Abstract
BackgroundThe oscillometric method of measuring blood pressure with an automated cuff yields valid estimates of mean pressure but questionable estimates of systolic and diastolic pressures. Existing algorithms are sensitive to differences in pulse pressure and artery stiffness. Some are closely guarded trade secrets. Accurate extraction of systolic and diastolic pressures from the envelope of cuff pressure oscillations remains an open problem in biomedical engineering.MethodsA new analysis of relevant anatomy, physiology and physics reveals the mechanisms underlying the production of cuff pressure oscillations as well as a way to extract systolic and diastolic pressures from the envelope of oscillations in any individual subject. Stiffness characteristics of the compressed artery segment can be extracted from the envelope shape to create an individualized mathematical model. The model is tested with a matrix of possible systolic and diastolic pressure values, and the minimum least squares difference between observed and predicted envelope functions indicates the best fit choices of systolic and diastolic pressure within the test matrix.ResultsThe model reproduces realistic cuff pressure oscillations. The regression procedure extracts systolic and diastolic pressures accurately in the face of varying pulse pressure and arterial stiffness. The root mean squared error in extracted systolic and diastolic pressures over a range of challenging test scenarios is 0.3 mmHg.ConclusionsA new algorithm based on physics and physiology allows accurate extraction of systolic and diastolic pressures from cuff pressure oscillations in a way that can be validated, criticized, and updated in the public domain.
Highlights
The oscillometric method of measuring blood pressure with an automated cuff yields valid estimates of mean pressure but questionable estimates of systolic and diastolic pressures
The present study addresses this problem with a new approach based upon the underlying physics, anatomy, and physiology
The analytical approach and algorithm presented here represent a solution to an open problem in biomedical engineering: how to determine systolic and diastolic blood pressures using the oscillometric method
Summary
The oscillometric method of measuring blood pressure with an automated cuff yields valid estimates of mean pressure but questionable estimates of systolic and diastolic pressures. As the pressure in the external cuff is slowly decreased by venting through a bleed valve, cuff pressure drops below systolic blood pressure, and blood will begin to spurt through the artery These spurts cause the artery in the cuffed region to expand with each pulse and cause the famous characteristic sounds called Korotkoff sounds. There are several ways to detect pulsatile blood flow as the cuff is deflated: palpation, auscultation over the artery with a stethoscope to hear the Korotkoff sounds, and recording cuff pressure oscillations. These correspond to the three main techniques for measuring blood pressure using a cuff [2]
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