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Cited by 24Cardiovascular Health and Disease PreventionBlood Pressure and Hypertension StudiesNon-Invasive Vital Sign Monitoring

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

G. Celler, Branko, Butlin, Mark, Argha, Ahmadreza, Tan, Isabella, Yong, Andy, Avolio, Alberto·2021·IEEE Transactions on Biomedical Engineering
DOI 10.1109/tbme.2021.3079578
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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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Crossref · 10.1109/tbme.2021.3079578

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  • The variability in error for systolic and diastolic BP plausibly interacts with arterial stiffness, resulting in Korotkoff sounds I and V being separate events from the exact movement of cuff pressure past systolic and diastolic BP.

    “The variability in error for systolic and diastolic BP plausibly has interaction with arterial stiffness, resulting in Korotkoff sounds I and V being separate events from the exact movement of the cuff pressure past the systolic and diastolic BP [43].”

    From Automated 'oscillometric' blood pressure measuring devices: how they work and what they measure (2022) · cites this paper as [43]

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  1. 10.1001/archinte.1993.00410240045005 · DOI

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Related

Authors
G. Celler, B., Butlin, M., Argha, A., Tan, I., Yong, A., & Avolio, A.
Affiliations
  • Macquarie University (AU)
  • UNSW Sydney (AU)
ORCID
Venue
IEEE Transactions on Biomedical Engineering
Publisher
Institute of Electrical and Electronics Engineers (IEEE)
Published
2021-12
Volume
68
Issue
12
Pages
3593-3601
ISSN
  • 0018-9294 (ISSN-L)
  • 1558-2531
DOI
10.1109/tbme.2021.3079578
OpenAlex
W3161802816
Cited by
24
References
47
Citations by year
2026: 3 · 2025: 2 · 2024: 9 · 2023: 5 · 2022: 3 · 2021: 2
FWCI
3.21
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • IEEE Transactions on Biomedical Engineering (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
Keywords
Korotkoff sounds, systolic blood pressure estimation, diastolic blood pressure estimation, blood pressure measurement error, arterial stiffness, cuff pressure, intra-arterial blood pressure, coronary angiography
MeSH terms
Blood Pressure, Blood Pressure Determination, Brachial Artery, Female, Humans, Male, Systole

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