RELATIVE EFFECTIVENESS OF AUTOMATED BLOOD PRESSURE MONITORING

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1 Volume 119 No , ISSN: (on-line version) url: ijpam.eu RELATIVE EFFECTIVENESS OF AUTOMATED BLOOD PRESSURE MONITORING 1 Mareshamani, Shubham kumar 2 1 Assistant Professor 2 UG Students, Department of Biomedical Engineering BIHER, BIST, Bharath University Chennai mareshamani.bme@bharathuniv.ac.in Abstract: Automated blood pressure cuff is the study of taking blood pressure measurement of a human. This project describes about how anybody can take blood pressure measurement at anywhere and it does not require any practical skill i.e, like doctor, nurse or lab assistant. Taking blood pressure at home is considered as the best and most accurate readings cause of subject s friendly atmosphere. As we know when people visit physician/doctor s clinic, the do feel anxiety and unfriendly type of environment which does effect the blood pressure readings. It is known as white coat syndrome. Apart from the traditional method, it does not required stethoscope because blood pressure is taken out by oscilloscopic method. For a accurate reading subject is supposed to settle down and body should not be in motion. He is not allowed to eat or drink anything for at least 30 minutes before taking blood pressure measurement cause it would also effect the reading. In this type of automatic blood pressure machine, subject is supposed to tie the bp cuff on the left arm of the body and turn on the device and he will get the reading in one minute of time. Keywords Automated blood pressure cuff, white coat syndrome, oscilloscopic method, pratical skill. I. INTRODUCTION Heart rate measurement is one of the very important parameters of the human cardiovascular system. The heart rate of a healthy adult at rest is around 72 beats per minute (bpm). Athletes normally have lower heart rates than less active people. Babies have a much higher heart rate at around 120 bpm, while older children have heart rates at around 90 bpm[1]. The heart rate rises gradually during exercises and returns slowly to the rest value after exercise. The rate when the pulse returns to normal is an indication of the fitness of the person. Lower than normal heart rates are usually an indication of a condition known as bradycardia, while higher than normal heart rates are known as tachycardia. Heart rate is simply and traditionally measured by placing the thumb over the subject s arterial pulsation, and feeling, timing and counting the pulses usually in a 30 second period. Heart rate (bpm) of the subject is then found by multiplying the obtained number. This method although simple, is not accurate and can give errors when the rate is high.[1-3] This project describes a technique of measuring the heart rate through a fingertip using a PIC microcontroller. While the heart is beating, it is actually pumping blood throughout the body, and that makes the blood volume inside the finger artery to change too. This fluctuation of blood can be detected through an optical sensing mechanism placed around the fingertip. The signal can be amplified further for the microcontroller to count the rate of fluctuation, which is actually the heart rate. The device has the advantage that it is microcontroller based and thus can be programmed to display various quantities, such as the average, maximum and minimum rates over a period of time and so on. Another advantage of such a design is that it can be expanded and can easily be connected to a recording device or a PC to collect and analyze the data for over a period of time

2 II. LITERATURE REVIEW Reliability of automated blood pressure devices used by hypertensive patients Med Mar; 98(3): William C W Wong, MB MRCGP, 1 Ivan K L Shiu, MB BS, 2 Thomas M T Hwong, MB FRCS, 3 and James A Dickinson, PhD FRACGP 4 Automated blood pressure (BP) devices are used by many hypertensive patients in Hong Kong, with or without medical advice. At two community clinics, we invited hypertensive patients aged between 40 and 70 years who used such a device to fill in a questionnaire and to have four sets of BP measurements, automated and mercury, at two visits. Of 290 hypertensive patients 120 fulfilled the criteria, and 73 of these agreed to participate. 53 devices measured arm BP, 21 measured forearm BP. The agreement between the mercury sphygmomanometer and the automated devices was poor, with average differences of 9.5 mmhg for systolic and 9.4 mmhg for diastolic and no clear advantage for either site of measurement. As a means of screening for BP >140/90 mmhg the sensitivity of the automated devices was 81% and the specificity was 80%. [4-6]There were large variations in how often and under what circumstances the devices had been used. One-fifth of the devices had been acquired on medical advice but only 11% of the participants were aware of the three important conditions for operating such devices. Critical Care Nurse (THOMAS AHRENS, RN, DNS, CCRN, CS Clinical Specialist/Research Scientist Barnes-Jewish Hospital, St Louis, MO) (SUSAN D. BELL, RN, MS, CNRN, CNP Nurse Practitioner, Neurosurgery Ohio State University Medical Center, Columbus, OH) (SUZETTE CARDIN, RN, DNSc, CNAA Adjunct Assistant Professor, UCLA School of Nursing, Los Angeles, CA) For more 20 years, non-invasive blood pressure (NIBP) monitors have been widely used in operating rooms and critical care units to closely monitor blood pressure in patients of all ages. Despite the widespread use of automated blood pressure monitors, clinicians continue to deliberate over the accuracy and reliability of automated NIBP devices compared to other methods of blood pressure determination Clinical research studies have demonstrated that when blood pressures (systolic, diastolic, and mean arterial) determined by NIBP monitors from various manufacturers are compared to direct arterial pressures, the two values are, on average, within 5 mm Hg of each other.1,9 Factors such as the anatomical location of measurement contribute to the differences that exist between direct and indirect methods. For example, in comparing brachial arterial pressure obtained by the NIBP monitor to radial arterial pressure obtained by direct arterial cannulation, radial arterial pressure is normally higher because the radial artery is a smaller vessel and creates greater resistance to flow, which in turn leads to a higher blood pressure reading than that determined via the brachial artery.[7-12] AHA Scientific Statement Recommendations for Blood Pressure Measurement in Humans and Experimental Animals Published online before print December 20, Thomas G. Pickering, MD, DPhil, John E. Hall, PhD, Lawrence J. Appel, MD, Bonita E. Falkner Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended.[13-14] They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-fourhour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing whitecoat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.[15-19] 11684

3 Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing. G Parati, R Casadei, A Groppelli, M Di Rienzo, G Mancia doi: /01.HYP The accuracy of blood pressure values obtained by continuous noninvasive finger blood pressure recording via the FINAPRES device was evaluated by comparison with simultaneous intra-arterial monitoring both at rest and during performance of tests known to induce fast and often marked changes in blood pressure. The comparison was performed in 24 normotensive or essential hypertensive subjects. The average discrepancy between finger and intra-arterial blood pressure recorded over a 30-minute rest period was 6.5 +/- 2.6 mm Hg and 5.4 +/- 2.9 mm Hg for systolic and diastolic blood pressure, respectively; a close between-method correspondence was also demonstrated by linear regression analysis. The beat-to-beat changes in finger systolic and diastolic blood pressure were on average similar to those measured intra-arterially during tests that induced a pressor or depressor response (hand-grip, cold pressor test, diving test, Valsalva maneuver, intravenous injections of phenylephrine and trinitroglycerine) as well as during tests that caused vasomotor changes without major variations in blood pressure (application of lower body negative pressure, passive leg raising). The average betweenmethod discrepancy in the evaluation of blood pressure changes was never greater than 4.3 and 2.0 mm Hg for systolic and diastolic blood pressure, respectively; the corresponding standard deviations ranged between 4.6 and 1.6 mm Hg. Beat-tobeat computer analysis of blood pressure variability over the 30-minute rest period provided standard deviations almost identical when calculated by separate consideration of intra-arterial and finger blood pressure tracings (3.7 and 3.8 mm Hg) respectively.[20-22] European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. Parati, Gianfrancoa; Stergiou, George Sb; Asmar, Rolandc; Bilo, Grzegorza; de Leeuw, Peterd; Imai, Yutakae; Kario, Kazuomif; Lurbe, Emparg; August Volume 26 - Issue 8. doi: /HJH.0b013e328308da66 The need to develop the current guidelines is related to the fact that home blood pressure monitoring (HBPM) is becoming increasingly important in the diagnosis and management of arterial hypertension. The rapid diffusion of this technique has been favoured by a number of factors, including technical progress and wider availability of HBPM devices, increasing awareness of the importance of regular BP monitoring, and recognition of the usefulness of HBPM by international hypertension management guidelines The purpose of the present guidelines is to update the recommendations given in the first consensus document on HBPM, published in year 2000 [4]. Like the previous document, this paper is also written to provide physicians and other healthcare providers with information on the use of HBPM in clinical practice on the basis of the available evidence and expert opinion. An Appendix to this article, which will be published online, is devoted to patients' information and training programmes. These guidelines are not aimed at dealing with the technological, economical and public health related aspects of HBPM use. IV. DISCUSSION A low-cost BP monitor has been developed to function as a health device. A standard inflatable cuff and an inexpensive peripheral make use of the considerable processing power to digitally process the pressure signal and compute the BP values using the oscillometric method. The aurdino software helped for devices allows the user to keep records of the measurements in their PC. The final point to consider is how to deploy the non-phone hardware. [23-39]Although the cuff, pump and tubing in a typical manual device cost low, and are easily replaced by local equipment, the electronics are not. It is therefore our intention to make the electronics available either as built-in systems for phones or as a low-cost add-on for the phone available through the same supply channels for phone accessories such as the charger, USB cables and batteries.[40-45] V. CONCLUSION Blood pressure is an important parameter and can reflect physiological information. Thus i proposed a method with is user friendly. Simple arduino uno board is connected with rest of the equipments. Patient has to tie the cuff around his left hand and switch on the blood pressure machine and rest will be done by itself and the result will be displayed on the monitor

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