Comparison of cuff inflation and cuff deflation brachial sphygmomanometry with intra-arterial blood pressure as reference

Branko G. Celler, Andy Yong, Imants Rubenis, Mark Butlin, Ahmadreza Argha, Rajan Rehan, Alberto Avolio

Research output: Contribution to journalArticlepeer-review


Conventional sphygmomanometry with cuff deflation is used to calibrate all noninvasive BP (NIBP) instruments and the International Standard makes no mention of calibrating methods specifically for NIBP instruments, which estimate systolic and diastolic pressure during cuff inflation rather than cuff deflation. There is however increasing interest in inflation-based NIBP (iNIBP) instruments on the basis of shorter measurement time, reduction in maximal inflation pressure and improvement in patient comfort and outcomes. However, we have previously demonstrated that SBP estimates based on the occurrence of the first K1 Korotkoff sounds during cuff deflation can underestimate intra-arterial SBP (IA-SBP) by an average of 14 ± 10 mmHg. In this study, we compare the dynamics of intra-arterial blood pressure (IABP) measurements with sequential measurement of Korotkoff sounds during both cuff inflation and cuff deflation in the same individual. In 40 individuals aged 64.1 ± 9.6 years (range 36-86 years), the overall dynamic responses below the cuff were similar, but the underestimation error was significantly larger during inflation than deflation, increasing from 14 ± 10 to 19 ± 12 mmHg (P < 0.0001). No statistical models were found which could compensate for this error as were found for cuff deflation. The statistically significant BP differences between inflation and deflation protocols reported in this study suggest different behaviour of the arterial and venous vasculature between arterial opening and closing which warrant further investigation, particularly for iNIBP devices reporting estimates during cuff inflation. In addition, measuring Korotkoff sounds during cuff inflation represents significant technical difficulties because of increasing pump motor noise.

Original languageEnglish
Pages (from-to)968-976
Number of pages9
JournalJournal of Hypertension
Issue number6
Early online date16 Jan 2024
Publication statusE-pub ahead of print - 16 Jan 2024


  • auscultatory methods
  • blood pressure
  • cuff inflation
  • Korotkoff sounds
  • linear models
  • noninvasive BP measurement
  • sphygmomanometry
  • systolic and diastolic blood pressure estimation


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