (augmentation index; augmentation pressure; backward and forward wave amplitude; estimated aortic pulse wave velocity). We investigated the relationship between averaged 24-hour values at baseline and the change in 24-hour BP at 3 months in RDN patients, corrected for observed trends in the sham group. RESULTS: There was a consistent inverse relationship between baseline augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity and BP response to RDN: the decrease in 24-hour systolic BP/diastolic BP was 7.8/5.9 (augmentation index), 8.0/6.3 (augmentation pressure), 6.7/5.4 (backward wave amplitude), 5.7/4.7 (forward wave amplitude), and 7.8/5.2 (estimated aortic pulse wave velocity) mm Hg greater for patients below versus above the respective median value (P<0.001 for all comparisons, respectively). Taking augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity into account, a favorable BP response following RDN, defined as a drop in 24-hour systolic blood pressure of ≥5 mm Hg, could be predicted with an area under the curve of 0.70/0.74/0.70/0.65/0.62 (P<0.001 for all, respectively). CONCLUSIONS: These results suggest that pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, may predict BP response to RDN.

Daily self-monitoring of blood pressure decreases systolic and diastolic blood pressure in hypertensive participants.

Hypertension is a major risk factor for cardiovascular diseases, and behavior modification has been shown to improve blood pressure (BP). We investigated whether daily self-monitoring of systemic BP and other factors related to cardiovascular events decreased BP in hypertensive participants. In this prospective, randomized, open, blinded-endpoint trial, we assigned 161 participants with hypertension to monitor their BP daily (BP-measurement group) or, in addition to BP, monitor their body fat, sleeping time, and daily step count (multiple-measurement group) or no self-monitoring (control group) for 2 months. The primary endpoint was the absolute change in systolic BP from baseline to 2 months after assignment. There were no differences in the baseline age and gender ratios among the three groups. After 2 months, systolic BP in the morning was unchanged in the control group, at a median of 149 mmHg [interquartile range (IQR) 136-164] from 150 mmHg (IQR 138-164), and was significantly decreased to 139 mmHg (IQR 125-148) from 142 mmHg (IQR 131-157) in the BP-measurement group. BP did not further decrease in the multiple-measurement group, 134 mmHg (IQR 121-146) from 141 mmHg (IQR 131-157). Daily self-monitoring of BP decreased the BP of participants with hypertension, but additional daily self-monitoring of body fat, sleeping time, and daily step count did not further decrease BP. This behavior modification merits use as a nonpharmacological hypertension treatment.

Orthostatic Blood Pressure Recovery Measured Using a Sphygmomanometer Is Not Associated with Physical Performance or Number of Falls in Geriatric Outpatients.

BACKGROUND: Orthostatic hypotension (OH) and impaired OH recovery derived from beat-to-beat blood pressure (BP) measurements are associated with detrimental clinical outcome, but the clinical relevance of OH recovery assessed using the widely available sphygmomanometer is still unclear. METHOD: 635 geriatric outpatients underwent comprehensive geriatric assessment, including orthostatic BP measurements using a sphygmomanometer, during supine rest and 1 and 3 min after standing up and assessment of physical performance (i.e., the timed up and go test and the Short Physical Performance Battery) and the number of falls in the past year. The association between BP recovery, defined as BP at 3 min minus BP at 1 min after standing up, with physical performance and falls was assessed using regression analyses, adjusting for age and sex, both in the entire cohort and after stratifying for the presence of OH at 1 min after standing up. RESULTS: BP recovery was not associated with physical performance or number of falls, neither in the entire cohort, nor in subpopulations with or without OH. CONCLUSION: The clinical relevance of BP recovery between 1 and 3 min after standing up could not be demonstrated. The results suggest that sphygmomanometer measurements have an inadequate time resolution to record the clinically relevant dynamics of orthostatic BP recovery.

Evaluation of correlation between digital vs. mercury sphygmomanometer in a middle-income country: The role of socio-economic situation.

BACKGROUND: Using manometer sphygmomanometers as standard measurement tool, there are controversial data regarding accuracy and validity of digital manometers for measurement of systolic (SBP) and diastolic blood pressure (DBP). Thus, we aimed to compare the accuracy of readings of digital sphygmomanometer in reference to mercury sphygmomanometer in a large population of healthy adults. METHODS AND MATERIALS: This cross-sectional study was performed on 1119 healthy adults. We measured participant's blood pressure once with mercury sphygmomanometer, as gold standard and again with digital mercury sphygmomanometer. Blood pressure was measured in sitting position after 5 min of rest and preferentially from right arm unless deformed. RESULTS: The mean ± standard deviation of age of participants was 37.25 ± 10.45 years. Majority of participants were male 588 (52.5%). The right/left SBP measured by digital sphygmomanometer were significantly higher compared with those measured by mercury sphygmomanometer: 115.37 ± 12.33 vs 110.95 ± 10.06/113.69 ± 11.77 vs 110.23 ± 10.34, respectively (P < .001), while an opposite result was observed about right/left DBP: 68.60 ± 8.55 vs 70.60 ± 8.31/69.39 ± 8.31 vs 70.75 ± 8.41, respectively (P < .001). In subgroup analysis in terms of marital status, education, and income, we observed similar findings. CONCLUSION: According to the results of our data analysis, it was shown that the digital device measurements had significant incompatibility with the mercury sphygmomanometers and it seems that digital devices still cannot be used as the gold standard in blood pressure measurement.

Miniature Non-invasive Blood Pressure Measurement and Verification System / 中国医疗器械杂志

Mercury sphygmomanometer based on traditional auscultation method is widely used in primary medical institutions in China, but a large amount of blood pressure data can not be directly recorded and applied in scientific research analysis, meanwhile auscultation data is the clinical standard to verify the accuracy of non-invasive electronic sphygmomanometer. Focusing on this, we designed a miniature non-invasive blood pressure measurement and verification system, which can assist doctors to record blood pressure data automatically during the process of auscultation. Through the data playback function,the software of this system can evaluate and verify the blood pressure algorithm of oscillographic method, and then continuously modify the algorithm to improve the measurement accuracy. This study introduces the hardware selection and software design process in detail. The test results show that the system meets the requirements of relevant standards and has a good application prospect.

Role of ankle brachial index measured by simple automatic sphygmomanometers in predicting postoperative kidney function in patients undergoing major cardiac surgery / El papel del índice tobillo-brazo medido mediante un esfigmomanómetro automático para pronosticar la función renal posoperatoria en pacientes que se sometieron a una cirugía cardíaca mayor

Abstract Introduction: Ankle-brachial pressure index is an objective, noninvasive test for predicting subclinical atherosclerotic diseases. We investigated the role of ankle-brachial pressure index measured with automated sphygmomanometer devices in the prediction of the development of acute kidney injury in patients undergoing major cardiac surgery. Methods: This single-centered, cross-sectional, and observational study was performed on 80 (66 males and 14 females, 58 ± 10 years) patients undergone cardiac surgery. Complete anamnesis, laboratory tests, intravenous fluids, medications, blood products, and all perioperative procedures were recorded in all patients before the surgery. Two automated sphygmomanometer devices giving equivalent results were used for measuring Ankle-brachial pressure index. The data in the first two days after the surgery were used for analysis. The criteria of AKIN were used in the diagnosis of acute kidney injury. Results: Twenty-one (23%) patients developed acute kidney injury in the postoperative period. None of the patients needed renal replacement therapy or died. There was no significant difference between mean ankle-brachial pressure index levels of patients with and without acute kidney injury (1.04 ± 0.17 and 1.06 ± 0.19, respectively, p=0.554). The mean ankle-brachial pressure index was significantly lower in patients with perioperative complications that cause hemodynamic instability (1.07 ± 0.14, 0.96 ± 0.13, p=0.016). On the multivariate analysis model, only perioperative hemodynamic complication development was found to be related to postoperative acute kidney injury. Conclusion: Ankle-brachial pressure index may have a role in predicting perioperative hemodynamic complications, which may cause acute kidney injury in patients undergoing major surgery. Simple automatic blood pressure devices can be used in daily practice for ankle-brachial pressure index measurement instead of complex and expensive doppler devices.

Resumen Introducción: El índice tobillo-brazo (ITB) es una prueba objetiva y no invasiva para diagnosticar la aterosclerosis asintomática. Investigamos el papel del índice tobillo-brazo medido a través de esfigmomanómetros automáticos para pronosticar el desarrollo de insuficiencia renal aguda en pacientes que se sometieron a una cirugía cardíaca mayor. Material y métodos: En este estudio observacional, transversal y unicéntrico, se incluyó a 80 pacientes (66 hombres y 14 mujeres de 58 ± 10 años) que se sometieron a una cirugía cardíaca. Se registraron los siguientes datos de todos los pacientes antes de la cirugía: anamnesis completa, análisis clínicos, líquidos intravenosos, medicamentos, productos hemoderivados e intervenciones perioperatorias. Para medir el ITB, se utilizaron dos esfigmomanómetros automáticos que arrojaron resultados similares. Se analizaron los datos recogidos los primeros dos días luego de la cirugía. Se siguieron los criterios de la AKIN para diagnosticar la insuficiencia renal aguda. Resultados: Veintiún pacientes (23 %) sufrieron insuficiencia renal aguda en el postoperatorio. Ninguno de los pacientes necesitó tratamiento renal sustitutivo ni falleció. No hubo diferencias significativas entre los valores medios del índice tobillo-brazo en pacientes con insuficiencia renal aguda y sin ella (1,04 ± 0,17 y 1,06 ± 0,19, respectivamente; p=0,554). El valor medio del ITB fue significativamente menor en pacientes con complicaciones perioperatorias que causan inestabilidad hemodinámica (1,07 ± 0,14; 0,96 ± 0,13; p=0,016). En el modelo de análisis multivariado, solo se encontró que la aparición de complicaciones hemodinámicas perioperatorias estaba relacionada con la insuficiencia renal aguda luego de la operación quirúrgica. Conclusión: Es posible que el ITB desempeñe un papel en la predicción de complicaciones hemodinámicas perioperatorias, que pueden causar insuficiencia renal aguda en pacientes sometidos a cirugía mayor. En la práctica diaria, pueden utilizarse dispositivos automáticos simples que calculan la tensión arterial para medir el índice tobillo-brazo, en lugar de dispositivos Doppler complejos y costosos.

Auscl-D: a mercury-free digital auscultatory sphygmomanometer.

More than quarter of world's population is consumed by hypertension, leading to premature death of thousands of people per year across the globe. One of the major reasons behind hypertension misdiagnosis is inaccurate blood pressure (BP) measurements, which can be attributed to various human or instrumentation errors. Currently used BP measuring sphygmomanometers, suffers from poor reliability, performance deterioration over time or are unable to meet environmental protection protocols. In this article, we propose a low-cost, highly portable, light-weight, easily manufacturable, battery operated, mercury free, auscultation based digital sphygmomanometer - Auscl-D, for easy and accurate BP measurements. The proposed device can be made from easily available components with cheap manufacturing processes available throughout globe, even in remote areas. The device demonstrated to have accuracy comparable to mercury sphygmomanometer, which is the gold-standard for BP measurements. The preliminary clinical trials were conducted at Dayanand Medical College & Hospital (DMCH) (Ludhiana, India), to compare the performance of proposed device with commonly used aneroid sphygmomanometers employing the auscultatory method and validated oscillometric sphygmomanometers from MicroLife. The test results show good agreement for systolic and diastolic BP measurements taken using Auscl-D device compared to the aneroid and oscillometric types. This shows the potential of proposed design to serve as low-cost, highly portable replacement for conventionally used sphygmomanometers, without the toxicity and reliability issues.