From Korotkoff and Marey to automatic non-invasive oscillometric blood pressure measurement: does easiness come with reliability?

ABSTRACT

The auscultatory technique remains the point of reference for the validation of non-invasive blood pressure measurement devices, although the exact origin of the Korotkoff sounds is still debated and comparison with intra-arterial measurement shows limits and pitfalls. Automatic oscillometric devices are now widely used by nurses, physicians, and patients. However, many available devices have not been duly validated. Moreover, they calculate systolic and diastolic blood pressures using undisclosed algorithms. Therefore, these devices are not interchangeable, and their reliability may be questionable in some clinical situations. Nevertheless, oscillometry is increasingly used, beside NIBP, for the assessment of central blood pressure and systemic arterial wall stiffness. Awareness of its limits and causes of error is all the more necessary.

KEYWORDS:

• Blood pressure
• measurement
• non-invasive
• auscultatory technique
• oscillometry

Financial & competing interests disclosure

The authors were supported by the EU METALIC scholarship #1262 from the European Union Erasmus Mundus program received by A. Benmira. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

ORCID

A. Benmira http://orcid.org/0000-0002-8785-293XA. Perez-Martin http://orcid.org/0000-0002-8527-7783I. Schuster http://orcid.org/0000-0002-8735-4308I. Aichoun http://orcid.org/0000-0002-1892-7256S. Coudray http://orcid.org/0000-0002-6110-2583F. Bereksi-Reguig http://orcid.org/0000-0002-5788-6055M. Dauzat http://orcid.org/0000-0002-9496-3857

Key issues

• Auscultation remains the reference for noninvasive blood pressure measurement but the exact origin of Korotkoff sounds is still debated.

• The auscultatory technique is rapidly superseded in the daily practice by the use of automatic oscillometric devices.

• These devices are still validated by comparison with auscultatory measurement

• They do not directly measure systolic and diastolic blood pressures but calculate them using undisclosed algorithms.

• Therefore, they are not interchangeable, and the same device should be used in a given patient for follow-up.

• They may give inconsistent results, especially in patients with very high or very low blood pressure, arrhythmia, and/or increased arterial wall stiffness.

• Direct intra-arterial measurement remains preferable for resuscitation and intensive care.

• Oscillometry will probably also be widely used, in the near future, for the assessment of central arterial blood pressure and arterial wall stiffness.