Although the mercury sphygmomanometer is widely regarded as the "gold standard" for office blood pressure measurement, the ban on use of mercury devices continues to diminish their role in office and hospital settings. To date, mercury devices have largely been phased out in US hospitals. This has led to the proliferation of non-mercury devices and has changed (probably for ever) the preferable modality of blood pressure measurement in clinic and hospital settings. In this article, the basic techniques of blood pressure measurement and the technical issues associated with measurements in clinical practice are discussed. The devices currently available for hospital and clinic measurements and their important sources of error are presented. Practical advice is given on how the different devices and measurement techniques should be used. Blood pressure measurements in different circumstances and in special populations such as infants, children, pregnant women, elderly persons, and obese subjects are discussed.
Keywordsblood pressure measurement; self-monitoring; ambulatory blood pressure monitoring
Basic techniques of blood pressure measurement Location of measurementThe standard location for blood pressure measurement is the brachial artery. Monitors that measure pressure at the wrist and fingers have become popular, but it is important to realize that systolic and diastolic pressures vary substantially in different parts of the arterial tree with systolic pressure increasing in more distal arteries, and diastolic pressure decreasing.
The auscultatory methodAlthough the auscultatory method using mercury sphygmomanometer is regarded as the 'gold standard' for office blood pressure measurement, widespread implementation of the ban in use of mercury sphygmomanometers continues to diminish the role of this technique. 72 The situation is made worse by the fact that existing aneroid manometers, © 2010 Elsevier Inc. All rights reserved.Corresponding author for proof and prints: Gbenga Ogedegbe, MD, Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, 423 East 23 rd Street, 15N-168, New York, NY 10010, olugbenga.ogedegbe@nyumc.org, Ph: 212-263-4183, Fax: 212-263-4201. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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The oscillometric techniqueThis was first demonstrated by Marey in 1876, 38 and it was subsequently shown that when the oscillations of pressure in a sphygmomanometer cuff are recorded during gradual deflation, the point of maximal oscillation corresponds t...