Blood pressure measurement
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Summary
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These studies suggest that accurate blood pressure measurement is influenced by various factors and can be achieved through different methods, including home measurements, transducers, ECG signals, photoplethysmography, and novel non-invasive technologies, with ongoing research needed for further improvement and widespread acceptance.
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Blood Pressure Measurement: Techniques, Accuracy, and Innovations
Traditional Blood Pressure Measurement Methods
Mercury and Aneroid Sphygmomanometers
The conventional method for measuring blood pressure involves the use of mercury and aneroid sphygmomanometers. These devices rely on occluding the artery of an extremity with an inflatable cuff to measure blood pressure either oscillometrically or by detecting Korotkoff sounds. Despite their widespread use, these methods are subject to variability due to factors such as respiration, emotion, exercise, meals, tobacco, alcohol, temperature, bladder distension, and pain, which can significantly influence blood pressure readings.
Home vs. Clinical Measurements
It has been recognized for over 50 years that blood pressure measured at home is typically lower than that recorded in a clinical setting. This discrepancy has been confirmed repeatedly, regardless of whether the measurements are taken by patients themselves or by their relatives or friends. This phenomenon underscores the importance of considering the environment in which blood pressure is measured.
Modern Techniques and Innovations
Oscillometric Devices and Automated Office Blood Pressure Measurement (AOBPM)
Oscillometric devices are widely used in hospitals and clinics for automated blood pressure measurement. However, these devices are prone to errors influenced by various factors such as patient activities before measurement, the measurement environment, and device settings. A systematic review identified 22 common error sources, with some causing significant increases or decreases in systolic and diastolic blood pressure. This highlights the need for standardized measurement procedures to ensure accuracy.
Continuous Non-Invasive Blood Pressure Measurement
Recent advancements have led to the development of continuous non-invasive blood pressure measurement techniques. These include the volume clamp method and radial artery applanation tonometry, which have been validated but require further improvement for routine clinical use. Continuous monitoring is crucial for reliable and timely hypertension detection, especially in critically ill patients and high-risk surgery patients.
Cuffless Blood Pressure Measurement
Cuffless blood pressure measurement has gained popularity due to its potential for convenience and continuous monitoring. Methods under investigation include pulse transit time, pulse wave analysis, and facial video processing. These methods can be calibrated or uncalibrated, with the latter not requiring periodic cuff device usage or demographic inputs. Despite the promise, no cuffless method has been broadly accepted yet.
Wearable Sensors and Deep Learning Techniques
Wearable sensors for continuous blood pressure monitoring are emerging as a revolutionary approach. For instance, a novel method using a one-channel electrocardiogram (ECG) signal combined with deep learning techniques has shown promising results. This method demonstrated compliance with the Association for the Advancement of Medical Instrumentation standards and achieved high accuracy in estimating mean arterial pressure, diastolic blood pressure, and systolic blood pressure. Similarly, another study proposed a method using photoplethysmography (PPG) signals, which also met the required standards for non-invasive blood pressure estimation.
Conclusion
Blood pressure measurement has evolved significantly from traditional mercury sphygmomanometers to advanced continuous and cuffless methods. While traditional methods remain widely used, modern techniques offer the potential for more accurate and convenient monitoring. Continuous non-invasive and cuffless methods, particularly those utilizing wearable sensors and deep learning, represent the future of blood pressure measurement, promising improved patient outcomes and more effective hypertension management. However, further research and standardization are needed to fully realize their potential in clinical practice.
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