Development of an intelligent blood pressure measurement device to reduce measurement variability
Lead Research Organisation:
Newcastle University
Department Name: Clinical and Laboratory Sciences
Abstract
We propose to research the causes of blood pressure measurement variability, and hence develop and evaluate improved measurement techniques, leading to the development of a prototype novel intelligent blood pressure measurement device that we will validate and assess clinically. High blood pressure is one of the leading cardiovascular risk factors for coronary artery disease, congestive heart failure, renal disease and stroke, and is a contributory factor in 30% of all deaths in the UK, and 4 million NHS bed days annually. Despite the importance of blood pressure measurement and its very widespread use, it is one of the most poorly performed diagnostic measurements in clinical practice. A single blood pressure measurement often determines the treatment (or non-treatment) received, in spite of high variability between measurements. However, consecutive blood pressure measurements in the same individual vary significantly, whether the measurements are taken manually or automatically. Our own research has shown that manual blood pressure measurements often vary by more than 10 mmHg between consecutive recordings. Measurement errors can seriously compromise diagnosis. A major review in the Journal of the American Medical Association (JAMA) estimated that a 5 mmHg error would result in 21 million Americans being denied treatment or 27 being exposed to unnecessary treatment, depending on the direction of the error. At the heart of this research proposal are observations we have made which will be able to detect potential measurement variability. We have seen a strong association between blood pressure variability and variability of the pressure pulses present in the arm cuff during blood pressure measurement. These observations have led to the proposal in this application, to research and develop techniques for an intelligent blood pressure measurement device that will use information about variability obtained from the cuff. The techniques developed will have intellectual property (which is currently being pursued) and potential for incorporation in electronic manual and automatic blood pressure devices. Measurement of stable clinical blood pressure will be the important achievement, giving clinical confidence in the measurement. Common disturbances that can influence clinical blood pressure measurement variability include heart rate changes, frequent ectopic beats, arrhythmias, patient movement, respiratory disturbances, coughing, talking and muscle tension. Our own research has shown that these disturbances are associated with changes in the oscillometric pulses in the cuff pressure. With stable data we see a smooth decrease in cuff pressure, along with a smooth variation in the amplitude of the small oscillometric pulses superimposed on the main descent of the cuff pressure curve. (These are the pulses analysed by automated blood pressure devices, and visible as pulsations of the mercury column during cuff deflation for manual measurements.) When blood pressure is varying we see deviations from these smooth pulse characteristics. We are in a unique position to investigate the influence of disturbances on blood pressure measurement variability. We have an extensive database comprising more than 1300 pre-recorded cuff pressure and oscillometric pulse pressure waveforms, recorded clinically in a variety of different subject groups with a wide range of blood pressures, together with auscultatory pressures measured simultaneously and independently by two trained members of our research group. Currently there are no publicly accessible databases of oscillometric waveforms. Our database was obtained as part of a European Union funded multi-centre international research consortium to develop a simulator for evaluating the accuracy of non-invasive blood pressure (NIBP) devices by enabling real, previously-recorded oscillometric waveforms to be regenerated. The data and simulator have important roles in the proposed project.
Organisations
- Newcastle University (Lead Research Organisation)
- AC Cossor & Son (Surgical) (Collaboration)
- Physikalisch-Technische Bundesanstalt (Collaboration)
- Crosshouse Hospital (Collaboration)
- Accoson (United Kingdom) (Project Partner)
- Edinburgh Royal Infirmary (Project Partner)
- Physikalisch-Technische Bundesanstalt (Project Partner)
People |
ORCID iD |
Alan Murray (Principal Investigator) |
Publications
Chen D
(2016)
Respiratory modulation of oscillometric cuff pressure pulses and Korotkoff sounds during clinical blood pressure measurement in healthy adults.
in Biomedical engineering online
Di Marco LY
(2012)
Effects of deep breathing on blood pressure measurement in healthy subjects
Diliang Chen
(2016)
A method for extracting respiratory frequency during blood pressure measurement, from oscillometric cuff pressure pulses and Korotkoff sounds recorded during the measurement.
in Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference
Liu C
(2016)
Comparison of stethoscope bell and diaphragm, and of stethoscope tube length, for clinical blood pressure measurement.
in Blood pressure monitoring
Pan F
(2017)
Variation of the Korotkoff Stethoscope Sounds During Blood Pressure Measurement: Analysis Using a Convolutional Neural Network.
in IEEE journal of biomedical and health informatics
Zheng D
(2014)
Effect of respiration on Korotkoff sounds and oscillometric cuff pressure pulses during blood pressure measurement.
in Medical & biological engineering & computing
Description | Confirmed that measurement conditions had a significant influence on the measured manual blood pressure, including talking, moving arm, and deeper than usual breathing. Developing decision analysis to determine blood pressure measurement quality, and identify poor measurements that should be repeated. Submitted patent application. |
Exploitation Route | Working with medical device industry to commercialise our intelligent BP measurement techniques. |
Sectors | Healthcare |
Description | Patent submitted. Looking for industrial collaborator. |
First Year Of Impact | 2009 |
Sector | Healthcare |
Impact Types | Societal,Economic |
Description | EPSRC KTA: Commercialization of a medical device with transfer of knowledge from our intelligent BP measurement research |
Amount | £21,726 (GBP) |
Organisation | Newcastle University |
Sector | Academic/University |
Country | United Kingdom |
Start | 08/2011 |
End | 06/2012 |
Description | EPSRC KTA: Implementation of intelligent quality index for BP measurement |
Amount | £9,100 (GBP) |
Organisation | Newcastle University |
Sector | Academic/University |
Country | United Kingdom |
Start | 08/2012 |
End | 03/2013 |
Description | EPSRC: Novel engineering solutions for easy and accurate manual BP measurement |
Amount | £492,397 (GBP) |
Funding ID | EP/I027270/1 |
Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
Sector | Public |
Country | United Kingdom |
Start | 12/2011 |
End | 11/2014 |
Description | NIHR Flexibility and Sustainability Funding |
Amount | £12,997 (GBP) |
Organisation | Newcastle upon Tyne Hospitals NHS Foundation Trust |
Sector | Academic/University |
Country | United Kingdom |
Start | 03/2011 |
End | 06/2011 |
Description | Academic collaborator: Dr John Amoore |
Organisation | Crosshouse Hospital |
Country | United Kingdom |
Sector | Hospitals |
PI Contribution | Dr John Amoore provide advice on commercial automatic blood pressure devices. |
Collaborator Contribution | Advice and publications |
Impact | Publication in Computing in Cardiology |
Start Year | 2008 |
Description | Academic collaborator: Dr Stephan Mieke |
Organisation | Physikalisch-Technische Bundesanstalt |
Country | Germany |
Sector | Academic/University |
PI Contribution | Dr Stephan Mieke collaborated with the blood pressure simulator. We also worked closely with him in the International Standards bodies to use the insights gained to develop the current international standards. |
Collaborator Contribution | Work on international standards |
Impact | Publication in Computing in Cardiology |
Start Year | 2008 |
Description | Commercial Partner: Mr Adrian Cossor |
Organisation | AC Cossor & Son (Surgical) |
Country | United Kingdom |
Sector | Private |
PI Contribution | Support of Mr Adrian Cossor, managing director of AC Cossor and manufacturer of the Accoson range of blood pressure devices, the only such devices manufactured in the UK. We have worked together over the Accoson electronic greenlight device, in which he invested significantly and which is returning royalties to Newcastle University and Newcastle NHS Trust. Mr Cossor contributed very positively for this project. |
Collaborator Contribution | Assistance with cuffs, and clinical measurement advice |
Impact | Continuing collaboration |
Start Year | 2008 |
Title | Medical device |
Description | Patent submitted, and funding for next stage applier for |
Type | Diagnostic Tool - Non-Imaging |
Current Stage Of Development | Refinement. Clinical |
Year Development Stage Completed | 2018 |
Development Status | Actively seeking support |
Impact | Better diagnosis |
Description | Standards |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Industry/Business |
Results and Impact | To develop and improve international standards |
Year(s) Of Engagement Activity | 2012,2013,2014,2015,2016 |