WO2006024871A1 - Procedes et appareils pour la mesure de la tension arterielle - Google Patents

Procedes et appareils pour la mesure de la tension arterielle Download PDF

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Publication number
WO2006024871A1
WO2006024871A1 PCT/GB2005/003409 GB2005003409W WO2006024871A1 WO 2006024871 A1 WO2006024871 A1 WO 2006024871A1 GB 2005003409 W GB2005003409 W GB 2005003409W WO 2006024871 A1 WO2006024871 A1 WO 2006024871A1
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WO
WIPO (PCT)
Prior art keywords
pressure
arterial
brachial
cuff pressure
cuff
Prior art date
Application number
PCT/GB2005/003409
Other languages
English (en)
Inventor
Phil Chowienczyk
Sally Brett
Original Assignee
King's College London
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by King's College London filed Critical King's College London
Publication of WO2006024871A1 publication Critical patent/WO2006024871A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/022—Measuring pressure in heart or blood vessels by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers

Definitions

  • This invention relates to the measurement of blood pressure and is directed to the provision of methods and apparatus of improved accuracy in the determination of blood pressure of patients especially during high cardiac output states, including exercise and pregnancy.
  • Exercise diastolic pressure may be influenced by endothelial function; exercise systolic pressure by endothelial function and large artery stiffness.
  • Mercury sphygmomanometry requires a trained observer and is becoming obsolete due to the requirement to phase out mercury based devices. Many automated methods for measuring blood pressure are available but these are of limited accuracy in high cardiac output states.
  • the present invention provides an automatic, objective and mercury free measurement of blood pressure that may be particularly important in high cardiac output states.
  • the method involves a novel approach combining the application of pressure and measurement of pressure to/within a cuff applied to the upper arm and around the brachial artery (brachial cuff) and the non ⁇ invasive recording of pressure fluctuations distal to the brachial cuff (i.e., at any position between the brachial cuff and the tips of the fingers).
  • the present invention provides apparatus comprising a combination of a brachial cuff and a non-invasive arterial pressure detector operatively connected to means for recording the effect of varying cuff pressure on the arterial pulse.
  • the apparatus of the present invention comprises 3 distinct components, namely a brachial cuff, a non-invasive arterial pressure detector and means for recording.
  • the brachial cuff and the non-invasive arterial pressure detector are operatively connected to the recording means.
  • the brachial cuff and the non-invasive arterial pressure detector may be connected to the recording means by any suitable connection, for example, wires or via a radio signal.
  • the brachial cuff may be any suitable brachial cuff known to those skilled in the art.
  • the non-invasive arterial pressure detector can be any suitable arterial pressure detector.
  • a preferred arterial pressure detector is an arterial tonometer.
  • Radial artery tonometry generally comprises the application of a piezo electric pressure sensor over the radial artery, and thereby provides a non-invasive means of obtaining a high fidelity arterial pressure waveform.
  • a number of instruments are commercially available. In the specific example of the invention described herein a Colin 7000 (Colin medical instrumentation corporation, USA) was used. This device applies a tonometer using a servo-controlled wrist strap and provides a continuous radial artery waveform.
  • Another preferred arterial pressure detector is a blood pressure cuff placed distal to the brachial cuff.
  • a further preferred arterial pressure detector that can be used is a photoplethysmograph.
  • a photoplethysmograph can be used to optically measure the movement of the arterial wall which is proportional to pressure.
  • the arterial pressure detector can be positioned anywhere distal to the brachial cuff (i.e., at any position between the brachial cuff and the tips of the fingers).
  • the preferred position of the arterial pressure detector will depend on the type of detector being used. For example, when the arterial pressure detector is a tonometer, it is preferably positioned around the wrist. When the arterial pressure detector is a photoplethysmograph it is preferably positioned to enable measurement of the radial artery.
  • the means for recording the effects of varying cuff pressure on the arterial pulse of an individual can be any suitable means. Preferably, the means for recording comprises a visual display system.
  • the means for recording also controls brachial cuff pressure and processes the data from the cuff and from the arterial pressure detector in order to calculate diastolic blood pressure, and preferably the systolic blood pressure, of an individual.
  • the diastolic and systolic blood pressures may be calculated by software using the methods described below.
  • the means for recording is preferably a computer that can display the calculated blood pressures in a suitable form.
  • the present invention also provides a method of measuring diastolic blood pressure of an individual, using the apparatus of the present invention comprising measuring the arterial pulse and brachial cuff pressure, determining the brachial cuff pressure at which the amplitude of the normal arterial pressure signal starts to decrease.
  • the amplitude of the normal arterial pressure signal is the amplitude when the brachial cuff does not apply any pressure to the brachial artery of the individual.
  • the oscillation from the arterial pressure detector placed distal to the brachial cuff start to decrease in amplitude (the difference between the maximum and minimum values within one cardiac cycle decrease).
  • the amplitude is monitored on a cycle by cycle basis.
  • pressure in the brachial cuff is taken as diastolic blood pressure.
  • the amplitude of pressure oscillations detected by the pressure sensor becomes substantially zero, pressure in the brachial cuff is taken as systolic blood pressure.
  • the method of measuring diastolic blood pressure comprises measuring the arterial pulse and brachial cuff pressure, increasing the brachial cuff pressure and recording the brachial cuff pressure at which the amplitude of the arterial pressure signal starts to decrease.
  • the brachial cuff pressure recorded is then considered to be the diastolic blood pressure.
  • the method of measuring diastolic blood pressure preferably comprises measuring the arterial pulse and brachial cuff pressure, increasing the brachial cuff pressure so that the amplitude of the arterial pressure signal starts to decrease and then slowly reducing the cuff pressure and recording the point at which the initial amplitude of the arterial pulse is restored.
  • the brachial cuff pressure recorded is then considered to be the diastolic blood pressure.
  • the present invention also provides a method of measuring systolic blood pressure of an individual, using the apparatus of the present invention comprising measuring the arterial pulse and brachial cuff pressure and determining the brachial cuff pressure at which the oscillations of the arterial signal are abolished.
  • the method of measuring systolic blood pressure comprises measuring the arterial pulse and brachial cuff pressure, and increasing brachial cuff pressure to identify the cuff pressure at which the oscillations of the arterial signal are abolished.
  • the identified brachial cuff pressure is considered to be the systolic blood pressure.
  • the method of measuring systolic blood pressure comprises measuring the arterial pulse and brachial cuff pressure, wherein the brachial cuff pressure is increased to abolish the oscillations of the arterial signal, and then decreasing the brachial cuff pressure to identify the cuff pressure at which the oscillations of the arterial signal re-appear.
  • the brachial cuff pressure identified is considered to be the systolic blood pressure.
  • Figure IA shows schematically apparatus for determining blood pressure by the method of the present invention.
  • a wrist tonometer (1) is used to obtain a non-invasive recording of a signal that closely follows pressure in the radial artery.
  • a brachial blood pressure cuff (2) is inflated to modulate the signal from the tonometer (1).
  • a control and processing unit (3) controls cuff pressure, reads cuff pressure and the tonometer signal and calculates diastolic and systolic blood pressure during inflation of the brachial cuff (2) according to set algorithms.
  • Figure IB shows schematically the control and processing unit (3).
  • Figure 2 shows a graph of the tonometer signal and the brachial cuff pressure.
  • the amplitude of the tonometer signal starts to decrease when cuff pressure equals diastolic blood pressure (A) and oscillations in the tonometer trace are obliterated when cuff pressure equals systolic blood pressure (B).
  • Figure 3 shows a graph of the tonometer signal and the brachial cuff pressure, wherein the method has been modified for more accurate but equally rapid determination of diastolic blood pressure.
  • Cuff pressure is increased rapidly until the amplitude of the tonometer signals starts to decrease (A). It is then decreased slowly until the amplitude returns to previous values (B). This occurs when cuff pressure equals diastolic blood pressure.
  • a similar modification can be applied to the determination of systolic blood pressure.
  • Tonometry (even when calibrated by reference to a standard cuff method) cannot be used to determine diastolic and systolic blood pressure due to drift of the pressure signal over the course of several tens of seconds due to movement artefact. Thus, although pressure is faithfully reproduced over a single or a few cardiac cycles, longer term measurements are inaccurate especially during exercise. To overcome this we have combined simultaneous cuff inflation with radial artery tonometry, "cuff- tonometry" as shown in Figure IA and IB.
  • the Colin 7000 tonometer (1) is positioned around the wrist of an individual so that the arterial pulse can be measured.
  • a brachial cuff (2) is positioned around the upper arm of the individual in accordance with standard procedures.
  • Both the tonometer and the brachial cuff are connected to control and processing unit (3).
  • the control and processing unit (3) controls cuff pressure, and reads cuff pressure and the tonometer signal.
  • the radial tonometry signal is continually monitored during cuff inflation. At the instant when cuff pressure exceeds diastolic pressure the amplitude of the tonometer signal decreases abruptly as shown in Figure 2. With increasing cuff pressure there is a progressive decrease in amplitude of the tonometer signal until, when cuff pressure reaches systolic pressure, the oscillations in the tonometer signal are obliterated: the signal remains constant over the whole cardiac cycle ( Figure 2). By simultaneously displaying cuff pressure and the tonometer signal diastolic and systolic pressure can be determined.
  • Diastolic pressure is the cuff pressure at the point at which the amplitude of the tonometer signal starts to change, systolic pressure cuff pressure at the point at which oscillations in the tonometer signal are obliterated.
  • Various modifications to this method are possible to improve its accuracy and ease of use:
  • the above method can be applied using a relatively rapid rate of cuff inflation. This allows approximate determination of systolic and diastolic blood pressure. The method can then be repeated using a slower rate of inflation when pressure is close to diastolic and systolic pressure. This will provide a more accurate determination of systolic and diastolic blood pressure.
  • the brachial cuff can be rapidly inflated until there is a decrease in tonometer amplitude. It can then be slowly deflated with subsequent increase in tonometer amplitude until the amplitude becomes similar to that before cuff inflation. This allows diastolic pressure to be accurately determined as the cuff pressure at which the amplitude of tonometer oscillations starts to change as shown in Figure 3. Similarly, to determine systolic blood pressure, the cuff can be rapidly inflated until tonometer oscillations are obliterated. It can then be slowly deflated until oscillations return. This allows systolic pressure to be accurately determined as the cuff pressure at which tonometer oscillations change from being present to being obliterated.
  • diastolic and systolic pressure may be automatically calculated using analogue to digital conversion of these signals and a software algorithm.
  • the most basic algorithm consists of monitoring the amplitude of the tonometer signal during inflation of the brachial cuff.
  • Diastolic blood pressure is taken as brachial cuff pressure at the time when the amplitude decreases by an amount that exceeds a threshold Ai (dependent on the rate of brachial cuff inflation).
  • Systolic pressure is taken as brachial cuff pressure at the time when the amplitude of the tonometer signal decreases below a second threshold A 2 (again dependent on the rate of brachial cuff inflation).
  • CT Cod Occlusion Tonometry
  • DBP mean difference 2.2 mmHg 1.2 mmHg SD 2.8 mmHg 2.1 mmHg
  • DBP mean difference -0.3 mmHg 1.3 mmHg SD 3.7 mmHg 6.3 mmHg
  • SBP Systolic blood pressure
  • DBP Diastolic blood pressure

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physiology (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Engineering & Computer Science (AREA)
  • Ophthalmology & Optometry (AREA)
  • Physics & Mathematics (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)

Abstract

La présente invention concerne la mesure de la tension artérielle et a trait à la fourniture de procédés et d'appareils d'une précision améliorée dans la détermination de la tension artérielle des patients, particulièrement pendant des états de débit cardiaque élevé, pendant l'exercice et pendant la grossesse. Cet appareil comprend la combinaison d'un brassard brachial et d'un détecteur de tension artérielle non invasif raccordé en fonctionnement à des moyens pour l'enregistrement de l'effet de la tension variable du brassard sur le pouls artériel.
PCT/GB2005/003409 2004-09-03 2005-09-02 Procedes et appareils pour la mesure de la tension arterielle WO2006024871A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB0419633.3 2004-09-03
GB0419633A GB0419633D0 (en) 2004-09-03 2004-09-03 Method and apparatus for the measurement of blood pressure

Publications (1)

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WO2006024871A1 true WO2006024871A1 (fr) 2006-03-09

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Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7717855B2 (en) 2006-12-06 2010-05-18 The Hospital For Sick Children System for performing remote ischemic preconditioning
EP2269502A1 (fr) * 2009-06-29 2011-01-05 Enverdis GmbH Procédé et dispositif de détermination d'une pression de fermeture et/ou d'ouverture artérielle dans un vaisseau sanguin
US8057400B2 (en) 2009-05-12 2011-11-15 Angiologix, Inc. System and method of measuring changes in arterial volume of a limb segment
US8764789B2 (en) 2011-04-15 2014-07-01 CellAegis Devices Inc. System for performing remote ischemic conditioning
US9393025B2 (en) 2010-04-08 2016-07-19 The Hospital For Sick Children Use of remote ischemic conditioning for traumatic injury
US10098779B2 (en) 2013-03-15 2018-10-16 The Hospital For Sick Children Treatment of erectile dysfunction using remote ischemic conditioning
US10136895B2 (en) 2010-03-31 2018-11-27 The Hospital For Sick Children Use of remote ischemic conditioning to improve outcome after myocardial infarction
US10213206B2 (en) 2013-03-15 2019-02-26 CellAegis Devices Inc. Gas powered system for performing remote ischemic conditioning
US10238306B2 (en) 2006-02-20 2019-03-26 Everist Genomics, Inc. Method for non-evasively determining an endothelial function and a device for carrying out said method
US10252052B2 (en) 2013-03-15 2019-04-09 The Hospital For Sick Children Methods relating to the use of remote ischemic conditioning
US10272241B2 (en) 2013-03-15 2019-04-30 The Hospital For Sick Children Methods for modulating autophagy using remote ischemic conditioning

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2562414A1 (fr) * 1984-04-06 1985-10-11 Lefebvre Jean Paul Procede et appareil de detection de la tension arterielle
EP0298620A1 (fr) * 1987-07-06 1989-01-11 The BOC Group, Inc. Appareil et méthode de surveillance pour la tension artérielle
DE3941777A1 (de) * 1989-12-18 1991-06-20 Siemens Ag Verfahren und anordnung zur blutdruckmessung
US6554773B1 (en) * 1997-09-12 2003-04-29 Polar Electro Oy Method and arrangement for blood pressure measurement

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2562414A1 (fr) * 1984-04-06 1985-10-11 Lefebvre Jean Paul Procede et appareil de detection de la tension arterielle
EP0298620A1 (fr) * 1987-07-06 1989-01-11 The BOC Group, Inc. Appareil et méthode de surveillance pour la tension artérielle
DE3941777A1 (de) * 1989-12-18 1991-06-20 Siemens Ag Verfahren und anordnung zur blutdruckmessung
US6554773B1 (en) * 1997-09-12 2003-04-29 Polar Electro Oy Method and arrangement for blood pressure measurement

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
NISSILA S ET AL: "Non-invasive blood pressure measurement based on the electronic palpation method", PROCEEDINGS OF THE 20TH ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. VOL.20 BIOMEDICAL ENGINEERING TOWARDS THE YEAR 2000 AND BEYOND (CAT. NO.98CH36286) IEEE PISCATAWAY, NJ, USA, vol. 4, 1998, pages 1723 - 1726 vol., XP010320834, ISBN: 0-7803-5164-9 *

Cited By (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10238306B2 (en) 2006-02-20 2019-03-26 Everist Genomics, Inc. Method for non-evasively determining an endothelial function and a device for carrying out said method
US7717855B2 (en) 2006-12-06 2010-05-18 The Hospital For Sick Children System for performing remote ischemic preconditioning
US8790266B2 (en) 2006-12-06 2014-07-29 The Hospital For Sick Children Methods and system for performing remote ischemic preconditioning
US9119759B2 (en) 2006-12-06 2015-09-01 The Hospital For Sick Children System for performing remote ischemic preconditioning
US9119761B2 (en) 2006-12-06 2015-09-01 The Hospital For Sick Children Methods and system for performing remote ischemic preconditioning
US8057400B2 (en) 2009-05-12 2011-11-15 Angiologix, Inc. System and method of measuring changes in arterial volume of a limb segment
US8657755B2 (en) 2009-05-12 2014-02-25 Angiologix, Inc. System and method of measuring changes in arterial volume of a limb segment
EP2269502A1 (fr) * 2009-06-29 2011-01-05 Enverdis GmbH Procédé et dispositif de détermination d'une pression de fermeture et/ou d'ouverture artérielle dans un vaisseau sanguin
US10136895B2 (en) 2010-03-31 2018-11-27 The Hospital For Sick Children Use of remote ischemic conditioning to improve outcome after myocardial infarction
US10194918B2 (en) 2010-04-08 2019-02-05 The Hospital For Sick Children Use of remote ischemic conditioning for traumatic injury
US11045207B2 (en) 2010-04-08 2021-06-29 The Hospital For Sick Children Use of remote ischemic conditioning for traumatic injury
US9393025B2 (en) 2010-04-08 2016-07-19 The Hospital For Sick Children Use of remote ischemic conditioning for traumatic injury
US8764789B2 (en) 2011-04-15 2014-07-01 CellAegis Devices Inc. System for performing remote ischemic conditioning
USRE47219E1 (en) 2011-04-15 2019-02-05 CellAegis Devices Inc. System for performing remote ischemic conditioning
US9205019B2 (en) 2011-04-15 2015-12-08 CellAegis Devices Inc. System for performing remote ischemic conditioning
US10213206B2 (en) 2013-03-15 2019-02-26 CellAegis Devices Inc. Gas powered system for performing remote ischemic conditioning
US10098779B2 (en) 2013-03-15 2018-10-16 The Hospital For Sick Children Treatment of erectile dysfunction using remote ischemic conditioning
US10252052B2 (en) 2013-03-15 2019-04-09 The Hospital For Sick Children Methods relating to the use of remote ischemic conditioning
US10272241B2 (en) 2013-03-15 2019-04-30 The Hospital For Sick Children Methods for modulating autophagy using remote ischemic conditioning

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