Korotkoff Sounds.
We were interested in the historical perspective that Arabidze et al. [1] brought to the subject of Korotkoff's auscultatory method of measuring blood pressure. The original description by the Reverend Stephen Hales performing the very first blood pressure measurement (which was actually published in 1733) does not make reference to a column of water as the authors suggest [2]. Hales wrote: 'Then untying the Ligature on the Artery, the Blood rose in the Tube eight Feet three Inches.'. He goes on to state that, 'When it was at its full Height, it would rise and fall at and after each Pulse two, three, or four Inches, and sometimes it would fall twelve or fourteen Inches, and have there for a time the same vibrations up and down at and after each Pulse, as it had, when it was at its full Height; to which it would rise again, after forty or fifty Pulses'. We believe this fall of '12 or 14 in' to have been the first description of blood pressure variability, which has wrongly been attributed to respirations by subsequent authors [3]. The mare's pulse rate was described to be about 50 beats per minute; therefore an unanaesthetized horse would not be likely to have a respiration rate of once per minute. One further important point of error concerning the Korotkoff sounds is their reproducibility. We have demonstrated recently that phase IV is reproduced or identified poorly, both in adults and even during pregnancy, when it has been recommended to be used in favour of phase V. We have also demonstrated that phase I (systolic blood pressure) is perceived to be significantly clearer than phase V [4].
Shennan
AH
Royal Postgraduate Medical School, Queen Charlotte's and Chelsea Hospital, London, UK.
Halligan
AW