Changes in oscillometric pulse amplitude envelope with cuff size: implications for blood pressure measurement criteria and cuff size selection

Ng, Kim-Gau; Small, C.F.

doi:10.1016/0141-5425(93)90003-h

Cited by 22 publications

(9 citation statements)

References 9 publications

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“…properties of the artery being measured and the mechanics and size of the occlusive arm cuff being used. [18][19][20] The differences seen in the present study may have been dictated, in large part, by decreased compliance in the arteries of the treated hypertensive subjects. Blood flow upstream and downstream from the cuff, particularly the influence of reflected waves, may also influence measurement and need consideration in the final oscillometric algorithm.…”

Section: Discussionmentioning

confidence: 58%

“…Unfortunately, there is as yet no generally valid recognized standard method of evaluation for oscillometric blood pressure measurement using a cuff pressure oscillogram 17 . Modelling suggests that the accuracy of any oscillometric device will be determined by how well any oscillometric algorithm takes account of the combined influences of the arterial pulse amplitude and wave‐form, the viscoelastic properties of the artery being measured and the mechanics and size of the occlusive arm cuff being used 18 –20 . The differences seen in the present study may have been dictated, in large part, by decreased compliance in the arteries of the treated hypertensive subjects.…”

Section: Discussionmentioning

confidence: 81%

“…The degree to which the proportional differences we have described may have been secondary to these variables is unknown. However, cuff-arm compliance and pressure transmission from the cuff to the brachial artery through the soft tissue of the arm do influence oscillometric determination of blood pressure 18,19 and, using specific brachial artery oscillometric devices, there have been previously reported associations between the differences in BP and not only age and level of blood pressure, but also lean body mass and upper arm circumference. 23 For simplicity and convenience, we used a simultaneous opposite arm protocol to compare the wrist monitors with conventional mercury sphygmomanometry.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Oscillometric Blood Pressure Measurements at the Wrist With an Upper‐arm Auscultatory Mercury Sphygmomanometer

Rogers

Burke

Stroud

et al. 1999

Clin Exp Pharma Physio

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1. Oscillometric devices for blood pressure (BP) measurement at the wrist are becoming more widely used in clinical practice. However, systematic comparisons with standard auscultatory BP measurement at the brachial artery are scarce. Therefore, we compared two such devices, the Boso-Mediwatch (Bosch & Sohn GmbH U. Co., Jungingen, Germany) and the Omron R3 (Omron Corp., Tokyo, Japan), with upper-arm auscultatory mercury sphygmomanometry. 2. In 20 normotensive subjects and 20 treated hypertensive subjects, the Boso-Mediwatch was applied to the left wrist by observer 1 and was compared with mercury sphygmomanometry of the right upper arm by observer 2. Each observer swapped sides and the procedure was repeated. The Boso-Mediwatch was then applied to the right wrist by observer 1 and was compared with mercury sphygmomanometry of the left upper arm by observer 2. Each observer once again swapped sides and the procedure was repeated. An identical protocol was followed for the Omron R3 in a further 20 treated hypertensive subjects and 20 normotensive subjects. 3. There were no significant differences between observers or left versus right arm for either oscillometric device or when measurements were performed by mercury sphygmomanometry. In normotensive subjects, the Boso-Mediwatch readings were higher than mercury sphygmomanometer readings, with mean differences (95% confidence intervals) of 3.9 (0.1, 7.6; P = 0.045) and 7.0 mmHg (4.7, 9.2; P < 0.001) for systolic and diastolic BP, respectively. In hypertensive subjects, the Boso-Mediwatch readings were lower for systolic BP (mean difference -6.0 mmHg (-11.6, -0.3; P = 0.04) but were higher for diastolic BP (mean difference 3.8 mmHg (1.4, 6.3; P < 0.01). 4. In normotensive subjects, the Omron R3 readings were higher, with mean differences of 3.2 (0.6, 5.8; P = 0.018) and 4.2 mmHg (1.6, 6.7; P = 0.003) for systolic and diastolic BP, respectively. In hypertensive subjects, the Omron R3 readings were lower for both systolic and diastolic BP (mean differences: -5.8 (-8.8, -2.8; P = 0.001) and -5.5 (-9.3, -1.6; P = 0.008), respectively). 5. For the Boso-Mediwatch, weighted least products analysis confirmed the presence of both fixed and proportional error for systolic BP but not for diastolic BP. For the Omron R3, fixed or proportional error was not detected for either systolic or diastolic BP. 6. These wrist oscillometric devices, although offering portability and convenience, give BP measurements that frequently differ substantially (by at least 5 mmHg) from readings simultaneously measured at the upper arm by a mercury sphygmomanometer. The magnitude and direction of differences detected are dependent on both the device used and the underlying level of BP.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Oscillometric Blood Pressure Measurements at the Wrist With an Upper‐arm Auscultatory Mercury Sphygmomanometer

Rogers

Burke

Stroud

et al. 1999

Clin Exp Pharma Physio

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“…It is essential to choose the correct cuff size because BP obtained from oscillometric devices may vary, depending on cuff size and cuff-arm compliance (60). The ABPM should be done on a normal workday rather than a rest day to obtain a typical BP profile.…”

Section: Device Validation and Analysis Of Abpm Datamentioning

confidence: 99%

Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Hypertension

Grossman

2013

Diabetes Care

101

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“…Although the importance of using a correctly sized cuff has been documented for over twenty years, this is still one of the most common sources of measurement error encountered with obese patients (Kmom 2003). Ng and Small (1993) showed by both experimental and analytical analysis that cuff-arm compliance and bladder size interact to affect the pulse amplitude, hence oscillometric BP measurements. A numerical study (Cristalli et al 1994) indicates that apart from cuff size, the periarterial pressure imposed by an external cuff also depends on various factors including elastic properties of the arm soft tissues, and arterial position.…”

Section: Blood Pressure Monitormentioning

confidence: 99%

Reduction of Skin Stretch Induced Motion Artifacts in Electrocardiogram Monitoring Using Adaptive Filtering

Liu

Pecht

2006

2006 International Conference of the IEEE Engineering in Medicine and Biology Society

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Cardiovascular disease (CVD) is the leading cause of death in many regionsworldwide, accounting for nearly one third of global deaths in 2001. Wearable electrocardiographic cardiovascular monitoring devices have contributed to reduce CVD mortality and cost by enabling the diagnosis of conditions with infrequent symptoms, the timely detection of critical signs that can be precursor to sudden cardiac death, and the long-term assessment/monitoring of symptoms, risk factors, and the effects of therapy. However, the effectiveness of ambulatory electrocardiography to improve the treatment of CVD can be significantly impaired by motion artifacts which can cause misdiagnoses, inappropriate treatment decisions, and trigger false alarms. Skin stretch associated with patient motion is a main source of motion artifact in current ECG monitors. A promising approach to reduce motion artifact is the use of adaptive filtering that utilizes a measured reference input correlated with the motion artifact to extract noise from the ECG signal. Previous attempts to apply adaptive filtering to electrocardiography have employed either electrode deformation or acceleration, body acceleration, or skin/electrode impedance as a reference input, and were not successful at reducing motion artifacts in a consistent and reproducible manner. This has been essentially attributed to the lack of correlation between the reference input selected and the induced noise.In this study, motion artifacts are adaptively filtered by using skin strain as the reference signal. Skin strain is measured non-invasively using a light emitting diode (LED) and an optical sensor incorporated in an ECG electrode. The optical strain sensor is calibrated on animal skin samples and finally in-vivo, in terms of sensitivity and measurement range. Skin stretch induced artifacts are extracted in-vivo using adaptive filters. The system and method are tested for different individuals and under various types of ambulatory conditions with the noise reduction performance quantified.

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Changes in oscillometric pulse amplitude envelope with cuff size: implications for blood pressure measurement criteria and cuff size selection

Cited by 22 publications

References 9 publications

Comparison of Oscillometric Blood Pressure Measurements at the Wrist With an Upper‐arm Auscultatory Mercury Sphygmomanometer

Comparison of Oscillometric Blood Pressure Measurements at the Wrist With an Upper‐arm Auscultatory Mercury Sphygmomanometer

Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Hypertension

Reduction of Skin Stretch Induced Motion Artifacts in Electrocardiogram Monitoring Using Adaptive Filtering

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