This thesis presents an improved oscillotonometric system for the measurement of human blood pressure. The study included: 1. The design of a hydraulic occlusive cuff, 2. The investigation of the wave forms taken from the blood pressure measurements, and 3. The design of a mechanism for the simulation of human blood pressure pulse. In this study, an experimental system consisting of a rigid shell occlusive cuff, a constant volume displacement pump, a transducer, and a chart recorder was designed and used for data collection.

The currently accepted methods for measuring systemic blood pressure are either highly accurate but invasive in nature or clinically convenient but prone to observer-related errors. A new oscillometric method uses sensitive signal conditioning and sensing equipment with a non-invasive arm cuff to record arterial pulsations. The goal of this study is to establish more reliable criteria for the identification of systolic and diastolic pressures from oscillometric data.

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING / Bibliography: leaves 94-97. / by Daniel Michael Chernoff. / M.S.

Blood pressure (BP) monitoring is an important tool for management of hypertension, which is a significant risk for cardiovascular disease and premature death. Since cuff-based BP measurement can be uncomfortable and does not provide continuous readings, several cuffless methods that are typically based on within-beat information or on the pulse transit time (PTT) have recently been investigated. This work proposes a novel cuffless BP estimation approach that mainly uses the information from cardiovascular dynamics of photoplethysmogram (PPG) waveforms. This work is divided into three parts. The first part proposes a calibration-free approach that uses dynamic changes in the pulse waveform. Results from 200 patients showed that the method achieved grade B, in terms of accuracy, for diastolic blood pressure (DBP) based on the British Hypertension Society (BHS) standard and complied with the accuracy requirements of the Association for Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) standard. The second part presents a method based on calibrated cardiovascular dynamics, achieved through a mathematical model that relates reflective PTT (R-PTT) to BP. Results from 30 patients showed a mean error (ME) of 0.58 mmHg, standard deviation of the error (SDE) of 8.13 mmHg, and a mean absolute error (MAE) of 4.93 mmHg for DBP and an ME of 2.52 mmHg, SDE of 12.28 mmHg, and an MAE of 8.82 mmHg for systolic blood pressure (SBP). The third part proposes a calibration-free method that combines morphology features and dynamic changes of the pulse waveform over short intervals. In this method a neural network was trained on 200 patients and tested on never-seen data from 25 other patients and provided an ME of -0.31 mmHg, SDE of 4.89 mmHg, and MAE of 3.32 mmHg for DBP and an ME of -4.02 mmHg, SDE of 10.40 mmHg, and MAE of 7.41 mmHg for SBP. Overall, the results show that cardiovascular dynamics may contribute useful information for cuffless estimation of BP.

Forty-six employees of an industrial bearing plant volunteered to participate in a workplace hypertension program. The purpose of this study was to lower hypertensive employees' blood pressure by having plant supervisors educate the employee in an eight-week hypertension program on his or her high blood pressure. This was done in an effort to aid employees in the management of their blood pressure, as well as to provide a source of emotional support within the plant. Subjects were randomly assigned to an experimental or control group. Supervisors of each hypertensive subject were given educational instruction on high blood pressure and variables related to hypertension. Supervisors also were given specific weekly assignments to convey to their subjects. Pretest and posttest measurements were made on blood pressure and knowledge concerning blood pressure. At the end of the eight-week intervention, a significant decrease in systolic blood pressure was seen in the experimental group with a 16 mm.Hg. drop (p < .05). There was no significant difference (p > .05) between the two groups on diastolic pressures, with both groups dropping to within the guidelines recommended by the American Heart Association (1987). Subjects in the experimental group scored higher on their knowledge of blood pressure than did subjects in the control group (p < .01). The results of this study indicate that a hypertensive educational intervention program may produce positive changes in employee blood pressure responses. / Master of Science

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Avdelningen för Medicinsk teknik på Akademiska sjukhuset har uppdaterat befintliga kalibreringsprotokoll för Welch Allyn 767 som används som referensmanometer vid kalibrering av blodtrycksmätare. I protokollet ska det enligt ISO 9001 och ISO 13485 ingå att vid varje kalibreringspunkt ange mätosäkerheten.  Rutiner kring detta var inte definierade. En modell för att ta fram mätosäkerhet utformades utifrån standardiserade metoder från “Guide to the expression of uncertainty in measurement” och anpassades för att kunna användas på den medicintekniska avdelningen. En mätmetod för kalibrering togs fram och med modellen beräknades mätosäkerhet för en referensmanometer. Mätosäkerheten med definierad mätmetod blev lägre än den av Welch Allyn specificerade mätosäkerheten på ± 3 mmHg. Felfortplantning från kalibrering till blodtrycksmätning undersöktes. Mätosäkerheten ökade i varje steg, varför avdelningen bör ta fram ett protokoll för hur kalibrering genomförs, och på så sätt förbättra spårbarheten. / The department of Medical Technology at Akademiska sjukhuset has updated their current protocol for calibration for Welch Allyn 767, which serves as a reference manometer for blood pressure meters when being calibrated. According to ISO 9001 and ISO 13485, the protocol has to include a measurement uncertainty for every given point of calibration. The routines regarding this were undefined. A model for retrieving measurement uncertainty was designed using standardized methods from “Guide to the expression of uncertainty in measurement” and was customized to be used at the department of Medical Technology. A method for calibration was created and used to calculate the measurement uncertainty for the reference manometer. This measurement uncertainty was smaller than the one specified by Welch Allyn, which was ± 3 mmHg. Propagation of uncertainty from the calibration to the blood pressure measurement was investigated. The measurement uncertainty increased in every step. Therefore, the department should introduce a protocol for how a calibration is performed, and thereby improve the traceability.

Avdelningen för Medicinsk teknik på Akademiska sjukhuset har uppdaterat befintliga kalibreringsprotokoll för Welch Allyn 767 som används som referensmanometer vid kalibrering av blodtrycksmätare. I protokollet ska det enligt ISO 9001 och ISO 13485 ingå att vid varje kalibreringspunkt ange mätosäkerheten.  Rutiner kring detta var inte definierade. En modell för att ta fram mätosäkerhet utformades utifrån standardiserade metoder från “Guide to the expression of uncertainty in measurement” och anpassades för att kunna användas på den medicintekniska avdelningen. En mätmetod för kalibrering togs fram och med modellen beräknades mätosäkerhet för en referensmanometer. Mätosäkerheten med definierad mätmetod blev lägre än den av Welch Allyn specificerade mätosäkerheten på ± 3 mmHg. Felfortplantning från kalibrering till blodtrycksmätning undersöktes. Mätosäkerheten ökade i varje steg, varför avdelningen bör ta fram ett protokoll för hur kalibrering genomförs, och på så sätt förbättra spårbarheten. / The department of Medical Technology at Akademiska sjukhuset has updated their current protocol for calibration for Welch Allyn 767, which serves as a reference manometer for blood pressure meters when being calibrated. According to ISO 9001 and ISO 13485, the protocol has to include a measurement uncertainty for every given point of calibration. The routines regarding this were undefined. A model for retrieving measurement uncertainty was designed using standardized methods from “Guide to the expression of uncertainty in measurement” and was customized to be used at the department of Medical Technology. A method for calibration was created and used to calculate the measurement uncertainty for the reference manometer. This measurement uncertainty was smaller than the one specified by Welch Allyn, which was ± 3 mmHg. Propagation of uncertainty from the calibration to the blood pressure measurement was investigated. The measurement uncertainty increased in every step. Therefore, the department should introduce a protocol for how a calibration is performed, and thereby improve the traceability.

Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive blood pressure measurements, using automated and manual devices, against invasive intra-arterial blood pressure measurements in patients with pre-eclampsia, during a hypertensive blood pressure peak. STUDY DESIGN: In this prospective study, women admitted to the Obstetrics Critical Care Unit, with confirmed pre-eclampsia and acute severe hypertension, who had an intra-arterial line in situ, were asked to participate. During an intra-arterial blood pressure peak, both an automated oscillometric and a blinded manual aneroid sphygmomanometric blood pressure was recorded. These two methods of blood pressure measurements were compared to intra-arterial blood pressure measurements. The accuracy of a mean arterial pressure (MAP) ≥ 125mmHg in detecting a systolic blood pressure (SBP) ≥ 160mmHg, using all three methods, was also determined. RESULTS: There was poor correlation between intra-arterial SBP and automated and manual SBP (r = 0.34, p < 0.01; r = 0.41, p < 0.01 respectively). The mean differences between automated and manual SBP compared to the intra-arterial SBP was 24 ± 17mmHg (p < 0.01) and 20 ± 15 mmHg (p < 0.01) respectively. There was better correlation between intra-arterial diastolic blood pressure (DBP) and automated and manual DBP (r = 0.61, p < 0.01; r = 0.59, p < 0.01 respectively). The mean differences of the automated and manual DBP was not statistically significant when compared to the intra-arterial DBP. There was poor correlation between the intra-arterial MAP and the automated MAP (r = 0.44, p < 0.01) and good correlation with the manual MAP (r = 0.56, p < 0.01). The mean differences of the automated and manual MAP were statistically significant (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 respectively). The sensitivity of automated and manual methods in detecting a SBP ≥ 160mmHg was 23.4% and 37.5% respectively. A MAP ≥ 125mmHg in detecting a SBP ≥ 160mmHg, when using intra-arterial, automated and manual methods of blood pressure measurements showed low sensitivity (35.9%, 21.9% and 17.2% respectively). CONCLUSION: This study demonstrated that both the automated and manual methods of blood pressure measurements were not an accurate measure of the true systolic intra-arterial blood pressure, when managing pre-eclamptic patients with acute severe hypertension. In such situations, intra-arterial blood pressure monitoring should be used when possible. When this is not possible, manual aneroid sphygmomanometry is recommended. Underestimating blood pressure, particularly SBP, may lead to severe maternal morbidity and mortality. / AFRIKAANSE OPSOMMING: DOELWIT: Die doel van hierdie studie is om die akuraatheid van nie invasiewe bloeddruk metings, wanneer geneem met outomatiese en manuele aparate, te vergelyk met intra-arteriele bloed druk metings in pasiente met pre-eklampsie, gedurende ‘n hipertensiewe bloeddruk piek. STUDIE ONTWERP: In hierdie prospektiewe beskrywende dwarssnit studie, was pasiente wat toegelaat was tot die Obstetriese Kritieke Sorg Eenheid met pre-eklampsie, akute erge hipertensie en ‘n intra-arteriele lyn in situ gevra om deel te neem. Gedurende ‘n intra-arteriele erge hipertensiewe piek is beide die outomatiese ossilometriese en die geblinde aneroide sfigmometer lesing neergeskryf. Hierdie twee metodes van non invasiewe bloed druk lesings is vergelyk met intra-arteriele bloed druk lesings. Die akuraatheid van ‘n gemiddelde arteriele bloeddruk ≥ 125mmHg om ‘n sistoliese bloeddruk ≥ 160mmHg op te tel met gebruik van al die drie metodes is ook uitgewerk. RESULTATE: Daar was swak korrelasie tussen intra-arteriele sistoliese bloed druk (SBD) metings en outomatiese en manuele SBD (r = 0.34, p < 0.01; r = 0.41, p < 0.01 onderskeidelik). Die gemiddelde verskille tussen outomatiese en manuele SBD wanneer vergelyk met intra-arteriele SBD was 24 ± 17mmHg (p < 0.01) en 20 ± 15 mmHg (p < 0.01) onderskeidelik. Beter korrelasie was gevind tussen intra-arteriele diastoliese bloed druk (DBD) en outomatiese en manuele DBD (r = 0.61, p < 0.01; r = 0.59, p < 0.01 onderskeidelik). Die gemiddelde verskille tussen outomatiese en manuele DBD wanneer dit vergelyk was met intra-arteriele DBD was nie statisties betekenisvol nie. Daar was swak korrelasie tussen intra arteriele gemiddelde arteriele bloeddruk en outomatiese gemiddelde arteriele bloeddruk (r = 0.44, p < 0.01) en beter korrelasie met manuele gemiddelde arteriele bloeddruk (r = 0.56, p < 0.01). Die gemiddelde verskille van outomatiese en manuele gemiddelde arteriele bloeddruk was betekenisvol (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 onderskeidelik). Die sensitiwiteit van outomatiese en manuele metodes om ‘n intra-arteriele SBD ≥ 160mmHg op te tel was 23.4% en 37.5% onderskeidelik. Die vermoë van ‘n gemiddelde arteriele bloeddruk ≥ 125mmHg om ‘n SBD ≥ 160mmHg op te tel, gemeet deur intra-arterieel, outomatiese en manuele metodes het lae sensitiwiteit getoon (35.9%, 21.9% en 17.2% onderskeidelik). GEVOLGTREKKING: Hierdie studie het gedemonstreer dat outomatiese en manuele metodes van bloeddruk meting nie akurate metodes is om ware intra-arteriele sistoliese bloeddruk te meet in pasiente met erge pre-eklampsie tydens ‘n erge hipertensiewe episode nie. In hierdie omstandighede moet intra-arteriele bloeddruk gemeet word indien beskikbaar. Indien dit nie beskikbaar is nie moet die manuele aneroiede sfigmomanometer gebruik word. Onderskatting van bloeddruk, veral sistoliese bloeddruk, kan lei tot erge moederlike morbiditeit en mortaliteit.

La mesure et le contrôle du pouls et du flux sanguin en continu sont d'importants paramètres pour l'évaluation de signes essentiels physiologiques sur la condition de santé d'un individu. Les dispositifs commerciaux existants, ainsi que les méthodes de recherche ou utilisées dans le milieu médical exigent un bon contact électrique ou optique pour obtenir cette mesure en continu. Pendant ces travaux de recherche, une méthode originale non invasive de mesure du rythme cardiaque fondée sur la perturbation localisée d'un champ magnétique au passage du flux sanguin a été développée, permettant l'acquisition des signaux à travers les vêtements, la transpiration, les salissures ou autres polluants dans l'environnement proche du capteur. Cette méthode est appelée la Signature Sanguine par Modulation Magnétique (MMSB) et les mesures ont été accomplies sur de multiples individus. Le système a été modélisé mathématiquement et simulé dans un environnement multiphysique, puis validé par l'utilisation des données expérimentales. Les résultats de mesure, en utilisant la méthode MMSB, pour le pouls et le flux sanguin ont été comparés et se trouvent bien corrélés, avec les résultats obtenus grâce à d'autres instruments. De plus, deux dispositifs ont été développés et sont en cours de commercialisation, pour des applications de vie quotidienne / Continuous pulse rate, blood pressure and blood flow monitoring are important for the assessment of physiological vital signs as these are able to provide continuous feedback on the health condition of an individual. Existing commercial, medical and research methods to continuously acquire such these physiological vital signs require good electrical or optical contact. During this research, a magnetic based sensing method, at room temperature, for blood pulse, flow and pressure is developed to achieve data acquisition through fabric, environmental contaminants and body-fluids. This method is named Modulated Magnetic Signature of Blood (MMSB) and physical measurements were conducted on multiple subjects, mathematically modelled and simulated in a multi-physics environment with verification through use of measurement data. Measurement results, using MMSB, for blood pressure and blood flow were compared, and found to be well correlated, with lifestyle device and medical research instruments respectively. In addition, two devices are developed, and are in the midst of commercialization, to support lifestyle applications