See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/50248629

A simulator for oscillometric blood-pressure signals to test automated

noninvasive sphygmomanometers

Article  in  The Review of scientific instruments · February 2011

DOI: 10.1063/1.3549803 · Source: PubMed

CITATIONS READS
7 389

4 authors, including:

Stephan Mieke
Physikalisch-Technische Bundesanstalt
38 PUBLICATIONS   386 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Stephan Mieke on 25 June 2015.

The user has requested enhancement of the downloaded file.

 REVIEW OF SCIENTIFIC INSTRUMENTS 82, 024303 (2011)

A simulator for oscillometric blood-pressure signals to test automated

noninvasive sphygmomanometers
W. Riedel, S. Mieke, R. Seemann, and B. Ittermanna)
Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, D-10587 Berlin, Germany
(Received 5 November 2010; accepted 27 December 2010; published online 28 February 2011)
A device was developed allowing to generate simulated human blood pressure signals for the pur-
pose of testing the performance of automated noninvasive sphygmomanometers. The apparatus re-
producibly generates blood-pressure oscillations synthesized from prerecorded measurements on hu-
man subjects. These real-life data allow for a much better evaluation of the accuracy of blood-pressure
measurements than the existing simulators using artificial and thus less realistic waveforms. To assess
the performance of a given sphygmomanometer under both stable and varying conditions, generated
signals can be repeated in their original shape or distorted by well-defined artifacts. In comparison to
clinical tests, the procedural influences on the performance testing of sphygmomanometers are largely
reduced when the simulator is used. © 2011 American Institute of Physics. [doi:10.1063/1.3549803]

I. INTRODUCTION on the detection of the so-called Korotkoff sounds which are

audible through a stethoscope applied to the artery in the inner
Hypertension is estimated to contribute about 4.5% to the
elbow below the cuff.
global disease burden, causing at least 7.1 × 106 premature
To perform an accurate reference measurement, the pre-
deaths per year.1 As a variety of effective treatments for hy-
cautions described in the aforementioned standards and pro-
pertensions are known, the reliable detection of this disease,
tocols have to be taken. Clinical trials are usually performed
i.e., reliable blood pressure measurements in primary health-
on subjects with different blood-pressure ranges, arm circum-
care, is key to address this global problem.
ferences, gender, age, etc.
Sphygmomanometers are devices to measure human
At present, almost all automated oscillometric sphygmo-
blood pressure. The prevalent automated method for this pur-
manometers require a fairly constant heartbeat to measure
pose is the oscillometric principle.2 In most cases an inflat-
correctly. They do not permit artifacts otherwise their accu-
able cuff is wrapped around the upper arm. It is inflated to
racy is lost. Some devices try to handle such situations by
about 30 mmHg above the systolic blood pressure3 to stop the
special software routines, error messages, or corrective pro-
blood flow and is then gradually deflated. The arterial blood
cedural measures. Under these conditions, it is practically im-
pressure in the arm superimposes small pressure pulses (re-
possible to evaluate the full performance in clinical trials, as
ferred to as “oscillations”) onto the (slowly varying) baseline
arrhythmic signals cannot be delivered in a reproducible way.
pressure generated by the cuff. As long as the baseline pres-
For functional rechecks of a device in the field—e.g., by
sure exceeds the systolic blood pressure, the brachial artery
legal authorities or calibration services—clinical trials are too
is fully closed; small oscillations, however, are still present.
time-consuming and too expensive. Therefore, only the static
With decreasing baseline pressure they are getting larger and
indication of the baseline pressure is checked. A deviation
less finely structured. Also, the baseline becomes less defined.
of more than ±3 mmHg is regarded as a malfunction.
After passing through a maximum, the oscillation amplitudes
This approach assumes that the clinically tested software
decrease again.
is unchanged and that the hardware other than the pressure
In an automated noninvasive sphygmomanometer, the
transducer, the signal amplifier, the analog-to-digital con-
cuff pressure, i.e., the sum of baseline pressure and oscil-
verter (ADC), and the cuff design does not affect the accuracy
lations, is measured by a suitable sensor, digitized, and fed
of the measurement. A simple pressure pulse generator8 can
to the internal microcomputer. At least the envelope function
then be applied to detect the changes of a limited set of other
is evaluated to compute systolic and diastolic blood-pressure
parameters.
values. The algorithms applied thereby are derived empiri-
cally from the clinical studies and are usually not disclosed
by the manufacturers. To check the measurements of such a II. SIMULATOR CONCEPT
device, it is thus necessary to test it in a black-box manner
by comparing it to a reference method in clinical trials, as de- Suitability and limitations of existing blood-pressure
scribed in several standards and protocols.4–7 simulators for the testing of sphygmomanometers were re-
Reference values for the diastolic and systolic blood pres- cently reviewed by Balestrieri and Rapuano.9 In the present
sures in a clinical trial are typically obtained by the ausculta- paper a new simulator is described. It is similar to the previous
tory method which is the most commonly used technique for devices in so far as it superimposes oscillations to a baseline
manual blood-pressure measurements. This method is based pressure by connecting the simulator directly to the pneumatic
system of a sphygmomanometer under test (SUT). The distin-
a) Electronic mail: Bernd.Ittermann@PTB.de. guishing feature is its ability to play back real-life oscillations

0034-6748/2011/82(2)/024303/7/$30.00 82, 024303-1 © 2011 American Institute of Physics

Downloaded 17 Mar 2011 to 192.53.103.200. Redistribution subject to AIP license or copyright; see http://rsi.aip.org/about/rights_and_permissions
 024303-2 Riedel et al. Rev. Sci. Instrum. 82, 024303 (2011)

FIG. 1. Schematic view showing the interplay of recording unit, blood-

pressure simulator, and sphygmomanometer.

recorded from human subjects under well-controlled clinical

conditions. The concept is illustrated in Fig. 1; it comprises
four procedural steps.
(i) Acquisition of oscillometric blood-pressure data from
human subjects with a specifically developed recording
unit.10
(ii) Preparation of a simulator database containing all os-
cillometric data together with clinical reference values
obtained by auscultation.
(iii) Processing the recorded raw data to obtain the model
signal to be output by the simulator.
(iv) Simulation, i.e., application of the model signal to the
SUT.
For step (iv), the simulator is connected to a SUT’s pneu-
matic system, as shown in Fig. 1. The SUT itself is set up
as normally, except that its cuff is wrapped around a rigid
metal cylinder instead of a human limb. Once a measurement
is started, the SUT creates its generic baseline-pressure curve;
frequently a rapid inflation followed by a slow deflation of the
cuff. The simulator detects the momentary baseline pressure, FIG. 2. (a) Measured cuff pressure p, i.e., baseline pressure overlaid by os-
looks up the best-fitting pressure oscillation in its database, cillations from a human subject. The baseline pressure is deflated at a rate of
and reproduces it with a digitally controlled membrane pump. about 3 mmHg/s. The average heart rate is 78 beats per minute. (b) Pressure
oscillations p separated by subtracting a least-squares fit to the pressure
This artificial oscillation on top of the baseline pressure is de- baseline. Insets: Regions around the systolic and diastolic pressures of this
tected by the SUT and evaluated according to its internal al- signal.
gorithm. The resulting blood-pressure indication of the SUT
can be then compared to the reference value in the simulator
database. nal is converted by a 16-bit ADC (Ref. 12) at a sampling rate
Signal output is exclusively based on the prerecorded of 2 kHz and stored on the hard disk. The 16-bit dynamic
data; within the concept of the simulator, it is not intended range is required to separate the small oscillations from the
to change any of the signal parameters in the field. This re- large baseline pressure. Previous data acquisition systems13
quires a considerable amount of datasets to be recorded but only had 12-bit resolution and employed electrical high-pass
eliminates handling errors during operation. filters to separate the slow decrease from the oscillation sig-
A detailed description of the simulator’s construction and nal. Due to this unrecoverable loss of information, 12-bit sig-
components will be given in Sec. IV. Also, the considerations nals cannot be used to fully regenerate the measured data at a
leading to a particular technical solution will be discussed. later time.
The spectral content of the signal in Fig. 2(b) and its in-
tegral are shown in Fig. 3. Integration starts at 0.5 Hz to ex-
III. OSCILLOMETRIC SIGNALS
clude residual near-dc signals which remained after baseline
In the following, a brief description of the aforemen- subtraction. There is no noticeable content beyond 12 Hz, and
tioned recording unit is given. The device in itself is of minor 95% of the spectral content is below 8 Hz.
importance for this paper, but some details on the oscillomet- The systolic and diastolic reference blood-pressure val-
ric measurements may facilitate the understanding of the data ues were determined simultaneously but independently by
processing. Figure 2 shows a real-life blood-pressure mea- two trained observers utilizing a double stethoscope for aus-
surement from the simulator database. Controlled by a per- cultation. If both observers agreed within 4 mmHg, the mean
sonal computer, the cuff is inflated rapidly and then deflated value was used as reference value. Together with the acquired
at a moderate rate of 2–3 mmHg/s. The cuff pressure is mea- cuff-pressure dataset, the observed blood pressure values and
sured by a piezoresistive pressure transducer.11 Its analog sig- the settings of the recording unit are stored in the database.

Downloaded 17 Mar 2011 to 192.53.103.200. Redistribution subject to AIP license or copyright; see http://rsi.aip.org/about/rights_and_permissions
 024303-3 Rev. Sci. Instrum. 82, 024303 (2011)

FIG. 3. Spectral content (solid line) and integrated spectrum (dashed line) of the oscillometric signal shown in Fig. 2(b). The fundamental heartbeat frequency
at 1.31 Hz is normalized to 100%. The integrated spectrum is normalized to 100% at 12 Hz.

IV. ARTIFICIAL OSCILLATION SIGNALS in Fig. 4. The pressure chamber above the diaphragm is con-
nected to the SUT tubing by means of a T-fitting which has
A. The generation of pressure oscillations
been inserted for the test.
To regenerate the recorded pressure data in the pneu- The baseline pressure generated by the SUT exerts a con-
matic system of a SUT, a pneumatic pulse generator with siderable force onto the diaphragm. In order to withstand this
high dynamical capabilities is needed. In principle, artificial force, an electronically commutated, brushless dc-motor14
oscillations in the cuff could be generated by a model of the is used as an actuator. The torque of the motor is trans-
human arm with a mechanical actuator inside. The actuator ferred to the diaphragm via a pulley-belt mechanism and a
could change the diameter or volume of the arm model. The
undefined volume and different elasticities of the various in-
flatable cuffs, however, would result in an undefined pressure
response at a given mechanical deformation. Therefore, we
opted to determine the momentary pressure in the cuff and
apply a feedback to the actuator in order to generate the de-
sired waveform. The measurement of the baseline pressure is
performed by simply inserting a T-fitting into the tube con-
necting the cuff and the measurement unit (console) of the
SUT and attaching a pressure sensor.
At the low frequencies occurring here (below 12 Hz),
the pressure propagates in the whole pneumatic system of
the SUT without noticeable delay. It is sufficient, there-
fore, to generate the oscillations externally by a pneumatic
pump and feed them into the tubing of the SUT.13 The cuff
is wrapped around a rigid cylinder substituting the human
arm. FIG. 4. Schematic sketch of the blood pressure simulator. Three-way cocks
The diaphragm pump used to feed pressure oscillations A and T are depicted in their simulation position, i.e., after all initial adjust-
into the pneumatic system of a SUT is schematically depicted ments have been performed.

Downloaded 17 Mar 2011 to 192.53.103.200. Redistribution subject to AIP license or copyright; see http://rsi.aip.org/about/rights_and_permissions
 024303-4 Riedel et al.
lever. The stroke of the diaphragm is limited to a few mil-
limeters in order to avoid any undue deformation. The pul-
ley has to exceed a certain minimum diameter in order to
avoid an excessive bending of the belt and to keep the shaft
rotation well below 360◦ . These constraints determined the
choice of the appropriate lever ratio and suitable diaphragm
diameter.
The waveform of the oscillations is taken from the sim-
ulator database mentioned above and output by means of a
combined ADC/DAC-adapter.12 The DAC signal controls the
motor current via the servocontroller,15 operated in current
output mode. The torque generated by a dc motor with a per-
manent magnetic or constantly excited stator is proportional
to the armature current and independent of the speed (torque
motor).
Due to the small displacements, the transmission ratio
and the active area of the diaphragm are nearly constant. The
force actuated on the diaphragm and the resulting pressure
is, therefore, proportional to the motor torque, and ideally,
this should allow for a simple feedforward control. As the
force does not depend on the deflection or speed, the gener-
ated pressure oscillation does not depend on the cuff’s volume
and the resulting baseline pressure: larger cuffs need larger
pumping strokes but the same motor current for a given pres-
sure oscillation. At higher baseline pressures from the cuff,
the required stroke for a given oscillation amplitude becomes
smaller, but the force to be added to the inflation force remains
the same again.
In practice, however, this appealing approach to control
the oscillation pressure directly via the motor current and
without feedback was not feasible due to the disturbances
caused by mechanical friction, the stiffness of the diaphragm
under pressure load, and by stick–slip effects of the motor
bearings. In addition, the transfer characteristics from the set-
point voltage to the output current were somewhat coarse due
to the pulse-width modulation scheme of the power amplifier.
Attempts to reduce these disturbances by applying mechan-
ical dither brought no satisfying success. Therefore, a feed-
back scheme utilizing stroke-amplitude control to overcome
the perturbations was required.
The control scheme of the pneumatic pulse generator has
to superimpose the oscillations onto the baseline pressure in
the cuff. The inflation and subsequent deflation of the cuff
are not controlled by the simulator, but are generated by the
pump and the exhaust valve of the SUT. This baseline pres-
sure exceeds the oscillation amplitudes by 2 orders of mag-
nitude, not to mention the finer structures of the oscillation
signal. In the simulator, the motor current has to compen-
sate the considerable force exerted by the baseline pressure
and in addition has to generate the small oscillations. A feed-
back control for the two tasks based solely on the signal of
the pressure sensor was not feasible due to the aforemen-
tioned friction and noise artifacts in the pressure signal. Fur-
thermore, a feedback scheme requires a considerably higher
sensor bandwidth than the moderate frequency content of the
oscillations in Fig. 3. The well-separated time scales of the
slowly varying baseline pressure and the much faster oscilla-
tions allow the motor to be controlled by a common feedback
loop.
Downloaded 17 Mar 2011 to 192.53.103.200. Redistribution subject to AIP license or copyright; see http://rsi.aip.org/about/rights_and_permissions
Rev. Sci. Instrum. 82, 024303 (2011)
The motor current compensating the baseline pressure
is controlled by sensing the position of the diaphragm.
The position signal is supplied by a conductive plastic
potentiometer16 attached to the motor shaft. The potentiome-
ter is fed with a constant voltage; the position-dependent
wiper voltage is input into the ADC. The feedback loop is
closed by real-time software running on the personal com-
puter. It controls the motor torque via the DAC output and the
servoamplifier.
The diaphragm tries to respond to the baseline pressure
by moving downward. The feedback counteracts this position
change. Roughly speaking, the position control holds the di-
aphragm near the center of the stroke range, regardless of the
baseline pressure. This feedback is slow enough not to inter-
fere with the oscillation strokes.
The oscillations are added to the set-point signal of the
position control scheme. Since the stroke depends on the cuff
volume, its inner pressure, and the atmospheric pressure, a
self-calibrating feedforward principle has to be applied. When
the cuff is fully inflated, the diaphragm performs some initial
probing pump-strokes under control of the angular transducer.
The pressure generated by the probing strokes is measured
and a slight digital averaging is applied for noise reduction.
The ratio between pressure signal and angular displacement
is the calibration factor for the oscillation strokes at the
current baseline pressure. Multiple short strokes are applied
in order to mimic the timing of anatomic oscillations. This
is important due to thermal transients between adiabatic and
isothermal compressions in the cuff, which occur on the same
time scale as the oscillations. The fast pressure variations
are henceforth controlled solely by means of the position
sensor.
The output of the pressure sensor is digitized and
smoothed by software low-pass filter to give the momentary
pressure in the cuff. This quantity is used to synchronize the
oscillations of the model signal as described in Sec. IV B. In
addition, the momentary cuff pressure is needed to calculate
the stroke required to generate a given oscillation amplitude,
which is inversely proportional to the absolute pressure (inter-
nal plus atmospheric pressure). This dependency is accounted
for by the real-time software.
The initial probing strokes could trigger an irregular reac-
tion of the SUT or could be disturbed by the beginning defla-
tion of the SUT. To avoid this, the T-fitting is equipped with a
three-way cock, the T-cock in Fig. 4, blocking the connection
to the SUT’s console during the probing strokes. The volume
of the cuffs was found to be rather constant once they had
been fully inflated. Therefore, the volume needs no further
software correction after initial probing.
Some recently developed sphygmomanometers measure
the oscillations during slow inflation and do not exploit the de-
flation phase at all. In these cases, an auxiliary pump inflates
the cuff prior to testing. This facilitates the initial stroke cali-
bration as well as the settling of the cuff-fastener to achieve a
constant cuff volume. The auxiliary pump is connected to the
pneumatic system via the A-cock (see Fig. 4). The probing
strokes are performed after full inflation of the cuff, while the
T-cock blocks off the SUT. Afterward, the auxiliary pressure
is released again through the A-cock.
 024303-5
B. Synchronization of the oscillometric signal with
the deflation of the SUT
The oscillation amplitude depends on the baseline
pressure from the cuff in a manner that is specific for each
subject—this is the rationale of sphygmomanometry. For
any model signal in the database the baseline pressure was
released at a rate controlled by the recording unit during
the clinical data collection. A SUT will, in general, deflate
the cuff at a different rate. At a given baseline pressure, the
SUT expects a defined oscillation amplitude and waveform
to indicate the same blood pressure values as recorded. Blood
pressure measurements do—within wide margins—not de-
pend on the deflation rate which is why this parameter varies
considerably across sphygmomanometers on the market.
Even stepwise deflation is practical. For the simulator it is
necessary, therefore, to output the recorded model oscillations
with a timing corresponding to the actual deflation rate of
the SUT. This cannot be achieved by simply shrinking or
stretching the time scale of the model signal, as this would
change the heartbeat rate and the oscillation waveforms. The
individual oscillation segments in the model signal have to be
treated separately, instead, such that neither their waveform
nor their frequency is compromised.
This requires a processing of the original blood pressure
recordings before they can be used for a simulation. The main
steps are as follows:
(i) separation of oscillation and baseline pressure;
(ii) segmentation of the oscillations.
The first step is achieved by subtracting a least-square fit
to the slowly varying baseline pressure. The remaining oscil-
lations [see Fig. 2(b)] are then dissected into single oscillation
periods (model segments) at their minima. A residual skew in
the model segments is removed by subtracting the tangent at
both minima to facilitate the concatenation of segments. An
impression of deskewed and concatenated segments is given
in Fig. 6(b).
Each segment is tagged with its accompanying baseline
pressure, i.e., the pressure which has been exerted while the
respective model segment was recorded. The individual seg-
ments are stored in a dataset for the real-time control of the
test process; the original dataset itself is no longer required.
During the testing of a SUT, the momentary baseline
pressure exerted by the SUT is measured. The software
selects—by means of the pressure tag—the correct model seg-
ment for that baseline pressure of the SUT. The selected seg-
ment is fed to the diaphragm–pump controller. After the cur-
rent model segment has been completed a new measurement
of the baseline pressure is performed and the next matching
model segment is selected and output by the drive-controller.
This will be repeated with the simulated heartbeat rate until
the baseline pressure has reached a lower limit. The subse-
quent model segments are easily “stitched” to the previous
ones without discontinuities due to the mentioned subtraction
of the tangents.
The model signals are recorded with a low deflation rate.
This way an excess of model segments is available, facilitat-
ing the selection of the model segment closest to the momen-
Downloaded 17 Mar 2011 to 192.53.103.200. Redistribution subject to AIP license or copyright; see http://rsi.aip.org/about/rights_and_permissions
Rev. Sci. Instrum. 82, 024303 (2011)
tary baseline pressure of the SUT. Before the segment ampli-
tude is fed to the control software as a position set-point, it
has to be scaled to the varying transfer ratio between stroke
and oscillation pressure, as described in Sec. IV A.
V. PERFORMANCE TESTS
A prototype of the blood-pressure simulator was built
(Fig. 5) and several tests were conducted to evaluate its per-
formance:
r comparing the generated pneumatic signal with elec-
trical sinusoidal signals;
r comparing the generated pneumatic signal with
recorded human signals;
r checking the repeatability and reproducibility of the
generated signals;
r investigating the effect of different cuff volumes on the
generation of the pneumatic signal.
Tests performed with clinical sphygmomanometers gave
standard deviation for repeated measurements with a fixed
setting staying within 1.5 mmHg for 70% (within 2.0 mmHg
for 90%) of the displayed results. The standard deviation
of the individual generated pressure pulse was below 0.02
mmHg for all pulse amplitudes up to 4 mmHg. Arbitrary er-
rors, intentionally imposed on the self-calibration of the sim-
ulator for different cuff sizes, produced accordingly shifted
results, thus proving that different cuff volumes are com-
pensated correctly. The frequency response of the pneumatic
system and its dependence on the diaphragm material (see
Sec. IV A) were investigated at Dresden Technical
University.17
Figure 6(a) shows the recorded test cycle of a rather
quickly (7 mmHg/s) deflating sphygmomanometer with
oscillations overlaid by the simulator. The model segments
are taken from the signal in Fig. 2(b). Due to the faster
deflation, only a subset of oscillations is used and the overlaid
oscillations are less visible than those in Fig. 2(a). In the fast
inflation phase they are actually indiscernible. The model seg-
ments, selected and concatenated in real-time, are shown in
Fig. 6(b). In contrast to Fig. 2(b), the segments of Fig. 6(b)
FIG. 5. (Color online) Mechanical interior of the prototype, (A) motor, (B)
belt, (C) lever, and (D) bellow-coupled angular transducer. The right front
pole is removed for clarity. The part partly obscured by the bellows is the
pressure chamber.
 024303-6 Riedel et al.
FIG. 6. (a) Test cycle of an automated SUT connected to the simulator. (b)
Oscillation segments to be superimposed to the fast pressure inflation and to
the slower measuring deflation of the SUT.
show a nonzero average. This is compensated by the slow
position control described in Sec. IV A. Evidently, the
synchronization of the oscillation segments with the baseline
pressure works even during the very fast initial inflation phase
(+30 mmHg/s). This is advantageous as certain sphygmo-
manometers measure the oscillations coarsely during the in-
flation phase in order to adapt the maximum inflation pressure
to the actual blood pressure of the subject to be examined.
The indication of the SUT in Fig. 6 was 116 mmHg sys-
tolic pressure, 69 mmHg diastolic pressure, and 76 heartbeats
per minute. A second SUT with significantly slower defla-
tion rate (3 mmHg/s) indicated 121 mmHg, 74 mmHg, and
78 beats per minute for the same model signal. Such discrep-
ancies, especially, if human artifacts come into play, are well
known from detailed surveys18 of the behavior of commercial
SUT’s.
VI. SUMMARY AND OUTLOOK
The basic concept of the blood-pressure simulator pre-
sented in this paper differs substantially from commercial de-
vices for the testing of sphygmomanometers. With its use of
prerecorded human signals which can be flexibly combined to
a wide range of realistic oscillometric waveforms, this simu-
lator emulates the only currently accepted reference measure-
Downloaded 17 Mar 2011 to 192.53.103.200. Redistribution subject to AIP license or copyright; see http://rsi.aip.org/about/rights_and_permissions
Rev. Sci. Instrum. 82, 024303 (2011)
ment, i.e., a clinical trial, more closely than any previously
existing instrument. Especially important in this context is its
capability to correctly reproduce pathological conditions and
artifacts, e.g., arrhythmia artifacts. The adaptive time scale to
adopt for different heart rates and the combination of real-life
signals with artifacts are both, to the best of our knowledge,
unique features of the device. In this particular respect the
new simulator even outperforms the clinical trial in assess-
ing a given sphygmomanometer, as it is capable to play back
irregular or otherwise rare waveforms repeatedly and repro-
ducibly, which is inherently impossible in a clinical study on
a limited cohort of human subjects.
After successful testing of the prototype, another five
units of the simulator were produced, one by PTB and four by
a commercial manufacturer19 which are now in use for clini-
cal research in the Asian and European Hospitals.
Given that some benefits of this simulator cannot be met
by clinical trials, it is intended to introduce its utilization into
future editions of regulatory standards governing the testing
of sphygmomanometers. This will be a lengthy process, how-
ever, requiring considerable international effort.
The simulator reaches its technical limits when it comes
to the testing of sphygmomanometers with non-standard cuff
geometry, especially, with a so-called wide-range cuff. For a
given blood pressure a wide-range and a normal cuff gener-
ate different oscillation signals. This is taken into account by
the manufacturer. The testing of such wide-range cuff devices
would require the recording of a new set of model-signals for
the respective cuff.
ACKNOWLEDGMENTS
The blood pressure simulator and the recording unit
were developed and manufactured under the EU contract
G6RD-CTC-2002-0076 with participating institutions from
Germany, the Netherlands, Slovenia, and the United
Kingdom.
1 J. A. Whitworth; World Health Organization, International Society of Hy-
pertension Writing Group, J. Hypertens. 21, 1983 (2003).
2 L. A. Geddes, M. Voelz, C. Combs, D. Reiner, and C. F. Babbs, Ann.
Biomed. Eng. 10, 271 (1982).
3 The prevailing medical pressure unit is mmHg; permitted by the interna-
tional system of units (SI). 1 mmHg = 133.3 Pa.
4 International Standard ISO 81060, “Non-invasive sphygmomanometers,”
Part 1 (2007); Part 2 (2009).
5 European Standard EN 1060-4, “Non-invasive sphygmomanometers,” Part
4 “Test procedures” (2004).
6 American National Standard ANSI/AAMI, SP10; “Manual, electronic or
automated sphygmomanometers” (2002).
7 E. O’Brien, J. Petrie, W. Littler, M. de Swiet, P. L. Padfield, D. G. Altman,
M. Bland, A. Coats, and N. Atkins, J. Hypertens. 11, 677 (1993).
8 J. N. Amoore, J. Med. Eng. Technol. 17, 25 (1993).
9 E. Balestrieri and S. Rapuano, IEEE Trans. Instrum. Meas. IM-59, 2391
(2010).
10 Informations-Technologie Babelsberg GmbH, Potsdam, Germany
(recordingunit.itbb.de).
11 PMP 4015; Piezoresistive pressure sensor, 10 PSI, 690 mbar, 517
mmHg. GE Measurements and Control Solutions, Billerica, USA
(www.gesensing.com).
12 APCI-3120; 16-bit-ADC, 14 bit DAC, PCI-Adapter. Addi-Data GmbH,
Rheinmünster, Germany (www.addi-data.com).
13 H. Groß, S. Mieke, and M. Ulbrich, J. Med. Eng. Technol. 20, 75 (1996).
14 EC 45; brushless dc-motor, 250 W. Maxon Motor AG, Sachseln, Switzer-
land (www.maxonmotor.com). The rated power is never applied due to the
 024303-7 Rev. Sci. Instrum. 82, 024303 (2011)

small angular speeds occurring here. The motor’s torque is needed to with- 16 P2201 A502; plastic potentiometer. Novotechnik OHG, Ostfildern,
stand the inflation pressure. Germany (www.novotechnik.com). Lifetime is 107 cycles or 100 full days
15 DES 50/5; four-quadrant, electronic commutating controller. Maxon of uninterrupted operation.
Motor AG, Sachseln, Switzerland (www.maxonmotor.com). A sin- 17 M. Mehner, B. Fischer, S. Mieke, R. Seemann, and F. Wonka, Biomed.

gle quadrant controller would be sufficient here because the in- Tech. 52(Suppl.), 1569047551 (2007).
flation pressure of the SUT loads the drive always in one di- 18 J. N. Amoore, Y. Lemesre, I. Murray, E. Vacher, S. Mieke, S. King,

rection and because the inertial braking forces never exceed this F. Smith, and A. Murray, J. Hypertens. 26, 35 (2008).
preload. 19 B. V. Lode, Groningen, The Netherlands.

Downloaded 17 Mar 2011 to 192.53.103.200. Redistribution subject to AIP license or copyright; see http://rsi.aip.org/about/rights_and_permissions
View publication stats