DE102005003678A1 - Blood pressure and pulse rate variability measurement device for a mammal has a blood pressure and pulse measurement device for connection to a limb extremity with a recording and analysis device connected to the measurement device - Google Patents

Abstract

Device for measuring arterial blood pressure and determination of pulse rate variability of mammal has a device that can be connected to an extremity of the mammal to permit blood pressure and pulse measurement and a device that connects to the latter device to record and evaluate the blood pressure and pulse data. An independent claim is made for a method for measuring the arterial blood pressure and determining the pulse rate variability.

Description

The The present invention relates to an apparatus and a method for measuring and influencing blood pressure and heart rate variability.

Of the Arterial blood pressure and heart rate variability are important physiological Parameters of cardiovascular physiology, especially in humans. The two parameters, especially seen in combination with each other, serve as medically relevant risk parameters for estimating a individual health risk. A sustained increase in the Blood pressure as well as a sustained reduction in heart rate variability statistically with an increase of the mortality and morbidity risks for the Affected.

The term "arterial blood pressure" refers to the physical pressure in the arterial vascular system, which depends essentially on cardiac output and total peripheral flow resistance in the vasculature.The risk associated with high blood pressure is also known in broad populations Often, those who suffer from high blood pressure or who want to prevent the development of their own blood pressure to a high value, devices are used to measure their own blood pressure.Almost always blood pressure gauges are used, which either according to the oscillometric principle of measurement or the acoustic principle Riva-Rocci works by applying a pressure above the systolic arterial blood pressure to a pressure cuff on the upper arm or wrist so that blood can no longer flow into the limb distal to the cuff, causing the cuff pressure to slowly decrease If the cuff pressure falls below the systolic arterial blood pressure, blood may flow through the compressed vessel during systole. This creates characteristic noises that can be registered by means of a microphone. Due to the inflowing blood pressure fluctuations are simultaneously triggered, which are transmitted to the pressure cuff and continue through the connection tube to the blood pressure meter. There they can be registered by a suitable sensor. By means of appropriate evaluation methods, the underlying blood pressure amplitude can now be calculated either from the acoustic signal or from the oscillometric pressure signal. 4 shows the pressure curve 401 in a cuff for measuring blood pressure and the oscillometric pressure fluctuations 402 , Usually, the amplitudes of the pressure curves are related to the largest amplitude. If the relative amplitude when exceeding the pressure from the cuff exceeds or falls below certain empirically determined values, the associated cuff pressure becomes the systolic or diastolic blood pressure 403 i. V. m. 401 determined.

Lies too high or too low blood pressure, usually becomes blood pressure medicamentous affected. A group often Prescribed medicines for lowering blood pressure are so-called "beta blockers", ie the β-adrenergic Receptors blocking and thus the heart performance-enhancing effect medicines containing (nor) adrenaline inhibiting compounds. The antihypertensive therapy with such drugs is often of unwanted Accompanied by regular effects Failure to follow the prescribed therapy. For example, complain Patients often have sleep disorders after taking beta-blockers, Potency problems and depressive moods.

• • Ewing-Test;
• • Valsalva-Manöver;
• • Tiefe Respiration mit 6 Atemzügen pro Minute;
• • Kurzzeit-HRV in Ruhe.

Heart rate variability (HRV) is the variability in heart rate from heartbeat to heartbeat. This can be calculated and specified by suitable mathematical methods (eg standard deviation). Heart rate variability is the mathematical correlate to the permanent adaptation of the heart rate to changing requirements in the human organism and is an expression of the neuro-vegetative regulatory capacity of a human body. Heart rate variability is calculated using a 24-hour ECG recorded by a portable ECG recorder. This procedure is usually used for cardiological questions. Secondly, heart rate variability is determined as the result of various neurophysiological functional tests performed at specialized centers or institutions ("Autonomous Diagnostics and Sleep Psychology in Clinic and Practice", J. Jörg (Hsg), Steinkopff Verlag, Darmstadt; "Diagnosis and Therapy of the autonomic diabetic neuropathy ", German Evidence-based Diabetes Guideline (DDG), as of April 15, 2002). These bump tests usually include the following test procedures:

• • Ewing test;
• • Valsalva maneuver;
• • Deep respiration with 6 breaths per minute;
• • Short-term HRV at rest.

The functional tests are performed by the patient himself, as directed by the examiner, stimulating his cardiovascular system, resulting in characteristic changes in the heart rate. The Ewing test asks the patient to get up quickly from lying down. In the Valsalva maneuver, he is instructed to exhale firmly with the larynx lid closed, thus creating overpressure in the chest. In deep respiration he is given a slow breathing rhythm with 6 breaths per minute, which he should follow. The short-term HRV measurement at rest involves the determination of HRV at rest without any special stimulation. These functional tests are mostly used by neurologists and diabetologists to quantify heart rate variability. The importance of heart rate variability as a risk parameter has been clearly demonstrated in a large number of studies (German Evidence-Based Diabetes Guideline (DDG), status 15.4.2002). However, it is unknown to wide circles of the population.

Both approaches Common to the determination of heart rate variability is the need to medical device and medical expertise. For medical questions becomes customary an electrocardiogram (ECG) registered. Meanwhile, special Systems on the market that are automated and standardized execution the study of heart rate variability in the professional, d. H. medically allow controlled area. But these systems stop that Operating staff high demands regarding the training level in ECG registration and subsequent determination of heart rate variability. For this Reason exists so far for Patients no way the determination of their heart rate variability as a self-measurement as well how to perform the familiar blood pressure measurement.

Of the the above-mentioned drug treatment of hypertension, For example, by beta-blockers, there is a comparable drug influence the heart rate variability not to the side. Because of this, the search for a therapy is at unsatisfactory levels of heart rate variability after before medical sense.

An effective approach is biofeedback. Heart rate variability can also be improved by biofeedback techniques (Lehrer PM et al., Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow, Psychosome, Med. 2003 (Sep-Oct), 65 (5): 796-805) ). This procedure is now also known in Germany as the concept of cardiac coherence training (www.stressball.de) and is based on the following principle:
The interface of body and mind is the autonomic (autonomic) nervous system. The latter consists essentially of two major opponents, the parasympathetic, which provides for regeneration and relaxation, and the sympathetic, which becomes active when performance has to be given to the outside (alarm system). Under sympathetic influence, for example, increases the heart rate and blood pressure, and stress hormones are released. The different influence of the parasympathetic and sympathetic nerves can be determined at the heart by means of heart rate variability (HRV). In the state of relaxation, there is a synchronization of respiration, blood pressure and heart rate, which is called "coherence." Neurovegetative reflex arcs, which are used to regulate blood pressure, are responsible for this synchronization (coherence) only in a state of relaxation It is highest at a respiratory rate of about 0.1 Hz, for example, a pharmacological blockade of the parasympathetic nervous system leads to the complete disappearance of coherence, and coherence is low under stress and stress (David Servan-Schreiber, The New Medicine of Emotions, Kunstmann-Verlag, ISBN 3-88897-353-8, pages 49-87.) The higher the coherence, the greater the heart rate variability.

It is now possible to measure the current coherence of a person by means of suitable mathematical methods. A suitable mathematical method is, for example, the spectral analysis of the heart rate. At maximum coherence only one frequency occurs in the spectral analysis of the heart rate, correspondingly high is the assigned peak in the (in 1 shown) spectral analysis of the heart rate (at 101).

the respective people can now audiovisually acknowledge its current coherence to be brought. A usual Representation is, for example, the visualization as a traffic light: red means low coherence, yellow is called average coherence, and green is synonymous with a high degree of coherence. By focusing on the signal shown, which is a surrogate of current coherence, Most people succeed in getting the signal and thus the underlying coherence in a desired To shift direction (classic biofeedback).

• 1) Biofeedback ist eine wirksame Methode, um den Blutdruck zu beeinflussen (Biofeedback of R-Wave-to-Pulse Interval Normalizes Blood Pressure, Applied Psychophysiology and Biofeedback, Vol. 28, No. 1, März 2003).
• 2) Eine Aktivierung des Parasympathikus ist physiologisch mit einem Absinken des arteriellen Blutdrucks verbunden.
• 3) Gerade beim Bluthochdruck-Kranken sind die neurovegetativen Reflexbögen im Vergleich zu Gesunden auffällig starr. Es ist durchaus wahrscheinlich, dass durch das Kohärenz-Training die zentralen Anteile der Reflexbögen wieder dynamischer auf Blutdruck-Änderungen ansprechen können und sich dadurch die Blutdruck-Regulation insgesamt verbessert.

As a rule, the biofeedback is extended by a breathing exercise. In this case, the user is audiovisually prescribed a respiratory rhythm that is particularly favorable for the strength of the coherence (usually 0.1 Hz). This enhances the influence of the parasympathetic nervous system and reduces the sympathetic tone. This form of neurovegetative influence is also called coherence training. Although primarily intended for relaxation and stress reduction, a positive effect of coherence training in addition to improving heart rate variability is also likely to affect blood pressure for three reasons:

• 1) Biofeedback is an effective method of influencing blood pressure (Biofeedback of R-Wave-to-Pulse Interval Normalized Blood Pressure, Applied Psychophysiology and Biofeedback, Vol. 28, No. 1, March 2003).
• 2) Activation of the parasympathetic nervous system is physiologically associated with a decrease in arterial blood pressure.
• 3) Especially in hypertensive patients neurovegetative reflex arches are conspicuously rigid compared to healthy. It is quite likely that coherence training will allow the central parts of the reflex arches to respond more dynamically to changes in blood pressure, thereby improving overall blood pressure regulation.

Of the Invention is based on the object, one for broad sections of the population affordable and also for understandable to the layman and to provide an applicable system for measuring blood pressure and / or heart rate variability this is also one with the measurement of blood pressure and / or heart rate variability simultaneously or this measurement downstream influence of blood pressure and Heart rate variability allows. In a preferred embodiment form the system should have the influence according to the task the heart rate variability through coherence training enable.

to solution the tasks set, the invention relates to a device for the measurement of the arterial blood pressure and for the determination of the heart rate variability of a mammal, the at least one attachable to a limb device for Measurement of blood pressure and thus the pulse of the mammal and at least one connected to the measuring device, the blood pressure and heart rate data of the mammal recording and evaluating recording and evaluation device includes.

The The invention further relates to a method for measuring the arterial Blood pressure and to determine the heart rate variability of a mammal, that includes the steps that he on one limb of the mammal at least means for measuring the blood pressure and thus the Pulse attaches and the blood pressure and pulse data of the mammal by means of one with the measuring device recorded recording and evaluation device records and / or evaluates.

The Invention will be described below with reference to the figures special embodiments of the invention by way of example, explained in more detail, without reference to the following described embodiments limited to be.

It demonstrate:

1 Spectral analyzes of the heart rate history, the figure labeled "101" showing the case of high (and thus more advantageous) cardiac coherence and the figure labeled "102" showing the case of low cardiac coherence;

2 the apparatus according to the invention for measuring the arterial blood pressure and determining the heart rate variability, wherein the lower figure shows the front view from the side of the opening for insertion of a limb and the upper figure shows the side view at an angle of 90 ° to the front view;

3 the combination of the device according to the invention including a conventional PC; and

4 the pressure curve 401 in a conventional blood pressure cuff and the oscillometric pressure fluctuations 402 a conventional pressure cuff.

The inventive device is used to measure the arterial blood pressure and determine the Heart rate variability of a mammal. The terms "arterial Blood pressure "and" heart rate variability "as used in the present description and in the claims were used already defined above.

Under The term "mammals" are used in the present Description and claims in the living organisms of the vertebrate class "Mammalia" understood Sense of the present invention may be any mammalian; in the sense of preferred embodiments For example, in the present invention, mammals are guinea pigs, mice Horses, dogs, cats, monkeys and are in particularly preferred embodiments People. The apparatus and method according to the invention are particular preferably applicable to humans for measuring its blood pressure and / or to determine its heart rate variability and / or their influence. It was the aim of the present invention and also with the present invention and with the method according to the invention achieved that the Measurement of arterial blood pressure and determination of heart rate variability by way a self-measurement of a human, particularly preferably one (im essential medically not trained) lay oneself at oneself he follows.

The device according to the invention for measuring the arterial blood pressure and determining the heart rate variability of a mammal comprises at least one attachable to an extremity means for measuring the blood pressure and thus the pulse of the mammal and at least one connected to the measuring device, the blood pressure and pulse data the mammal recording and evaluating recording and evaluation device. In the context of the present description and the claims, the term "at least one measuring device" or "at least one recording and evaluating device" is understood to mean that the device is a respectively designated device, for example a measuring device, or Also, several devices, such as multiple measuring devices may include. In the context of the present invention, of course, are devices which - to call the claimed in claim 1 system - a measuring device and a plurality of recording and evaluation devices or even a plurality of measuring devices and a recording and evaluation device or one or more measuring devices and a recording device and an evaluation device may include. The activities and tasks of the several facilities of one type may be the same or different. Thus, in certain, possibly case-preferred embodiments of the device, a plurality of measuring devices at different locations or at different extremities of the mammalian body may measure or determine data (eg, arterial blood pressure and / or heart rate variability). In other embodiments, the function of recording and evaluating the data may be carried out in different devices of the device, which are optionally optionally interchangeable with one another optionally (ie not compulsory, but only upon invocation / command or upon input of a corresponding signal). Particularly preferred embodiments of the invention include a measuring device and a data recording and / or evaluating recording and evaluation device.

Especially preferred according to the invention is a device with such an attachable to a limb device for Measurement of the blood pressure and the pulse of the mammal, which on a finger of the mammal, for example, on a human finger can. Such measuring devices for a measurement on the finger are as such state of the art. They include, for example, but not limiting, an annular Cuff that is placed around the finger or in the finger is put into it. The cuff will be up to one - for example in individual cases adjustable - maximum pressure inflated with air (or other inert gas) (i.e. Pressure), causing it to expand and around the extremity - for example the finger - closes. One integrated in the cuff or working separately from it Sensor or even a set of multiple sensors that are distal (i. H. from the heart of the mammal or People seen beyond the cuff) and / or proximal (i.e., from the heart of the mammal or People from this side of the cuff) is / are attached, measure that Blood pressure and / or pulse. The sensor (s) may be, for example, but not limited to, optical or photoplethysmographic sensors be. The cuff (s) or one or more other blood pressure measuring devices and / or pulse can the blood pressure and / or pulse at the same time (i.e., in a measuring step or in two simultaneous measuring steps) or in succession measure (i.e., in successive two or more measuring steps). It is particularly according to the invention preferred as simple and reliable possible, that the Measurement of arterial blood pressure by means of one or more Sensors / sensors a measurement according to the above described oscillometric Measuring method is and / or that the Measurement of the pulse a measurement according to the infrared transmission method or infrared reflection method; the latter is for example described in the publication DE-A 102 49 863.

In a still more preferred embodiment of the invention in the device, the device attachable to a limb for measurement the blood pressure and the pulse of the mammal a device that during insertion the extremity triggers the beginning of the measurement. This triggering device can be any device with the aforementioned function, However, it is more preferably alternatively a mechanical or a optical triggering device. With In other words, the measurement on the extremity of a mammal, for example on the finger of a human, is triggered by the fact that either the extremity / the finger at insertion into the device or at the end of the insertion process mechanically Contact triggers that the signal to start the measurement is or triggers, or the extremity / the Finger passes or reaches an optically controlled path, For example, a light barrier or the like, the interruption of which Signal to start the measurement or trigger it.

In a further, likewise preferred embodiment of the device according to the invention, the apparatus for measuring the blood pressure and the pulse of the mammal which can be attached to a limb has a device for interrupting the blood pressure measurement, the actuation of which results in the limb being released immediately. This device may be any device known to those skilled in the art for such purposes, but most preferably is a signaling device which at the end of the measurement is delivered to the measuring device and / or the pumps, valves, etc. controlling it, and by reducing, for example the cuff pressure to ambient pressure or a near-pressure thereby allowing the return, for example, the pressure cuff in the normal state or deflated and thus exerting no pressure on the limb state, so that the limb is released and can be pulled out of the measuring device. However, the device may also be a separate switch, possibly also designed as an emergency switch, ie particularly prominent or color specially marked, switch, such as a pressure switch; As a result, an immediate release of the extremity from the measuring device is made possible even in an emergency.

Between the beginning of the measuring process, for example by introducing the extremity, for example, a finger, in the measuring device, for example the pressurizable cuff, and completion of the measuring process, for example, by pressing the switch and release the extremity, for example the finger, from the measuring device, for example, the pressure cuff, measures distally and / or proximally from the cuff an optical, photoplethysmographic sensor, the - like stated above - either be carried out according to the transmission or the reflection method can, the blood pressure on the finger or finger pulse. The measuring device can be connected to an evaluation unit by means of a suitable interface (for example USB) connected, too has a display unit, e.g. a commercial one PC with appropriate software. With the help of over a period of time (for example, but not limiting) 30 seconds to 3 minutes The value of the pulse measured on the finger can be determined by the evaluation unit the heart rate variability be determined. This happens after in the medical field generally usual Standards. For For this purpose, one skilled in the art may choose one of up to 40 different mathematical ones approaches To fall back on. One of these results, for example, from the publication "Heart Rate Variability: Standards of Measurement, Physiological Interpretation and Clinical Use; Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology; Circulation 1996, March 1st 1996, 93 (5): 1043-1065 "or from the publication "Recommendations for the Practice of Clinical Neurophysiology: Guidelines of the International Federation of Clinical Neurophysiology, Electroenceph. Clin. Neurophysiol. 1999, Suppl. 52. "Corresponding programs are in on data transfer systems storable and processable form before and are linked to the measured or specific data. In order to can on the previously usual complex ECG measurement to determine heart rate variability omitted become.

The cuff pressure is now steadily reduced and both the oscillometric signals and the photoplethysmographic signals are analyzed continuously. From the oscillometric data, the blood pressure is calculated in a manner known per se (as explained above) 4 Is referred). The heart rate is calculated from the plethysmographic signals. The corresponding signals are used in the determination of heart rate variability.

In a further embodiment of the device according to the invention which is particularly preferred for improving the quality of the measured values, the evaluation device for calculating the blood pressure from the oscillometric data links the oscillometric pressure signal to the pulse wave signal in such a way that the accuracy of the oscillometric blood pressure measurement is improved becomes. This is done in such a way that upon release of pressure from the measuring cuff and falling below the systolic blood pressure value and (once more) when falling below the diastolic blood pressure value characteristic changes of the pulse wave curve occur. These are measured by picking up the pulse wave signal distal to the stagnation site. The actual systolic and diastolic blood pressure can now be determined from the diagram according to 4 determine more precisely. Next to the curve of the relative pressure fluctuations 403 namely, the pulse wave signal 404 considered. This allows a reliable determination of the time at which the cuff pressure corresponds exactly to the systolic or diastolic blood pressure, and thus a more accurate determination of the two values in the manner shown in FIG.

In a further, likewise preferred embodiment, the invention relates to a device for measuring the arterial blood pressure and determining the heart rate variability of a mammal with a measuring device and a recording and evaluating device, as described above, wherein the device additionally comprises at least one memory Means for storing the recorded and evaluated blood pressure and pulse measurement data. There may be one or more (similar or different) memory units. If the device according to the invention comprises a plurality of storage devices, they may be the same or different. Such a device is particularly advantageous because only the reliable storage of data to observe a longer-term development and derive rules from the data, with which the two physiological parameters for the benefit of the mammal / human / patient can be improved. Thus, for example, the current blood pressure value can be automatically stored in a corresponding database in the sense of a blood pressure diary be chert. The memory device can be, for example, a memory device which is recorded and / or evaluated, usually electronic data, for storage and storage, as is well known to the person skilled in the art and which requires no further explanation here. The memory device is particularly preferably a memory device customary in conventional data processing and storage systems; by way of example, but not limitation, a hard disk of a PC, a floppy disk, a USB stick, a (for example, but not necessarily magnetically based) tape storage, a disk storage, an optical storage, etc. are mentioned. It is crucial for the storage unit that the data are stored securely, can be supplemented at any time by new data from the same mammal / human / patient or other mammal / human or patient, allow recording and evaluation and possibly also correlation with other data and if appropriate, they can be further processed or transferred further.

In a further preferred embodiment comprises the device according to the invention additionally at least one device for transmission recorded, evaluated and / or stored blood pressure and pulse data of a mammal at least one directly connected device for visualization the data, preferably to a display or a printer, or to at least one remote device for storage and / or visualization the data, preferably to a remote memory and / or a remote display and / or to a remote printer. It can one or it can multiple transmission unit (s) in the device according to the invention to be available; at several transmission facilities can these may be the same or different. With the help of the transmission facility (s) can they recorded and / or evaluated and / or stored data for the Operator of the device (be it a doctor or his assistant or the patient himself) are visualized and made possible Transfer facilities become. As an example, the most preferred embodiments called the device, which is a visualization of a Display (for example, the display associated with a PC) or via a display Expression (for example, about a printer connected to a PC). Other examples, however, they are not restrictive like the aforementioned, relate to a measuring device with a or several additional means of transmission (s) for the transmission of Data to a not directly connected, but remote device for storing and / or visualizing data. Such facilities are also the expert from the prior art extensive known and need no detailed explanation at this point. Transmission facilities of the the latter type essentially serve the transmission of data on paths, their use by the security and completeness of the transferred Data, the speed of transmission over more or less long distances and easy accessibility, for example, even in emergency situations or situations involving a require quick decision are marked. Especially preferred embodiments The invention relates to such devices for transmitting a radio device (ie a device that transmits data and information allowed on waves and frequencies substantially in the radio-frequency range), an access facility to the public Telephone network (ie a device that transmits data via per Telephone, fax, modem, etc. public accessible Lines and other transmission paths the telephone services), an access device to the Internet on (usually) digital way and / or electronic access device Traffic. Of the mentioned facilities can / at the Device according to the invention one or more facilities may be present at the same time or one transmission in succession the recorded, evaluated and / or stored data allow.

In even more preferred devices according to the invention are the recording and evaluation device and the memory device in a device or even more preferably comprise the recording and evaluation device and the memory device a commercial Personal computer. Furthermore, it corresponds to a particularly preferred Embodiment of Invention, when the recording and evaluation device and the memory device and the transmission device in one Device are combined, preferably wherein the recording and Evaluation device and the memory device and the transmission device a commercial one Personal computers include. Such devices are by their compatibility with conventional Personal computer (PC) systems easy to use in the personal (Working and living) environment of a person / patient accessible and can Therefore, easily be fitted in such an environment, which is the acceptance increased their use and helps to avoid errors in use.

• – Identifikation der Herzschläge aus dem Pulswellensignal;
• – Berechnung der Herzfrequenz-Verlaufs;
• – Plausibilitätsprüfung;
• – Berechnung der Time-Domain-Parameter der HRV: Standard-Statistik (z. B. Standardabweichung, Variationskoeffizient, RMSSD, Mittelwert usw.);
• – Interpolation des Herzfrequenz-Verlaufs;
• – Spektralanalyse;
• – Berechnung der Frequency-Domain-Parameter (Power in bestimmten Frequenzbändern; Peak-Frequenzen usw.);
• – Bestimmung der HRV aus den Frequency-Parametern.

In further particularly preferred embodiments, in the device according to the invention, the evaluation device is suitable for calculating the heart rate variability of the mammal or human from the measured pulse or heart rate data. This is done by methods known per se, for example according to the in the mentioned above publications methods. With particular advantage, a mathematical determination of heart rate variability (HRV) is performed by means of a computer program written to determine this parameter. This has the following essential program steps:

• - Identification of heartbeats from the pulse wave signal;
• - calculation of heart rate history;
• - plausibility check;
• - calculation of HRV time-domain parameters: standard statistics (eg standard deviation, coefficient of variation, RMSSD, mean, etc.);
• - Interpolation of heart rate history;
• - spectral analysis;
• - calculation of the frequency domain parameters (power in certain frequency bands, peak frequencies, etc.);
• - Determination of the HRV from the frequency parameters.

The invention also relates to a method for measuring arterial blood pressure and heart rate variability of a mammal, in particular a human. The method according to the invention comprises the steps of attaching at least one device for measuring blood pressure and pulse to a limb of the mammal or human being, and the blood pressure and pulse data of the mammal by means of a recording and recording device connected to the measuring device Evaluator records and / or evaluates. In the following, the method according to the invention will be explained in more detail with reference to the measurement and evaluation on humans, without being limited thereto. The method can, of course, be carried out on any mammal, without the invention being subject to any restrictions in this respect. Most preferably, the method is performed on humans in such a way that a medically unskilled or even a layman can perform the method, in particular by means of the invention can perform ago direction and thus determine in itself blood pressure and heart rate data and determine the heart rate variability can or can be determined by means of the device according to the invention. For the description of particularly preferred method steps is hereinafter also to the figures, in particular the 2 and 3 , Referenced.

The attachment of the measuring device to an extremity of the human is carried out in a particularly preferred manner by applying a measuring device to an easily accessible and easily deployable limb of the human, for example, preferably on a finger. This is the human extremity or the finger 301 in the recess 202 the measuring device 201 introduced.

In a particularly preferred embodiment In the process, a device is attached to the extremity of the mammal simultaneous or sequential measurement of arterial blood pressure and the pulse. This can be any known to the skilled person facilities. Especially however, preferred is the device for measuring the blood pressure a working according to the oscillometric measuring method blood pressure measuring device and the pulse measuring device is an infrared transmission method or infrared reflection method operating device.

Even more preferably, according to the invention, because of the substantially automatic operation of the entire measuring procedure from start to finish by obtaining the data, a method of attaching to the extremity of the mammal a device for measuring arterial blood pressure and pulse comprising a mechanical or a an optical device which, upon insertion of the extremity, initiates the beginning of the measurement, and / or which has a device for interrupting the blood pressure measurement, the actuation of which has the result that the extremity is released immediately. Such devices allow an unpredictability of the operation of the device ago by a layman independent implementation of the method according to the invention. Namely, it becomes when inserting, for example, a finger 301 in the opening / recess 202 a mechanical or optical device 206 such as a mechanical or optical switch 206 or a pressure sensor 206 operated, which sets the measuring process in motion. In the same way, by pressing a device 208 such as a switch, which also serves as a general or emergency switch 208 may be executed, the extremity such as the finder are released immediately, either in an emergency or at regular termination of the measurement process.

In a further preferred embodiment of the method, one brings on the extremity of the human, for example on the finger 301 , a pressurizable annular sleeve 203 at. The pressure is supplied by a pump operating in the device 204 , For example, a micropump 204 , When the required pressure is reached, a sensor measures 207 in the present case distal to the cuff, the pulse measurable on the finger. The sensor 207 may be in a preferred embodiment, an optical, photoplethysmographic sensor, which may be carried out either according to the transmission principle or according to the reflection principle, as already explained above. The determined pulse is transmitted via a recording and evaluation unit 205 , which in the most preferred cases, also the control of the entire measuring method over can take, recorded, optionally evaluated and forwarded in further preferred cases to other units of the device, such as a memory unit and / or a transmission or transmission unit. After pressing the interrupt unit 208 For example, a switch 208 , the measuring process is connected, the pressure on the cuff 203 is adapted to the ambient pressure (ie shut down again), and the extremity such as the finger 301 can be released again, ie from the cuff 203 and the opening 202 be pulled out.

In particularly preferred embodiments linked to the method one in the evaluation device for calculating the oscillometric blood pressure the oscillometric pressure signal so with the pulse wave signal that the accuracy the oscillometric blood pressure measurement is improved. this happens in the upper already closer explained way.

Further is it preferred according to the invention in the method by means of the evaluation device, the heart rate variability of the mammal to calculate the measured pulse or heart rate data by calculation, even more preferably from the measured pulse or heart rate data by means of a for the computational determination of heart rate variability written Computer program in the evaluation unit the heart rate variability mathematically to investigate. This happens even more preferably in the above already described in detail way.

In the method, it is then possible from the measured and subsequently further calculated data further preferably by means of the measuring device 201 Pulse wave signals are continuously registered and calculated by the computer program of the evaluation device, the current heart coherence. In further preferred embodiments, this is done by performing a spectral analysis of the heart rate history from which cardiac coherence can be calculated. For this purpose, the heart rate curve is interpolated, and a Fourier transform of the interpolated values is performed. The spectrogram can now be used to calculate the dominant frequency (master frequency) on the basis of the frequency peak. If, for example, the spectral power in a narrow frequency band around the master frequency in relation to the power in the rest of the frequency band is set, then a quotient is obtained which formulates the heart coherence mathematically well. 101 shows a spectrogram with a clear master frequency around 0.1 Hz and very little other frequency components. The resulting quotient would be high, which corresponds to high cardiac coherence. The 102 shows a Spek trogram with a mixture of different frequencies. The quotient of power _{master frequency} / power _{other frequency components} is - as desired - low. In 1 "PSD" means Power Spectral Density (this term is commonly used in medical terminology), and "T" stands for measurement time.

The data determined in this way will then be the data store supplied and are stored there according to a predetermined system, for example in table or graphic form. They can be made according to special embodiments the invention of the storage unit for the user traceable transmit to other units, For example, on means for visualizing the determined and / or stored data. The visualization can be on every one Expert known way without these limitations subject to the invention. The visualization can be, for example on a screen associated with a computer system or via a computer Printers are done on a suitable print medium that the user for your own information or for other purposes, for example one (to be explained below) Biofeedback training, can query. However, a transmission can also to third parties. This can happen automatically or initiate the transmission by the user or the third party. The third party can, for example be a doctor of the user for whose information the data is a device remote from the system for receiving the data to visualize the data displayed, such as a Screen or over a printer on a print medium.

In a further preferred embodiment of the method, the determination, recording, evaluation, optionally storage and optionally transmission of the data, the latter for example to a screen in front of the user, can be followed by a so-called "biofeedback training" of the user data obtained from the measurement of blood pressure and heart rate variability in the form of current cardiac coherence data, as determined in the above method The current cardiac coherence is brought to the user's attention acoustically or audiovisually, in biofeedback suitable form This may be, for example, but not limited to, animated objects such as a balloon or a butterfly that rise with increasing cardiac coherence and descend with decreasing cardiac coherence Light is a high-range cardiac coherence and its red light shows low-range cardiac coherence. Audio biofeedback is also possible: low cardiac coherence due to noises from Thunderstorms or storms that change with increasing cardiac coherence towards a noise of a spring day with, for example, bird chirping or sounds of a flowing stream. By concentrating on the visualized signal, the user can improve the current cardiac coherence by means of breathing exercises for which he or she is given audiovisual or acoustic instructions, ie shifting the signal given to him in the direction of improving the cardiac coherence and thereby approximating physiological data such as relaxation, synchronization of respiration, blood pressure and heart rate (pulse), which is referred to as "classical biofeedback." In particularly preferred embodiments, coherence can be favorably influenced, in particular by means of audiovisual or acoustic presetting of the respiratory rate ("breathing rhythm") to 0.1 Hz , This can be done, for example, by an animated "breath bar" on the screen, which determines the rhythm of the respiration, or a sound whose change of volume and / or frequency dictates the rhythm of the respiration, thereby strengthening the influence of the parasympathetic and the Sympathetic tone reduces what is termed "coherence training". When used regularly, this will favorably affect blood pressure and heart rate variability.

It is according to the invention particularly preferred that the "biofeedback training" automatically following measurement the blood pressure and pulse data is performed. It is, however possible, to start this only if this is done by the user and / or by the treating person Doctor expressly is desired.

through the device according to the invention and The method that can be performed with the device can also from a non-medically trained person, so everyone Layman, a measurement of one's own blood pressure and heart rate data in a simpler way and error-avoiding manner. This can be then the heart rate variability determine. The data can be easily recorded, evaluated and save and can from third parties (for example the user's doctor) and / or also be viewed by the user. The former is for surveillance Extremely relieving the patient and also allowing for treatment or diagnosis of the patient in the home environment. The latter allows on-site (possibly also at home) a biofeedback training the patient to improve the parameters of blood pressure and heart rate variability as a result of the training.

101

spectral analysis a heart rate course with high cardiac coherence

102

spectral analysis a heart rate course with low cardiac coherence

201

measuring device

202

Ausparung for the introduction a finger

203

inflatable Pressure cuff for oscillometric blood pressure measurement

204

micropump for inflating the pressure cuff

205

Tax- and registration device

206

pressure sensor

207

photoplethysmographic sensor

301

human extremity

302

measuring device

303

connection to the evaluation and display unit

304

evaluation and display unit

Claims (22)

Apparatus for measuring arterial blood pressure and for determining the heart rate variability of a mammal comprising at least one on one extremity Attachable device for measuring blood pressure and thus of Pulse of the mammal and at least one with the measuring device connected, recording and evaluating the blood pressure and pulse data of the mammal Recording and evaluation device. Apparatus according to claim 1, additionally comprising at least a memory device for storing the recorded and evaluated blood pressure and pulse data of a mammal. Apparatus according to claim 1 or claim 2, comprising additionally at least one device for transmission recorded, evaluated and / or stored blood pressure and pulse data of a mammal to at least one directly connected device for visualization the data, preferably to a display or a printer, or at least one remote device for storing and / or Visualizing the data, preferably to a remote memory and / or a remote display and / or to a remote printer. Apparatus according to claim 3, comprising as means to submit a radio device, an access device to the public Telephone network, one Access device to the Internet by analogue or digital means and / or an electronic traffic access device. Apparatus according to any one of claims 1 to 4, wherein the device attachable to a limb for measuring the blood pressure and the pulse of the mammal is a device for the simultaneous or sequential measurement of the arterial blood pressure according to the oscillometric measuring method and the pulse by the infrared transmission method or infrared reflection method. Device according to one of claims 1 to 5, wherein the at a extremity attachable means for measuring blood pressure and pulse of the mammal a mechanical or an optical device comprising during insertion the extremity the Start of measurement triggers. Device according to one of claims 1 to 5, wherein the at a extremity attachable means for measuring blood pressure and pulse of the mammal has a device for interrupting blood pressure measurement, their operation entails that the extremity is released immediately. Device according to one of claims 1 to 7, wherein the at a extremity attachable means for measuring blood pressure and pulse of the mammal is a pressurizable annular sleeve, the one mechanical or optical switch when inserting the Extremity Start of the measurement, and a switch for immediate interruption of the measurement Actuate having. Device according to one of claims 1 to 8, wherein the evaluation means for calculation the oscillometric blood pressure the oscillometric pressure signal so linked to the pulse wave signal that the accuracy of the oscillometric Blood pressure measurement is improved. Apparatus according to any one of claims 1 to 9, wherein the recording and evaluating means and the memory device are combined in one device, preferably wherein the recording and evaluation device and the Memory device include a standard personal computer. Apparatus according to claim 10, wherein the recording and evaluation facility and the memory device and the transmission device in a device, preferably wherein the recording and evaluation device and the memory device and the transmission device commercial Personal computers include. Device according to one of claims 1 to 11, wherein the evaluation device suitable is, the heart rate variability of the mammal calculated from the measured blood pressure and pulse data, preferably wherein the evaluation unit for the computational determination the heart rate variability written Computer program has. Method for measuring arterial blood pressure and determining the heart rate variability of a mammal comprising the steps of that he on one limb of the mammal at least means for measuring the blood pressure and thus the Pulse attaches and the blood pressure and pulse data of the mammal by means of one with the measuring device recorded recording and evaluation device records and / or evaluates. A method according to claim 13, wherein at the extremity of the mammal a Device for the simultaneous or sequential measurement of the arterial blood pressure according to the oscillometric measuring method and the pulse according to the infrared transmission method or infrared reflection method install. A process according to claim 13 or 14, wherein the extremity of the mammal a device for measuring arterial blood pressure and blood pressure Pulses attaching a mechanical or an optical device to grasp, when inserting the extremity triggers the beginning of the measurement, and / or the means for interrupting blood pressure measurement has, whose operation entails that the extremity is released immediately. A process according to any one of claims 13 to 15 wherein the extremity of the mammal attaching a pressurizable annular sleeve, which is a mechanical or optical switch used when inserting the extremity triggers the beginning of the measurement, and a switch for immediate interruption of the measurement Acting has. A process according to any one of claims 13 to 16, wherein in the evaluation device for calculating the oscillometric blood pressure the oscillometric pressure signal is linked to the pulse wave signal so that the accuracy the oscillometric blood pressure measurement is improved. A process according to any one of claims 13 to 17, wherein the evaluator, the mammalian heart rate variability from the measured blood pressure and pulse data calculated, preferably wherein one from the measured blood pressure and pulse data by means of a for the computational Determination of heart rate variability written computer program the heart rate variability is calculated in the evaluation unit. Method according to one of Claims 13 to 18, in which a pulse wave signal is continuously registered by means of the measuring device and is detected by means of the computer program of the evaluation device calculates the current cardiac coherence. The method of claim 19, wherein additionally Heart-coherence biofeedback training to influence blood pressure and / or heart rate variability. A method according to any one of claims 13 to 20, wherein the data collected in the recording and evaluation facility the blood pressure and the pulse of the mammal and possibly also the Cardiac Coherence Biofeedback Training Data in a memory device stores. The method of claim 21, wherein the stored Data visualized, preferably on a display or by means a printer on a print medium visualized, and / or wherein one transmits the stored data by means of data transmission to a third party.