Sphygmomanometer

A sphygmomanometer also known as blood pressure monitor is a medical device used to

measure the blood pressure.

The name Sphygmomanometer is a combination of Greek word "Sphygmos" which means pulse
and the scientific term "Manometer" which means pressure meter.

Conventional blood pressure monitoring device is the Mercury Sphygmomanometers. An

inflatable cuff attached to the blood pressure monitor is placed around the patient's upper arm
while the patient is seated beside a table by resting the arm on the table. A stethoscope is placed
below the cuff, around the inside of the elbow.
Air is pumped into the cuff and this increases pressure around the arm and the examiner
observers the pulse sounds till the blood flow stops to the arm being examined. Then air pressure
is slowly released by deflating the cuff and the point at which the blood flow is restored is
recorded as the systolic pressure. The reading indicates the maximum output pressure generated
by the heart while its pumping.
3 Types of blood pressure monitors (Sphygmomanometers)
Techniques to accurately measure blood pressure have been around for more than 100 years. The
meaning of the numbers obtained were not clear till the later half of the 20th century when links
to heart disease and stroke were linked to high blood pressure. It was previously assumed that
high blood pressure was a part of the natural process of ageing.
1. Mercury Sphygmomanometer

Mercury Sphygmomanometers
Blood pressure readings produced by conventional sphygmomanometers based on mercury are
considered as the golden standard in the health industry.
Mercury based products have been banned in many countries due to the toxicity associated with
the metal. However, some exceptions have been made for medical devices like conventional
sphygmomanometers that are used in clinical settings due to the lack of alternative medical
devices that can produce similar accurate readings.
Mercury sphygmomanometers have a manually inflatable cuff that is attached to the measuring
unit by tubes. The measuring unit has a transparent tube containing mercury that is calibrated and
marked in millimeters of mercury (mmHg).
During the recording procedure, it’s important to place the unit on a flat surface on its upright
position. The healthcare worker operating the unit can read the reading at eye level to the unit.
These devices are very delicate and special care should be taken while operating, storing or
transporting the unit. Accidental dropping of the unit can result in the rupture of the mercury
containing tube and the spilling of the toxic mercury metal.

Advantages of Mercury Sphygmomanometers

● It’s a simple medical device and the device is very durable. If properly used, this device
can be used for a lifetime.

● This device can produce accurate readings and do not require any readjustments or
recalibrations.

Disadvantages of Mercury Sphygmomanometers

● It’s a bulky medical device that should be handled carefully to prevent damage to the
mercury containing tube.

● Operating this device requires practice and is not suitable for household uses.

● People with hearing or visual disabilities cannot use this device. The reading should be
read on a flat surface at eye level.

2. Aneroid Sphygmomanometer
 Aneroid Sphygmomanometers

Aneroid means “without fluid”. These devices do not use mercury and are considered as a safer
alternative when compared to mercury based sphygmomanometers.
The recording procedure using an aneroid sphygmomanometer is very similar to a conventional
mercury based Sphygmomanometers requiring inflating and deflating the cuff with the exception
that most Aneroid devices come with an attached stethoscope to the cuff.
The device consists of a cuff that is attached by tubes to a dial gauge marked in millimeters of
mercury (mmHg). Inside the gauge head the device uses mechanical parts to convert the cuff
pressure into a gauge based reading.
Aneroid Sphygmomanometers comes in various form factors and some of the commonly found
variants are:

Advantages of Aneroid Sphygmomanometers

● They are cheaper, more portable and less expensive compared to mercury
sphygmomanometers

● The aneroid gauge can be placed in any position for easy reading. Dials comes in
various sizes for comfortable and quick interpretation.

● The also come with build in stethoscope.

● The aneroid gauge can be attached to the cuff for single hand operation of the device.

Disadvantages of Aneroid Sphygmomanometers

● The aneroid gauge is a delicate mechanism. Special care should be taken to prevent
accidental bumping or dropping of the gauge.
 ● Aneroid gauges require periodic cross checking with mercury sphygmomanometer to
make sure that the internal mechanisms are working perfectly. It may require
recalibration by experts if the device is giving faulty reading.

● Like mercury sphygmomanometer, people with hearing or visual disabilities cannot use
the device.

● Operating aneroid sphygmomanometers requires practice.

3. Automatic Digital Sphygmomanometer

Automatic Digital Sphygmomanometer

Oscillometric devices are commonly referred as Automatic Digital Sphygmomanometers or
Digital Sphygmomanometers. These devices use an electronic pressure sensor for measuring the
blood pressure and the readings are given out digitally on a display.
These devices have inflatable cuffs like Mercury or Aneroid Sphygmomanometers and the cuff
is attached to the electronic unit. However, the main difference is in the technique used for
measuring the blood pressure.
Mercury or Aneroid Sphygmomanometers reports are based on the sounds produced by the
blood flowing inside the arteries. Digital Sphygmomanometers evaluates and measures the
oscillations of the arteries using pressure sensors.
As the cuff is inflated and then deflated later, oscillations occurs. These oscillations are
processed using an algorithm to produce systolic and diastolic values that are digitally displayed
on the device display.
It is interesting to note that the working principles behind the oscillometric devices were
discovered even before Korotkoff’s technique came into existence. However, due to various
factors oscillometric approach remained unpopular till recently.
Automatic Digital Sphygmomanometers are usually battery operated. Some models designed for
field use have dual power sources like battery and solar cells. They come in two variants:

Full-automatic blood pressure monitors: These devices have an electric pump for inflating the
cuff. The operation of the device is very easy and requires minimum inputs from the user.
Once the cuff is placed on the upper arm, the device can be switched on and the reports are
produced automatically.

Semi-automatic blood pressure monitors: The user has to inflate the cuff manually by hand
using the bulb like a conventional device. Once inflated, the device can then start deflating the
cuff automatically and beyond this point the reading is produced in a similar way as an automatic
device.
These devices consume less power and can be more suitable for field operations where resources
might be limited.

Wrist blood pressure monitors: These are digital blood pressure monitors that work similar to
upper arm blood pressure monitors. It can be used by individual who find arm based devices
uncomfortable or painful. However, medical experts do not recommend these devices for
everyone, due to the possibility of receiving false reading due to improper use. Blood pressure
monitors are very sensitive to body position and special care should be taken during their use in
order to get accurate readings.

Advantages of Automatic Digital Sphygmomanometers

● The device is very compact and portable. Operating the device is extremely easy and
this is the preferred device of choice for personal monitoring at home.

● Since most of the critical operations are done automatically during the recording
process, chances of human error are minimum.

Disadvantages of Automatic Digital Sphygmomanometers

● The device is delicate and proper care should be taken while handling the device.
Repairing the device can be complicated and in most cases the device has to be serviced
by the manufacturer.

● Even the most advanced devices can produce incorrect reading with some individuals.
Therefore, it necessary to periodically counter check with conventional Mercury
sphygmomanometers for accuracy.