Blood Pressure Measurement in Clinical Practice Methods and Emerging Options

“Whatever the measurement system is, it needs to be consistent, repeatable, and as unbiased as possible” Pearl Zhu[1] William Harvey discovered circulation in 1628 and century elapsed before Reverend Stephen Hales performed his famous experiment in 1733, demonstrating the rise of blood to height of eight feet, three inches, in glass pipe placed in artery of Horse. It was not until non-invasive occluding arm cuff devised by Scipione Riva Rocci in 1896 that clinical measurement of blood pressure (BP) became reality. He inflated cuff, until it occluded pulse distal to cuff. This application of external counter pressure until the pulse disappeared by palpation corresponds to peak systolic BP (SBP). Quantification of counterpressure was done by connecting the inflatable bag to mercury manometer� In April 1905, Russian surgeon-Nikolai Sergeevich Korotkoff described the measurement of BP by auscultation-peak systolic pressure corresponding to onset of audible sounds by Stethoscope distal to occluding cuff and disappearance of sounds to end-diastolic pressure� Alternative methods of BP measurement, using oscillometry, applanation tonometry, volume clamp method, and analysis of various parameters of arterial pulse wave, have been utilized for noninvasive measurement of arterial BP� The evolution of methods of BP measurement continues and the latest technique of non-invasive measurement of BP using Android smartphone, is commercially available but not yet approved by regulating organizations and professional societies� Direct intra-arterial pressure measurement by cannulation of the vessel is gold standard, but it is not practical for routine clinical measurement of ambulatory patients, as it is invasive and requires technical skill and is associated, although rarely with potential major complications of occlusion of vessels and injury to adjacent structures� Thus, indirect non-invasive measurement of BP is currently clinical standard� Most of these methods base the measurement of pressure, indirectly by applying counter pressure to blood vessels or analyzing various components of pulse wave recorded indirectly by device/sensors applied to blood vessels, transcutaneously� Abstract