Blood pressure measurement methodologies: present status and future prospects

The seminal advances of Riva Rocci made by introducing a brachial cuff with peripheral palpation, and of Korotkoff by auscultation of sounds associated with changes in arterial blood flow due to cuff pressure, have been the lynchpin of non-invasive measurement of blood pressure. Non-invasive quantification of blood pressure of the brachial artery has utility in risk prediction and hypertension management, despite inherent inaccuracies in the method, that an individual does not have a single blood pressure but a variability in blood pressure reflecting diurnal rhythm and physiological responses to daily life, and that brachial artery pressure may not be the precise pressure seen by the heart, kidney, and brain. This article discusses the inherent limitations of blood pressure measurement, the site of measurement, and currently largely ignored technical issues such as traceable calibration of blood pressure devices. The improvements in temporal resolution of blood pressure measurement with cuffless measurement of blood pressure are highlighted with the challenges of these techniques discussed. The future challenges are to obtain reliable continuous blood pressure measurements to quantify risk not only on blood pressure values but also on the entire beat-to-beat profile during daily living.