Automated blood pressure measurement during ergometric stress testing: Possibilities of Finapres

Background: The accurate recording of the blood pressure response to ergometry is of increasing interest in clinical practice, yet its measurement is susceptible to considerable error. We searched the literature for studies that describe devices designed for automated measurement of indirect blood pressure during dynamic exercise. As a possible alternative we studied in seven normotensive subjects noninvasive continuous finger arterial and simultaneously recorded intrabrachial pressure before,during and after maximal bicycle ergometry to 220 - 340 watts. Results: The automated devices designed to pick up the Korotkoff sounds, even with support of R-wave EKG detection, amplification of K-sounds and/or implementation of microprocessor technology did not achieve the accuracy of conventional Riva-Rocci-Korotkoff sphygmomanometry. At maximal exercise brachial systolic, diastolic and mean responses were 67 +/- 20, 13 +/- 7 mm Hg and 35 +/- 13 respectively. In the finger systolic pressure increased significantly more (85 +/- 29 mm Hg, p < 0.05) but comparable responses were found for diastolic and mean pressure (18 +/- 12 mm Hg and 36 +/- 18). Conclusions: Automated blood pressure devices are not an improvement over conventional auscultatory measurement. Finger blood pressure can be measured even at maximal exercise, with a reliable continuous measurement of intrabrachial responses for mean and diastolic pressures.