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The patterns of sound phenomena during decompression of the brachial artery formed the basis of the auscultatory method (or the Korotkov method).

The auscultatory or sound method of measurement is also called the Korotkov method, which got its name from the name of the Russian surgeon who proposed this principle of measuring blood pressure. High degree of confidence in the results obtained and low price , whose work was based on this method, made the auscultatory method of measuring blood pressure the leading technique that has not changed for more than a century since its discovery.

The auscultatory method of measuring blood pressure is based on the process of listening to the sound of a pulsation (Korotkoff sounds) of a occluded artery. To do this, before starting the procedure, a tonometer cuff is put on the patient's shoulder and tightly fixed. It is important that the cuff covers the area of the artery located 2-3 centimeters above the antecubital fossa. With the help of intensive squeezing of the pear of the tonometer, air is pumped into the cuff. Injection stops approximately 30 mm. rt. Art. above the level of systolic pressure, when the pulsation of the artery completely ceases to be heard. At this moment, the pressure in the cuff of the device is high enough, and completely blocks the blood flow. The specialist taking the measurements, leans the head of the stethoscope to the bend of the elbow, where the radial artery passes, and carefully listens to the tones that are synchronous with the heartbeat. The first Korotkoff sound occurs when the pressure drops to a level equal to the systolic or upper pressure. The blood at this moment passes jerkily along the artery squeezed by the cuff (pulsation). Then the air in the cuff begins to descend, the pressure drops, and it ceases to create restrictions on blood flow. Tones are muffled until they disappear completely, which is typical for diastolic or lower pressure.

As mentioned earlier, this method is characterized by high reliability of the data obtained, and the low price of mechanical blood pressure monitors determines the widespread use of the technique among medical personnel and patients who take measurements on their own at home. But the auscultatory method also has its drawbacks. Often, unskilled users perform the procedure incorrectly: they pump excess air into the cuff, they make mistakes when listening to Korotkoff sounds, they decompress air from the cuff too quickly, or vice versa, too slowly.

Any device has a level of average error; in a pressure gauge, its indicator is about 5-10 millimeters of mercury. Errors during the measurement give additional units of error, therefore, as a result, the average error of the sound method is 5-15 millimeters of mercury.

The oscillometric method is one of the successfully used non-invasive methods for measuring blood pressure. It is mainly used in semi-automatic and automatic devices for measuring pressure - tonometers, as well as devices for long-term recording of indicators - blood pressure monitors.

It was first proposed by the French physiologist Marey in 1876, but for a long time the method was not in demand due to the complexity of the study.

Now this technique is very well studied, the obtained indicators are analyzed using special programs and converted into numbers that we see on the monitor. These programs are kept secret by manufacturers and are constantly being improved, trying to get rid of the main drawback that the oscillometric method has - the dependence of the accuracy of the readings on the movement of the patient during the measurement.

Method principle

Arterial oscillography registers changes in tissue volume under conditions of dosed compression and decompression of a blood vessel. Such a change in volume is associated with an increase in arterial blood supply to the tissue during a pulse shock. Compression and decompression of the limb in which the artery passes is carried out using a cuff.

In this case, the inner surface of the cuff becomes the sensor that registers the change in the volume of the limb, imperceptible to the eye. The change in cuff pressure is the main indicator that this method analyzes. Through the cable, information is transmitted to the device, which processes it using an analog-to-digital converter and a microprocessor with a program for calculating indicators and turns it into an image - pressure numbers on the display.

If the rhythm is disturbed, the pulse fluctuations become irregular, which is also captured by the sensitive cuff. Information about a missed or premature heartbeat is perceived and reflected on the display as an arrhythmia.

It is clear that during oscillography, the pulse is also recorded, the measurement results of which are also visible on the screen of the tonometer.

How the measurement is carried out

The blood pressure cuff is designed in such a way that air can be dosed into it and then released. In the first phase, compression (compression) of the limb occurs, and in the second phase, relaxation (decompression). The oscillometric method assumes that it simultaneously serves as a receiver of pulse oscillations (in contrast to the Korotkov method).

The cuff is placed and fixed on the shoulder. The compression in it with the help of an automatic or manual pump is raised to a level slightly higher than the systolic pressure in the brachial artery. In automatic blood pressure monitors, the determination of the desired compression in the cuff is carried out automatically. In semi-automatic devices, the patient himself is guided by the desired degree of compression of the limb. After that, a smooth stepwise decrease in pressure in the cuff is performed - decompression.

In the earliest arterial oscilloscopes, all measurements were made on paper tape. During decompression, when the pressure in the cuff became equal to systolic, an abrupt amplification of oscillations appeared on the arterial oscillogram, that is, deviations of the record from a straight line. The oscillations stopped at the moment when the compression level in the cuff became equal to the diastolic one. The cuff stopped capturing changes in the volume of the shoulder during pulse waves.

The method of measuring blood pressure used in modern devices is based on the same principle. At each stage of decompression, the device determines how pronounced the oscillations inside the cuff are. With a sharp increase in these fluctuations, systolic pressure is recorded, and when it stops, diastolic pressure is recorded.

The method determines the pressure, which is usually slightly higher than when using Korotkoff sound tones heard with a stethoscope. However, these indicators differ slightly, and in arterial hypertension they are almost equal.

Advantages and disadvantages

The main disadvantage of the oscillometric method is the need for immobility of the limb during the measurement.

The method also has advantages over measuring blood pressure using Korotkoff sounds:

the accuracy of the results does not depend on the person conducting the study;
the ability to correctly measure with weak tones, an “infinite” tone or an “auscultatory gap”, when the usual sound characteristics are changed using a phonendoscope;
the ability to impose a cuff on a thin layer of clothing;
the need for special training.

The oscillometry method is also used in devices for the analysis of arterial and peripheral vascular resistance, stroke and minute volumes of the heart, and other characteristics of blood circulation.

3 Benefits of the method

4 Disadvantages of the Korotkoff method

Russian surgeon Nikolai Korotkov introduced the auscultatory method of measuring blood pressure in 1905. The novelty was that the pressure was listened to with a stethoscope attached to the pulsating artery. It immediately began to be used along with other non-invasive methods. It was this method that was taken as the basis for the invention of modern tonometers.

The essence of the method

Blood pressure is determined by the force of blood pressure exerted on the walls of blood vessels and their resistance. Distinguish:

Systolic (upper limit). It is determined by the ratio of the volume of blood ejected by the heart to the resistance in the arteries.
Diastolic (lower). Describes pressure in peripheral blood vessels.

Measurement of blood pressure by auscultatory method was carried out using an apparatus that included a rubber cuff, an air cylinder that inflated the cuff and a mercury manometer. The main idea of the method discovered by Korotkov: if the artery is completely pulled, no sounds will be heard, and as you relax, tones will be heard, allowing you to determine the upper and lower digits of blood pressure.

The description of the auscultatory technique assumes that a cuff is put on the upper arm and inflated with air using a pump so that the artery is compressed enough to exceed the person's systolic BP level. The air-filled cuff blocks the flow of blood, so there is no sound. With gradual decompression, characteristic sounds begin to be heard, which is necessary to determine blood pressure. The first tones appear when the tourniquet weakens to the level of systolic pressure, the blood begins to flow in jerks. The sound becomes muffled as the pressure of the cuff fluctuates between the upper and lower limits. When the tourniquet weakens below the diastolic level, the sound becomes even more muffled and soon subsides. It was this method that became the basis for the invention of a mechanical tonometer.

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How is blood pressure measured using the Korotkoff method?

Devices for measuring blood pressure are constantly being improved. But not all of them work according to the auscultatory method, therefore, they do not always give an accurate result. The automatic blood pressure monitor is simple and easy to use, even people without special training can easily use it. But doctors still believe that mechanical pressure measurement gives more reliable results. When working on the auscultatory method, it is necessary to follow some rules in order to get the correct value, namely:

The patient is placed or seated, having previously given a rest for 10-15 minutes.
It is forbidden to strain or talk during the procedure.
The cuff is tightly fixed on the bare shoulder so that the finger passes.
A stethoscope is placed in the antecubital fossa above the pulsating brachial artery.
The cuff is inflated so that after the noise in the artery has completely subsided, the arrow is 20-30 mm Hg higher. Art. noiseless indicator.
From the pump slowly (at an approximate speed of 2 mm / s) release air, in parallel, follow the pressure gauge needle. When the first tones appear, the level of systolic pressure is determined. When the tones subside sharply, diastolic blood pressure is indicated.

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The Korotkoff method may have inaccurate measurement results in some cases.

Measurement of blood pressure according to the Korotkoff method in some atypical situations cannot give accurate results. Sometimes there are paradoxical deviations from the norm, in which it is difficult or impossible to listen to the tones correctly. To be prepared for this, it is important to know the basic nuances, namely:

Endless tone. It manifests itself in the fact that even with a decrease in the squeezing force of the cuff below the diastolic pressure, Korotkoff's tones are still heard. Most often occurs in children and pregnant women with increased cardiac output.
auscultatory failure. This is a phenomenon in which tones stop completely after listening to systolic pressure and resume only if the pressure in the cuff is released. The calm time is 40 mm Hg. Art. This phenomenon complicates the determination of the upper limit, so it must be probed with your fingers.
Paradoxical pulse. An atypical phenomenon in which Korotkoff sounds disappear on inhalation, and appear on exhalation. If such deviations are observed, diseases of the lungs or the cardiovascular system take place.

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Advantages of the method

The great advantage of the method is non-invasiveness, that is, intervention in the work of the body is required.

Simplicity and ease. The method is convenient, so it can be used at home. To use a mechanical apparatus, you need to get a little hands on.
Accuracy. The technique gives accurate results, which is why it is recognized all over the world.
Constancy. Failures in the heart rhythm and other external factors do not affect the receipt of error-free results.

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Disadvantages of the Korotkov Method

If a person has problems with hearing or vision, there will be difficulties in measuring pressure.
When a patient has a dull tone (no sounds are heard) or one of the atypical phenomena, the Korotkoff method may give incorrect readings.

But there are also problems of measuring blood pressure in a non-invasive way that have been solved over time. Previously, it was considered a disadvantage that in order to use the method, you need to be specially trained in this. But scientists solved this problem by introducing automatic blood pressure monitors to the world. It was assumed that external noises could interfere with listening to Korotkov's tones, but this problem is not significant during a ward examination.

The auscultatory method is the most common, tonometers are constantly being improved. On sale there are not only automatic devices that do not require a stethoscope, but also wrist ones. The latest models are convenient to take with you on a trip, for training or jogging. Such novelties even overcome some of the shortcomings of the Korotkov method, for example, a tonometer can be used in the subway or in a store, and not only in a quiet place.

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What is the oscillometric method for measuring blood pressure

The oscillometric method for measuring blood pressure is widely used today. In medicine, 2 more types of blood pressure measurement are used - invasive and non-invasive.

Measurement methods

All methods for measuring pressure that exist today were finally developed in the 20th century.

Invasive, it is also called the direct method, is that a special probe is inserted into the human artery, on which a pressure sensor is installed. From it, the readings are transmitted to a special device that processes the data and displays arterial values on the monitor in real time. The advantage of the method is the high accuracy of measurements, which does not depend on the state of the vessels, the presence of arrhythmias and other pathologies of the human body. But it is possible to measure the pressure of blood in the vessels in this way only in a hospital, since the patient requires constant monitoring. If the probe falls out of the artery, there will be severe bleeding, possibly infection. This technique is used in surgical interventions, in intensive care units and intensive care units.

In 1905, the outstanding Russian surgeon Nikolai Sergeevich Korotkov, with a report at the Imperial Military Academy, revolutionized the practice of measuring blood pressure by proposing a new, completely non-traumatic technique, which was called the Korotkov tone method.

non-invasive way

The sound (auscultative, Korotkoff tone method) method is extremely simple: a sphygmomanometer is used, connected to a cuff and a pear. At the same time, air was injected into the cuff and the phonendoscope.
He puts on a cuff on his shoulder, air is forced into it, the arteries are pinched. The phonendoscope is applied to the bend of the radial artery. The cuff is slowly deflated. As soon as the first sample of blood in the artery is heard in the phonendoscope, the value of systolic pressure is visually recorded on the sphygmomanometer, as soon as the tones fade, the diastolic pressure is recorded.
This method is officially recognized by the World Health Organization as a reference method. Despite its simplicity, this technique has disadvantages:

dependence on the characteristics of the one who conducts the measurement (vision and hearing);
special skills are required;
dependence on external noise.

A device for measuring blood pressure is called a tonometer.

With the development of electronics in 1976, Omron Corporation developed an oscillometric method for measuring pressure. This is the next stage in the development of the Korotkoff tone method, only fully automated. Its essence lies in the fact that the bleeding of air from the cuff occurs in steps, where at each stage the pulsation in the cuff is analyzed. The most powerful pulsation is systolic pressure, attenuation is diastolic. This method is used in most automatic and semi-automatic blood pressure devices. The range of manufactured devices is extremely wide.

Simplicity and Precision

Now everyone can take measurements at home without contacting a specialist. Thus, the oscillometric method is fully automated and does not depend on the user's skills. For simplicity, we will use the term electronic tonometer.

There is a huge range of blood pressure monitors on the market: from miniature models that measure pressure on the wrist, to large stationary devices for mass measurements.

Blood pressure monitors on the wrist are suitable for those whose age does not exceed 30 years, they are less accurate. They are more suitable for those who lead an active and healthy lifestyle, go in for sports and serve to monitor pressure before and after training, respectively, adjusting the load.

Blood pressure monitors with a cuff on the shoulder fit absolutely everyone. They are of 2 types:

semi-automatic - air is pumped into the cuff manually using a pear, then the process is automated;
automatic - just put on the cuff and press the button.

Engineers develop models suitable for almost all categories of citizens. There are tonometers that confidently determine the pressure in the presence of various pathologies. The cost of such devices is higher.

The advantages of these devices:

anyone can use the device;
suitable for those who have arrhythmia;
low dependence on external noise;
independence from the human factor.

Myths about electronics

Often people do not trust electronics, because when measuring blood pressure, they do not follow the basic rules. You can often hear: I measured at home, walked up to the 5th floor to a neighbor, and there it shows differently. We list the basic rules for measuring pressure:

Pressure must be measured at rest: if you are worried or come from somewhere, you need 20 minutes. relax.

Measurements are taken in a sitting position, the cuff should be at the level of the heart. When using tonometers that measure pressure on the wrist, the hand with the tonometer should be in the area of \u200b\u200bthe heart.

The interval between measurements should not be less than 20 minutes. Or you need to make 3 consecutive measurements with an interval of no more than 15 seconds. and calculate the average value, discarding obviously false ones.
It is desirable to measure pressure either on a bare arm or through a thin fabric of clothing.

Often these simple rules are not followed, and it seems to many that the tonometer is wrong. Only the whole principle of the oscillometric method is that the device works according to the same algorithm every time, that is, no matter how many times you measure pressure, the device will do the same action, because it is electronics, and it executes a given program.

The oscillometric measurement method is simple and reliable.

Suitable for blood pressure control at home even for those who have hypertension or hypotension. The method has been clinically tested, and it has been proven that it has no contraindications.

You can use any methods for measuring pressure. The main thing is to constantly monitor your condition and lead a healthy lifestyle.

Why is 24-hour blood pressure monitoring performed?

An important characterizing factor in human health is blood pressure. It is this that determines the well-being and quality of life. Today, everyone can purchase an electric automatic device for measuring pressure at home and at any time get information about it, but there are situations when you need to measure this indicator repeatedly. In this case, 24-hour blood pressure monitoring (ABPM) is used.

Indications for the procedure
ECG and BP monitoring by Holter
BP monitoring by BiPiLAB system daily
Patient Instruction

To date, three methods of measuring blood pressure are used in medicine: auscultatory, oscillometric and invasive. Most often, monitoring devices are used that include oscillometric and auscultatory methods, which, in combination with each other, allow a more complete picture of the disease to be obtained.

Indications for the procedure

Individuals suspected of having symptomatic hypertension.
Individuals with white coat syndrome. We are talking about those who have increased pressure in the walls of a medical institution in the case of a measurement carried out by a nurse.
Persons with “borderline” blood pressure readings, which were detected with repeated changes by the Korotkov method.
Persons with increased blood pressure at the workplace.
Persons suffering from concomitant diseases, which include heart failure, metabolic disorders, syncope, etc.
Persons with high blood pressure lability. We are talking about those whose pressure fluctuates too much from the minimum to the maximum high.
Elderly over 60 years of age.
Individuals with nocturnal hypertension.
Persons with poor heredity.
Persons with severe arterial hypertension, difficult to treat.
Persons who need to receive a prognosis for the further development of the disease.
Women in pregnancy.
Persons with disorders of the autonomic system.
Persons with type 1 diabetes.

I must say that it will not be possible to obtain accurate data by self-measuring blood pressure, because diagnostics cannot be carried out at night, because for this a person needs to wake up, and this will inevitably increase pressure and distort the results. In addition, the performance of different devices can differ significantly from each other.

It is believed that the most accurate data can be obtained by measuring the Korotkoff method. At the same time, experts recommend using semi-automatic devices with automatic air injection. The manual pressurization process may increase the pressure for a short time.

ECG and BP monitoring by Holter

Daily monitoring of blood pressure and ECG allows you to get a more complete picture of the disease, especially when there are hidden forms of heart disease that do not manifest themselves clinically, but are diagnosed on the ECG in a state of motion.

The American scientist Holter developed an instrumental diagnostic method based on recording the electrical activity of the heart muscle, which occurs during life and changes depending on the presence of certain heart diseases. At the same time, electrodes are placed on the patient's chest, which read information about the work of the main "motor" of the body and send it to the connected portable device.

In it, the data is processed by software and recorded in the form of electrocardiograms, which are stored in the memory of the device. With this method, they can simultaneously apply a cuff to the shoulder and thus conduct daily monitoring of blood pressure using an oscillometric method. In case of any ambiguities, the diagnosis can be extended up to 7 days.

This method has a lot of advantages and advantages over the standard ECG, which does not always allow recording myocardial ischemia and paroxysmal rhythm changes. This method of measuring blood pressure is almost the only one for those patients whose heart function deteriorates with minimal movement.

This research technique is indicated for those patients who complain of pressing or burning pain behind the chest and in the region of the heart, which may or may not radiate under the scapula and arm from the side of the main “motor”. Pain in the left side of the chest, especially at night, is also the basis for the procedure.

This also applies to those who suffer from shortness of breath with a suffocating cough, suffer from lack of air, a feeling of sinking heart, frequent dizziness, fainting and periodic failures in the work of the main “motor” of the body. There are no contraindications for the procedure, except in cases where it is technically impossible to perform, for example, with severe obesity, body burns, etc.

BP monitoring by BiPiLAB system daily

This device records the patient's systolic, diastolic, mean BP and pulse rate in an automated, non-invasive way. The oscillometric method will provide accurate data on the patient's state of health with weak Korotkoff sounds, hypotension, and in the case when the auscultatory method did not give a result. At the same time, a cuff is placed on the patient's arm, which does not impair the patient's quality of life and does not make noise, which is very important for comfortable sleep.

The device is connected to the computer programmatically, that is, through special software and a communication cable. It is often combined with Holter monitoring of ECG and blood pressure. In the future, the data from both devices are processed in one program and the results are combined in a common report.

Patient Instruction

To achieve good results and to achieve a minimum number of erroneous measurements, the patient is instructed. He is introduced to the rules of conduct during monitoring, here they are:

During operation of the device, the arm with the cuff must be extended along the body and relaxed.
During the entire period of diagnosis, it is not recommended to engage in physical labor and sports.
If the device starts measuring while moving, it is necessary to stop, relax and only after the end of its work continue further actions.
It is not recommended to follow the readings of the device during the measurement, as anxious expectation can distort the further result.
At night, try to fall asleep without thinking about the operation of the device.
Keep a diary and during monitoring reflect your well-being and all your actions in it.
Do not shower or bathe during the entire diagnostic period.
Do not kink the pump tube.

Assessment of the results of ABPM is given after a day from the start of the study. A special computer program analyzes them, and the doctor, on the basis of this, gives a conclusion about the variability of pressure, the dynamics of morning readings, the hypotension index, and then compares the obtained values with the average standard indices. Based on these data, a set of measures is prescribed that will improve the patient's health status.

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