2011 International Conference On Instrumentation, Communication Information Technology and Biomedical Engineering

8-9 November 2011, Bandung, Indonesia

Noninvasive Blood Pressure (NIBP) Measurement

by Oscillometric Principle
Rosmina Jaafar, Hisham Mohamad Desa, Zulkifli Mahmoodin, Muhammad Rosli Abdullah, Zarimin Zaharudin
Medical Engineering Technology, Universiti Kuala Lumpur British Malaysian Institute, Malaysia
(Tel : +603-61841000; e-mail: rosmina@bmi.unikl.edu.my)

Abstract- This paper describes the development of a noninvasive deflation of the cuff pressure is recorded and used for
blood pressure measurement (NIBP) device based on the estimating the SBP and DBP.
oscillometric principle. The device is composed of an arm cuff, an
air-pumping motor, a solenoid valve, a pressure transducer, and a
2x16 characters LCD display module and a microcontroller which
acts as the central controller and processor for the hardware. In
the development stage, an auxiliary instrumentation for signal Method
acquisition and digital signal processing using LabVIEW, which is Palpatory
also known as virtual instrument (VI), is incorporated for (Riva-Rocci)
learning and experimentation purpose. Since the most
Auscaltatory
problematic part of metrological evaluation of an oscillometric
NIBP system is in the proprietary algorithms of determining Ultrasonic
systolic blood pressure (SBP) and diastolic blood pressure (DBP),
the amplitude algorithm is used. The VI is a useful tool for
Tonometry
studying data acquisition and signal processing to determine SBP
and DBP from the maximum of the oscillations envelope. The
knowledge from VI procedures is then adopted into a stand alone
NIBP device. SBP and DBP are successfully obtained using the
circuit developed for the NIBP device. The work done is a proof of Oscillometric
(most popular
design concept that requires further refinement. and widely
used)
Keyword: auscultatory, oscillometric, mean arterial pressure,
systolic and diastolic pressure
TABLE I
LIST OF METHODS FOR NIBP
NIBP Principles
Palpable pulse when cuff pressure equals systolic
pressure (SBP)
Based on sound waves generated from artery
Based on frequency difference between transmitted and
reflected ultrasound wave when passed through arteries
When the blood vessel is partly collapsed, the
surrounding pressure equals to the artery pressure which
can be measured using an array of pressure sensors and
the cuff is around the wrist.
The intra-arterial pulsation is transmitted via cuff to
transducers (example: piezo-electric pressure sensor),
SBP and DBP are estimated from the maximum
amplitude of the pressure oscillation by using an
empirical algorithm

I. INTRODUCTION
An automated noninvasive blood pressure (NIBP) device
offers convenient blood pressure measurement to the users. The
device should be able to obtain both the systolic blood pressure
(SBP) and diastolic blood pressure (DBP). It should also allow
repeated measurements which can be performed outside the
healthcare center such as in an office, research setting or even
at home. NIBP can be measured by implementation of few
different principles. The established methods of NIBP
measurement [1] are listed in Table 1.
Typical NIBP measurement involves the use of an arm cuff
that is wrapped around the brachial artery and inflated to a
pressure above the SBP of the person. Of the few different
principles of NIBP measurement, the oscillometric method has
Fig.1. State of the arteries and the presence of pressure oscillations
been widely used in almost all portable blood pressure
monitors that record both SBP and DBP. The oscillometric
method was first demonstrated in 1876 and it involves the
The oscillometric NIBP measurement works similiar to the
observation of oscillations in the sphygmomanometer cuff auscultatoric method, which utilizes a stethoscope placed
pressure[1]. These oscillations are caused by the oscillations of
underneath the cuff for listening the Korotkoff sounds during
blood flow, which is the pulse. Fig. 1 illustrates the cuff
the gradual deflation of cuff pressure. Instead of recording the
pressure, its oscillation and state of the arteries during gradual
readings acoustically, the oscillometric method records and
cuff pressure deflation. The pressure oscillations during the
evaluates the pressure oscillations originating from the

978-1-4577-1166-4/11/$26.00 ©2011 IEEE

 2011 International Conference On Instrumentation, Communication Information Technology and Biomedical Engineering
pulsating arteries. These oscillations have a typical curve which
occurs when the blood flow first is temporarily interrupted and
then starts flowing again. The oscillations become stronger and
diminish until they disappear when the blood starts flowing
normally. Because the oscillations begin well above SBP and
continue below DBP, both SBP and DBP can only be estimated
indirectly according to empirically derived algorithm[1].
Frequency of the oscillations represents the frequency of the
heart beating. Thus, pulse rate can also be estimated from the
time from peak to peak of the pressure oscillations. The
estimated values of SBP, DBP and pulse rate are then
visualized on a display panel.
The ultimate objective of developing the oscillometric NIPB
monitoring device is to incorporate its utilization in a vascular
study in a separate future work. The vascular study will
involve measuring the blood pressure noninvasively and
stimulating the vascular reactivity following a blood flow
blockage of 50 mmHg above the person’s SBP at the brachial
artery. The success of the oscillometric NIBP project will
surely facilitate the future vascular study.
II. METHODS
System Block Diagram
The block diagram of the oscillometric NIBP is shown in
Fig. 2. An ATMEL microcontroller ATmega328 is used to
control the circuitry including the motor air pump, solenoid
valve and display panel. As the pressure oscillations are only
“visible” if the cuff pressure is released gradually and slowly (3
to 5 mmHg/sec) [2], a solenoid valve is used to do this.
Motor
air pump
Motor ATmega
Electronic 328
Arm Pressure
Circuitry A/D
Cuff sensor
and
I/O
Solenoid
valve PWM
LabVIEW
LCD
data
display
acquisition
Fig. 2. Block diagram of the NIBP measurement system
LabVIEW is used during the development stage of the NIBP
measurement especially for data acquisition and signal
processing. Recorded blood pressure data is filtered by band
pass filter with cutoff frequencies of 0.3 Hz and 6 Hz to
remove high frequency signals including the noise from power
line. After filtering, the pressure oscillations are amplified and
the maximum amplitude of the oscillations is determined. The
maximum amplitude of pressure oscillation is used to estimate
the SBP, DBP and pulse rate. Similar procedures to obtain the
results through the use of LabVIEW data acquisition and signal
processing are used for the development of a detached (stand
8-9 November 2011, Bandung, Indonesia
alone) system of NIBP measurement device. Thus, the end
product does not require the interfacing with LabVIEW.
Description of electronic circuitry and system components
A. Pressure sensor
The pressure sensor used is SenSym ICT ASDX005 with
working pressure range 0-5psi, sensitivity of 8V/psi and
accuracy within +/- 2.0% [3]. The sensor has a built in miniature
Wheatstone bridge and microprocessor system that detects and
amplifies the small change of input air pressure and convert it
to voltage output. The active pressure sensor having the built in
internal amplifier system makes the sensor, which has output
voltage ranges between 0 to 5V, is easy to handle.
B. Motor air pump and solenoid valve
The NIBP requires an motor air pump to inflate the cuff that
compresses the arteries under the arm and temporarily blocks
blood circulation in the brachial artery. During the release of
air from the cuff, pressure oscillations will be observed
indicative of the presence of SBP and DBP. As the pressure
oscillations are only “visible” if the cuff pressure is released
gradually and slowly (3 to 5 mmHg/sec), a solenoid valve is
also required. Slow release of air pressure during cuff deflation
can be achieved through a technique known as pulse wave
modulation (PWM) control by the microcontroller.
C. Microcontroller Atmega328
The microcontroller Atmega328 that has a built in 10-bit
analogue to digital converter (ADC) is used to control the
NIBP circuitry. This includes the control of motor air pump,
solenoid valve, calculation of pressure from the sensor’s output
voltage and determination of SBP and DBP as well as to
control the LCD display panel.
D. Electronic circuitry
The electronic circuitry of the NIBP device includes driver
circuits for microcontroller, motor air pump, and filter circuit.
These circuits are constructed on different printed circuit
boards which can be stacked together to produce compact
electronic system.
In order to obtain the pressure oscillations during cuff
deflation signal filtering is done through hardware filtering.
The pressure oscillations have the amplitude which varies
between 1mmHg to 3 mmHg in different individuals and the
oscillations frequency is equivalent to the heart rate of the
person. A filter circuit should filter unwanted frequencies such
as noise from the power line, which is far above the oscillation
frequency, and at the same time amplify the amplitude of the
oscillations.
E. LCD display panel
A display module of parallel LCD 2x16 characters is used to
display the measured pressure of SBP and DBP. In this design,
four data lines are used to transfer a character byte in two
nibbles, thus minimizing the number of pins used.
 2011 International Conference On Instrumentation, Communication Information Technology and Biomedical Engineering
8-9 November 2011, Bandung, Indonesia

Estimation of SBP, DBP and pulse rate

SBP and DBP can be estimated from the mean arterial
pressure (MAP) where MAP is identified as the peak of the
oscillations [4]. Equation (1) and (2) show the inter relationship
of SBP, DBP and MAP [4].
1
MAP DBP (SBP DBP ) (1)
3
1 2
MAP SBP DBP (2)
3 3

Pressure oscillation waveforms are used to identify systolic (a)

point and diastolic point. SBP occurs when the slope of peak
oscillations is minimum while DBP occurs when the slope is
maximum [5]. From the oscillation waveforms, SBP is observed
at the point where the ratio of systolic amplitude to maximum
amplitude is equals to 0.55; whereas, DBP is observed at the
point where the ratio of diastolic amplitude to maximum
amplitude is equals to 0.85[5].

III. RESULTS AND DISSCUSSION

The results from tests and experiments by VI using Labview
that are shown in Fig. 3 reveal the pressure oscillations during
the cuff deflation. These oscillations are extracted and
amplified. The maximum peak of oscillation indicates the
MAP. Fig. 4 shows parts of the hardware of the NIBP device.
(b)
Fig.3: Pressure signals acquired from Labview experiments showing the
(a) SBP at the beginning of pressure oscillations and
(b) Pressure oscillations (output from bandpass filter)

A. Pressure sensor
According to the manufacture’s data sheet, the pressure
sensor’s sensitivity is 0.8V/psi, which is approximately
equivalent to 0.8V/51.7mmHg or 15.5mV/mmHg. From the
results of sensor testing (Table 2), the actual measured
sensitivity of the pressure sensor obtained from the slope of the
line of sensor response (Fig. 5) is 15.8mV/mmHg. The actual
sensitivity is almost the value as specified in the data sheet.
The calculation for pressure sensed by the pressure sensor is
illustrated as the following:

TABLE II
PRESSURE SENSOR TEST RESULTS

Fig.4 Parts of hardware of the NIBP device

 2011 International Conference On Instrumentation, Communication Information Technology and Biomedical Engineering
8-9 November 2011, Bandung, Indonesia

The band pass filter is constructed such that its gain is

variable by using variable resistors. The gain range ranges from
unity gain to approximately 160. Results of the band pass filter
developed for the NIBP device is shown in Fig.6. The filtered
pressure oscillations have been used to indicate the point for
Fig.5 Pressure sensor response the SBP and DBP, which is 120mmHg and 75mmHg,
respectively.
B. Motor air pump and solenoid valve
The motor air pump, controlled by the microcontroller, is
turned on and rapidly pumps the cuff until pressure is
180mmHg. Once the pressure reaches the maximum limit set
through the microcontroller program, the motor is turned off
and solenoid valve is alternately turned on and off through
PWM signals from the microcontroller. From multiple tests and
experiments, a PWM signal having 95% duty cycle is able to
cause the valve to gradually release air pressure at a rate of
5mmHg/sec. As soon as the cuff pressure drops to below
40mmHg, the valve is then turned off completely releasing all
air trapped in the cuff.

C. Microcontroller Atmega328
The microcontroller Atmega328 is a 28-legs microcontroller
having 6 pins for the analogue input/ouput and 14 pins digital
input/output. The NIBP device utilizes one analogue pin that is
designated to read the pressure sensor’s output voltage and two
digital pins each one is to drive the air motor pump and
solenoid valve, respectively. Another four digital pins are used
to send data of a character byte in two nibbles to the LCD
display module.

D. Electronic circuitry
To fulfill the requirement of having a filter circuit to remove
high frequency noise and keep the frequency of interest, which
is the low frequency of heart rate, an active band pass filter is
constructed using op-amps with the lower and higher cutoff
frequencies of 0.3 Hz and 6 Hz, respectively. The gain for the
filter is chosen such that the maximum oscillation amplitudes
do not exceed 5V that is to be fed to the microcontroller. The
calculation for gain requirement for the filter is shown as
follows:
input pressure oscillations:
1mmHg – 3mmHg = 15.8mV – 47.4mV

output of pressure sensor :

0V –5V Fig. 6 (a) Pressure signal acquired from the NIBP device
(b) Pressure oscillations after filtering
 2011 International Conference On Instrumentation, Communication Information Technology and Biomedical Engineering
IV. CONCLUSION AND RECOMMENDATIONS
The procedures from VI experiments using Labview have
provided means for learning process to comprehend the
oscillometric technique of NIBP measurement. The work done
through development of the hardware circuitry and firmware
for the NIBP device is capable of demonstrating proof of
design concept only. Before the device can be utilized for
measuring the NIBP in future studies and research setting, the
NIBP device requires further system refinement. Multiple tests
and experiments such as to explore the device repeatability and
reproducibility are required in order to produce an accurate
NIBP device that can be used in future research activities as
originally planned.
ACKNOWLEDGMENT
This work was supported by the Short Term Research Grant,
grant no. STR09020, from Universiti Kuala Lumpur. The
authors would like to thank Siti Nur Hidayah Ab Malek and
Nur Syazwani Mohd Sahari for their kindness and commitment
8-9 November 2011, Bandung, Indonesia
during development of the project especially for circuit testing
and data collection.
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