Measuring arterial blood pressure in humans: Auscultatory and automatic measurement techniques for human biological field studies

Abstract

Human biologists have been examining arterial blood pressure since they began studying the effects of the environment and culture on the health of diverse populations. The Korotkoff auscultatory technique with a trained observer and aneroid sphygmomanometer is the method of choice for blood pressure measurement in many bioanthropological field contexts. Korotkoff sounds (the first and fifth phases) are the preferred determinants of systolic and diastolic pressure, even in infants, children, pregnant women, and the elderly. Training of observers, positioning of individuals, and selection of cuff size are all essential for obtaining standardized measurements. Automatic electronic devices are increasingly being used for blood pressure measurement in human biological studies. The automatic monitors often use the oscillometric method for measuring pressure, but must be validated before use. The emergence of automatic ambulatory blood pressure monitors has opened another avenue of research on blood pressure in human biology, where allostasis and circadian responses to environmental change and real life behavioral challenges can be defined and evaluated, largely because there is now the ability to make multiple measurements over time and in varying contexts. Stand-alone automatic monitors can also be substituted for manual auscultated readings in field contexts, although in studies where participants measure their own pressure, education about how the devices work and protocol specifics are necessary. Finally, computer-driven plethysmographic devices that measure pressure in the finger are available to evaluate shortterm reactivity to specific challenges. | I NT ROD UCTI ONThe circulation of blood in the body is made possible by the continuous rhythmic pumping action of the heart, which generates a pulsatile flow when it ejects blood from the left ventricle into the aorta. The pressure exerted against the inner walls of blood vessels during the maximum push of the blood pulse as the left ventricle contracts is systolic blood pressure. Diastolic blood pressure is the force exerted during relaxation and dilatation of the heart, as it refills with blood prior to its next contraction. It is the minimum pressure of the blood pulse. Arterial blood pressure is thus expressed as two numbers: the maximum (systolic) and minimum (diastolic) pressure of a pulse wave of blood as it is expelled from the heart. Because each pulse generates pressure, the number of measureable maxima and minima over a 24 hour period will be equal to the number of heart beats (or ventricular contractions), which will range from 100,000 to perhaps 130,000 in an average healthy person (James, 2007;O'Rourke, 1990).The first easily reproducible noninvasive method for quantifying the maximum and minimum of the blood pulse was developed by Nikolai Korotkoff (1874Korotkoff ( -1920, a Russian field surgeon during the Russo-Japanese war (1904)(1905). American Journal of Human BiologyKorotkoff stumbled upon the method as he was devising a means of ascert...

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