JPWO2020026647A1 - Automatic blood pressure measuring device - Google Patents

Abstract

Provided is an automatic blood pressure measuring device with an autonomic nerve analysis function that can measure the blood pressure and inspect the autonomic nervous state at the time of blood pressure measurement without providing a separate electrode to acquire an electrocardiogram. By reducing the pressure of the cuff until the blood pressure judgment at the time of blood pressure measurement is completed and stopping the pressure reduction for a certain period after the blood pressure measurement is completed, the heartbeat is synchronized between the time when the blood pressure measurement is completed and the time when the pressure reduction is stopped for a certain period after the blood pressure measurement is completed. By the heartbeat synchronization wave acquisition means 31 for obtaining a wave, the heartbeat cycle related value detecting means 32 for detecting the fluctuation of the heartbeat cycle related value from the heartbeat synchronization wave obtained by the heartbeat synchronization wave acquiring means 31, and the heartbeat cycle related value detecting means 32. The frequency analysis means 33 that calculates the frequency component ratio of the low frequency component and the high frequency component by frequency analysis of the fluctuation of the detected heart rate cycle-related value, and the tension that determines the degree of tension of the subject based on the calculated frequency component ratio. It has a degree determination means 34.

Description

The present invention relates to an automatic blood pressure measuring device that measures a blood pressure value of a subject based on a heartbeat-synchronized wave obtained when a part of the body of the subject is pressed with a cuff. More specifically, the present invention relates to a blood pressure measuring device. The present invention relates to an automatic blood pressure measuring device with an autonomic nerve analysis function that inspects the autonomic nerve state at the time of blood pressure measurement in addition to the measurement.

As a general method of autonomic nerve analysis, a method of frequency analysis of fluctuations in heart rate variability is known. Fluctuations in heart rate variability can be obtained by measuring the RR interval of an electrocardiographic waveform or a pulse wave.

The cycle of cardiac contraction is not always constant, and there are usually subtle fluctuations as shown in FIG. It is said that the fluctuation of the contraction of the heart is controlled by the autonomic nerve, and it is said that the activity state of the autonomic nerve can be understood by analyzing the fluctuation of the contraction of the heart. Specifically, when an electrocardiograph is attached to the subject and the interval of R wave generation of the electrocardiogram is frequency-analyzed, peaks are detected at two locations as shown in FIG.

The lower peak, that is, LF (Low frequency) is 0.05 to 0.20 Hz, and the higher HF (High frequency) is 0.25 to 0.35 Hz. LF represents the activity of the sympathetic nerve that controls tension and excitement, and HF represents the activity of the parasympathetic nerve that suppresses tension and excitement.
Therefore, by knowing the ratio of these two components, it is possible to estimate the tense state and relaxed state of the subject.

FIG. 11 is a perspective view illustrating the overall configuration of a conventional automatic blood pressure measuring device with an autonomic nerve evaluation function (see Patent Document 1). The automatic blood pressure measuring device 110 has a cuff 112 wound around a part of the living body, for example, the upper arm, a plurality of ECG electrodes including ECG electrodes 114a and 114b, and a plurality of keys provided on the upper surface of the main body 116. It includes an input keyboard 118, an image display 120 provided on the front surface of the main body 116, and an output printer 122 provided on the side surface of the main body 116.

Japanese Patent No. 5584111

In the conventional automatic blood pressure measuring device 110 with an autonomic nerve analysis function, it is necessary for the subject to wear a cuff 112 on his arm and to attach a plurality of ECG electrodes 114a and 114b to the subject to acquire an electrocardiogram. It is complicated. It is also necessary to prepare an electrocardiographic detection device for detecting the electrocardiogram.

The present invention is intended to solve the problem of such a conventional configuration, and is autonomous at the time of blood pressure measurement without providing an electrode for measuring blood pressure and separately acquiring an electrocardiogram. It is an object of the present invention to provide an automatic blood pressure measuring device having an autonomic nerve analysis function capable of examining a nervous state.

The automatic blood pressure measuring device of the present invention is based on a heartbeat-synchronized wave, which is a pulse wave signal synchronized with the heartbeat obtained when a part of the subject's body is pressed with a cuff. It is an automatic blood rate measuring device that measures the blood pressure value. It reduces the pressure of the cuff until the blood pressure judgment at the time of blood pressure measurement is completed, and stops the pressure reduction for a certain period after the blood rate measurement is completed. A heartbeat synchronization wave acquisition means for obtaining a heartbeat synchronization wave while decompression is stopped for a certain period of time after the end, and a heartbeat cycle related value detection means for detecting fluctuations in heartbeat cycle related values from the heartbeat synchronization wave obtained by the heartbeat synchronization wave acquisition means. And, the frequency analysis means for calculating the frequency component ratio of the low frequency component and the high frequency component by frequency analysis of the fluctuation of the heart rate cycle related value detected by the heart rate cycle related value detecting means, and the calculated frequency component ratio are used for the test. It has a tension determination means for determining a person's tension.

According to the present invention, by performing sampling processing using the time of the heartbeat synchronization wave interval as a heartbeat cycle-related value, a pulse wave transmitted to the periphery by the contraction of the heart detected during blood pressure measurement instead of the R wave of the electrocardiogram. That is, the fluctuation of the contraction of the heart can be detected from the generation interval of the heartbeat synchronous wave, and the activity state of the autonomic nerve can be estimated by frequency analysis of the fluctuation.

Further, the automatic blood pressure measuring device of the present invention maintains the subject at rest for a certain period of time when the degree of tension of the subject determined by the tension degree determining means exceeds a predetermined reference value, and again after a certain period of time. It is desirable to have a means of notification that either directs the measurement or alerts the patient to possible elevated blood pressure due to tension.

As a result, when the tension of the subject determined by the tension determination means exceeds a predetermined reference value, the subject is instructed to maintain rest for a certain period of time and to perform the measurement again after a certain period of time. Alternatively, a warning is given that blood pressure may be elevated due to tension.

(1) By reducing the pressure of the cuff until the blood pressure determination at the time of blood pressure measurement is completed and stopping the pressure reduction for a certain period after the completion of the blood pressure measurement, during the blood pressure measurement and during the period when the pressure reduction is stopped for a certain period after the completion of the blood pressure measurement. Detected by the heartbeat synchronization wave acquisition means for obtaining the heartbeat synchronization wave, the heartbeat cycle related value detecting means for detecting the fluctuation of the heartbeat cycle related value from the heartbeat synchronization wave obtained by the heartbeat synchronization wave acquisition means, and the heartbeat cycle related value detecting means. A frequency analysis means that calculates the frequency component ratio of the low frequency component and the high frequency component by frequency analysis of the fluctuation of the heart rate cycle-related value, and the tension determination that determines the tension level of the subject based on the calculated frequency component ratio. With a configuration having means, one automatic blood pressure measuring device can simultaneously perform heart rate measurement and frequency analysis of heart rate cycle-related values indicating the state of the autonomic nerve, and can inspect the autonomic nerve state at the time of blood pressure measurement. It will be possible.

(2) When the tension of the subject determined by the tension determination means exceeds a predetermined reference value, the subject is instructed to maintain rest for a certain period of time, and the measurement is performed again after a certain period of time. Alternatively, due to a configuration having a notification means for alerting the possibility that the blood pressure is rising due to tension, the subject for a certain period of time when the degree of tension of the subject at the time of blood pressure measurement exceeds a predetermined reference value. Note that it is possible to make an accurate blood pressure measurement by keeping the patient at rest and instructing the patient to take the measurement again after a certain period of time, and that the blood pressure measurement result may not be accurate due to tension. It becomes possible to arouse.

It is a perspective view of the automatic blood pressure measuring apparatus with an autonomic nerve analysis function in embodiment of this invention. It is a block diagram of the automatic blood pressure measuring apparatus with an autonomic nerve analysis function in embodiment of this invention. It is a functional block diagram of the microcomputer circuit of FIG. It is a pulse wave diagram and the pulse wave peak position diagram of the automatic blood pressure measuring apparatus with an autonomic nerve analysis function in the embodiment of the present invention. It is a pulse wave interval graph figure of the automatic blood pressure measuring apparatus with an autonomic nerve analysis function in embodiment of this invention. It is an equal time interval conversion figure of the pulse wave interval of the automatic blood pressure measuring apparatus with an autonomic nerve analysis function in embodiment of this invention. It is an autonomic nerve analysis result display screen of the automatic blood pressure measuring apparatus with an autonomic nerve analysis function in embodiment of this invention. It is a flowchart which shows the processing content of the software program of the automatic blood pressure measuring apparatus with an autonomic nerve analysis function in embodiment of this invention. It is a figure which shows the example of the fluctuation of the heartbeat synchronization wave. It is a figure which shows the example of the frequency analysis of the fluctuation of a heartbeat synchronization wave. It is a perspective view explaining the overall structure of the conventional automatic blood pressure measuring apparatus with an autonomic nerve evaluation function.

1 Automatic blood pressure measuring device with autonomic nerve analysis function 2 Arm insertion part 3 Arm 4 Arm mount 5 Cuff 6 Palm 7 Display 8 Printer 9 Air supply pump 10 Exhaust valve 11 Cuff fixing means 12 Pressure detection circuit 13 Pulse wave detection circuit 14 Microcomputer circuit 15 External memory 16 Insufflation pump drive circuit 17 Exhaust valve drive circuit 18 Cuff drive means 19 LCD display 20 Recorder 21 Speaker 31 Heart rate synchronization wave acquisition means 32 Heart rate cycle related value detection means 33 Frequency analysis means 34 Tension Judgment means 35 Notification means

FIG. 1 is a perspective view of an automatic blood pressure measuring device with an autonomic nerve analysis function according to an embodiment of the present invention.

In FIG. 1, the automatic blood pressure measuring device 1 with an autonomic nerve analysis function according to the embodiment of the present invention mounts an arm insertion portion 2 into which an arm 3 which is a part of a living body of a subject is inserted and an arm 3. It is provided with an arm mounting table 4. The arm insertion portion 2 is provided with a cuff 5 that tightens the arm to prevent blood pressure when measuring blood pressure.

Further, the automatic blood pressure measuring device 1 with an autonomic nerve analysis function includes a display unit 7 showing a blood pressure measurement result, an autonomic nerve analysis result, and the like. The surface of the display unit 7 is a touch panel, and various input processes can be performed. Further, the automatic blood pressure measuring device 1 with an autonomic nerve analysis function includes a printer 8 that prints a blood pressure measurement result, an autonomic nerve analysis result, and the like.

FIG. 2 is an internal block diagram of the automatic blood pressure measuring device 1 with an autonomic nerve analysis function of FIG. In FIG. 2, the air supply pump 9 is a pump that supplies air to the cuff 5. The air supply pump 9 is driven by an air supply pump drive circuit 16 controlled by a microcomputer circuit 14 described later. The air supply pump 9 and the air supply pump drive circuit 16 constitute a pressurizing means for pressurizing the pressure of the cuff 5.

The exhaust valve 10 is a valve that exhausts the air inside the cuff 5. The exhaust valve 10 is driven by an exhaust valve drive circuit 17 controlled by a microcomputer circuit 14 described later. The exhaust valve 10 is for exhausting the air inside the cuff 5 to the outside to adjust the exhaust during blood pressure measurement, exhaust in an emergency, and the like. The exhaust valve 10 and the exhaust valve drive circuit 17 constitute a pressure reducing means for reducing the pressure of the cuff 5.

The cuff fixing means 11 includes a geared motor that tightens the cuff 5 wound around the subject's arm 3 and a brake solenoid that locks the geared motor. The cuff fixing means 11 is driven by a cuff driving means 18 controlled by a microcomputer circuit 14 described later. The cuff drive means 18 includes a belt drive control circuit for driving a geared motor and a brake control circuit for controlling a brake solenoid.

When the subject's arm 3 is inserted into the cuff 5 with the palm 6 facing upward, the subject's ID is input on the touch panel of the display unit 7, and measurement is started with a measurement button (not shown), the geared. The motor is driven, the cuff 5 is tightened to the subject's arm 3, the brake solenoid is energized, and the cuff 5 is fixed to the subject's arm.

The pressure detection circuit 12 includes a semiconductor pressure sensor and an electric circuit. At the time of blood pressure measurement, air is supplied from the air supply pump 9 to the cuff 5, and the inserted arm 3 is tightened to a specified pressure. At the time of this measurement, the pressure detection circuit 12 obtains an electric output proportional to the cuff pressure value. The change in pulse wave is superimposed on this electrical output.

The pulse wave detection circuit 13 filters the electric output obtained from the pressure detection circuit 12 and outputs only the change in the pulse wave.

The microcomputer circuit 14 includes an air supply pump drive circuit 16 (air supply pump 9), an exhaust valve drive circuit 17 (exhaust valve 10), a cuff drive means 18, a pressure detection circuit (semiconductor pressure sensor) 12, and a pulse wave detection circuit 13. It is a CPU to be connected. FIG. 3 is a functional block diagram of the microcomputer circuit 14. The microcomputer circuit 14 functions as each means 31 to 35 shown in FIG. 3 by controlling the operation of each of these elements by executing the program shown in the flowchart of FIG. 8 to be described later.

In FIG. 3, the heartbeat synchronous wave acquisition means 31 drives the exhaust valve 10 by controlling the exhaust valve drive circuit 17 based on the inputs from the pressure detection circuit 12 and the pulse wave detection circuit 13, and at the time of blood pressure measurement. By depressurizing the pressure of the cuff 5 until the blood pressure determination is completed and stopping the depressurization for a certain period after the blood pressure measurement is completed, a heartbeat synchronous wave is obtained between the blood pressure measurement and the time when the depressurization is stopped for a certain period of time after the blood pressure measurement is completed. It is a means.

During normal blood pressure measurement, the air pressure in the cuff 5 wrapped around the subject's arm 3 fluctuates in response to the blood flow in the artery. In the pulse wave detection circuit 13, the heartbeat synchronization wave (pulse wave data), which is a pulse wave signal synchronized with the heartbeat, is extracted by extracting the fluctuating portion of the pressure (air pressure) obtained by the pressure detection circuit 12. obtain.

At the time of normal blood pressure measurement, the heartbeat synchronous wave acquisition means 31 controls the air supply pump drive circuit 16 to drive the air supply pump 9 to tighten the cuff 5 at a pressure higher than the systolic blood pressure and press the exhaust valve drive circuit 17. By controlling and driving the exhaust valve 10, the blood pressure is gradually reduced to below the minimum blood pressure at a constant pressure speed, and the blood pressure is determined. At this time, the heartbeat synchronous wave acquisition means 31 continues to reduce the pressure of the cuff 5 until the blood pressure determination at the time of normal blood pressure measurement is completed, that is, until the generated pulse wave level reaches a certain constant value below the reference value, and then the pressure is reduced. By stopping, a heartbeat-synchronized wave is obtained between the time when the blood pressure is being measured and the time when the depressurization is stopped for a certain period of time after the blood pressure measurement is completed.

FIG. 4 is a graph of pulse wave data sampled by the pulse wave detection circuit 13. FIG. 4 is a diagram in which pulse wave data is extracted through a bandpass filter (0.7 Hz to 3.0 Hz) in the frequency band of the pulse wave, and then the position and value of the peak for each pulse wave are obtained.

The heartbeat cycle-related value detecting means 32 is a means for detecting fluctuations in the heartbeat cycle-related value from the heartbeat-synchronized wave obtained by the heartbeat-synchronized wave acquiring means 31. The inter-heartbeat-cycle-related value is a value indicating an interval (interval time) for each beat of a heartbeat-synchronized wave that is periodically generated in accordance with the heartbeat. The heartbeat cycle-related value detecting means 32 performs sampling processing using the time of this heartbeat synchronization wave interval as a heartbeat cycle-related value, and transmits it to the periphery by the contraction of the heart detected during blood pressure measurement instead of the R wave of the electrocardiogram. The fluctuation of the contraction of the heart is detected from the generation interval of the pulse wave, that is, the heartbeat synchronization wave.

FIG. 5 is a diagram depicting fluctuations in the peak interval of the generated pulse wave, with the peak interval of the pulse wave data of FIG. 4 on the vertical axis and the time of occurrence of the pulse wave on the horizontal axis.

FIG. 6 shows the pulse wave data replaced with evenly spaced data (500 msec) based on the peak intervals of the generated pulse waves in FIG. 5 (Lagrange complementation process).

The frequency analysis means 33 is a means for calculating the frequency component ratio of the low frequency component and the high frequency component by frequency analyzing the fluctuation of the heart rate cycle related value detected by the heart rate cycle related value detecting means 32 by Fourier transform or the like. The calculated frequency component ratio is stored in the storage unit of the microcomputer circuit 14, and is output to output means such as the LCD display 19, the recorder 20, and the external memory 15. The external memory 15 is a storage means for storing measurement result data as time-series data for each subject.

FIG. 7 is a display screen of the autonomic nerve analysis result of the automatic blood pressure device with the autonomic nerve analysis function according to the embodiment of the present invention. The power spectral density is a graph of the power spectral intensity obtained by frequency-analyzing the fluctuation of heart rate variability. In the case of this figure, the area of power from 0.04 to 0.15 Hz is a low frequency component obtained by frequency-analyzing the fluctuation of the peak interval of the pulse wave, and the area of power from 0.1 to 0.40 Hz is the frequency. It is the analyzed high frequency component. Further, LF (low frequency component) and HF (high frequency component) represent the result of frequency analysis numerically, and the frequency component ratio LF / HF is the component ratio of the low frequency component and the high frequency component.

The tension determination means 34 is a means for determining the tension of the subject based on the frequency component ratio calculated by the frequency analysis means 33. More specifically, the tension determination means 34 determines the tension of the subject based on whether or not the calculated frequency component ratio LF / HF is within a predetermined reference range, and estimates the activity state of the autonomic nerve. ..

When the tension of the subject determined by the tension determination means 34 exceeds a predetermined reference value, the notification means 35 instructs the subject to maintain rest for a certain period of time and to perform measurement again after a certain period of time. It is a means of alerting you to the possibility that your blood pressure may be rising due to tension. The instruction or alert by the notification means 35 is given by an announcement by the LCD display 19 or the speaker 21, a message printing by the recorder 20, or the like.

FIG. 8 is a flowchart showing the processing contents of the software program stored in the microcomputer circuit 14 used in the automatic blood pressure measuring device with the autonomic nerve analysis function according to the embodiment of the present invention.

When a subject matching the ID is selected in S1 and measurement is started, the heartbeat synchronization wave acquisition means 31 sets the initial pressurization value of pressurizing the cuff 5 wrapped around the subject's arm in S2 to 190 mmHg. do.

The heartbeat synchronization wave acquisition means 31 controls the air supply pump drive circuit 16 in S3 to drive the air supply pump 9 to start air supply from the air supply port of the cuff 5, and in S4 and S5, the air supply in the cuff 5 is started. When the pressure value reaches 190 mmHg, the air supply is stopped.

When the heartbeat synchronous wave acquisition means 31 stops the air supply in S5, the decompression speed is calculated in S6, and the exhaust valve 10 is operated by the exhaust valve drive circuit 17 to gradually reduce the pressure of the cuff 5 at a constant speed. Further, the heartbeat synchronization wave acquisition means 31 continuously takes in the pressure data and the pulse wave data of the cuff 5 into the storage unit (memory) of the microcomputer circuit 14 at a fixed cycle in S7. Blood pressure is determined by the oscillometric method from the captured pressure data and pulse data.

After the blood pressure value is normally determined, as shown in S8, the heartbeat synchronization wave acquisition means 31 takes in pulse data for autonomic nerve analysis from the systolic blood pressure determination time as shown in S11. It continues for a predetermined time, here for 30 seconds, until it elapses.

In S9, the pulse level detected as the decompression is advanced gradually decreases. Therefore, when the detected pulse level becomes 1/2 or less of the maximum pulse level, the heartbeat synchronization wave acquisition means 31 Closes the exhaust valve 10 by the exhaust valve drive circuit 17 to stop the depressurization.

In S12, the heartbeat synchronization wave acquisition means 31 captures pulse wave data for a predetermined time from the systolic blood pressure determination time, here for 30 seconds, and then opens the exhaust valve 10 by the exhaust valve drive circuit 17 to open the autonomic nerve. Move to analysis processing.

In the autonomic nerve analysis data processing, the heart rate cycle-related value detecting means 32 detects the peak position of each sampled pulse group in S13 and calculates the peak position data. Further, the heart rate cycle-related value detecting means 32 compares the RR interval between each pulse wave with the average RR of all pulse waves, and if it is above or below the specified level, replaces it with the average RR. And add correction.

In S14, the heart rate cycle-related value detecting means 32 converts the peak position data into equal time interval data, calculates the time between peaks of the pulse wave, and converts it into the time interval data. The pulse wave peak interval value at each peak position can be obtained from the peak position data, but time series data (data with a fixed period) is required for frequency analysis. Therefore, it is necessary to interpolate the data at the time when the actual data does not exist by using the pulse wave peak interval value (actual data) at each peak position obtained from the peak position data. Interpolation is performed using Lagrange interpolation.

The frequency analysis means 33 performs a Fourier transform of the equi-time interval data (500 msec, 1024 points) obtained in S14 in S15, and calculates a power spectrum. The index value LF is a power spectrum area of 0.04 Hz to 0.15 Hz, and HF is a power spectrum area of 0.15 Hz to 0.40 Hz.

In S16, the frequency analysis means 33 records the index values LF and HF and the blood pressure value at that time as data of the subject matching the ID in the external memory 15 in time series.

The tension determination means 34 determines in S17 whether or not the measured blood pressure value is within an appropriate range. When the LF / HF obtained by frequency analysis of the fluctuation of the heart rate cycle-related value is within the reference range, the notification means 35 displays the normal result when the blood pressure is normal as shown in S18.

On the other hand, when the LF / HF is out of the reference range, the notification means 35 displays an inappropriate result as shown in S19. More specifically, the notification means 35 keeps the subject at rest for a certain period of time when the tension of the subject determined by the tension determination means 34 exceeds a predetermined reference value, and after a certain period of time. The microcomputer circuit 14 performs the remeasurement process by instructing the measurement to be performed again or calling attention to the possibility that the blood pressure is elevated due to tension.

As described above, in the automatic blood pressure measuring device 1 with the autonomic nerve analysis function in the present embodiment, the time of the heartbeat synchronization wave interval is used as the heartbeat cycle-related value for sampling processing, so that the blood pressure is measured instead of the R wave of the electrocardiogram. It is possible to estimate the activity state of the autonomic nerves by detecting the fluctuation of the contraction of the heart from the pulse wave transmitted to the periphery by the detected contraction of the heart, that is, the generation interval of the heartbeat synchronous wave, and analyzing the frequency. With one automatic blood pressure measuring device 1, the blood pressure measurement and the frequency analysis of the heart rate cycle-related value indicating the state of the autonomic nerve can be performed at the same time, and the autonomic nerve state at the time of measuring the autonomic nerve can be inspected.

Further, in the automatic blood pressure measuring device 1 with an autonomic nerve analysis function in the present embodiment, when the degree of tension of the subject at the time of blood pressure measurement exceeds a predetermined reference value, the subject is maintained at rest for a certain period of time and is constant. By instructing the measurement to be performed again after the period, it is possible to perform an accurate blood pressure measurement, and it is possible to warn that the blood pressure measurement result may not be accurate due to tension.

Further, in the automatic blood pressure measuring device 1 with an autonomic nerve analysis function in the present embodiment, the blood pressure value in normal times is estimated from the past blood pressure value and the history data of the tension degree recorded in the external memory 15 for each subject. You can also do it.

The automatic blood pressure measuring device of the present invention is useful as an automatic blood pressure measuring device with an autonomic nerve analysis function that examines the autonomic nervous state at the time of blood pressure measurement in addition to blood pressure measurement.

Claims (2)

Automatic blood pressure measurement that measures the blood pressure value of the subject based on the heartbeat-synchronized wave, which is a pulse wave signal synchronized with the heartbeat obtained when a part of the subject's body is pressed with a cuff. It ’s a device,
By reducing the pressure of the cuff until the blood pressure judgment at the time of blood pressure measurement is completed and stopping the depressurization for a certain period after the end of the blood pressure measurement, the heartbeat is synchronized between the time during the blood pressure measurement and the time when the decompression is stopped for a certain period after the end of the blood pressure measurement. Blood pressure synchronization wave acquisition means to obtain waves,
A heartbeat cycle-related value detecting means that detects fluctuations in the heartbeat cycle-related value from the heartbeat synchronization wave obtained by the heartbeat synchronization wave acquisition means, and a heartbeat cycle-related value detecting means.
A frequency analysis means for calculating the frequency component ratio of the low frequency component and the high frequency component by frequency analyzing the fluctuation of the heart rate cycle related value detected by the heart rate cycle related value detecting means.
An automatic blood pressure measuring device including a tension degree determining means for determining the tension degree of the subject based on the calculated frequency component ratio. When the tension of the subject, which is determined by the tension determination means, exceeds a predetermined reference value, the subject is instructed to maintain rest for a certain period of time and perform measurement again after a certain period of time. The automatic blood pressure measuring device according to claim 1, which has a notification means for alerting the possibility that the blood pressure is rising due to tension.

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