• Sphygmomanometer


    • A sphygmomanometer, blood pressure meter, blood pressure monitor, or blood pressure gauge is a device used to measure blood pressure, composed of an inflatable cuff to collapse and then release the artery under the cuff in a controlled manner, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. Manual sphygmomanometers are used in conjunction with a stethoscope.

      A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or aneroid gauge), and a mechanism for inflation which may be a manually operated bulb and valve or a pump operated electrically.

      Both manual and digital meters are currently employed, with different trade-offs in accuracy versus convenience.

      A stethoscope is generally required for auscultation (see below). Manual meters are used by trained practitioners, while it is possible to obtain a basic reading through palpation alone, this only yields the systolic pressure.

      Digital meters employ oscillometric measurements and electronic calculations rather than auscultation. They may use manual or automatic inflation, but both types are electronic, easy to operate without training, and can be used in noisy environments. They measure systolic and diastolic pressures by oscillometric detection, employing either deformable membranes that are measured using differential capacitance, or differential piezoresistance, and they include a microprocessor. They accurately measure mean blood pressure and pulse rate, while systolic and diastolic pressures are obtained less accurately than with manual meters, and calibration is also a concern. Digital oscillometric monitors may not be advisable for some patients, such as those suffering from arteriosclerosis, arrhythmia, preeclampsia, pulsus alternans, and pulsus paradoxus, as their calculations may not correct for these conditions, and in these cases, an analog sphygmomanometer is preferable when used by a trained person. Digital instruments may use a cuff placed, in order of accuracy and inverse order of portability and convenience, around the upper arm, the wrist, or a finger. The oscillometric method of detection used gives blood pressure readings that differ from those determined by auscultation, and vary according to many factors, such as pulse pressure, heart rate and arterial stiffness, although some instruments are claimed also to measure arterial stiffness, and some can detect irregular heartbeats.

      • Mercury sphygmomanometers are considered the gold standard. They show blood pressure by affecting the height of a column of mercury, which does not require recalibration. Because of their accuracy, they are often used in clinical trials of drugs and in clinical evaluations of high-risk patients, including pregnant women.
      • Aneroid sphygmomanometers (mechanical types with a dial) are in common use; they may require calibration checks, unlike mercury manometers. Aneroid sphygmomanometers are considered safer than mercury sphygmomanometers, although inexpensive ones are less accurate. A major cause of departure from calibration is mechanical jarring. Aneroids mounted on walls or stands are not susceptible to this particular problem.
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