Are Korotkoff Sounds Reliable Markers for Accurate Estimation of Systolic and Diastolic Pressure Using Brachial Cuff Sphygmomanometry?

G Celler, B; Butlin, M; Argha, A; Tan, I; Yong, A; Avolio, A

Are Korotkoff Sounds Reliable Markers for Accurate Estimation of Systolic and Diastolic Pressure Using Brachial Cuff Sphygmomanometry?

G Celler, B Butlin, M Argha, A

Tan, I Yong, A Avolio, A

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Publisher:: IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC
Publication Type:: Journal Article
Citation:: IEEE Trans Biomed Eng, 2021, 68, (12), pp. 3593-3601
Issue Date:: 2021-12

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Field	Value	Language
dc.contributor.author	G Celler, B
dc.contributor.author	Butlin, M
dc.contributor.author	Argha, A https://orcid.org/0000-0002-8276-9774
dc.contributor.author	Tan, I
dc.contributor.author	Yong, A
dc.contributor.author	Avolio, A
dc.date.accessioned	2022-03-17T21:40:51Z
dc.date.available	2022-03-17T21:40:51Z
dc.date.issued	2021-12
dc.identifier.citation	IEEE Trans Biomed Eng, 2021, 68, (12), pp. 3593-3601
dc.identifier.issn	0018-9294
dc.identifier.issn	1558-2531
dc.identifier.uri	http://hdl.handle.net/10453/155301
dc.description.abstract	It is well known that non-invasive blood pressure measurements significantly underestimate true systolic blood pressure (SBP), and overestimate diastolic blood pressure (DBP). The aetiology for these errors has not yet been fully established. This study aimed to investigate the accuracy of Korotkoff sounds for detection of SBP and DBP points as used in brachial cuff sphygmomanometry. Brachial cuff pressure and Korotkoff sounds were obtained in 11 patients (6 males: 69.0 ± 6.2 years, 5 females: 71.8 ± 5.5 years) undergoing diagnostic coronary angiography. K2 Korotkoff sounds were obtained by high-pass filtering (>20 Hz) the microphone-recorded signal to eliminate low frequency components. Analysis of the timing of K2 Korotkoff sounds relative to cuff pressure and intra-arterial pressure shows that the onset of K2 Korotkoff sounds reliably detect the start of blood flow under the brachial cuff and their termination, marks the cuff pressure closely coincident with DBP. We have made the critical observation that blood flow under the cuff does not begin when cuff pressure falls just below SBP as is conventionally assumed, and that the delay in the opening of the artery following occlusion, and the consequent delay in the generation of K2 Korotkoff sounds, may lead to significant errors in the determination of SBP of up to 24 mmHg. Our data suggest a potential role of arterial stiffness as a major component of the errors recorded, with underestimation of SBP much more significant for subjects with stiff arteries than for subjects with more compliant arteries.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC
dc.relation.ispartof	IEEE Trans Biomed Eng
dc.relation.isbasedon	10.1109/TBME.2021.3079578
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	0801 Artificial Intelligence and Image Processing, 0903 Biomedical Engineering, 0906 Electrical and Electronic Engineering
dc.subject.classification	Biomedical Engineering
dc.subject.mesh	Blood Pressure
dc.subject.mesh	Blood Pressure Determination
dc.subject.mesh	Brachial Artery
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Systole
dc.title	Are Korotkoff Sounds Reliable Markers for Accurate Estimation of Systolic and Diastolic Pressure Using Brachial Cuff Sphygmomanometry?
dc.type	Journal Article
utslib.citation.volume	68
utslib.location.activity	United States
utslib.for	0801 Artificial Intelligence and Image Processing
utslib.for	0903 Biomedical Engineering
utslib.for	0906 Electrical and Electronic Engineering
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
utslib.copyright.status	closed_access	*
dc.date.updated	2022-03-17T21:40:49Z
pubs.issue	12
pubs.publication-status	Published
pubs.volume	68
utslib.citation.issue	12

Abstract:

It is well known that non-invasive blood pressure measurements significantly underestimate true systolic blood pressure (SBP), and overestimate diastolic blood pressure (DBP). The aetiology for these errors has not yet been fully established. This study aimed to investigate the accuracy of Korotkoff sounds for detection of SBP and DBP points as used in brachial cuff sphygmomanometry. Brachial cuff pressure and Korotkoff sounds were obtained in 11 patients (6 males: 69.0 ± 6.2 years, 5 females: 71.8 ± 5.5 years) undergoing diagnostic coronary angiography. K2 Korotkoff sounds were obtained by high-pass filtering (>20 Hz) the microphone-recorded signal to eliminate low frequency components. Analysis of the timing of K2 Korotkoff sounds relative to cuff pressure and intra-arterial pressure shows that the onset of K2 Korotkoff sounds reliably detect the start of blood flow under the brachial cuff and their termination, marks the cuff pressure closely coincident with DBP. We have made the critical observation that blood flow under the cuff does not begin when cuff pressure falls just below SBP as is conventionally assumed, and that the delay in the opening of the artery following occlusion, and the consequent delay in the generation of K2 Korotkoff sounds, may lead to significant errors in the determination of SBP of up to 24 mmHg. Our data suggest a potential role of arterial stiffness as a major component of the errors recorded, with underestimation of SBP much more significant for subjects with stiff arteries than for subjects with more compliant arteries.

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