Sphygmomanometer

A sphygmomanometer (/ˌsfɪɡmoʊməˈnɒmɪtər/ SFIG-moh-mə-NO-mi-tər), also known as a blood

pressure monitor, or blood pressure gauge, is a device used to measure blood pressure, composed of an
inflatable cuff to collapse and then release the artery under the cuff in a controlled manner,[1] and a
mercury or aneroid manometer to measure the pressure. Manual sphygmomanometers are used with a
stethoscope when using the auscultatory technique.

A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or

aneroid gauge), and a mechanism for inflation which may be a manually operated bulb and valve or a
pump operated electrically.

Etymology
The word sphygmomanometer uses the combining form of sphygmo- + manometer. The roots involved
are as follows: Greek σφυγμός sphygmos "pulse", plus the scientific term manometer (from French
manomètre), i.e. "pressure meter", itself coined from μανός manos "thin, sparse", and μέτρον metron
"measure".[2][3][4]

Most sphygmomanometers were mechanical gauges with dial faces, or mercury columns, during most of
the 20th century. Since the advent of electronic medical devices, names such as "meter" and "monitor"
can also apply, as devices can automatically monitor blood pressure on an ongoing basis.

History
The sphygmomanometer was invented by Samuel Siegfried Karl
Ritter von Basch in the year 1881.[1] Scipione Riva-Rocci
introduced a more easily-usable version in 1896. In 1901,
pioneering neurosurgeon Dr. Harvey Cushing brought an example
of Riva-Rocci's device to the US, modernized and popularized it
within the medical community. Further improvement came in
1905 when Russian physician Nikolai Korotkov included diastolic
blood pressure measurement following his discovery of
"Korotkoff sounds". William A. Baum invented the
Baumanometer brand in 1916,[5] while working for The Life
Extension Institute which performed insurance and employment
physicals.[6]
A French sphygmomanometer used
during World War I
Types
Both manual and digital meters are currently employed, with different trade-offs in accuracy versus
convenience.
BP 138/73 mmHg as result on Aneroid sphygmomanometer with
electronic sphygmomanometer an adult cuff

Aneroid sphygmomanometer dial, Clinical mercury manometer

bulb, and air valve

Clinical WelchAllyn
sphygmomanometer

Manual
A stethoscope is required for auscultation (see below). Manual meters are best used by trained
practitioners, and, while it is possible to obtain a basic reading through palpation alone, this yields only
the systolic pressure.

Mercury sphygmomanometers are considered the gold standard. They indicate pressure
with a column of mercury, which does not require recalibration.[7] Because of their accuracy,
they are often used in clinical trials of drugs and in clinical evaluations of high-risk patients,
including pregnant women. A frequently used wall mounted mercury sphygmomanometer is
also known as a Baumanometer.[6]
Aneroid sphygmomanometers (mechanical types with a dial) are in common use; they may
require calibration checks, unlike mercury manometers. Aneroid sphygmomanometers are
considered safer than mercury sphygmomanometers, although inexpensive ones are less
accurate.[8] A major cause of departure from calibration is mechanical jarring. Aneroids
mounted on walls or stands are not susceptible to this particular problem.

Digital
Digital meters employ oscillometric measurements and electronic calculations rather than auscultation.
They may use manual or automatic inflation, but both types are electronic, easy to operate without
training, and can be used in noisy environments. They calculate systolic and diastolic pressures by
oscillometric detection, employing either deformable membranes that are measured using differential
capacitance, or differential piezoresistance, and they include a microprocessor.[9] They estimate mean
arterial blood pressure and measure pulse rate; while systolic and diastolic pressures are obtained less
accurately than with manual meters,[10] and calibration is also a concern.[11][12][13] Digital oscillometric
monitors may not be advisable for some patients, such as those with arteriosclerosis, arrhythmia,
preeclampsia, pulsus alternans, and pulsus paradoxus, as their calculations may not be correct for these
conditions,[14][15] and in these cases, an analog sphygmomanometer is preferable when used by a trained
person.

Digital instruments may use a cuff placed, in order of accuracy[16] and inverse order of portability and
convenience, around the upper arm, the wrist, or a finger.[17] Recently, a group of researchers at Michigan
State University developed a smartphone based device that uses oscillometry to estimate blood
pressure.[18][19] The oscillometric method of detection used gives blood pressure readings that differ from
those determined by auscultation, and vary according to many factors, such as pulse pressure, heart rate
and arterial stiffness,[20] although some instruments are claimed also to measure arterial stiffness, and
some can detect irregular heartbeats.

Operation
In humans, the cuff is normally placed smoothly and snugly around an upper arm, at roughly the same
vertical height as the heart while the subject is seated with the arm supported. Other sites of placement
depend on species and may include the flipper or tail. It is essential that the correct size of cuff is selected
for the patient. Too small a cuff results in too high a pressure, while too large a cuff results in too low a
pressure. For clinical measurements it is usual to measure and record both arms in the initial consultation
to determine if the pressure is significantly higher in one arm than the other. A difference of 10 mmHg
may be a sign of coarctation of the aorta. If the arms read differently, the higher reading arm would be
used for later readings.[21] The cuff is inflated until the artery is completely occluded.
With a manual instrument, listening with a stethoscope to the
brachial artery, the examiner slowly releases the pressure in the
cuff at a rate of approximately 2 mmHg per heart beat. As the
pressure in the cuffs falls, a "whooshing" or pounding sound is
heard (see Korotkoff sounds) when blood flow first starts again in
the artery. The pressure at which this sound began is noted and
recorded as the systolic blood pressure. The cuff pressure is
further released until the sound can no longer be heard. This is
recorded as the diastolic blood pressure. In noisy environments Medical student taking blood
where auscultation is impossible (such as the scenes often pressure at the brachial artery
encountered in emergency medicine), systolic blood pressure
alone may be read by releasing the pressure until a radial pulse is
palpated (felt). In veterinary medicine, auscultation is rarely of use, and
palpation or visualization of pulse distal to the sphygmomanometer is
used to detect systolic pressure.

Digital instruments use a cuff which may be placed, according to the

instrument, around the upper arm, wrist, or a finger, in all cases elevated
to the same height as the heart. They inflate the cuff and gradually reduce
the pressure in the same way as a manual meter, and measure blood
pressures by the oscillometric method.[9]
Explanation of how blood
pressure is measured
based on Korotkow sounds
Significance
By observing the mercury in the column, or the aneroid gauge pointer, while releasing the air pressure
with a control valve, the operator notes the values of the blood pressure in mmHg. The peak pressure in
the arteries during the cardiac cycle is the systolic pressure, and the lowest pressure (at the resting phase
of the cardiac cycle) is the diastolic pressure. A stethoscope, applied lightly over the artery being
measured, is used in the auscultatory method. Systolic pressure (first phase) is identified with the first of
the continuous Korotkoff sounds. Diastolic pressure is identified at the moment the Korotkoff sounds
disappear (fifth phase).

Measurement of the blood pressure is carried out in the diagnosis and treatment of hypertension (high
blood pressure), and in many other healthcare scenarios.

See also

Medical portal
Critical closing pressure

References
1. Booth J (1977). "A short history of blood pressure measurement" (https://www.ncbi.nlm.nih.g
ov/pmc/articles/PMC1543468). Proceedings of the Royal Society of Medicine. 70 (11): 793–
9. doi:10.1177/003591577707001112 (https://doi.org/10.1177%2F003591577707001112).
 PMC 1543468 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543468). PMID 341169 (htt
ps://pubmed.ncbi.nlm.nih.gov/341169).
2. Harper D. "sphygmomanometer" (https://www.etymonline.com/?term=sphygmomanometer).
Online Etymology Dictionary.
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Dictionary.
4. σφυγμός (https://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.04.0057:entry=
sfugmo/s), μανός (https://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.04.005
7:entry=mano/s), μέτρον (https://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:199
9.04.0057:entry=me/tron). Liddell, Henry George; Scott, Robert; A Greek–English Lexicon at
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5. U.S patent 1594039 Manometer (https://patents.google.com/patent/US1594039A/)
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External links
US patent 1089122 (https://worldwide.espacenet.com/textdoc?DB=EPODOC&IDX=US1089
122), Francis Ashley Faught, Charles J Pilling, "Apparatus for measuring and indicating
blood-pressure", issued 1914-03-03
US patent 1594039 (https://worldwide.espacenet.com/textdoc?DB=EPODOC&IDX=US1594
039), William A Baum, "Manometer", issued 1926-07-27
US patent 2560237 (https://worldwide.espacenet.com/textdoc?DB=EPODOC&IDX=US2560
237), R. H. Miller, "Sphygmomanometer", issued 1951-07-10
US patent 6752764 (https://worldwide.espacenet.com/textdoc?DB=EPODOC&IDX=US6752
764), Man S. Oh, "Pocket sphygmomanometer", issued 2004-06-22

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