Differences in Blood Pressure among Measurements with Oscillometric and Mercury Sphygmomanometers

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  • オシロメトリック式自動血圧計と水銀血圧計を使用した血圧測定における較差に関する研究
  • オシロメトリックシキ ジドウ ケツアツケイ ト スイギン ケツアツケイ オ シヨウシタ ケツアツ ソクテイ ニ オケル カクサ ニ カンスル ケンキュウ

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It is still ambiguous that blood pressure measurement with oscillometric sphygmomanometer is comparable to that with mercury sphygmomanometer. Moreover, the mechanisms underlying the differences in blood pressure among these two measurements have not been well understood. We have attempted to examine compatibility of the oscillometric device (HEM─747IC, Omron) and explored the mechanisms for the differences in blood pressure measurements. Fifty healthy young subjects (22 ± 2y) outfitted a cuff on the upper arm. A tube from the cuff is connected to both oscillometric and mercury sphygmomanometer via a Y-tube. The cuff was inflated with the oscillometric sphygmomanometer while auscultatory measurement with mercury sphygmomanometer was simultaneously performed by two skilled nurses during cuff-deflation, which enabled simultaneous ipsilateral measurement. From regression analysis, systolic blood pressures measured with two devices were totally correlated (r＝0.94, slope＝0.98) whereas diastolic pressures were much less correlated (r＝0.80, slope＝0.68). However, certain guideline such as a guideline from Association for the Advancement of Medical Instrumentation would authorize accuracy of this oscillometric sphygmomanometer because the average values of differences between two measurements for systolic and diastolic pressure were only 1.7 ± 4.2 mmHg(mean ± SD) and 4.5 ± 5.2 mmHg, respectively. The diastolic pressure difference was found to correlate significantly with diastolic pressure, heart rate and pulse pressure. A diastolic pressure measured with the oscillometric device tends to be greater when diastolic pressure per se is lower, or heart rate is increased, or pulse pressure is greater. This phenomenon may attributed to a tendency of this device to measure Korotkoff' s 4th point when the vascular sound is more changing because of greater stroke volume and/or lowered peripheral vascular resistance. Inasmuch as this tendency, it is recommended for the nurse to review the self-monitored blood pressure of the clients on regular basis.

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