Blood pressure measuring method and device therefor

Abstract

The invention relates to a method for ascertaining respiration-corrected blood pressure values and to a device having a control unit for carrying out the methods. In this case, at least two blood pressure values are provided in a single measurement and used as a basis for determining the influence of the respiration and hence the respiration correction. Furthermore, the method also allows the determination of continuous blood pressure values from individual value measurements even if a narrow cuff is used.

Description

[0001] Blood pressure measurement method and device therefor

[0002] The invention relates to methods for determining blood pressure values ​​and a device with a control unit for carrying out the methods.

[0003] Blood pressure and its temporal progression is an important parameter, especially with regard to a person's medical condition. Based on the progression of blood pressure values ​​and the progression of blood pressure values ​​as a function of time, certain parameters can be calculated or derived. The temporal variation of blood pressure during several cardiac cycles is recorded to derive certain parameters, such as the systolic blood pressure value and the diastolic blood pressure value. It is important to ensure that the blood pressure measurement is as accurate and precise as possible.

[0004] Blood pressure measurement is a fundamental medical examination method and plays a crucial role in the diagnosis and monitoring of high blood pressure, also known as hypertension. Regular blood pressure monitoring is of great importance for maintaining physical health. High blood pressure can indicate serious health problems such as cardiovascular disease, stroke, and kidney failure. Therefore, it is important to monitor blood pressure regularly and to take appropriate measures when necessary.

[0005] REPLACEMENT SHEET (RULE 26) to take action. Blood pressure measurement can also help detect and treat various diseases. These include, for example, hypertension, diabetes, kidney disease, or thyroid disease.

[0006] Various methods for measuring blood pressure are described in the state of the art. The most commonly used method is the non-invasive Riva Rocci method, which is based on the evaluation of pressure measurements taken on the arm. This method is now considered the gold standard and is widely used in clinical and home settings due to its accuracy and reliability.

[0007] The Riva Rocci method is a non-invasive method for measuring blood pressure. It was first developed in 1896 by the Italian physician Scipione Riva Rocci. This method uses an inflatable cuff placed around the upper arm to block blood flow in the artery, and a stethoscope to listen to the sounds produced as the cuff slowly deflates. The readings are then read using a manometer.

[0008] Over time, other methods for measuring blood pressure have been developed from the Riva Rocci method, such as automated measurement using digital devices. Nevertheless, the basic Riva Rocci method remains an important method in medical practice due to its accessibility and simplicity.

[0009] A measurement using the Riva Rocci method described above typically takes more than 60 seconds and can be uncomfortable for the user, particularly due to the high pressure required initially. Therefore, continuous or long-term blood pressure monitoring using state-of-the-art technology is only possible in exceptional cases and with very coarse temporal resolution (usually one value every 10 minutes). Such a series of individual measurements at intervals of several minutes is used today and is sometimes referred to as "continuous" monitoring. However, this term is misleading, since continuous monitoring is not taking place, and the intervals and thus the temporal resolution are so large that the dynamic changes in blood pressure occur far below this temporal resolution.Therefore, an abnormality cannot be reliably detected; rather, it remains a matter of chance whether an abnormality is detected. An abnormality can only be detected if the measurement interval was randomly chosen so that a measurement point coincidentally occurs at the same time as an abnormal event. Furthermore, it is precisely during such events that many state-of-the-art cuff measurement devices produce inaccurate measurements. Furthermore, even when a measurement is successful, they cannot provide meaningful measurement values ​​due to the methodology.

[0010] Although the term "continuous" is used below for the present invention, this does not necessarily mean the long interval measurement used in the prior art. Rather, at least the individual measurement intervals are shorter, and in addition, other parameters can sometimes be determined in addition to blood pressure during the same period, for example, in order to obtain meaningful values ​​from the measured values ​​during monitoring. Ideally, blood pressure values ​​can be determined for each heart pulse present within a measurement period, thus providing true continuous monitoring.

[0011] To overcome the problems of inaccuracies in blood pressure measurement and continuous monitoring, other methods have been developed in the state of the art that can determine blood pressure indirectly using other vital signs. For example, it has been known for many years that the pulse wave transit time is a reflection of blood pressure. Theoretically, such methods can determine blood pressure for each heartbeat. In order for blood pressure to be derived from the pulse wave transit time or other vital parameters (so that the measured values ​​of the pulse wave transit time or other vital parameters can be meaningfully reflected in the blood pressure values), a calibration between the vital sign and another method that measures blood pressure must be carried out before such a continuous indirect blood pressure measurement, which is carried out indirectly and via other vital parameters.For continuous imaging, however, the analysis of light irradiated into tissue is also of interest. These methods, collectively known as photoplethysmography (PPG), show variations in the output signal with the heart rate, the analysis of which, in principle, also allows for the determination of blood pressure. The advantage of these methods is the use of only one measurement point on the body and the associated ease of use. However, even in this case, blood pressure determination relies on high-quality calibration.

[0012] However, the accuracy of currently known methods (e.g., digital upper arm cuffs or other cuffs) based on the Riva Rocci method is not sufficient to perform a simple and accurate calibration. If calibration is performed at rest, the measurement inaccuracy of the Riva Rocci method means that, at best, only a trend measurement is possible. A better, albeit more complicated, calibration using currently known Riva Rocci methods is possible if calibration is performed at rest and while the user is exercising. In addition to the sources of error caused by the user's movement during exercise, this procedure also has the disadvantage that the user must actively execute a calibration plan and is subjected to stress.

[0013] If calibration is performed at normal pressure and then high blood pressure is to be measured (e.g., during exercise), the errors introduced during calibration multiply many times over. Therefore, for continuous and non-stressful blood pressure measurement at the level of invasive blood pressure measurement, it is crucial that the calibration is performed with highly precise and, if possible, error-free measurements that reflect even the slightest changes in blood pressure. A change in blood pressure is necessary for calibration. If the quality of the calibration measurement is very high, this change may be a natural change, e.g., a change in blood pressure due to breathing or a change in blood pressure due to regular arterial adaptation in the extremities.

[0014] There is currently no system on the market that can continuously and non-invasively measure blood pressure in a way that would enable diagnosis or warning of illnesses. Current methods that promise such functionality lack accuracy and the ability to correctly detect extreme changes in blood pressure. There is a risk that healthy people will be classified as ill, causing them to worry unnecessarily and use healthcare services, thereby unnecessarily limiting these services for the general public. However, this is relatively acceptable compared to the reverse problem. If sick people are classified as healthy by current systems, this can reduce their quality of life or even be life-threatening. Continuously measuring systems promise that illnesses can be detected early.However, if a disease is not detected, the user is lulled into a false sense of security until it may be too late for optimal treatment.

[0015] The present invention is intended to close this gap, allowing the method for non-invasive and, in particular, continuous blood pressure measurement to be calibrated in a user-friendly and more accurate manner, thus enabling medical diagnoses based on the measured values. However, the method itself also represents added value. The method not only determines blood pressure according to today's definition, but also takes into account the dynamic influences on blood pressure caused by respiration, allowing a broader picture of blood pressure. Thus, blood pressure fluctuation due to respiration can be included as an additional parameter in the definition of the blood pressure value tuple, alongside systole and diastole.

[0016] A person's blood pressure reading is fundamentally influenced not only by the heartbeat or cardiac cycle. Rather, the body regulates the pressure of blood in the arteries based on a variety of phenomena. This regulation leads to fluctuations in blood pressure and its value. The following causes and phenomena are typical for this fluctuation:

[0017] • Heartbeat

[0018] • Breathing

[0019] • Arterial adaptation in the extremities

[0020] • Physical exertion • Mental exertion

[0021] • Fluid balance

[0022] • Food intake

[0023] • Sleep cycle

[0024] • Menstrual cycle

[0025] • Monthly cycle

[0026] • Artery condition

[0027] • Age

[0028] The fluctuations in blood pressure, the body's reaction to these phenomena, are divided into orders. The order represents the effect, and the phenomenon the cause.

[0029] This differentiation is often confused in the literature. The order refers to a frequency of change in blood pressure, and the phenomenon to a frequency of the cause. For example, second-order blood pressure fluctuations result from breathing. However, the phase and amplitude of the breathing phenomenon are not necessarily correlated with the phase and amplitude of the second-order blood pressure fluctuation. Using the present invention, a blood pressure value can be determined that is independent of the blood pressure fluctuations caused by breathing. This allows phase shifts and abnormal amplitude ratios to be determined. What can be detected from values ​​that deviate from the normal is beyond the scope of this patent specification and will be described in subsequent publications.

[0030] In the literature (e.g. H. Hinghofer-Szalkay: Practical Physiology, 3rd ed. Blackwell Berlin 1994) the following orders are distinguished:

[0031] • First-order blood pressure fluctuations: Blood pressure fluctuations caused by the phenomenon of the heartbeat. The form of the fluctuation depends on the heart and the arteries. Systolic pressure is significantly influenced by the ejection performance of the left heart and the elasticity of the arterial system. Diastolic pressure is significantly influenced by the pulse rate and peripheral flow resistance. Second-order blood pressure fluctuations: Blood pressure fluctuations caused by the phenomenon of respiration.

[0032] • Third-order blood pressure fluctuations: Blood pressure fluctuations caused by the phenomenon of arterial adaptation in the extremities. These fluctuations are also called Traube-Hering-Meyer waves.

[0033] The phenomena occur at different lengths of time. Therefore, a blood pressure measurement can be examined for the influence of the individual phenomena using Fourier analysis, for example. This makes it possible to determine the influence of each phenomenon on blood pressure. This is well known for breathing; it is known that breathing can change the blood pressure of a resting body by up to 15 mmHg in systole and up to 5 mmHg in diastole. However, this differentiation has its limits today. However, it is currently only possible to differentiate between two simultaneously occurring phenomena. One of these phenomena is always the heartbeat, which leads to the well-known blood pressure values ​​systole and diastole, and one of the other phenomena, which is today named by a pressure difference to the blood pressure values ​​systole and diastole.

[0034] The effects of individual phenomena on blood pressure can cancel each other out or reinforce each other. Example: Under stress, the effect of breathing can no longer be detected, especially in older people. This can be explained by the fact that the stiffness of the arteries (phenomenon: arterial condition) is high and that under high pressure, further increases are suppressed by breathing. Figure 7 shows a schematic pressure curve for the phenomena of heart rate, breathing and stress. This figure outlines how the individual phenomena affect and influence each other. Figure 7 shows a schematic pressure curve 7000 of the blood in a person's artery as a function of time, with the person's stress condition changing over time. The example shown represents a recovery phase, which is why the pressure drops overall (indicated by line 7300).However, within the general downward trend, a regional trend is also evident: less pronounced at the beginning, but stronger towards the end, when the person is more recovered. This regional trend is indicated by line 7200 and can be attributed to the phenomenon of the influence of breathing on blood pressure. Finally, when considering the local changes in the blood pressure curve, another change can be seen, the strength of which (amplitude of the oscillation curve) is highest at the beginning, but lower towards the end, when the person is more recovered. These changes correspond to the changes due to the person's heart rate and are indicated by line 7100. The figure thus shows the individual phenomena, but also their interaction.

[0035] Questions that consider three phenomena cannot be answered by measurement due to a lack of resolution (or, if invasive measurement were used, due to the difficulty of application). One such question is: What influence does breathing have on systole and diastole blood pressure values ​​when physical exertion is present? To answer this question, the influences of the phenomena of heart rate, breathing, and physical exertion on arterial pressure must be considered separately.

[0036] The present invention can be used by a user in such a way that only the two phenomena of heartbeat and breathing cause a change in blood pressure. The influence of other phenomena may be present, but their influence on the measured values ​​should only be present over a longer period of time, so that the influence can be regarded as constant over the measurement period. In particular, the method uses the change in blood pressure due to breathing to detect the blood pressure change due to the heartbeat and then track it at later times to detect changes caused by any other phenomena. Breathing changes the heart's actions. When you inhale, the heart rate increases slightly and the arteries stiffen. When you exhale, the pulse rate drops and the stiffening of the arteries also decreases. This leads to regular blood pressure adjustment.

[0037] This is triggered by activation of the sympathetic nervous system during inspiration and the parasympathetic nervous system during exhalation. With normal breathing and in healthy people this means a change of 2-3 mmHg for systole and 1-2 mmHg for diastole. However, heavy breathing or illness can mean that this change is more pronounced during breathing. In addition to breathing, physical exertion, state of health, medication, physical condition and age all influence blood pressure adaptation. A healthy young adult shows a drop in blood pressure when inhaling with a simultaneous increase in heart rate and vice versa when exhaling. With physical exertion both blood pressure and heart rate increase. The example of a healthy person alone shows that the adaptation of blood pressure is complex. In addition to these physical influences, the location and / orThe type of measurement influences the result of the measurement. A cuff measurement depicts the peripheral blood pressure in the affected extremity. The influences on peripheral blood pressure are diverse; for example, blood flow can be impaired by diseases such as arteriosclerosis or impaired windkessel function. Another example is that during sporting activity, the central blood pressure increases, while at the same time the blood pressure in the arm does not increase as much when the arm is not under stress (e.g., when cycling). As a rule, if the cause of the data is only peripheral, the blood pressure measurement is also a blood pressure measurement for the peripheral pressure. Examples of this are cuff measurements, light wave measurements, acoustic measurements, and temperature measurements. If measurement methods also record direct actions of the heart, e.g.When an ECG is used, the central blood pressure is at least partially depicted. An example of this is blood pressure determination based on the pulse wave transit time. In a state-of-the-art measurement (see Figure 1), the pressure in the cuff is increased at a constant rate. The air pressure in the cuff is influenced by the pulse in the arteries below the cuff. At low pressures, the blood can flow unhindered; this means that the tension in the muscles and tissue is higher than the pressure in the cuff. Therefore, the pulse or a change in pressure cannot be recognized in the pressure curve. If the air pressure in the cuff increases, this tension cannot be maintained in the heart pulse, initially during diastole. During diastole, artifacts occur in the heart pulse; this means deviations lead to lower measured values ​​of the air pressure and the heart pulse.If the pressure in the cuff continues to rise, blood flow can no longer be maintained smoothly, even during the phases between diastole and systole in the heart rate. At even higher air pressures, blood flow is disrupted at every phase, including systole. The cuff is deformed with the pulse, and the heart rate is thus reflected in the air pressure. The air pressure is now exactly between the values ​​of diastole and systole. If the air pressure is increased further, the artery is squeezed more and more until no more blood flow is possible because the artery has collapsed. The intensity of the artifacts due to the heart rate initially increases with the air pressure and then decreases again. The curve of the intensity of the artifacts due to the heart rate therefore shows exactly one arc.

[0038] Of course, the behavior of the blood pressure of a real person does not usually correspond to the idealized curve that the state of the art methods assume and use. One such non-idealized curve is shown in Figure 2. For example, the blood pressure and thus the air pressure curve 2000 in the cuff changes due to breathing and the curve of the intensity 2100 of the artifacts 2010, 21 10 due to the heart pulse shows several arcs 21 1 1 , 21 12, 21 13. In the state of the art methods, for example, only one arc, e.g. 21 12, from this curve is used. This leads to an overestimation of the diastole and / or underestimation of the systole. In the state of the art methods, for example, all arcs are sometimes averaged and interpreted as one arc, which leads to an underestimation of the diastole and overestimation of the systole.

[0039] The problem with the prior art methods is that certain assumptions are made for the measurements and, in particular, additional effects that influence the blood pressure value are ignored or, due to the large intervals between the measurement periods, are arbitrarily averaged due to the nature of the method. In particular, the problem with the previously known measurement methods is that individual blood pressure values ​​are assigned to certain values ​​or averages of certain values ​​from the individual value measurements, whereby no further information is taken into account in the individual value measurements and therefore only a single value of the uncorrected blood pressure value is output, in particular one that does not take further effects, such as respiration, into account. In particular, this gives rise to the problem that continuous blood pressure values ​​cannot be determined from air pressure measurements and that the effects of respiration on the blood pressure measurement are ignored orare arbitrarily averaged, so that the blood pressure values ​​determined depend on the respective effect of breathing.

[0040] The present invention provides a solution to the aforementioned problem by providing better evaluation of single-value measurements, in particular single-value air pressure measurements. The single-value measurements are, for example, those that represent a pressure value on the skin above arteries. Currently preferred and also conceivable in this disclosure of the invention, these pressure values ​​are generated with a cuff and quantified using the air pressure within the cuff. Nevertheless, other possibilities exist and can be implemented with the present invention to generate and quantify such pressurization. One possibility is the use of ceramic-based pressure sensors, utilizing the piezoelectric effect, or polymer-based pressure sensors, measuring a variable electrical resistance, which are pressed against the skin with a mechanical device.Regardless of how the pressurization is generated and how it is quantified, the values ​​of the individual value measurements of such devices can be used for the method and system according to the invention.

[0041] In particular, the problem is solved by the method according to claim 1 and a measuring device, in particular in the form of a cuff, according to claim 13. Further advantageous embodiments are set out in the further dependent claims and in the following embodiments.

[0042] The method according to the invention makes it possible to determine a respiration-corrected blood pressure value of a person, in particular a person who is breathing. Such a respiration-corrected blood pressure value indicates a blood pressure value depending on a specific breathing state of the person and is thus a respiration-corrected blood pressure value within the meaning of this disclosure. Such a breathing state can, for example, represent maximum inhalation or maximum exhalation. In order to provide a more accurate picture of blood pressure as a function of respiration, it is therefore proposed that at least two respiration-corrected blood pressure values ​​be determined, which, if possible, represent two opposing extreme states in the breathing state of a breathing phase of the person.

[0043] The invention relates to a method for determining at least two respiration-corrected first blood pressure values ​​of a person. Blood pressure values ​​are typically divided into two different types: systolic blood pressure values ​​and diastolic blood pressure values. Such a first blood pressure value can, in particular, be a systolic blood pressure value. However, it is also possible for the first blood pressure value to be a diastolic blood pressure value. It is also conceivable, however, that in addition to the at least two respiration-corrected first blood pressure values, namely systolic blood pressure values, at least two respiration-corrected second blood pressure values, namely diastolic blood pressure values, are also determined.

[0044] It is also possible to determine a plurality of respiration-corrected first blood pressure values. In this case, the values ​​of the plurality no longer have to be assigned to the two opposing extreme states described above, provided the plurality is based on such values. For clarity, the plurality of respiration-corrected first blood pressure values ​​is referred to as the first plurality. Here, too, the first blood pressure value of the first plurality can be a systolic blood pressure value or a diastolic blood pressure value. It is also possible to determine both the first plurality of first blood pressure values, namely the systolic blood pressure values, and a further plurality of respiration-corrected second blood pressure values, namely diastolic blood pressure values. This further plurality of respiration-corrected second blood pressure values, namely diastolic blood pressure values, is referred to as the second plurality for clarity.

[0045] In this case, the at least two respiration-corrected first (or also the further, such as the second) blood pressure values ​​are determined as described below. The feature "respiration-corrected" is to be understood in particular as a determination of at least two blood pressure values, for which blood pressure values ​​are used that can be determined within one and the same phase segment of a respiration. Thus, two values ​​are intentionally used that are within the same respiration phase, whereby the present invention fundamentally differs from the approaches of the prior art methods, in which such values ​​are not considered and used individually, but rather are disregarded, for example, by an algorithm based on the moving average.The problem with this state-of-the-art approach is that the information about the influence of respiration on blood pressure is lost and - depending on the selection of the algorithm's reference frame - an incorrect absolute value is output.

[0046] The starting point of the method according to the invention is the time-resolved acquisition of individual values ​​of a value that can be assigned to the blood pressure value. For this purpose, several individual value measurements are performed within a measurement period, in particular a single and / or uninterrupted one. This acquisition of individual values ​​of a value can be carried out at short intervals using a first device based on a first sensor of the first device. By means of further method steps, respiration-corrected blood pressure values, and in particular continuous blood pressure values, can then be determined from these individual value measurements.

[0047] The individual value measurements can usually be performed on some existing devices. Therefore, new devices are not necessarily required; the existing devices simply need to be expanded and configured to carry out the inventive methods. Ideally, this can be achieved through a software update.

[0048] In the method according to the invention, as is also partly known from the prior art, the device, in particular the first device, can apply pressure within the measuring period. Such pressure is generally applied to a part of the person used as the measuring area, usually to a part of the person's skin. The device is generally configured to vary the pressure. For this purpose, pressure is generally applied based on a pressure change rate predetermined over the measuring period. For example, the pressure applied to the skin can increase within the measuring period according to a predetermined pressure change rate.In particular, during the measurement period in which the individual values ​​of the method according to the invention are recorded in a time-resolved manner, only and in particular exclusively a strictly monotonically increasing pressure application or, alternatively, a strictly monotonically decreasing pressure application can occur. As the measurement progresses, in which further individual values ​​can be recorded and evaluated for further applications, e.g., for determining continuous blood pressure values, it is conceivable that the pressure application can then be changed. For example, this increase can become greater or smaller over the course of the measurement, or the pressure application can even be reduced or maintained at a predetermined level.To ensure easier subdivision and differentiation, it is advisable to refer to such a period as the second measurement period, and the period in which several individual measurements are taken to determine at least two respiration-corrected first blood pressure values ​​for a person as the first measurement period. Unless a more specific limitation of the period is specified below, the period refers to the first period. However, it is also possible to initially reduce the pressure based on the predetermined pressure change rate, starting from an already high pressure.

[0049] In any case, the values ​​of the individual measurements at least partially reflect this varying pressure.

[0050] Advantageously, therefore, for example, within the measurement period, a pressure exerted on a part of the person used as a measuring area varies, in particular, it increases or decreases, in particular from a minimum pressure value to a maximum pressure value or from a maximum pressure value to a minimum pressure value. Advantageously, the individual value measurements are recorded during the variation of the pressure. Advantageously, the pressure exerted on the measuring area and its variation are generated by the first device, to which the first sensor is also assigned.

[0051] In the simplest case, the values ​​of the individual value measurement are pressure values. In particular, the pressure values ​​can be air pressure values, whereby a cuff, in particular an air pressure cuff, is preferably used for the individual value measurement. In particular, the pressure value can be a pressure value determined on the basis of a measurement of an electrical voltage or electrical resistance, in particular one caused by the piezoelectric effect. In particular, the first sensor has a pressure sensor, in particular an air pressure sensor, or a sensor for measuring the electrical voltage or electrical resistance. In particular, the first device is a pressure cuff, in particular an automated one. Time-resolved is understood in particular to mean a measurement in which both the measured value, in this case the value assigned to the blood pressure value, and the time at which the measured value is recorded are recorded.

[0052] According to the invention, in a further method step, at least one non-respiration-corrected first blood pressure value of the person is / are determined from the individual value measurements. Here, too, the first blood pressure value is to be understood, for example, as a systolic blood pressure value or a diastolic blood pressure value. If both respiration-corrected first, namely systolic, blood pressure values ​​and respiration-corrected second, namely diastolic, blood pressure values ​​are determined, then it is provided that, in addition to determining the at least one non-respiration-corrected first, systolic, blood pressure value from the individual value measurements, at least one non-respiration-corrected second, diastolic, blood pressure value of the person is determined. This determination of the non-respiration-corrected blood pressure value(s) is carried out in particular according to methods known from the prior art, in particular according to the method according to Riva-Rocci and Korotkoff.The time point corresponding to the time of the value of the time-resolved individual value measurements and the time point corresponding to the time point of the determined non-respiration-corrected blood pressure value are each determined as a reference time point. For the first non-respiration-corrected blood pressure value, this time point is therefore determined as a first reference time point. Similarly, for the second non-respiration-corrected blood pressure value, its time point can be determined as a second reference time point.

[0053] Furthermore, according to the invention, at least a first phase segment of a person's breathing, in particular a first phase segment of a breathing phase, is recorded in a time-resolved manner within the measurement period. This recording takes place in particular in the form of a recording of a breathing curve of the person, which has phase segments of the breathing, in particular of the individual breathing phases. The phase segments, and thus also the first phase segment, have one, in particular exactly one, in particular local, maximum value in the breathing curve. This can, for example, be a maximum value compared to previous and later values ​​of the breathing curve. Such a maximum value can, for example, be a maximum inspiration of the person occurring within the breathing phase. However, the assignment of a maximum value to a maximum inspiration depends significantly on the method used to determine the breathing curve and the phase segments.For the sake of simplicity, this assignment is used, even though the maximum value may not be a maximum value from a mathematical point of view.

[0054] Time-resolved recording also allows the times of these maximum values ​​to be captured. The maximum value of the first phase segment is recorded as the first time point, namely the first time point of the first phase segment. If a second phase segment is recorded in a similar manner, its maximum value is also recorded as the first time point, namely the first time point of the second phase segment.

[0055] The phase segments, and therefore also the first phase segment, also have one, in particular exactly one, particularly local, minimum value in the breathing curve. This can, for example, be a minimal value compared to previous and subsequent values ​​of the breathing curve. Such a minimum value can, for example, be the person's maximum exhalation occurring within the breathing phase. However, the assignment of a minimum value to a maximum exhalation depends significantly on the method used to determine the breathing curve and the phase segments. For the sake of simplicity, this assignment is used, even though the minimum value may not actually be a minimum value from a mathematical point of view. What is particularly relevant is that the maximum value represents the opposite of the minimum value.

[0056] Time-resolved recording also allows the times of these minimum values ​​to be recorded. The minimum value of the first phase segment is recorded as the second time point, namely the second time point of the first phase segment. If a second phase segment is recorded in a similar manner, its minimum value is also recorded as the second time point, namely the second time point of the second phase segment.

[0057] The first phase segment is selected from the recorded phase segments such that the first reference time falls within the period encompassing the first phase segment. The period of the first phase segment can be defined, in particular, by the first and second times of the first phase segment. However, the end or the beginning of the period of the first phase segment does not necessarily have to coincide, in particular exactly, with the first or second times of the first phase segment. Such proximity, in particular agreement, depends in particular on the method chosen to record and determine the phase segments or the maximum and minimum values.

[0058] If a second reference time has also been recorded or determined, it is provided that a second phase section is recorded in an analogous manner to the first phase section and its times are determined, wherein the second phase section is selected from the phase sections such that the second reference time falls within the period comprising the second phase section. With regard to the period of the second phase section, reference is made to the above with regard to the period of the first phase section.

[0059] With regard to the time-resolved recording within the measurement period, in particular the first and / or second measurement period, it is preferred that the same time resolution, in particular with the same time intervals and the same times, be used for recording the individual values ​​and for recording respiration, in particular a respiration curve, in particular the respiration curve described below. However, it is essential that the period in which the individual values ​​are recorded encompasses the period of the first and / or second phase segment. In particular, each phase segment contains exactly one maximum value, in particular exactly one maximum inspiration, and exactly one minimum value, in particular exactly one maximum expiration.In particular, the first phase section and the measurement period are selected such that within the first phase section there is only and / or exactly one, in particular local, maximum value and only and / or exactly one, in particular local, minimum value in the respiration curve.

[0060] The first point in time, for example, of the first phase segment does not necessarily have to be before the second point in time of the first phase segment. Rather, the numbering of the points in time is based on the values ​​in the breathing curve, i.e. the first point in time a maximum value and the second point in time a minimum value. Thus, the phase segment can first have a maximum value and then a minimum value. However, the phase segment can also first have a minimum value and then a maximum value. Depending on the definition of such a breathing phase, a breathing phase usually has either two maximum values ​​and one minimum value (a breathing phase is defined as first having an inhalation, then moving on to the next inhalation via an exhalation) or two minimum values ​​and one maximum value (a breathing phase is defined as first having an exhalation, then moving on to the next exhalation via an inhalation).It is also conceivable for the first phase segment to have a maximum value first and the second phase segment to have a minimum value first, or vice versa. According to the invention, it is only relevant that the respective reference time lies or falls within the respective time periods of the phase segments defined by the respective first and second times of the respective phase segments.

[0061] Preferably, the period of the first phase segment is derived based on the times of the first time, in particular the maximum inhalation, and the second time, in particular the maximum exhalation. In particular, the beginning of the first phase segment is determined based on one of the times consisting of the first time and the second time, and the end of the first phase segment is determined based on the other time, i.e., the second time or the first time.

[0062] Advantageously, the first time point of a phase segment also corresponds to one of the start and end of the phase segment, and the second time point of the phase segment corresponds to the other of the start and end of the phase segment. However, the inventors have recognized that such a correspondence is not necessarily the case. Rather, a divergence can often be detected between the actual start of the phase segment and, for example, the first time point or second time point. The reason for this lies in the measurement method used to record breathing and thus the breathing curve from which the phase segments are determined. Depending on the measurement method, the effects of an effect that actually underlies the maximum value, namely maximum inspiration, are only present or measurable with a time delay.Therefore, it may be necessary to determine both the beginning and the end of the phase segment, in order to determine the period of the phase segment in which the reference time should lie, based on both the first time point and the second time point, or on the basis of a first or second time point of a previous or subsequent phase segment. For this purpose, it may be necessary to apply a predetermined weighting to the values ​​used, the first and second time points of the phase segments involved. This weighting depends, for example, on the method used.

[0063] For example, a time center can be determined for the predetermined weighting.

[0064] For the weighted time center, for example, the time interval between the first and second time points used, in particular the maximum exhalation and maximum inspiration, is used. Furthermore, offset corrections of the method used to determine the first and second time points, in particular the maximum inspiration and maximum exhalation, are used for the weighted time center. These can either be specified by the manufacturer or determined experimentally.

[0065] The inventors recognized that when recording the respiratory curve and the maximum inspiration and maximum expiration, the length of the breathing and the measurement method can lead to a temporal offset between the recorded times of the maximum inspiration and maximum expiration. For example, the respiratory curve can be determined from an ECG curve or using an acceleration sensor. If the ECG is used, the times of the maximum inspiration and maximum expiration can be determined using the RR intervals, for example. However, the RR intervals are sinusoidal, for example, and therefore do not indicate different breathing lengths and, in particular, do not indicate the fact that an inspiration phase can be longer or shorter (usually shorter) than an expiration phase. The problem with a measurement using an acceleration sensor is that, for example, a short pause in breathing occurs after the expiration phase.However, an acceleration sensor can only detect changes and can therefore only record the maximum time with an offset.

[0066] These phenomena are accounted for by the weighted time center. This can be determined either by estimation or by experimental methods using a calibration. For this purpose, the actual recording of the respiratory curve is compared with an absolute measurement method of the respiratory curve, and a corresponding calibration is established.

[0067] For example, a first phase segment is determined from the recorded maximum inhalations and maximum exhalations, in which the first reference time also lies. Furthermore, a second phase segment is determined from the recorded maximum inhalations and maximum exhalations, in which the second reference time also lies. In order to determine and advantageously output a respiration-corrected blood pressure value, at least two first blood pressure values ​​are determined, each of which represents blood pressure values ​​within a phase segment of respiration during maximum exhalation and maximum inspiration.

[0068] According to the invention, the blood pressure value assigned to the first time point of the first phase segment in the individual value measurements or a blood pressure value determined on the basis of the blood pressure value assigned to the first time point of the first phase segment is determined as the first of the at least two respiration-corrected first blood pressure values. In particular, the first of the at least two respiration-corrected first blood pressure values ​​is a respiration-corrected first blood pressure value at maximum inspiration. In particular, the respiration-corrected first blood pressure value at maximum inspiration is a respiration-corrected first systolic blood pressure value at maximum inspiration.

[0069] According to the invention, the blood pressure value assigned to the second time point of the first phase segment in the individual value measurements or a blood pressure value determined based on the second time point of the first phase segment is determined as the second of the at least two respiration-corrected first blood pressure values. In particular, the second of the at least two respiration-corrected first blood pressure values ​​is a respiration-corrected first blood pressure value at maximum exhalation. In particular, the respiration-corrected first blood pressure value at maximum exhalation is a respiration-corrected first systolic blood pressure value at maximum exhalation.

[0070] It is also possible to determine respiration and thus the phase segments using a different method, in particular based on time-resolved values ​​from individual measurement values ​​taken within the measurement period by a second sensor, in particular a second device. This can be done, for example, using an ECG measurement. In this case, the values ​​of the individual measurement used to determine the blood pressure value are measured using a first device, and the measurement for the phase segments is performed using a second device, namely an ECG.

[0071] Determining respiration and phase segments using an ECG is well known in the art. Respiration is determined from changes in the cardiac interval. The cardiac interval is determined for each heartbeat. The basis for this is data depicting the heart pulse. These are typically recorded using an ECG or PPG. However, a variety of other sensors also allow for usable imaging of the heart pulse, e.g., temperature measurements, polymer pressure sensors, or even ultrasound sensors. This data is analyzed for a distinctive feature within the image of the heart pulse, so that one such feature is found for each heart pulse. The time interval between two consecutive points in time at which such a feature is found is the cardiac interval.If ECG data is used as the data basis, the distinctive feature is typically the R-wave, and the cardiac interval is called the RR interval. If the duration of the cardiac intervals is plotted on a graph at the times of the corresponding cardiac pulse, local minima and maxima can be identified. The times of the local minima indicate the times of maximum inspiration, while the times of the local maxima indicate the times of maximum expiration.

[0072] If at least two respiration-corrected second blood pressure values ​​are also to be determined and a second phase segment and a second reference time point have been determined, the blood pressure value assigned to the first time point of the second phase segment in the individual value measurements or a blood pressure value determined based on the blood pressure value assigned to the first time point of the second phase segment is determined as the first of the at least two respiration-corrected second blood pressure values. In particular, the first of the at least two respiration-corrected second blood pressure values ​​is a respiration-corrected second blood pressure value at maximum inspiration.In particular, the respiration-corrected second blood pressure value at maximum inspiration is a respiration-corrected second diastolic blood pressure value at maximum inspiration, and the blood pressure value assigned to the second time point of the second phase segment in the individual value measurements or a blood pressure value determined on the basis of the second time point of the second phase segment is determined as the second of the at least two respiration-corrected second blood pressure values. In particular, the second of the at least two respiration-corrected second blood pressure values ​​is a respiration-corrected second blood pressure value at maximum expiration. In particular, the respiration-corrected second blood pressure value at maximum expiration is a respiration-corrected second diastolic blood pressure value at maximum expiration.

[0073] In particular, it is conceivable that the blood pressure value determined based on the respective time point of the respective phase segment is determined based on a pressure correction. For the pressure correction, the values ​​of the individual measurement values ​​that have changed due to the varying pressure are corrected by the pressure factor, for example, using a linear regression based on the predetermined pressure change rate or a bandpass filter.

[0074] The method according to the invention therefore makes it possible, in particular, to determine and output a blood pressure value as a function of respiration. A value at maximum exhalation or maximum inhalation is generally particularly meaningful, since in these two states the maximum effects towards higher or lower blood pressure values ​​are present. Advantageously, at least the first and second respiration-corrected first blood pressure values ​​are output. However, it is also conceivable to output at least one respiration-corrected first blood pressure value based on the first and second respiration-corrected first blood pressure values. For this purpose, for example, the first and second respiration-corrected first blood pressure values ​​could represent the basis for a, in particular factored, mean value.

[0075] The methods according to the invention, when used alone, are primarily intended to improve the quality of a measurement compared to the methods based on Riva Rocci in use today and to provide new measured values ​​that the previously known measuring methods cannot provide. The methods according to the invention can therefore either be carried out with a device that is optimized for the method or can be integrated into existing systems. Existing systems must meet requirements regarding pump performance and valve control and have a suitable calculation unit. Conventional upper arm and forearm cuff systems according to the state of the art are generally not suitable for carrying out the method due to limited hardware, but can usually be enabled with comparatively little effort through the use of modern pumps and calculation units.Today's smartwatches that have cuff measurement are usually already capable of this procedure.

[0076] The improvement in the quality of the blood pressure values ​​measured compared to the state of the art is based on the following: If several measurements are carried out consecutively using the state of the art technology, it can be observed that different values ​​are generally output, even though the cuff has not been moved or otherwise altered and the same measurement method was used with the same optimal user behavior. The reasons for this are manifold, but are not taken into account in the previously known methods due to the process steps and instead lead to systematic deviations: 1 . Change in blood pressure due to changes in the excitation state of the

[0077] User (white coat syndrome). For example, an elevated blood pressure reading is to be expected during the first and subsequent measurements if the user is unfamiliar with the measurement method. Respect for the measurement is higher during the first measurement, which leads to an increase in blood pressure during the first measurement compared to subsequent measurements.

[0078] 2. Adaptation of the body to the measurement. By the initial stress on the

[0079] Body through the cuff, the arteries adapt to counteract the pressure from outside.

[0080] 3. Irregular heartbeat can lead to misinterpretation of blood pressure.

[0081] 4. Influence of breathing on blood pressure and the choice of heart rate for

[0082] Measurement.

[0083] Only the first point is a "true" change in blood pressure. A true change in blood pressure is defined as a change in blood pressure due to a change in the blood pressure within the cardiovascular system. The other points (2 to 4), on the other hand, are changes due to influences that should not result in a change in blood pressure originating from the heart, but which, according to the current state of technology, lead to a change in the detectable result, for example, because an averaging process takes place that includes different situations according to reasons 2 to 4 (e.g., different respiratory cycles or an irregular heartbeat involved in the averaging).

[0084] The invention presented here solves this problem, for example, by not considering an average of the heartbeats, but preferably by including each heartbeat in the measurement period, which corresponds to the period for individual value measurements using conventional cuff measurement methods and also includes the pressure change phase, and by recording the influence of respiration. The special feature of the invention is therefore, among other things, that in addition to the values ​​assigned to the blood pressure values, further information is incorporated that can have an effect on the values ​​assigned to the blood pressure value during the same measurement period, namely, for example, respiration.

[0085] State-of-the-art measurement methods also exhibit measurement inaccuracies in the case of irregular heartbeats (e.g. arrhythmias). This is because modern systems assume that blood pressure remains constant over the measurement period. This is not the case with arrhythmias; here, each heartbeat can have a different blood pressure. It is a health concern if pauses in the heartbeat are too long or if individual heartbeats have very high blood pressure values. It is precisely these isolated pressure peaks that can cause individual arteries to burst, which can lead to illnesses such as clots in the brain. Recording multiple heartbeats, as with the method according to the invention, makes it possible to detect and classify arrhythmias. Arrhythmias are not necessarily considered a disease; our own studies have shown that arrhythmias occur more frequently in athletic young people.Other studies indicate that up to 1.1% of the population suffers from arrhythmias. The classification of an arrhythmia depends on its frequency and whether a pattern or regularity can be identified. Depending on the classification of an arrhythmia, the procedure can then formulate the blood pressure of individual heartbeats into a meaningful result and / or issue a corresponding warning about the arrhythmia.

[0086] Since every heartbeat in particular is recorded during the measurement period, the method presented here can record additional measured values ​​in addition to the actual blood pressure values. This data includes values ​​for respiration, heartbeat, blood pressure curves and illnesses. The precise breakdown of the measured variables is explained in more detail in a subsequent section. Another application of the invention presented here can be in conjunction with other measuring devices. These are, on the one hand, devices for recording the heart pulse, such as an ECG or devices based on light waves, and, on the other hand, devices that enable continuous blood pressure measurement. With the help of devices for recording the heart pulse, other medical diagnostics can be carried out. Outside of extreme situations, such as atrial fibrillation, it is assumed in medical practice that each QRS complex in the ECG is followed by a cardiac activity.However, studies by the inventors have shown that this is not the case. In arrhythmias, for example, shortened RR intervals can occur. In some subjects, it can be seen that the second QRS complex of such a shortened RR interval does not lead to a detectable pulse, or only to a limited extent. However, in other subjects with initially apparently similar symptoms, a pulse can be measured.

[0087] In conjunction with temperature measurements, changes in the vascular condition can be detected. Investigations of the invention using temporally and high-resolution temperature measurement methods have shown that, for example, during physical activity, temperature jumps occur during periods of stress and relief.

[0088] However, the method presented here will primarily be used in conjunction with other devices for continuous blood pressure measurement. These devices are based on recording other vital data and converting it into a blood pressure value with the help of calibration. Systems that can measure blood pressure continuously already exist today. However, these systems are very inaccurate and / or require complicated interaction with the user for calibration. For example, the determination of continuous blood pressure values ​​from the pulse wave transit time has been known for many years. Calibration requires two blood pressure measurements, one at normal blood pressure and one at elevated blood pressure, which must be recorded at different times due to the changing blood pressure of the person being measured. In some of today's systems, the elevated blood pressure is generated, for example, by sporting activity.To perform a "good" calibration, a significant change in blood pressure is required due to the measurement inaccuracies and influences described above. This places considerable stress on the user and leads to measurement errors, as a measurement taken during or shortly after strenuous physical activity is inaccurate due to movement and increased heart rate.

[0089] Calibration is necessary because the correlation between vital signs and blood pressure varies from person to person and depends on factors such as health status, body weight, and fluid balance. Thus, a change in the correlation over the course of a few days is conceivable, and calibration would have to be repeated at least daily. This demonstrates that current systems are either unsuitable for everyday use or inaccurate.

[0090] The invention presented here circumvents these problems. The method according to the invention preferably determines the blood pressure for each heartbeat within the measuring phase, which corresponds to the period of individual value measurements using conventional cuff measuring methods and also includes the pressure change phase. This period is also referred to below as the measuring period. The inventors have recognized that such a measuring phase comprises one or more breaths. The inventors have therefore recognized that a change in blood pressure is caused by breathing alone and that the prerequisite for calibration with a high and a low blood pressure value could therefore already be met by a measurement under normal stress. The method according to the invention determines, for example, the highest and lowest blood pressure values ​​within breathing, the breathing cycle, together with the times of the heartbeats from which these values ​​are derived.This represents the first part of the invention. The other part is provided by the device for continuous blood pressure measurement. For a device based on pulse transit time, this is the pulse transit time at the same time points. The result of calibration in this case is an inverse linear relationship between pulse transit time and blood pressure, so that a blood pressure value can be determined for each additional pulse transit time value. Current systems for continuous blood pressure monitoring of this type, such as CNAP from Dräger, can currently only perform a trend measurement. Using this method, these systems could also determine absolute values. The method therefore also represents added value in the clinical field.

[0091] In a further application, more than one device operated with the method can be used on different extremities. By comparing the image of the pulse waves between the extremities, e.g. the two legs or arms, it can be determined whether the blood flow in one of the extremities is impaired, e.g. due to arteriosclerosis. In addition to these asymmetries in the bloodstream, which might not be detected with one-sided measurements, other parameters such as the stiffness of the arteries, the elasticity of the blood vessels, heart rate variability and other important cardiovascular parameters can be measured. Additional parameters such as the pulse wave transit time or the location of a vascular disease can be recorded if more than one device is attached to an extremity or if the position of a device is varied.Similar products in this regard, which can be surpassed by their easier handling and the recording of other parameters (e.g. regarding respiration), are CardioScreen from medis or PhysioFlow from Manatee Biomedica.

[0092] In contrast to the prior art, in which the influence of breathing is viewed as a disruptive factor and averaging leads to systematic, arbitrary deviations and incorrect values, the method according to the invention is intended to detect the influence of breathing so that the influence of breathing can be displayed when the measured values ​​are output. The prior art allows a cuff to be used to determine a measured value tuple consisting of one value each for systole, diastole and pulse for a measurement. Furthermore, other measured variables such as pulse pressure and RR interval can be derived, although these can also only be determined once per measurement. A measurement with a state-of-the-art cuff takes 30-90 seconds depending on the design and the existing blood pressure, see Fig. 1.For this reason, the values ​​for systole and diastole usually come from different heartbeats, as the measurement times of the individual values ​​are typically 10-30 seconds apart. Furthermore, depending on the manufacturer, blood pressure fluctuations due to respiration lead to arbitrary, albeit systematic, deviations and inaccurate values. All state-of-the-art measuring devices have in common that the influence of respiration is interpreted as a disturbance, and a value that takes the effect of respiration into account is not included in the measured value tuple.

[0093] By detecting or using respiration, the invention also makes it possible to make blood pressure measurement more accurate and to provide more information about the cardiovascular system.

[0094] Preferably, the following measured variables can also be collected based on the invention, in particular from the values ​​of a cuff measurement, i.e. from air pressure values ​​of the cuff measurement:

[0095] 1. Measurements that are comparable to the state of the art cuff measurements, but surpass them by better defining the user's condition at the measurement point:

[0096] - Diastole averaged over respiration;

[0097] Systole averaged over respiration;

[0098] - Pulse / heartbeats per minute averaged over respiration;

[0099] - Detection of the presence of arrhythmias;

[0100] 2. Measurements that cannot be measured using the state-of-the-art cuff measurement technology:

[0101] - Respiratory parameters:

[0102] • Respiratory rate / breaths per minute;

[0103] • Time of inspiration, e.g. the first time point of a phase segment;

[0104] • Time of exhalation, e.g. the second time point of a phase segment;

[0105] • Synchronicity with the heart pulse;

[0106] - continuous values ​​during the pressure change phase for the measured variables diastole and systole: • The determination of more than one measured value for diastole and systole for each heartbeat in parallel with the measurement, from the same pressure curve;

[0107] • Assignment of the individual measured values ​​to the phase of breathing;

[0108] - Characteristic values ​​for the measured quantities diastole and systole:

[0109] • Position within the breathing phase

[0110] • Value at a given position within the breathing phase

[0111] • Maximum and minimum value within the respiration

[0112] - Heart rate parameters:

[0113] • It is possible to determine measurements of the heart rate for each heartbeat during the period in which the pressure curve shows variations;

[0114] • Heart rate variability;

[0115] • The severity and classification of arrhythmias;

[0116] • Value at a given position within the breathing phase;

[0117] • Maximum and minimum value within the respiration;

[0118] - Illustration of the blood pressure curve for part of the measurement period:

[0119] • Presence of reflection waves;

[0120] • Augmentation by reflection waves;

[0121] • The change of augmentation by breathing;

[0122] • In the case of arrhythmias, the pressure level of the heartbeats affected by the arrhythmia can be used to determine the functionality of the heart valves;

[0123] • Imaging of cardiac fibrillation and atrial flutter;

[0124] • Response of heart rate to medication.

[0125] It is possible for the values ​​that can be assigned to the blood pressure value and the respirations to be based on two different output data sets that were recorded and / or determined by different sensors or devices, e.g. a first and a second device. For example, the measurement of individual values ​​of the values ​​assigned to the blood pressure value can be carried out using a cuff, a first device, whereby these individual values ​​are part of a first output data set, and the measurement of the respiratory cycle can be carried out using another device, a second device, whereby the values ​​of the respiratory cycle are part of a second output data set. However, it is also possible, and this is even preferred, provided that both the values ​​assigned to the blood pressure value and the values ​​for the respiratory cycle are recorded using the same device, the first device, thus requiring only one output data set.However, it is essential for both embodiments that the data sets cover the same measurement period and, if possible, the same time resolution, preferably with the same points in time.

[0126] In principle, the value associated with the blood pressure can be recorded using any suitable device. Likewise, respiration and respiratory cycles can be recorded or determined using any suitable device. However, preferably, at least the value associated with the blood pressure is recorded using a cuff.

[0127] Advantageously, the first sensor comprises a pressure sensor, in particular an air pressure sensor, or a sensor for measuring electrical voltage or electrical resistance. In particular, the first device is a pressure cuff, in particular an automated one. Advantageously, the value of the individual measurements is a pressure value, in particular an air pressure value, or a pressure value determined based on a measurement of an electrical voltage or electrical resistance, in particular one caused by the piezoelectric effect.

[0128] Advantageously, the phase segments, in particular the first phase segment, in particular the first and second points in time of the phase segments, in particular the first and second points in time of the first phase segment, in particular the respiration and / or the respiration curve, are determined by means of a second sensor, in particular a second device, wherein the second sensor is part of an ECG or an impedance sensor, a light wave-based sensor, in particular as part of a PPG or SpO2 measuring device, a microphone, an acceleration sensor, an ultrasonic sensor or a temperature sensor. In this case, in particular two data sets are then recorded with different devices. Alternatively, the first sensor advantageously comprises a pressure sensor, in particular an air pressure sensor, or a sensor for measuring electrical voltage or electrical resistance.In particular, the first device is a pressure cuff, in particular an automated one, and advantageously, the phase segments, in particular the first phase segment, in particular the first and second times of the phase segments, in particular the first and second times of the first phase segment, in particular the respiration and / or the respiration curve are determined from the values ​​of the individual measurement values ​​acquired with the first sensor. In this case, in particular, a data set is acquired with the same sensor.

[0129] The following table shows possible combinations of sensors or combinations of data sets and their origins to record, on the one hand, the individual values ​​that can be assigned to the blood pressure value and, on the other hand, the respiration or breathing cycles. Here, the preferred method of measuring individual values ​​that can be assigned to the blood pressure value, namely cuff measurement, is used:

[0130] Variant Determination of pressure Determination of respiration values ​​using: using:

[0131] 1. Cuff ECG

[0132] 2. Cuff light wave based sensor

[0133] 3. Cuff Cuff

[0134] 4. Cuff acceleration sensor

[0135] 5. Cuff microphone

[0136] 6. Cuff Ultrasound

[0137] 7. Cuff temperature

[0138] 8. Cuff impedance measurement

[0139] What all of the above variants have in common is that the pressure values ​​are derived from a cuff measurement. Depending on its shape, the cuff can be used at different positions on the body, e.g. on the wrist or on the upper arm. For this purpose, the pressure in the cuff is measured and simultaneously changed. The output values ​​for determining respiration are based on the analysis of the changes in the respective signals. The sensors can be combined with the cuff in a device, e.g. in the form of a wristband, or can be worn at other locations on the body relative to the cuff, connected to appropriate data interfaces. The exact logic or procedural steps for determining respiration from the individual output signals, as well as for determining the pressure values ​​and comparing the pressure values ​​with respiration, are described in a later section.

[0140] From the user's perspective, the method according to the invention is particularly comparable to previously known measurements and methods using an automated cuff. The invention can be used when the pressure in the cuff is increasing or decreasing. Use with increasing pressure is preferable, as this allows for a shorter measurement time and thus less stress for the user. In the simplest case, the pressure change is carried out, in particular linearly, typically with a pressure change between 1 and 20 mmHg / s, in particular between 1 and 10 mmHg / s, in particular of approximately 5 mmHg / s. If higher quality measurement results are required, a lower pressure change rate of, for example, 1 mmHg / s is necessary. A lower rate can also be used so that values ​​for diastole and systole can be recorded continuously over a longer period of time.This is an assessment of the strain on the user and the quality of the measured values. Preferably, however, the rate of pressure change should be dynamically adjusted during the measurement. When measuring while the pressure is increasing, a high pressure change rate can initially be selected from the unstressed state (e.g. 10 mmHg / s) in order to find the contact between the cuff and the skin. Then, at a lower rate (e.g. 7 mmHg / s), the lowest pressure is found at which a rhythmic change in the pressure curve due to the heart rate can be recognized; with a suitable choice of pressure sensor, this can already be below the diastole pressure. Following this is the actual measuring phase; here the pressure is changed depending on the measurement objective. This phase particularly includes the measuring period. If the objective is to obtain only one value for diastole and systole as quickly as possible, a pressure change of, for example, 5 mmHg / s can be selected.The other end of the pressure change requirement is the representation of the pressure curve within the heart pulse; for this, for example, a pressure change rate of 1 mmHg / s is preferable. The measurement is finished when no variations due to the heart pulse or only slight variations in the pressure curve can be seen. When using the invention to reduce pressure, the pressure is first increased to a high pressure, typically with the maximum power of the pump but no more than 15 mmHg / s, e.g. 200 mmHg. Depending on the technical equipment, the pressure can be changed at a predetermined pressure change rate. Technically, this can be achieved using a variable valve, multiple valves for different rates, or one (or more) valves while using the pump at a lower power.Typically, however, only a fixed, non-variable valve is used these days, which can reduce the pressure almost evenly over the typical measuring range (40-200 mmHg). If variable pressure reduction is possible, after inflation the pressure is initially released quickly (e.g. at -7 mmHg / s) in order to find the pressure at which changes in the pressure curve due to the heart rate can already be detected. With a suitable sensor selection this can already be above systole. However, if a pulsation is already detectable at the starting pressure, further pumping is necessary. The precise method for finding this starting pressure is described in the state of the art and is only summarized here. If a pulsation is also detectable after the first pressure increase, the starting pressure must be increased again. This process is repeated until either a suitable starting pressure is found or until a maximum pressure is reached (e.g. 300 mmHg).The determination of the starting pressure can be further optimized by determining the strength of the pressure variation due to the heart rate at the current starting point. A suitable pressure increase for the starting pressure point can now be determined from empirical measurements. If the initial pressure of the pressure pulsation is found to be above systole, the pressure reduction rate is reduced to a lower (absolute) value, depending on the measurement requirements; see above for pressure increase. If no or only slight pulsation is detected (the pressure is now below diastole), the pressure can be released at the maximum rate.

[0141] At the same time as the pressure measurement (i.e., the individual value measurements), the baseline values ​​for determining respiration are measured, i.e., within the same measurement period. If other methods for determining respiration are used, these can either be integrated into the cuff itself, so that optimal positioning is achieved when the cuff is applied. With external devices, these are applied according to the respective device specifications. What both device types have in common is that the individual sensors can also be dynamically and automatically regulated.

[0142] The variations presented in the table above are conceivable, although other combinations are also possible.

[0143] ECG (variant 1) or impedance (variant 8) does not require any further regulation. With light wave-based variants (variant 2), which include variants such as PPG or SpO2 measuring devices, the brightness can be regulated by regulating the electrical current for generating the light. If the light wave measurement is integrated into the cuff, the signal becomes weaker with increasing pressure and cannot detect a heart pulse if the blood flow has come to a standstill. It is therefore advisable to increase the brightness at higher pressures in order to obtain a good output signal. The brightness should not be changed too much or unevenly. If the detection of respiration is based solely on the change in the RR interval, a greater change is possible (e.g. 0.5 mA / s with typical green LEDs).If respiration detection is also based on the assessment of pulse rate, the change in light intensity must not be so high (e.g., 0.1 mA / s). Cuff (variant 3) does not allow further adjustment, as it is already used to measure pressure. Acceleration sensor (variant 4) requires no further adjustment. Microphone (variant 5) can be adjusted by adjusting the sensitivity. If the microphone is used below the cuff, the adjustment is analogous to that for light waves. Ultrasound (variant 6) can be adjusted with regard to output power and reception sensitivity. Here, too, the adjustment is analogous to that for light waves.

[0144] For methods 1, 2, 5, 6, 7, and 8 for detecting respiration, three basic data sets are typically used: 1. Change in the heart rate interval; 2. Change in the maximum or minimum measured values ​​within the heart rate; 3. Adjustment of parameters that adapt the sensor technology. For all methods (except 3), a measured value curve filtered with a low-pass filter can also be used. The filtering is selected so that respiration is determined from local minima and maxima of the measured value curve.

[0145] Advantageously, a pressure-corrected intensity curve is determined from the individual measurement values ​​using a regression line or a bandpass filter to correct for the varying pressure. This method is also partly known from the prior art and is used in this way.

[0146] Advantageously, changes in the values ​​of the individual measurements are determined. These changes in the values ​​are changes occurring over time within the measurement period. These changes are determined, for example, from a mathematical derivative of the values ​​of the individual measurements, a derivative over time, i.e., as a function of time. Alternatively, but at least less preferred at present due to inaccuracies, the changes can also be determined using a filter, particularly a bandpass filter, or by subtracting a best-fit line.

[0147] A change progression curve is then determined from the aforementioned changes, and from this, the phase segments, in particular the first phase segment, and the first and second points in time of each phase segment can be determined. In particular, the start and end of each phase segment and / or the period of each phase segment can be determined from the change progression curve.

[0148] Advantageously, for the determination of the phase sections from the aforementioned change curve, several local extrema, namely local maxima and local minima, in particular in the change curve, are determined.

[0149] Advantageously, a first and a second best-fit curve are determined from the local extrema to determine the phase segments. The first best-fit curve is formed as a best-fit curve based on the points of the local maxima, in particular all of the local maxima adjacent over time. Furthermore, the second best-fit curve is formed as a best-fit curve based on the points of the local minima, in particular all of the local minima adjacent over time. Advantageously, the first best-fit curve and the second best-fit curve form an envelope around the local extrema, i.e. the local minima and local maxima. Advantageously, several local maximum distances, for example all those recorded during the measurement period, and several local minimum distances, for example all those recorded during the measurement period, are determined between the first best-fit curve and the second best-fit curve.In particular, a distance is formed at at least one point in time, in particular at each point in time, within the measurement period by the difference value of an envelope of the local maxima and the value of the envelope of the local minima.

[0150] Advantageously, the phase segments, in particular their time period, in particular their beginning and end, are determined by the time of two successive local minimum or maximum distances over time. The local maximum distance within the first phase segment is advantageously determined as the maximum inhalation of the first phase segment. Furthermore, the time of this local maximum distance is advantageously determined as the first time point. The local minimum distance within the first phase segment is advantageously determined as the maximum exhalation of the first phase segment. The time of this local minimum distance is advantageously determined as the second time point.

[0151] Alternatively or additionally, to determine the phase sections, a time interval between the two local extrema that are adjacent in time is determined from the time interval between two local extrema that are adjacent in time, wherein each phase section, in particular its start and end, is determined by two successive local largest time intervals of the time intervals in time, and the local largest time interval within the respective phase section and the time of the local largest time interval within the phase section are determined as the first time point as the maximum inhalation of the respective phase section, and a local smallest time interval of the time intervals within the respective phase section and the time of the local smallest time interval within the phase section are determined as the second time point as the maximum exhalation of the respective phase section.

[0152] Advantageously (as already indicated above) a first plurality of the at least two respiration-corrected first blood pressure values ​​of the person are determined as continuous first blood pressure values. In the interests of easier differentiation, this can be referred to as recording several individual value measurements within a second measuring period. The first measuring period differs from the second measuring period in that in the first measuring period the pressurization can only be a continuously and monotonically increasing pressurization or alternatively a continuously and monotonically decreasing pressurization. It is conceivable that the recording of several individual value measurements within a second measuring period takes place by a second sensor of the device or by a sensor of a second device. Furthermore, a third plurality of phase segments can preferably also be determined.Preferably, each blood pressure value of the first plurality can then be assigned to a respective cardiac cycle of the person. In particular, each phase segment of the third plurality of phase segments can have at least two of the at least two respiration-corrected first blood pressure values ​​of the first plurality.

[0153] Advantageously, during continuous blood pressure determination, changes, particularly gradients, in the values ​​of the individual measurements are determined. These changes are derived from the values ​​of the individual measurements, particularly those exhibiting the varying pressure loading, and are changes in the values ​​of the individual measurements that are independent of the varying pressure loading, i.e., they do not include, for example, the linear increase in the pressure loading. Such change values ​​can be determined in particular by means of a mathematical derivation of the values ​​of the individual measurements over time. An intensity curve can be determined from these change values. This intensity curve can be identical to the change curve mentioned above.

[0154] This intensity curve then has a plurality of local extrema. In particular, the intensity curve has a plurality of, in particular at least two, in particular at least three, in particular at least six, local minima and a plurality of, in particular at least two, in particular at least three, in particular at least six, local maxima. A local minimum and a local maximum are to be understood in particular as a mathematical local minimum or maximum. In particular, a local maximum has an individual value of the changes which is the largest individual value of the changes compared to the immediately preceding and subsequent individual values. In particular, a local minimum has an individual value of the changes which is the smallest individual value of the changes compared to the immediately preceding and subsequent individual values.

[0155] The intensity curve differs from the pressurization-corrected intensity curve in that the intensity curve considers the changes in the slope of a curve from the values ​​of the individual value measurements, i.e. in the simplest case the mathematical derivation of the curve is considered, and the pressurization-corrected intensity curve considers the absolute values ​​minus the pressurization.

[0156] To determine the pressurization-corrected intensity curve, changes, in particular gradients, in the individual value measurements that are independent of the varying pressurization are advantageously determined from the values ​​of the individual value measurements exhibiting the varying pressurization. This determination can be carried out, for example, using a bandpass filter, in particular a digital one, or based on a regression line or a derivative of the course of the individual value measurements as a function of time, in particular a first mathematical derivative. According to the invention, a course of the individual values ​​of the changes is formed from the changes thus determined and determined as a pressurization-corrected intensity curve. This pressurization-corrected intensity curve then has several local extrema.In particular, the intensity curve has a plurality of, in particular at least two, in particular at least three, in particular at least six, local minima and a plurality of, in particular at least two, in particular at least three, in particular at least six, local maxima. A local minimum and a local maximum are to be understood in particular as a mathematical local minimum or maximum. In particular, a local maximum has an individual value of the changes which is the largest individual value of the changes compared to immediately preceding and subsequent individual values. In particular, a local minimum has an individual value of the changes which is the smallest individual value of the changes compared to immediately preceding and subsequent individual values.

[0157] If a first device, in particular a cuff, is used which has a narrow pressurisation surface, in particular a cuff width, in particular a cuff width of less than ten centimetres, in particular less than six centimetres, in particular less than five centimetres, in particular a maximum of four centimetres, in particular three centimetres, and / or of at least 0.1 mm, in particular at least 1 mm, in particular at least 1 cm, it can be provided according to the invention that, based on the intensity curve, a device width-corrected, in particular cuff width-corrected, intensity curve comprising the plurality of local extrema is determined. The local extrema are generally local maxima and local minima, wherein the extrema are then used to form the approximate straight lines.

[0158] If a cuff is used as the first device, the device width corrected intensity curve represents a cuff width corrected intensity curve.

[0159] The determination of the fixture-width-corrected intensity curve is based on the values ​​of the individual value measurements, which represent the starting point. Therefore, for the determination of the fixture-width-corrected intensity curve, the intensity curve based on the values ​​of the individual value measurements can be used, which, in particular, shows changes independent of the varying pressure application. However, other values ​​based on the values ​​of the individual value measurements can also be used.In particular, to determine the device-width-corrected intensity curve, an intensity curve is first determined by this intensity curve representing the first mathematical derivative of the values ​​of the individual measurement values ​​represented as an extrapolated curve. Thus, the intensity curve is determined using the first mathematical derivative of the values ​​of the individual measurement values ​​as a function of time. The intensity curve thus determined exhibits several local extrema, namely local maxima and local minima.

[0160] Advantageously, a first, second and third lower approximation line and a first, second and third upper approximation line are formed to determine the device width-corrected, in particular cuff width-corrected, intensity curve.

[0161] Advantageously, to form the device width-corrected, in particular cuff width-corrected, intensity curve, individual values ​​of the device width-corrected intensity curve are formed by multiplying the individual values ​​of the intensity curve by a time-dependent width correction factor, wherein the width correction factor is based in particular on a standardized difference, wherein the difference is a difference between the individual values ​​of the first, second and third lower approximation lines present at the respective times and the individual values ​​of the first, second and third upper approximation lines present at the respective times and is standardized by a standardization parameter.

[0162] Advantageously, the first upper approximation line is formed from the local maxima of the intensity curve present in a first time period. Advantageously, the second upper approximation line is formed from the local maxima of the intensity curve present in a second time period. Advantageously, the third upper approximation line is formed from the local maxima of the intensity curve present in a third time period. Advantageously, the first lower approximation line is formed from the local minima of the intensity curve present in a fourth time period. Advantageously, the second lower approximation line is formed from the local minima of the intensity curve present in a fifth time period. Advantageously, the third lower approximation line is formed from the local minima of the intensity curve present in a sixth time period.The lower approximation lines are thus assigned to the local minima of the intensity curve present in different time periods, and the upper approximation lines are assigned to the local maxima of the intensity curve present in different time periods. The beginning and end of the first, second, third, fourth, fifth, and sixth time periods lie within the measurement period.

[0163] The beginning of the first period is before the beginning and end of the second period and the third period, and the beginning of the fourth period is before the beginning and end of the fifth period and the sixth period. Furthermore, the end of the third period is after the beginning and end of the first period and the second period, and the end of the sixth period is after the beginning and end of the fourth and fifth period.

[0164] Advantageously, the beginning of the first time period coincides with the beginning of the fourth time period. Advantageously, the end of the third time period coincides with the end of the sixth time period.

[0165] Furthermore, the beginning of the second time period preferably corresponds to the end of the first time period and the end of the second time period corresponds to the beginning of the third time period and the beginning of the fifth time period corresponds to the end of the fourth time period and the end of the fifth time period corresponds to the beginning of the sixth time period.

[0166] Furthermore, the end of the first time period and the beginning of the third time period are selected such that the second upper approximation line has the minimum deviation from the local maxima present within the second time period, and the end of the fourth time period and the beginning of the sixth time period are selected such that the second lower approximation line has the minimum deviation from the local minima present within the fifth time period.

[0167] Advantageously, the second upper approximation line is formed for the local maxima of the local extrema of the device width-corrected intensity curve present in the third and / or second time period.

[0168] Advantageously, the first upper approximation line is formed to the local maxima of the local extrema of the device width-corrected intensity curve present in the first time period.

[0169] Advantageously, the second lower approximation line is formed from the local minima of the local extrema of the device-width-corrected intensity curve present in the sixth and / or fifth time period. Advantageously, the first lower approximation line is formed from the local minima of the local extrema of the device-width-corrected intensity curve present in the fourth time period.

[0170] Advantageously, the normalization parameter is based on the difference between the lower and upper approach lines at the beginning of the second time period and the difference between the lower and upper approach lines at the beginning of the fifth time period.

[0171] Advantageously, the intensity curve, in particular one corrected for device width, has at least six local maxima, each with a largest individual value of the intensity curve, in particular one corrected for device width, compared to immediately preceding and subsequent individual values, and at least six local minima, each with a largest individual value of the intensity curve, in particular one corrected for device width, compared to immediately preceding and subsequent individual values.

[0172] If the first device provides a sufficiently wide pressure application area, the subsequent process step can be carried out using the values ​​of the intensity curve; otherwise, the values ​​of the device width corrected intensity curve, and not the non-device width corrected intensity curve, should be used in the subsequent process step.

[0173] According to the invention, in a further method step, at least one, preferably at least two, upper approximation lines and at least one, preferably at least two, lower approximation lines are formed. The at least one upper approximation line is formed as an approximation line to the maxima of the local extrema of the intensity curve, in particular the device width-corrected one, present in the measurement period. In particular, the formation of the at least one upper approximation line is based on a regression line, in particular a linear one. The at least one lower approximation line is formed as an approximation line to the minima of the local extrema of the intensity curve, in particular the device width-corrected one, present in the measurement period. In particular, the formation of the at least one lower approximation line is based on a regression line, in particular a linear one.Preferably, at least two upper and at least two lower approximation lines are formed. The first upper approximation line comprises local maxima that occur at an earlier time and / or at lower pressures in the values ​​of the individual measurements assigned to the blood pressure values ​​and / or at lower pressurization than the local maxima on which the second upper approximation line is based. Furthermore, the first lower approximation line comprises local minima that occur at an earlier time and / or at lower pressures in the values ​​of the individual measurements assigned to the blood pressure values ​​and / or at lower pressurization than the local minima on which the second lower approximation line is based.

[0174] In a further method step, to determine the first plurality of at least two respiration-corrected first blood pressure values, i.e., the continuous respiration-corrected first blood pressure values, the individual values ​​of the intensity curve, in particular the device-width-corrected one, are standardized and scaled according to the invention. The standardization is based, in particular, on a difference between the upper approximation line and the lower approximation line present at the respective times of the individual values. In particular, the standardization is therefore based on a function of time, which is formed from the difference between the upper approximation line and the lower approximation line as a function of time.

[0175] The scaling is based in particular on a scaling constant, wherein the scaling constant is based in particular on the difference between the standardized value of the intensity curve, in particular device width-corrected, present at the first and second time points of the first phase segment and the first and second of the at least two respiration-corrected first blood pressure values. Thus, in particular, the standardized individual values ​​are scaled such that the standardized individual value present at the first time point thus scaled corresponds to the systolic blood pressure value previously determined during the individual value determination at the first time point. Scaling makes it possible to determine pressure values ​​from the standardized individual values, which correspond to a trend measurement, which pressure values ​​can in particular be assigned to the person's blood pressure value.

[0176] For this purpose, for example, the scaling constant can be based not only on the difference just mentioned, but also on an average value formed from the at least two respiration-corrected first blood pressure values ​​and the at least two respiration-corrected second blood pressure values, whereby the respiration-corrected first blood pressure value corresponds to a systolic blood pressure value and the respiration-corrected second blood pressure value corresponds to a diastolic blood pressure value.The scaling constant thus includes, for example, the difference between the standardized values, the difference between the respiration-corrected first blood pressure values, and the mean of the respiration-corrected first and second blood pressure values, in particular in the form: (1 / (first respiration-corrected first blood pressure value minus second respiration-corrected first blood pressure value)) * (standardized individual value at the first time point minus standardized individual value at the second time point) * 0.25 * (first respiration-corrected first blood pressure value + second respiration-corrected first blood pressure value + first respiration-corrected second blood pressure value + second respiration-corrected second blood pressure value). Instead of a uniform averaging (0.25), a different weighting can also be used.

[0177] From these standardized and scaled individual values, a blood pressure curve can be determined and is determined according to the invention, in which local maxima and local minima are present. According to the invention, the first plurality of respiration-corrected first blood pressure values ​​are determined from the individual values ​​of the blood pressure curve assigned or assignable to the local maxima or minima. Advantageously (as already indicated above), in addition to the at least two respiration-corrected first blood pressure values, at least two respiration-corrected second blood pressure values ​​are also determined. It is also possible to determine additional respiration-corrected blood pressure values. With regard to blood pressure values, however, it has become established among experts to specify the characteristic values ​​of the systolic and diastolic blood pressure values ​​for the blood pressure value.Therefore, it is usually sufficient to determine two types of respiration-corrected blood pressure values, namely respiration-corrected first blood pressure values ​​and respiration-corrected second blood pressure values, whereby the first blood pressure values ​​are systolic blood pressure values ​​and the second blood pressure values ​​are diastolic blood pressure values.

[0178] Accordingly, if the advantageous determination of the at least two respiration-corrected second blood pressure values ​​is to be carried out, the method according to the invention proceeds with regard to the second blood pressure values, the diastolic blood pressure values, in an analogous manner to the first blood pressure values, the systolic blood pressure values.

[0179] In particular, the following procedure is followed:

[0180] A non-respiration-corrected second blood pressure value of the person is determined from the individual value measurements, whereby the time of the non-respiration-corrected second blood pressure value within the measurement period is determined as a second reference time point.

[0181] Furthermore, a second phase segment of the respiration having a minimum value, in particular a maximum inhalation, in the respiration curve at a first time point of the second phase segment and a maximum value, in particular a maximum exhalation, in the respiration curve at a second time point of the second phase segment is recorded in a time-resolved manner within the measurement period, wherein the second phase segment is selected such that the second reference time point falls within the period comprising the second phase segment.

[0182] In addition, the blood pressure value assigned to the first time point of the second phase section in the individual value measurements or a blood pressure value determined at the first time point of the second phase section is determined as the first of the at least two respiration-corrected second blood pressure values, in particular the maximum inspiration, and the blood pressure value assigned to the second time point of the second phase section in the individual value measurements or a blood pressure value determined at the second time point of the second phase section is determined as the second of the at least two respiration-corrected second blood pressure values, in particular the maximum expiration.

[0183] If the advantageous determination of the at least two respiration-corrected second blood pressure values ​​is carried out, it is then also possible to advantageously determine a second plurality of the at least two respiration-corrected second blood pressure values ​​in addition to the first plurality of the at least two respiration-corrected first blood pressure values. In the method according to the invention, the second plurality can also be determined in a manner analogous to that used for determining the first plurality.

[0184] In particular, the following procedure is followed:

[0185] From the blood pressure values ​​assigned to the local maxima of the blood pressure curve, respiration-corrected, continuous, first, systolic blood pressure values ​​of the first plurality of the at least two respiration-corrected first systolic blood pressure values ​​are determined, and from the blood pressure values ​​assigned to the local minima of the blood pressure curve, respiration-corrected, continuous, second, diastolic blood pressure values ​​of the second plurality of the at least two respiration-corrected second diastolic blood pressure values ​​are determined.

[0186] If an upper arm cuff is used, it is usually approximately 1 / 3 the width of the length between the shoulder joint and the elbow joint, as this is considered ideal. The inventors recognized that using a wider cuff results in lower blood pressure readings, while using a cuff that is too narrow results in excessively high readings. This is due to the causes of variations in the air pressure curve caused by the heartbeat. These causes are: 1. Diastolic pressure does not amplify tissue pressure sufficiently to counteract the air pressure in the cuff, resulting in variations between heartbeats.

[0187] 2. The systolic pressure increases the air pressure in the cuff by reducing the volume of the cuff, a variation to the heart pulses occurs.

[0188] These causes overlap depending on the air pressure in the cuff; cause 1 occurs at lower pressures, and cause 2 at higher pressures. A third mechanism of action is the collapse of the arteries, which restricts blood flow as the pressure continues to rise, and completely stops at a certain pressure at even higher pressures. The size of the cuff influences the severity of the aforementioned causes. A wide cuff, as used in the current state of the art (approximately 1 / 3 of the length between the shoulder joint and the elbow joint), suppresses cause 2.A cuff that is too wide, i.e., even wider than the wide cuff mentioned above, also results in a larger skin surface being covered, thus compressing a larger volume of tissue. Blood flow is affected even at lower pressures, so cause 1 already applies at lower pressures; in such a case, the blood pressure is determined to be too low. A cuff that is too narrow (i.e., narrower than the cuff mentioned above, which has a width of approximately 10 mm)However, a narrow cuff (which has a length of 1 / 3 of the length between the shoulder joint and the elbow joint) allows cause 2 to become more apparent; with such a narrow cuff, pulsation can still be detected at higher pressures, but due to the not irrelevant occurrence of cause 2, an elevated blood pressure value is determined, provided that the blood pressure value is determined according to the procedures for determining blood pressure in accordance with the state of the art.

[0189] For the method according to the invention, a narrow cuff, e.g. with a width of approximately 2-5 cm, in particular 3-4 cm, is particularly advantageous, even if normal, wide cuffs are also suitable for the method according to the invention, but with such wide cuffs the device width correction does not have to be carried out, or such a correction generally hardly leads to a correction.

[0190] The advantage of using a narrow cuff, with which in particular the device width correction according to the invention can be carried out, is that with it not only the heart pulse but also other smaller variations can be resolved particularly well. A narrow cuff does not dampen the variations as much, so that even small fluctuations in blood pressure, such as those due to breathing, can be detected in the intensity of the variations. Since the influence of breathing is not to be observed or taken into account in the prior art methods, a wide wristband is used for precisely this reason in the prior art in order to avoid this effect of cause 2 as much as possible. The width is determined based on the arm diameter and length; for an upper arm cuff, the width should correspond to approximately one third of the length from shoulder to crook of the arm.For the method according to the invention, a narrow width does not represent a major obstacle and is particularly useful when respiration is to be determined directly from the air pressure curve. Figure 4 shows a pressure curve 4000 that was recorded with a 3 cm wide cuff. It can be seen that the variations 4010 are visible up to the stop at 270 mmHg; a determination of the blood pressure according to the state of the art would output a systole of over 200 mmHg (a reference measurement with a state of the art device resulted in a blood pressure of 140 / 100 mmHg). Graph 4200 shows the first derivative of the air pressure curve (scaled representation). The two cause regions can be identified by the local minima. At time 1 60s the local minima become deeper, which means that cause 2 is becoming increasingly important for the variations.Graph 4200 is the basis for all subsequent steps to determine the time points for pressure measurements (the pressures are then read off the barometric pressure curve 4000 at the respective times) and the time points for respiration. Furthermore, this curve 4200 can be used to determine the ranges of significance of both factors, enabling a blood pressure calculation comparable to state-of-the-art calculations, even with narrow cuffs.

[0191] In particular, some steps of the method according to the invention are based on steps that are also known from the prior art, in particular to ensure the suitability of the method according to the invention with known devices. Nevertheless, the method according to the invention is expanded by some essential steps that specifically target and incorporate the use and determination of parameters and information that are generally ignored in the prior art methods, or whose influence is minimized by averaging or selecting the cuff width. The individual steps are simplified and exemplary:

[0192] 1. Detection and filtering of the effect of cause 2 on the intensity of the variations. This step is not found in the prior art, as the influence and effect of cause 2 was attempted to be minimized by appropriately selecting the device width. After detection and filtering, an intensity curve is obtained, particularly one corrected for the device width, which corresponds to an optimal intensity curve for the prior art. The intensity curve, particularly one corrected for the device width, now corresponds to an intensity curve that would have been recorded with a cuff that was optimally wide for the user.

[0193] 2. Determination of diastole and / or systole blood pressure values ​​(D1 and S1 ), without taking into account the influence of respiration, according to the state of the art method.

[0194] 3. The times at which D1 and / or S1 were determined mark the corresponding breaths. The pressure at the time of, for example, inhalation and exhalation is then found in the pressure curve. These values ​​are then, for example, the results for the blood pressure during inhalation and exhalation, respectively, and thus indicate a blood pressure value depending on a specific breathing state of the person; they are therefore respiration-corrected blood pressure values ​​within the meaning of this disclosure.

[0195] Point 1 above is required if a cuff that is too narrow (relative to the state of the art) is to be used, which is advantageous for determining respiration and is generally necessary for displaying continuous blood pressure values. However, if only the influence of respiration on blood pressure is to be assessed, in particular, if no continuous blood pressure value is to be determined, this point is not necessary.

[0196] For example, a blood pressure can be assigned to the pressure variations in the air pressure curve due to the heart rate. With completely regular breathing and a healthy heart rate, the following approach would be conceivable: The phase of breathing in which the variation occurs linearly determines which value between the previously determined blood pressure values ​​for inhalation and exhalation should be output. However, this approach does not provide any additional information and is also dangerous, as cases that do not conform to the assumption of regular breathing and a healthy heart rate cannot be detected. However, this approach can be used to verify the subsequent logic. If a data set is recorded and the above assumptions are met, the results of this approach must agree with those of the subsequent logic.

[0197] The following is an example of the advantageous determination of the multitude of blood pressure values, the continuous blood pressure values: For the logic for determining continuous blood pressure values, the following assumptions can be made:

[0198] 1 . The intensity of the variations on the pressure curve reflects the blood pressure. This means that if an air pressure in the cuff (between diastole and systole and, depending on the cuff width, also above) is maintained (on average), a change in the magnitude of the variations is linear with a change in blood pressure. 2. For a pressure above diastole and in the period in which the cause

[0199] 2 of the pressure variation comes into play, a heart pulse is completely represented in the variation.

[0200] 3. For the period mentioned under 2., the following also applies: If the blood pressure remains constant and the cuff is not too wide, the height diameter of the envelope of the intensity curve decreases linearly with increasing air pressure in the cuff. From 3., it follows that (assuming) the variations in the air pressure curve also decrease linearly with increasing pressure.

[0201] 4. The values ​​for systole are in the period mentioned under 2.

[0202] For example, the logic proceeds as follows:

[0203] 1. Determine the period during which cause 2 of the pressure variation primarily occurs. This is analogous to point 1 when determining the blood pressure values ​​for inspiration and expiration. This is done based on the intensity curve, which is determined by the derivative of the pressure curve.

[0204] 2. The intensity curve is determined according to the state of the art using a suitable bandpass filter.

[0205] 3. The envelope around this intensity curve is determined, from which the height diameter is known for each time point.

[0206] 4. The temporal progression of the height diameter is approximated linearly.

[0207] 5. The intensity curve from point 2 is normalized with the temporal progression of the vertical diameter in the region where cause 2 primarily occurs. The curve is then scaled so that the intensity curve at the time points at which the systole values ​​were determined corresponds to these. This normalization and scaling takes place in the range in which the data resolution allows for meaningful scaling. With a good output signal (high pulse pressure, no movement), this can be achieved using modern pressure sensors up to a vertical diameter of one-tenth of the maximum vertical diameter. The result is a pressure curve that maps the blood pressure progression in the arteries below the cuff.

[0208] 6. This curve is examined for local minima and maxima. The maxima are values ​​for systole, whereby a value can be provided for each heartbeat during this period. The local minima are values ​​for diastole, whereby here, too, a value can be provided for each heartbeat. It should be noted that the values ​​for diastole should not be interpreted as absolute values, as these were only determined indirectly from the values ​​for systole. However, these values ​​indicate the trend and magnitude of the change in diastole.

[0209] However, this embodiment represents only one possible example of carrying out the method according to the invention.

[0210] Advantageously, the measurement period comprises at least ten seconds and advantageously the recording of the individual value measurements that result in the continuous blood pressure measurement takes place at each heartbeat.

[0211] Alternatively, the above-mentioned determination of a plurality of blood pressure values ​​can also be a determination of a plurality of non-respiration-corrected blood pressure values ​​or even a determination of a plurality of non-respiration-corrected or respiration-corrected relative blood pressure values. Such a determination could be referred to as a trend measurement. For this purpose, the scaling of the standardized individual values, in particular the device-width-corrected intensity curve, is omitted or scaled solely on the basis of non-respiration-corrected blood pressure values. The advantage of such a determination is that, for example, a determination of respiration is not necessary. Nevertheless, a determination of the blood pressure trend is possible, either solely as a change over time or as a non-respiration-corrected value.Under certain circumstances, such statements are equally sufficient and represent an improvement over previously known methods of continuously recording blood pressure. Therefore, a determination of a plurality of relative blood pressure values ​​is also proposed. This method is carried out in a manner analogous to the method according to the invention described above. For this purpose, the plurality of individual measurements of the value assigned to the person's blood pressure value are first recorded in a time-resolved manner within the measurement period using the first sensor of the first device. Nevertheless, a non-respiration-corrected blood pressure value does not need to be determined to determine the plurality of relative blood pressure values.Rather, the changes, in particular gradients, of the values ​​of the individual measurement values ​​that are independent of the varying pressure application can be determined directly, in particular by means of a mathematical derivative with respect to time, from the values ​​of the individual measurement values, in particular those exhibiting the varying pressure application. From this, the intensity curve, comprising the multiple local extrema, can then be directly determined. Here, too, a device-width-corrected intensity curve can be determined, if necessary, as described above.

[0212] The at least one, in particular at least two, upper approximation lines are then formed for the local maxima of the intensity curve, in particular the device width-corrected one, present in the measurement period, in particular the third and / or the second time period or the first time period, and the at least one, in particular at least two, lower approximation lines are then formed for the local minima of the intensity curve, in particular the device width-corrected one, present in the measurement period, in particular the sixth and / or the fifth time period or the fourth time period.

[0213] To determine the multitude of relative blood pressure values, the individual values ​​of the intensity curve, especially the device width-corrected ones, are normalized based on the difference between the upper approximation line and the lower approximation line at the respective time points. However, scaling with the scaling constant is not performed.

[0214] From the standardized individual values, a relative blood pressure curve is then determined, which exhibits local maxima and local minima. The numerous relative blood pressure values ​​are determined from the blood pressure values ​​assigned to the local maxima or minima of the relative blood pressure curve. It is also possible to perform scaling based on non-respiration-corrected blood pressure values. This would allow numerous non-respiration-corrected blood pressure values ​​to be determined. For this purpose, a non-respiration-corrected blood pressure value is used as the scaling constant, not a respiration-corrected blood pressure value, and the respective reference time is used as the time point.

[0215] The object is also achieved by a device, in particular a cuff, in particular an air pressure cuff, with a wristband, wherein the device provides an inflatable volume and has a control unit. The control unit is set up and configured to inflate the volume, in particular based on a predetermined pressurization change rate, and is further set up and configured to carry out the method according to the invention. In particular, the device also has at least one non-volatile storage medium, which is in particular connected to the control unit and / or on which the pressurization change rate and / or the method according to the invention is stored. Advantageously, the device is also set up to record and determine the breathing curve of the method according to the invention.

[0216] The object is also achieved by a device, in particular a cuff, in particular an air pressure cuff, with a wristband, wherein the device provides an inflatable volume and has a control unit. The device is a device for determining at least two respiration-corrected first blood pressure values ​​of a person.

[0217] The control unit is designed and configured to inflate the volume, in particular based on a predetermined pressurization at a predetermined pressurization change rate, in particular within a measurement period. In particular, only and in particular exclusively a strictly monotonically increasing pressurization or, alternatively, a strictly monotonically decreasing pressurization can occur during the measurement period.

[0218] The device further comprises

[0219] • at least one storage unit and / or one evaluation unit and

[0220] • a first sensor which is set up and configured to record a plurality of forces acting on a sensor surface as individual value measurements of pressure fluctuations in a time-resolved manner within a measurement period and to send the data recorded as pressure fluctuations to the storage unit and / or evaluation unit.

[0221] For certain embodiments, the device may also comprise a second sensor or alternatively a receiving unit.

[0222] The second sensor is set up and configured to detect electrical currents and / or electromagnetic waves, light waves, acceleration, sound, temperature and / or electrical resistance within the measuring period and to transmit the detected data to the evaluation unit and / or storage unit.

[0223] The receiving unit is used to receive

[0224] • a signal that was detected in a time-resolved manner by a second sensor that is set up and configured to detect and transmit electrical currents and / or electromagnetic waves, light waves, acceleration, sound, temperature and / or electrical resistance, or

[0225] • time-resolved information regarding phase segments of the person's breathing within the measurement period and / or a breathing curve of the person within the measurement period, set up and configured.

[0226] However, in certain embodiments it is also possible for the device to evaluate phase segments of the person's breathing on the basis of the individual value measurements recorded by the first sensor.

[0227] The evaluation unit is also set up and configured,

[0228] • to determine a non-respiration-corrected first blood pressure value of the person from the individual value measurements, whereby due to the configuration of the first sensor as a time-resolved sensor of the evaluation unit, the times of the individual value measurements are also sent and the time of the non-respiration-corrected first blood pressure value within the measurement period is determined as a first reference time;

[0229] • a first phase section of a person's breathing having one, in particular exactly one, in particular local, maximum value, in particular a maximum inhalation, in a breathing curve at a first time point of the first phase section and a minimum value, in particular a maximum exhalation, in the breathing curve at a second time point of the first phase section within the measurement period is recorded in a time-resolved manner, wherein the first phase section is selected such that the first reference time point falls within the period comprising the first phase section.

[0230] The evaluation unit can be set up and configured to determine the respiration curve based on the individual value measurements recorded by the first sensor.

[0231] However, the evaluation unit can also be set up and configured to determine the respiration curve on the basis of the data acquired by the second sensor or the phase sections of a person's respiration within the measurement period or to analyze a received respiration curve of the person within the measurement period in a time-resolved manner.

[0232] The evaluation unit is also set up and configured,

[0233] • to determine a first individual value from the individual value measurements, which is assigned to the first time point of the first phase section in the individual value measurements or which is assigned to a value in the individual value measurements based on the first time point of the first phase section, and

[0234] • to determine a second individual value from the individual value measurements, which is assigned to the second point in time of the first phase section in the individual value measurements or which is assigned to a point in time of the first phase section in the individual value measurements based on the second point in time of the first phase section.

[0235] Advantageously, the force detected as a pressure fluctuation by the first sensor can be a force acting on the sensor surface that is caused by a change in a person's blood pressure.

[0236] Advantageously, the first individual value can be the first of the at least two respiration-corrected first blood pressure values, in particular the maximum inspiration, and the second individual value can be the second of the at least two respiration-corrected first blood pressure values, in particular the maximum expiration.

[0237] In particular, the evaluation unit is set up and configured to carry out the method according to the invention.

[0238] Advantageously, the device is a cuff, in particular an air pressure cuff, with a wristband, wherein the wristband has a longitudinal extension, wherein the wristband is designed to enclose a part of the body along its longitudinal extension, wherein the wristband has a width extension with a width of less than 5 cm, in particular 4 cm or less.

[0239] Advantageously, the device is a cuff with a wristband, wherein the cuff is in particular a part of a wristwatch, in particular a smart watch.

[0240] Further advantageous embodiments are illustrated by way of example in the following description of the accompanying schematic figures. Figure 1 shows (a) an ideal pressure curve of a measurement using a prior art cuff during an external pressure increase, and (b) variations within this pressure curve after evaluation using a digital filter;

[0241] Fig. 2 (a) a pressure curve of a person breathing heavily during an external pressure increase and (b) variations within this pressure curve after evaluation by means of a digital filter;

[0242] Fig. 3 (a) a schematic pressure curve of the air pressure (Y-axis) over time (X-axis) during the pressure increase of a measurement with an air pressure cuff, (b) the evaluation of the pressure curve according to Riva Rocci and Korotkoff for determining a non-respiration-corrected diastolic and systolic blood pressure, (c) the evaluation according to the invention with correction and use of the respiration or the respiratory cycle within the series of measurements, which was used for the determination (in b) of the diastolic and systolic blood pressure in order to obtain diastolic and systolic blood pressure values ​​under different breathing conditions;

[0243] Fig. 4 (a) a measurement of a pressure curve over time and (b) determined variations of the pressure curve from (a) for the inventive determination of breathing states from the pressure curve;

[0244] Fig. 5. (a) a pressure curve with a difference from the state of the

[0245] Technique narrower cuff over time, (b) an intensity curve according to the invention as a slope curve of the pressure curve by forming a derivative of the pressure curve, (c) a device width corrected intensity curve according to the invention, which was corrected for the effects of the narrower cuff and in (d) the normalized and (e) the normalized and scaled device width corrected intensity curve according to the invention to determine continuous blood pressure values; Fig. 6. (a) a first scenario, (b) a second scenario and (c) a third

[0246] Scenario) of recording maximum inspiration and maximum expiration and determining the first phase segment;

[0247] Fig. 7. Section of a curve of the air pressure to illustrate different influences on the expression of variations within the air pressure curve due to various influences changing the blood pressure.

[0248] The figures illustrate exemplary embodiments of the method in a simplified manner, so that individual features of the invention are particularly simple and clear. The size ratios (e.g., of the peaks, amplitude, or the distances between the peaks) are therefore not necessarily realistic. Likewise, the values ​​of the Y-axis and Y-axis do not necessarily represent realistic values. In particular, no Y-axis values ​​are given for the intensity curves. In the figures, identical elements are provided with identical reference symbols.

[0249] The following examples refer to an air pressure cuff, also referred to as "cuff," which performs the blood pressure measurement. This can be, for example, a standard wrist or upper arm cuff. However, it is also possible for devices other than a cuff to perform the blood pressure measurement. Regarding the cuff, it is possible that devices other than a standard wrist cuff are used for this purpose. For example, some smartwatches already have cuffs that measure blood pressure via the cuff.

[0250] The figures show diagrams including air pressure curves showing individual measured values ​​of the air pressure within the cuff. Individual air pressure curves can be assigned to blood pressure values ​​of the person on whom the measurement was carried out using the cuff. The blood pressure values ​​are determined using individual measurements of the air pressure in the pressure cuff recorded during the measurement using the pressure cuff over a measuring period (Figure 5). The time of the measuring period is therefore shown on the X-axis of the diagram shown in the figures, and the Y-axis usually shows the air pressure values ​​of the individual measurements or the person's blood pressure values ​​determined from the individual measurements of the air pressure values.The curve resulting from the individual measurements of the air pressure values ​​over time is called the air pressure curve and describes the air pressure values ​​as a function of time, and the curve resulting from the blood pressure values ​​determined from the individual measurements of the air pressure values ​​is therefore also called the blood pressure curve or blood pressure curve and describes the blood pressure values ​​as a function of time.

[0251] As a rule, the barometric pressure curve is shown in section (a) of the following figures. In some cases, the absolute blood pressure values ​​associated with the measured barometric pressure are shown on the Y-axis, or at least relative values. As mentioned above, the absolute values ​​on the Y-axis shown in the figures are not necessarily realistic.

[0252] The illustration in Figure 1 shows an ideal curve of air pressure values. The ideal air pressure curve 1000 is shown in section a) of Figure 1. It can be seen that the air pressure value basically increases continuously during the measurement period. This is due to the fact that during the measurement period, i.e. during the individual value measurements, the air pressure in the cuff was increased, e.g. at a constant rate (pressurization rate), as is usual at the start of a cuff measurement. The individual values ​​of the recorded air pressure therefore increase and therefore also show these changes in pressure during the pressurization. As is the case with the prior art, it is not possible to determine a meaningful blood pressure value from every individual air pressure measurement. For this purpose, a method is required to calculate a meaningful blood pressure value from the air pressure values ​​determined in this way, e.g.to determine a diastolic blood pressure value or a systolic blood pressure value. Various procedures for this are described in the prior art. These form the basis for the present invention. In addition to the continuous increase in the determined blood pressure value in the pressure curve 1000, several fluctuations or variations 1010 of the air pressure can be seen on the curve of the pressure curve 1000. These variations are based, among other things, on fluctuations in blood pressure over time caused by the heartbeat. The air pressure in the cuff is influenced by the pulse in the arteries that are located below the cuff and are indirectly contacted by it. It can also be seen that at the beginning (on the left in the diagram) hardly any or no variations can be seen and at the end equally smaller fluctuations can be seen.

[0253] As the air pressure in the cuff increases, blood can flow unhindered at low cuff pressures. Conversely, this means that the tension in the muscles and tissue is higher than the pressure in the cuff, so that no variations caused by blood flow in the arteries can be detected in the individual values ​​of the air pressure measurement in the cuff. Therefore, the pulse, the variations or a change in pressure cannot be detected in the initial course of the pressure curve 1000. If the air pressure in the cuff increases, this tension, which prevents the detection of a variation, and thus the air pressure, cannot be maintained at a certain point in time, initially during the diastolic phase of the cardiac cycle. During diastole in the cardiac cycle, variations or artifacts occur towards lower blood pressure values.If the air pressure in the cuff continues to rise, blood flow can no longer be maintained smoothly in the heart rate between diastole and systole, and variations can be seen. At even higher air pressures, blood flow is disrupted at every phase, including during systole. The cuff is deformed with the pulse, or the air pressure in the cuff changes, so that the heart rate is reflected in the air pressure. At these higher pressures, the measurable air pressure is now exactly between the diastole and systole values. If the air pressure in the cuff continues to increase, the artery is squeezed more and more until no more blood flow is possible because the artery has collapsed. At this point, no variation can be seen. Overall, the intensity of the variations increases as the pressure increases.Artifacts due to the heart rate initially increase with increasing air pressure and then decrease again as the air pressure continues to rise. If there are no other circumstances that would influence the pressure in the arteries, one would expect this pattern of variations.

[0254] These variations can be seen even more clearly in the representation of section b) of Figure 1.

[0255] The representation of section b) of Figure 1 is based on the recorded individual air pressure measurements during the measurement period, with the continuous increase removed / filtered out. This can be done purely mathematically, e.g., by determining a regression line as a function of time and subtracting 1000 from the blood pressure values ​​of the pressure curve. However, it is also possible to achieve this with a bandpass filter, particularly a digital one. The technology used for this is known from the state of the art and is implemented, in particular, in existing devices and cuffs, based on the respective sensor used, particularly in a manufacturer-specific manner.Although this filtering of the continuous, general increase in the measured air pressure due to the external pressure increase (pressurization correction) in the device is necessary and is solved sufficiently satisfactorily by the manufacturer's method, it does not represent an independent aspect of the present invention.

[0256] In the filtered curve 1 100, also called the pressure-corrected intensity curve 1 100, the fluctuations or variations 1 1 10 are now clearly visible. It can be seen that the intensity, i.e., the highs and lows of the variations, increase and decrease.

[0257] These variations 1 1 10 are essentially based on changes in air pressure caused by the systolic phase of the cardiac cycle and the diastolic phase of the cardiac cycle, respectively. Furthermore, it can be seen that the intensity of these variations initially increases and then decreases over time, but only a single such increase and decrease is discernible, i.e., only one arc is visible. In theory, and in the ideal case (as discussed above), the measured values ​​also correspond to such a simple curve.

[0258] As a rule and in practice, however, such a course cannot be observed when measuring a real person, since other circumstances change the blood pressure and thus influence and change the individual value measurements of the air pressure itself.

[0259] Such a measurement on a real person breathing during the measurement period is shown in Figure 2.

[0260] In this Figure 2, section a) also shows the individual measured air pressure values ​​and thus the resulting air pressure curve for 2000. Blood pressure values ​​are based on individual measurements of air pressure values ​​measured in a cuff. Here, too, the pressure in the cuff was increased over time, which is why the figure shows a general increase in the determined air pressure value.

[0261] The air pressure values ​​shown in Figure 2 were determined from individual measurements taken within the measurement period on a person who was breathing heavily during the measurement period.

[0262] Once the general pressure increase recorded due to the increase in air pressure is removed / filtered out, the graph shown in section b) of Figure 2 results. This graph, similar to Figure 1, shows the pressurization-corrected intensity curve 2100, which depicts the filtered pressure curve 2100. To create this intensity curve, a band filter (pressurization correction) can again be used, for example.

[0263] In the filtered pressure curve 2100, the variations 21 10 can be seen again. However, the intensity of the variations 21 10 does not increase continuously once and then decrease again. Rather, several increases and decreases in the intensity of the variations 21 10 can be seen. A first increase followed by a decrease in the intensity of the variations 21 10 can be seen in a first group 21 1 1 of the variations 21 10 at approximately 157 s, a second increase followed by a decrease in the intensity of the variations 21 10 can be seen in a second group 21 12 in the time period from 1 63 s to 1 67 s, and a third increase followed by a decrease in the intensity of the variations 21 10 can be seen in a third group 21 13 at 172 s. The general increase and the general decrease can also be seen - the first 21 1 1 and third group 21 13, for example, show lower intensities than the second, middle group 21 12.Nevertheless, it can be seen - the individual groups 21 1 1 , 21 1 2, 21 13 can be clearly distinguished from one another - that other circumstances than the measurement method (increase or decrease in the air pressure in the cuff) change the detectable air pressure values. An evaluation according to the state of the art would either only evaluate the middle group 21 1 2 (since this is clearly recognizable as the familiar arc) or the logic underlying the state of the art would interpret two or all three visible groups as one arc, as one group. Which interpretation is chosen depends on the precise implementation of the logic underlying the state of the art and can be different with slightly different data (e.g. in a directly subsequent measurement on the same person without changing the cuff).

[0264] It is therefore quite possible that the logic underlying the state-of-the-art technology considers not only the middle group 21 1 2, but also the lower group 21 1 1. In such a case, lower diastolic blood pressure values ​​are output. If only the middle group 21 1 2 is considered, a higher diastolic blood pressure value is output. However, these differences in output with the same data are unsatisfactory.

[0265] In Figure 3, section (a) shows a schematic representation of individual air pressure values ​​measured with an air pressure cuff. The air pressure prevailing in the cuff is shown on the Y-axis and plotted over time on the X-axis, resulting in an air pressure curve 3000. The individual value measurement was carried out over a measurement period, during which time the pressure in the air pressure cuff was increased, i.e. rose. It can be seen that initially no variations 3010 can be seen in the pressure curve 3000. As already described in connection with Figures 1 and 2, this is due to the measurement method used, since the pressure exerted by the cuff on the measuring area on the person's skin is not yet sufficient to detect a measurable change in the counterpressure generated by the pressure in the arteries in the heartbeat.

[0266] In the middle part of the pressure curve 3000, such variations 3010 can be seen, whereby these variations 3010 disappear again later on with a further increase in the pressure in the cuff, among other things because the artery is squeezed off and collapsed, i.e. no more blood flows and thus no more pressure fluctuations can occur in the artery.

[0267] As in the prior art, a diastolic and a systolic blood pressure are first determined. However, the influence of respiration on the recorded blood pressure is ignored in this determination, which is why, in the terminology of this disclosure, the blood pressure thus determined is referred to as the non-respiration-corrected blood pressure. For this purpose, in a first step, the pressure increase is filtered out of the pressure curve 3000. This can be done in different ways. Typically, a digital bandpass filter is used for this purpose; however, in the simplest case, a theoretical pressure increase curve, given by a linear adjustment of the pressure curve, can also be subtracted from the pressure curve.

[0268] In the following description of the remaining figure description, the terminology used with regard to the non-respiration-corrected first blood pressure value and the respiration-corrected first blood pressure values ​​refers to a systolic blood pressure value, thus to a non-respiration-corrected systolic blood pressure value and the respiration-corrected systolic blood pressure values, and with regard to the non-respiration-corrected second blood pressure value and the respiration-corrected second blood pressure values, refers to a diastolic blood pressure value, thus to a non-respiration-corrected diastolic blood pressure value and the respiration-corrected diastolic blood pressure values.

[0269] The thus filtered pressure curve 3100 is shown in section (b) of Figure 3. Based on this, an evaluation of the blood pressure value according to Riva Rocci and Korotkoff is performed to determine a non-respiration-corrected diastolic and systolic blood pressure. In this filtered pressure curve 3100, an upper compensation curve 3150 and a lower compensation curve 3160 are determined. These curves extend over the entire course of the pressure curve 3100, in which variations 3110 of the air pressure value in the pressure curve 3100 can be detected. The upper adjustment curve 3150 represents an approximation to the largest intensities 3120 of the variations 31 10 determined via the X-axis and the lower adjustment curve 3160 represents an approximation to the smallest intensities 3130 of the variations 31 10 determined via the X-axis.In some cases, the term "envelope" is used in this disclosure for the combination of an upper best-fit curve and a lower best-fit curve, even though mathematically this actually refers to families of straight lines, but otherwise applies to the same principle.

[0270] In the method according to the invention, a greatest distance 3170 on the Y-axis (i.e., at the same X-value in each case, i.e., at the same time in each case) between the upper 3150 and lower 3160 compensation curve is then determined. Starting from this greatest distance 3170, a further distance 3171 is determined between the compensation curves 3150, 3160 on the Y-axis towards lower air pressures, here to values ​​earlier in time, which is relatively smaller than the greatest distance 3170 by a predetermined value, e.g., one specified by the cuff manufacturer. This distance and point is identified in the figure with the reference symbol 3171. A time point 3181 in the pressure curve 3000 is assigned to this distance 3171. The non-respiration-corrected diastolic blood pressure is then based on the air pressure value 3091 recorded at this time.For this purpose, the blood pressure 3091 corresponding to the time of the distance 3171 is read out on the pressure curve 3000 and used as the non-respiration-corrected diastolic blood pressure. For the purposes of the present disclosure of the invention and the claims, this time and the blood pressure are the second reference time 3181 and the non-respiration-corrected second (diastolic) blood pressure based on the air pressure 3091. In an analogous manner, starting from the greatest distance 3170, a further distance 3172 is determined between the compensation curves 3150, 3160 on the Y-axis towards higher air pressures, here to later values, which is relatively smaller than the greatest distance 3170 by a predetermined value, e.g., specified by the cuff manufacturer. This distance is marked as a point on the upper approximation curve 3150 in Figure 3 with the reference symbol 3172.The non-respiration-corrected systolic blood pressure is then based on this distance 3172 and the times 3182 assigned to this value, as well as the recorded air pressure value 3092. For this purpose, the air pressure 3092 associated with the time 3182 of the distance 3172 is read from the air pressure curve 3000 and used as the non-respiration-corrected systolic blood pressure. For the purposes of the present disclosure of the invention and the claims, this time is the first reference time 3182 and is the non-respiration-corrected first (systolic) blood pressure, which is determined from the air pressure 3092.

[0271] However, since the blood pressure values ​​that can be recorded are higher or lower due to breathing, the blood pressure values ​​that can be recorded from the air pressure values ​​3091, 3092 at the first 3181 or second time 3182 can be higher or lower due to breathing than the actual diastolic or systolic blood pressure of the person that is not influenced by breathing.

[0272] For this reason, respiration is used in the form of several phase segments, in particular a first phase segment 3572 and a second phase segment 3571 of respiration, and a corresponding blood pressure value is determined taking this respiration or the respective phase segment into account. For this purpose, several maximum inhalations and several maximum exhalations, and thus several phase segments based on the maximum inhalations and maximum exhalations, are advantageously recorded in the same measurement period in which the individual value measurements of the cuff air pressure 3000 were taken.

[0273] Breathing, the breathing curve, and the resulting maximum inhalations and exhalations, as well as the phase segments, can be recorded and determined using another device, e.g., an ECG or PPG sensor. However, breathing and the breathing curve can also be recorded and determined from the air pressure values ​​and the pressure curve 3000.

[0274] The breathing curve can be described using the recorded values ​​and describes inhalation and exhalation. The breathing curve thus has a maximum value, which represents, for example, the maximum inhalation, and a minimum value, which represents, for example, the maximum exhalation. Several such cycles of maximum inhalations and exhalations are now shown in section c) of Figure 3 together with the filtered pressure curve 3100, namely for the section of the time period in which the compensation curves 3150 and 3160 were determined and in which the non-respiration-corrected blood pressure values ​​were determined based on the air pressure values ​​3092, 3091 at the first and second reference times 3182, 3181.The phase segments 3571, 3572 are defined by the maximum exhalations and inhalations. A second phase segment 3571, for example, initially has a maximum inhalation and then a maximum exhalation. The following maximum inhalation is already assigned to the next phase segment. The second phase segment begins at or shortly before the time of maximum inhalation and ends at or shortly after the time of maximum exhalation. As explained below, a phase segment, namely a first phase segment 3572, is used for systole, which first has a maximum exhalation. Accordingly, the first phase segment 3572, for example, initially has a maximum exhalation and then a maximum inhalation. The following maximum exhalation is already assigned to the next phase segment.The first phase segment begins at or shortly before the time of maximum exhalation and ends at or shortly after the time of maximum inspiration. The times of the respective maxima 3520, i.e., the maximum inspiration of each phase segment 3571, 3572, are recorded as the first time point 3583, 3586, and the times of the respective minima 3530, i.e., the maximum exhalation of each phase segment 3571, 3572, are recorded as the second time point 3584, 3585.

[0275] In the method according to the invention, the second phase segment 3571 is then determined in such a way that it has exactly one maximum inhalation at the first time 3583 and exactly one maximum exhalation at the second time 3584, and between the beginning of the second phase segment and the end of the second phase segment lies the second reference time 3181. Thus, the phase segment present when the non-respiration-corrected diastolic blood pressure value is recorded for the air pressure 3091 is selected.

[0276] In addition, a first phase segment 3572 is determined, which has exactly one maximum exhalation at the second time 3585 and exactly one maximum inhalation at the first time 3586, and between the beginning of the first phase segment and the end of the first phase segment lies the first reference time 3182. Thus, the phase segment present when the non-respiration-corrected systolic blood pressure value is recorded at the air pressure 3092 is selected.

[0277] In order to qualify breathing accordingly, a diastolic and a systolic blood pressure value can then be determined and output as a corresponding blood pressure value at maximum exhalation and maximum inhalation, respectively.

[0278] For the diastolic blood pressure value at maximum inspiration (in the sense of the application, the first of the respiration-corrected second blood pressure value), the air pressure 3093 of the pressure curve 3000 present at the first time point 3583 of the second phase section 3571 is read from the pressure curve 3000, which is based on the individual value measurements, and the diastolic blood pressure value at maximum inspiration is thus determined.

[0279] For the diastolic blood pressure value at maximum exhalation (in the sense of the application, the second of the respiration-corrected second blood pressure value), the air pressure 3094 of the pressure curve 3000 present at the second time point 3584 of the second phase section 3571 is read from the pressure curve 3000, which is based on the individual value measurements, and thus the diastolic blood pressure value at maximum exhalation is determined.

[0280] For the systolic blood pressure value at maximum exhalation (in the sense of the application, the second of the respiration-corrected first blood pressure value), the air pressure value 3095 of the pressure curve 3000 present at the second time point 3585 of the first phase section 3572 is read out from the blood pressure values ​​of the pressure curve 3000 based on the individual value measurements, and thus the systolic blood pressure value at maximum exhalation is determined.

[0281] For the systolic blood pressure value at maximum inspiration (in the sense of the application, the first of the respiration-corrected first blood pressure value), the air pressure value 3096 of the pressure curve 3000 present at the first time point 3585 of the first phase section 3572 and based on the individual value measurements is read out from air pressure values ​​of the pressure curve 3000, which are based on the individual value measurements, and thus the systolic blood pressure value at maximum inspiration is determined.

[0282] The values ​​obtained in this way for diastole and systole during maximum inspiration and expiration can now either be used directly in the following calculations or, preferably, corrected for the external pressure increase during the identified respiratory phase. Alternatively, the external pressure increase during the identified respiratory phase can also be corrected beforehand.

[0283] A correction is required for maximum accuracy and is preferable, for example, for the calibration of third-party devices. This is not necessary for a pure blood pressure reading.

[0284] The correction assumes that the external pressure increase p(t) occurs linearly with time t over the two phase sections, each with a pressure change rate m, which is positive when the pressure increases during the measurement and correspondingly negative when the pressure is falling and is not necessarily the same for both phase sections, but is usually given by p(t) = m*t + b. This pressure change rate is specified externally by a pump and / or a valve, as described above. It is also assumed that the blood pressure values ​​for air pressures 3091 and 3092 are equal to these air pressures and therefore do not need to be corrected. The blood pressures determined from air pressures 3093, 3094, 3095 and 3096 are now subject to the error to be corrected, since the externally specified pressure has changed within the phase sections.This error pressure for the blood pressure, the values ​​resulting from the air pressure values ​​3093, 3094, 3095 and 3096, results from the time difference between the times 3583, 3584 to 3181 or 3585, 3586 to 3182 multiplied by the pressure change rate m. It should be noted that the time differences are a negative number if the time difference refers to a later point in time to an earlier point in time.

[0285] This pressure error, which is determined separately for each time point (3583, 3584, 3535, 3536), is subtracted from the respective barometric pressures (3093, 3094, 3093, 3096). These corrected barometric pressure values ​​are then used for the previously described blood pressure values.

[0286] From the pair of values ​​consisting of the diastolic blood pressure value at maximum inspiration and the diastolic blood pressure value at maximum expiration, an averaged, respiration-corrected diastolic blood pressure value can then be determined, for example, by averaging the values ​​of the pair. The same procedure can be used for the pair of values ​​for the systolic blood pressure value.

[0287] One difficulty the inventors encountered during implementation is that the length of the inhalation phases and the length of the exhalation phases, as well as the measurement methods used to determine the respiratory curve, lead to a systematic error, whereby the determinable times of maximum inhalation and maximum exhalation are recorded with a time delay relative to the values ​​assigned to the blood pressure value and their times, which can be determined in the individual value measurements. This is due to the fact that the different methods for determining respiration use different definitions regarding the start and end of a breath, and that different methods for determining respiration record the times of the respiratory phases differently. This time delay can be incorporated and corrected in a particularly advantageous development of the invention.An example of such a correction is shown in Figure 6 and will be described later.

[0288] In Figure 4, in subsection a), a pressure curve 4000 is shown over time, consisting of several individual air pressure measurements, which were obtained by measuring the air pressure in the air pressure cuff. In this pressure curve 4000, variations 4010 in the pressure curve can be seen—analogous to the pressure curves shown in the previous figures—at least in one time interval. If the information regarding the person's breathing, i.e., the breathing cycles, is not provided by other devices or sensors during the measurement period, the information regarding breathing, i.e., the breathing cycles, can be determined from the pressure curve 4000 during the measurement within the measurement period.

[0289] For this purpose, the general gradient over time due to the increase in air pressure can be filtered from the pressure curve 4000, analogous to the previous descriptions for obtaining curves 1100, 2100, 3100. However, it is preferred if the first mathematical derivative of the pressure curve 4000 is formed over time in order to depict the changes in the pressure curve. Such a derivative of the pressure curve 4000 over time is shown in section b) of Figure 4, with the values ​​of the derivative scaled for clarity. In this scaled intensity curve 4200, the gradients of the pressure curve 4000 are scaled. Thus, the variations 4010 present in the pressure curve 4000 are also recognizable there, namely through local maximum and minimum values ​​4210 in the intensity curve 4200.Thus, the maximum values ​​4210 in the intensity curve 4200 represent local maxima 4220, and the minimum values ​​4210 in the intensity curve 4200 represent local minima 4230. It can be seen that the absolute values ​​of the local maxima 4220 and local minima 4230 fluctuate over time, namely, in a first, rough approximation, they initially increase and then decrease again. Furthermore, a somewhat more detailed examination reveals that the absolute values ​​of the local maxima 4220 and local minima 4230 cyclically increase and then decrease again. From this cyclical pattern, the person's breathing cycles during the measurement period can now be determined using the method according to the invention.

[0290] For this purpose, the maximum values ​​4220 and the minimum values ​​4230 are considered, and a fitting curve is created for each of them. The first fitting curve 4250 is therefore a fitting curve for the local maxima 4220, and the second fitting curve 4260 is a fitting curve for the local minima 4230. For both the first fitting curve 4250 and the second fitting curve 4260, a best fit is preferably used, e.g., via a least-squares fitting (between the fit and the data point), particularly iteratively, so that the respective extreme values ​​in the intensity curve 4200 are optimally approximated. It is also possible to create the fitting curves only in sections so that they better correspond to the detected cycles.

[0291] In the created compensation curves 4250 and 4260, local fluctuations on and within the respective compensation curve can be seen. For example, the first, upper compensation curve 4250 has a locally maximum intensity value 4253 at approximately 1:55 seconds. Since the second, lower compensation curve 4260 also has a locally lowest value 4263 at the same point, the distance between the two compensation curves 4250, 4260 is maximum at this point in time compared to the surroundings. Such a local maximum distance results from the change in blood pressure during respiration. Conversely, this means that the distance is a measure of respiration itself. The inventors have taken advantage of this circumstance. Therefore, these maximum intervals, for example 4253 to 4263 and 4256 to 4266, are assigned a maximum state of breathing, i.e. a maximum inhalation or a maximum exhalation, within a breathing cycle at this time 4283.As discussed again below, such maximum distances are to be assigned to a maximum inhalation when using the derivative function. The subsequent minimum distance between the two compensation curves 4250, 4260, and thus a locally minimum value 4254 in the upper compensation curve 4250 and a locally maximum value 4264 in the lower compensation curve 4260, is to be assigned to the opposite maximum state of respiration at time 4284.

[0292] By determining these two points in time, 4283 and 4284, the period of a phase segment of respiration can be derived. Such a phase segment must be taken into account when assigning diastolic or systolic blood pressure values.

[0293] It is not important whether the period of the phase segment first has a maximum value, in particular whether this begins with it, and then a minimum value, in particular whether it ends with it. It is also possible for the phase segment and its period to be found from an opposite combination of the minimum and maximum distances between the compensation curves 4260 and 4250. For this purpose, a minimum distance between the compensation curves, for example at time 4285 and points 4265 on the lower compensation curve 4260 and 4255 on the upper compensation curve 4250, can be found as the beginning. The end of this phase segment is formed by a subsequent local maximum of the distance between the two compensation curves 4250 and 4260 at time 4286 between points 4266 and 4256.

[0294] The assignment of a local maximum (e.g., 4253 to 4263 or 4256 to 4266) or minimum (e.g., 4254 to 4264 or 4255 to 4265) distance between the compensating curves 4250 and 4260 to a maximum position within the respiration, i.e., maximum inhalation or maximum exhalation, depends on the method used to determine the intensity curve. For example, if the intensity curve is determined using a bandpass filter, the intensity curve reflects the blood pressure. Consequently, a locally maximum distance between the compensating curves 4250 and 4260 corresponds to maximum exhalation, and conversely, a locally minimum distance corresponds to maximum inhalation. The exact opposite applies if the intensity curve results from a mathematical derivation.

[0295] Consequently, the assignment of these two types of phase sections to the first 3571 and second phase sections 3572 necessary for the analysis is determined by the exact method of determining the intensity curve.

[0296] Additionally, or alternatively, the temporal interval between the local maxima and the local minima can also be considered. Thus, instead of the absolute value of the local maxima and minima, the temporal interval between consecutive local maxima or consecutive minima, or the temporal interval between consecutive local minima and maxima or maxima and minima, is considered. For this purpose, it is advantageous if the data underlying this analysis was acquired at a data rate of at least 200 Hz.

[0297] A shortest time interval, also called interval, between local maxima or local minima of a maximum inhalation and a longest time interval between the local maxima or minima of a maximum exhalation is assigned.

[0298] These two types of assignment of a maximum exhalation or inhalation by means of absolute values ​​of the local maxima and minima or by means of the interval length between the local maxima or minima represent two different phenomena that can be technically evaluated by means of the method according to the invention.

[0299] The following section explains an example in more detail:

[0300] Two data sets are required for data processing: the intensity of the variations in the cuff pressure curve and the respiration information. If respiration is to be determined directly from the air pressure curve, a narrow cuff is advantageous. However, this requires further calculation to distinguish the transition of the causes of the variations. In the state of the art, the intensity of the variations is determined directly from the pressure curve using a suitable bandpass filter. This is also a possible approach for the method presented here. Since the absolute value of the variations is not important, the first mathematical derivative of the pressure curve can also be used. This has the advantage that information is not lost through filtering.The derivative shows a local maximum and a local minimum for each variation. The derivative itself (averaged over a longer period of time) shows the pressure change rate, which is determined by the pump (when measuring at increasing pressure) or by the valve (when measuring at decreasing pressure), and should assume a value that is as constant as possible due to the pump or valve. The intensity curve of the variations is examined with regard to local minima and maxima, resulting in a list consisting of tuples in the form of time to intensity value. The information on respiration is a list of tuples in the form of time of maximum inspiration and time of maximum expiration. From these values, the values ​​for the time of inspiration and expiration, as well as the respiratory rate, can be determined. The information on respiration can be determined using another method, e.g.Methods for determining ECG, light waves, and acceleration sensor data are known to those skilled in the art. Methods based on microphones, ultrasound, or temperature are less common, but their evaluation is very similar to the evaluation of methods using light waves. However, determining respiration directly from the air pressure curve is advantageous. In Figure 4, the envelope (consisting of the upper fitting curve 4250 and the lower fitting curve 4260) of the intensity curve of the variations in the air pressure curve, which was determined by mathematical derivation, shows changes with respiration. Reference symbol 4284 marks an example point in time at which the envelope has a local minimum height diameter.Such a time is a time of maximum exhalation; the times of the local maximum height diameter of the envelope at the time marked with the reference symbol 4283 as an example is the time of maximum inspiration. Another method is to detect the interval between two consecutive variations. This interval decreases with inspiration and increases again with exhalation. The suitability of both methods of determining respiration varies from person to person, as these phenomena are not always visible. In principle, for both variants, the time of maximum inspiration or the time of maximum exhalation can be determined with a temporal error of half the cardiac pulse interval that exists at the time of the respective measuring points, due to methodological reasons.

[0301] Ideally, both phenomena are detectable in a single data set and can be evaluated together to increase accuracy. However, there are also data sets in which one of the two features cannot be resolved sufficiently to detect respiration. This is particularly the case at a data rate of less than 200 Hz, as in this case the intervals often cannot be resolved sufficiently. Therefore, both features of the phenomena are first evaluated to detect respiration. Then, based on quality factors of the resulting data, an assessment is made as to which method is suitable and which is not. These quality factors are the periodicity and the amplitude of the respiration curve. The periodicity results from the times of inspiration and expiration determined using the method, or from the interval times of respiration. For this purpose, a coefficient of variation of the interval times is determined.The coefficient of variation is given by the standard deviation divided by the mean of the interval times and is expressed as a percentage. When determined from the characteristic of the distance between the fitting curves 4260 and 4250, the amplitude is given by the difference between the distance during inspiration and the distance during expiration. When determined from the characteristic of the interval between the variations, the amplitude is given by the difference between the interval times during inspiration and expiration. Regarding the difficulty of determining the beginning and end of the first and second phase segments, please refer to Figure 6.

[0302] In section a) of Figure 5, individual air pressure values ​​measured using a cuff within a measuring period are shown as an air pressure curve 5000 over time. Essentially, a blood pressure value can be assigned to the air pressure. A general increase in pressure can be seen in the air pressure curve 5000. This pressure increase is a result of the cuff measurement. During the cuff measurement, the pressure exerted by the cuff on the measuring area is varied, in this case increased, and thus pressurization occurs in the measuring area on a person. This occurs by pumping more air into the cuff. Air is pumped into the cuff at a predetermined pressurization rate of change. The figure shows a simple case of pressurization, namely with a constant and positive pressurization rate of change.However, a non-constant or partly positive and partly negative pressure change rate over the measurement period is also possible. The measurable pressure curve 5000 then shows this varying (constant or non-constant, positive, negative, or both) pressure change.

[0303] Regardless of the pressure increase, additional variations 5010 in the measured air pressures can be measured in the pressure curve 5000.

[0304] From this pressure curve 5000 and the variations 5010, in addition to the at least two respiration-corrected first, systolic and second, diastolic individual blood pressure values, indicated here by the systolic blood pressure values ​​5077 and 5078 and the diastolic blood pressure values ​​5073 and 5074, a first plurality of respiration-corrected systolic blood pressure values ​​can be determined using the previously described inventive method. It is also possible to determine a second plurality of respiration-corrected diastolic blood pressure values. In the example of an inventive evaluation of schematic air pressure values ​​shown in Figure 5, these last two aspects of the further advantageous evaluation option will now be presented.

[0305] This evaluation option has two aspects. Firstly, it shows how continuous blood pressure values ​​are determined and secondly, although this is not always necessary, it should be shown how a narrow cuff can be used. The term "continuous" refers to the recording of blood pressure values ​​over a longer period of time, preferably at short intervals, preferably for each heartbeat. Furthermore, "narrower" means that the data is recorded using a cuff that is narrower than the cuff used in the state of the art. According to the state of the art, a cuff for use on the upper arm has an optimal width if this width is one third of the length between the shoulder joint and the elbow joint. As already specified above, a narrow cuff can, in particular, be as little as 3 cm wide.

[0306] As already described above, a narrow cuff leads to measurement errors when using state-of-the-art methods. In this case, the blood pressure reading is typically too high, particularly for systole. This is because the pressure variations, shown here by 5010, are not only caused by the tissue and arteries below the cuff, but can also originate from directly adjacent tissue and arteries. With a wide and therefore optimal cuff for state-of-the-art technology, this effect is small compared to the pressure variations caused by the arteries below the cuff and is further mechanically suppressed by the large volume of the cuff. With narrow cuffs, however, this effect is no longer negligible and leads to pressure variations being detectable even at high cuff pressures.Even when using a standard cuff with standard cuff widths, one or two individual blood pressure values ​​can be determined from the 5000 barometric pressure curve, for example, using a digital bandpass filter. However, it is desirable to determine a continuous blood pressure value, especially when the rate of change of pressure is low. Due to the inherent nature of the Riva Rocci and Korotkoff method (multiple heart pulses are required for the determination), continuous blood pressure values ​​cannot be determined using this method. A sufficiently long time interval is required to obtain the measured values, meaning that, for example, a blood pressure value cannot be determined for every heart pulse.

[0307] Figure 5 illustrates a further development of the method according to the invention for obtaining continuous blood pressure values ​​from individual measurements of the air pressure value from a cuff, using a narrow cuff. For this reason, several additional method steps are required, as shown in sections b) and c) of Figure 5, to obtain continuous blood pressure values ​​from the air pressure values. If a cuff with sufficient width is used, an intensity curve can be determined directly, as mentioned, for example, using a bandpass filter, which then has the shape shown in section c) of the intensity curve 5300.

[0308] Using a wide cuff over a narrow cuff has the advantage of being simpler. However, it has several disadvantages. Firstly, the intensity curve is mechanically filtered due to the large volume, and secondly, it becomes blurred because the measurement area is large and therefore affects many arteries.

[0309] With a wide cuff, it is also impossible to determine over what period the blood pressure curve is fully reflected in the air pressure curve. From another perspective, a narrow cuff is advantageous because it allows for less strain on the user and thus a lower rate of pressure change, allowing for a longer measurement and thus a longer continuous blood pressure determination. However, the following will discuss the case shown in Figure 5, i.e., a measurement with a narrow cuff.

[0310] After measuring the individual values ​​and creating the pressure curve 5000, the change curve 5200 or intensity curve 5200 is created, for example, using the mathematical derivative function. This intensity curve 5200 represents the recorded air pressure values ​​regardless of the varying pressurization. In this intensity curve 5200, the variations 5010 of the pressure curve 5000 are present and recognizable as maximum values ​​5220 and as minimum values ​​5230 of the intensity curve 5200 along the measurement period. The minimum values ​​5230 are those individual values ​​of the intensity curve 5200 that have the lowest individual values ​​compared to the immediately preceding individual value and the immediately following individual value.The maximum values ​​5220 are those individual values ​​of the intensity curve 5200 which have the highest individual values ​​compared to the immediately preceding individual value and the immediately following individual value.

[0311] However, these local extrema 5220, 5230 are not evenly distributed. Rather, it can be observed that from a certain point in time or a certain higher pressure of pressurization, the local maxima and from a certain point in time or a certain higher pressure of pressurization, the local minima increase significantly, i.e., the maxima become larger and the minima have smaller values. This is, on the one hand, the fundamental effect of the pressurization, as further described above, and, on the other hand, an effect of the narrow cuff, since from these pressures of pressurization, the effect of the cuff being too narrow begins to emerge, i.e., excessive pressures and reverse fluctuations are recorded.

[0312] However, with the following procedural steps, these effects can be adequately taken into account in the evaluation and thus eliminated. Thus, a correction for the effects caused by the cuff width is performed, creating a cuff-width-corrected curve, which can then be used, for example, to determine individual blood pressure values ​​or, as shown in Figure 5, to determine continuous blood pressure values.

[0313] In a first method step, several, in particular three, lower approximation lines 5261, 5262, 5263 and three upper approximation lines 5251, 5252, 5253 are formed. This is implemented, for example, by a linear approximation of a line to the local extrema.

[0314] In this case, the first point in time within the pressure curve and thus within the measurement period at which the variations 5010 lie outside the noise level is preferably selected as the starting point of the first upper approximation line 5251 and the first lower approximation line 5261, and the last point in time within the pressure curve at which the variations 5010 lie outside the noise level is preferably selected as the end point of the third upper approximation line 5253 and the third lower approximation line 5263.

[0315] The first upper approximation line 5251 is formed and determined in such a way that an approximation line to the local maxima 5220 present in a first time period is formed for the first upper approximation line 5251, whereby the beginning 5280 of the first time period is defined by the beginning of the first upper approximation line 5251. The time from which the approximation of the first upper approximation line 5251 to the local maxima 5220 falls below a predetermined degree of determination is taken as a temporary end of the first upper approximation line 5251 and the first time period.

[0316] In a next step, the third upper approximation line 5253 is formed, which is formed as an approximation line to the local maxima 5220 present within a third time period, whereby the end 5283 of the third time period is defined by the end of the third upper approximation line 5253. The time from which the approach of the third upper approximation line 5253 to the local maxima 5220 falls below the predetermined coefficient of determination is taken as a temporary start of the third upper approximation line 5253 and the third time period.

[0317] Starting from the temporary end of the first time period and first upper approach line 5251 and the temporary start of the third time period and third upper approach line 5253, a second upper approach line 5252 is determined within a second time period, so that the temporary start of the second upper approach line 5253 and the second time period coincides with the temporary end of the first upper approach line 5251 and the temporary end of the second upper approach line 5253 and the second time period coincides with the temporary start of the third upper approach line 5253.The temporary end of the second upper approach line 5252, and thus the temporary start of the third upper approach line 5253, and the temporary start of the second upper approach line 5252, and thus the temporary end of the first upper approach line 5251, are then changed iteratively until the second upper approach line 5252 is an approach line that has the smallest deviation from the local maxima 5220 present in the second time period, in particular exceeds a predetermined coefficient of determination.As soon as this final second upper approach line 5252 is iteratively determined, the resulting end of the first upper approach line 5251 is determined as the final end 5281 of the first time period, the resulting end of the second upper approach line 5252 as the final end 5282 of the second time period, the resulting beginning of the second upper approach line 5252 as the final beginning 5281 of the second time period and the resulting beginning of the third upper approach line 5253 as the final beginning 5282 of the third time period.

[0318] The same procedure is followed for the lower approach lines.

[0319] The first lower approximation line 5261 is determined and formed in such a way that an approximation line to the local minima 5230 present within a fourth time period is formed for the first lower approximation line 5261, whereby the beginning 5285 of the fourth time period is defined by the beginning of the first lower approximation line 5261. The time from which the approximation of the first lower approximation line 5261 to the local minima 5230 falls below the predetermined coefficient of determination is taken as a temporary end of the first lower approximation line 5261 and the first time period.

[0320] In a next step, the third lower approximation line 5263 is formed, which is formed as an approximation line to the local minima 5230 present within a sixth time period, whereby the end 5288 of the sixth time period is defined by the end of the third lower approximation line 5263. The time from which the approximation of the third lower approximation line 5263 to the local minima 5230 falls below the predetermined coefficient of determination is taken as a temporary beginning of the third lower approximation line 5263 and the third time period.

[0321] Starting from the temporary end of the fourth time period and first lower approach line 5261 and the temporary start of the sixth time period and third lower approach line 5263, a second lower approach line 5262 is determined within a fifth time period, so that the temporary start of the second lower approach line 5263 and the fifth time period coincides with the temporary end of the first lower approach line 5261 and the temporary end of the second lower approach line 5263 and the fifth time period coincides with the temporary start of the third lower approach line 5263.The temporary end of the second lower approach line 5262, and thus the temporary start of the third lower approach line 5263, and the temporary start of the second lower approach line 5262, and thus the temporary end of the first lower approach line 5261, are then changed iteratively until the second lower approach line 5262 is an approach line that has the smallest deviation from the local minima 5230 present in the second time period, in particular exceeds a predetermined coefficient of determination.As soon as this final second lower approach line 5262 is iteratively determined, the resulting end of the first lower approach line 5261 is determined as the final end 5286 of the fourth time period, the resulting end of the second lower approach line 5262 is determined as the final end 5287 of the fifth time period, the resulting beginning of the second lower approach line 5262 is determined as the final beginning 5286 of the fifth time period, and the resulting beginning of the third lower approach line 5263 is determined as the final beginning 5287 of the sixth time period.

[0322] This results in differences between the different upper and lower approach lines at different times, and thus in different distances, also called height differences, between the upper and lower approach lines. The first time at which the narrow cuff's exaggerated effect significantly influences the air pressure values ​​is the beginning of 5281 of the second time period or the beginning of 5286 of the fourth time period. The reason why the beginning of 5281 of the second time period and the beginning of 5286 of the fourth time period are not identical is likely because the effect depends on the specific blood pressure within the cardiac cycle.The different times 5281 and 5286 arise from the fact that at the high pressure of the systolic cardiac cycle the effect of the (too) narrow cuff already comes into effect from 5281, whereas at the lower pressure during the diastolic phase of the cardiac cycle the effect has just not yet appeared and only comes into effect from 5286. As a possible solution, it is therefore proposed that an average value 5289 is calculated from the beginning 5281 of the second time period and the beginning 5286 of the fourth time period and the distance between the upper and lower approximation lines present at this time 5289 of the average value is used as a normalization parameter, the cuff width correction constant.

[0323] In a further method step, in order to obtain values ​​independent of the effect of the cuff width and thus the cuff-width-corrected intensity curve 5300, the individual values ​​of the change curve 5200 present at the respective time are multiplied by a width correction factor, in particular a cuff width correction factor. The cuff width correction factor is based on a standardized difference between the upper and lower approach lines. The difference is based on the distance, the height difference, between the upper and lower approach lines at the respective time, and the standardization of the difference is based on the standardization parameter, the cuff width correction constant.This standardized difference, also called the cuff width correction factor, is specifically the quotient of the height difference at the respective point in time and the cuff width correction constant, with the cuff width correction constant as the dividend and the height difference as the divisor of the quotient. In addition to the cuff width correction factor, the width correction factor also consists of a cuff target factor, which describes the target shape of the intensity fluctuation 5300. The target shape is 0 at times 5285 and 5283 and 1 at time 5289. Between these three points in time, the target shape is partially linear. In summary, a value of curve 5300 at a point in time is the value at that point in time of curve 5200 multiplied by the cuff width correction factor at that point in time multiplied by the cuff target factor at that point in time.

[0324] From the individual values ​​thus obtained, the device width corrected intensity curve 5300 is formed, which has several local maxima 5320 and several local minima 5330, i.e. individual values ​​which have smaller or larger individual values ​​compared to the neighboring individual values.

[0325] At least relative continuous blood pressure values ​​could be determined from this device-width-corrected intensity curve 5300. This would allow changes over time to be determined, and these relative changes could be used, for example, to track changes in state. It is also possible to obtain non-respiration-corrected absolute blood pressure values ​​from this device-width-corrected intensity curve 5300. For this purpose, the device-width-corrected intensity curve 5300 would have to be scaled. However, since the object of the invention is to provide, in particular, respiration-corrected blood pressure values, individual respiration-corrected blood pressure values ​​can be determined from this device-width-corrected intensity curve 5300. This can be done in a manner analogous to that described for Figure 3 and, if applicable, Figure 4.

[0326] Since an advantageous further development provides continuous blood pressure values, continuous blood pressure values ​​are now determined from this device-width-corrected intensity curve 5300, as described below. For this purpose, a second upper approximation line 5352 and a second lower approximation line 5362 are determined.

[0327] The second upper approximation line 5352 represents a, in particular linear, approximation to the local maxima 5320 of the device-width-corrected intensity curve 5300, namely starting from the end of the device-width-corrected intensity curve 5300, which corresponds to the air pressure values ​​at high pressure loads. The second upper approximation line 5352 preferably represents an approximation up to the time of the mean value 5289. The second lower approximation line 5362 represents a, in particular linear, approximation to the local minima 5330 of the device-width-corrected intensity curve 5300, namely starting from the end of the device-width-corrected intensity curve 5300, which corresponds to the air pressure values ​​at high pressure loads. The second lower approximation line 5362 preferably represents an approximation up to the time of the mean value 5289.

[0328] This procedure (considering only the range 5472 at high pressures) usually provides a usable result for 90% of this time range of the second approximation line (envelope in this time range at high pressures), especially with good sensors.

[0329] It should be noted that it is also possible to convert directly from 5200 to 5400 by not using the cuff target factor or cuff correction factor. The method described here is therefore necessary if the curves 5472 and 5471 are to be deduced from a cuff that is of optimal width according to the state of the art. The signal of the air pressure curve 5000 and the device width-corrected intensity curve 5300 determined from it in the range 5471 at lower pressures or pressurizations, i.e. up to time 5289, can only be considered medically to a limited extent, since in this range the blood pressure curve may and under certain circumstances not be fully reflected in the air pressure curve. This is generally not the case at higher pressures; rather, in this range the blood pressure values ​​are generally fully reflected in the air pressure curve.

[0330] Nevertheless, it is also possible to use the values ​​at lower pressures. For this purpose, it is possible to determine a first upper approximation line 5351 and a first lower approximation line 5361. The first upper approximation line 5351 represents a, in particular linear, approximation to the local maxima 5320 of the device-width-corrected intensity curve 5300, namely starting from the beginning of the device-width-corrected intensity curve, which corresponds to the air pressure values ​​at low pressures. The first upper approximation line 5351 preferably represents an approximation up to the time of the mean value 5289. The first lower approximation line 5361 represents a, in particular linear, approximation to the local minima 5330 of the device width corrected intensity curve 5300, namely starting from the beginning of the device width corrected intensity curve, which corresponds to the air pressure values ​​at low pressure loads.The first lower approximation line 5361 preferably represents an approximation up to the time of the mean value 5289.

[0331] This results in differences between the different upper and lower approach lines at different times and thus different distances, also called height differences, between the upper and lower approach lines 5351, 5352, 5361, 5362.

[0332] In a further method step, in order to be able to determine continuous blood pressure values ​​and thus initially obtain a continuous, relative blood pressure curve 5400, the individual values ​​of the device width-corrected intensity curve 5300 present at the respective time are normalized. The normalization is based on the height differences between the upper and lower approximation lines 5351, 5352, 5361, 5362 present at the respective time. In the simplest case, the individual value of the device width-corrected intensity curve 5300 present at the respective time is divided by the height difference present at this time. As a result, the local maxima in the device width-corrected intensity curve normalized in this way fluctuate around an upper approximation line 5450 based on the first and / or second upper approximation line, which is now flat due to the normalization.The local minima in the device width-corrected intensity curve normalized in this way also fluctuate around a lower approximation line 5460 based on the first and / or second lower approximation line, which is now flat due to the normalization.

[0333] These standardized individual values ​​for the respective time points, which represent the relative blood pressure curve 5400, are then scaled with a scaling constant.

[0334] The scaling is based on the differences between the standardized individual values ​​in the relative blood pressure curve and the absolute respiration-corrected blood pressure values. Therefore, if the respiration-corrected first, i.e., systolic blood pressure values ​​are to be used as a basis, as shown in Figure 5, the values ​​for systole 5077 and 5078, which were determined using the previously described method, are used. These systole values ​​describe the highest and lowest values ​​within respiration, and the values ​​were determined at a single point in time, specifically at a heartbeat. In addition, the standardized individual values ​​for these two points in time are used, i.e., the standardized individual values ​​5477 and 5478, which can be determined at the first 5087 and second point in time 5088 from the relative blood pressure curve 5400.In addition to this scaling, a correction in the absolute value range is required, since the use of the mathematical derivation has lost any connection to an absolute value. However, this "offset" error is accepted and recalculated as follows. For this purpose, it is proposed and implemented in Figure 5 that an average value is used from the respiration-corrected systolic and diastolic blood pressure values, i.e., an average value is taken from the four values. The background to this is the following:

[0335] The offset error refers to the diastole values ​​and is half the change in pulse pressure during the measurement. For example, if the values ​​determined for respiration-corrected diastole were 78 mmHg and 82 mmHg, and at this time there was also a systole of 1 18 / 122 mmHg (which cannot be measured with the individual value determination at this time), the pulse pressure would be 40 mmHg. At another time during the measurement period, at which the systole is measurable in a single value determination (see Figure 3), however, the blood pressure has changed and according to the invention only the values ​​128 mmHg and 132 mmHg can be determined. It can be assumed that the diastole, which is now not measurable, also increased at this time, so that the pulse pressure remains unchanged. Based on the determination according to the invention, however, an incorrect pulse pressure of 50 mmHg would now result.This pulse pressure being 10 mmHg too high leads to a continuous diastole value being 5 mmHg too high.

[0336] The basis is the blood pressure values ​​during inspiration and expiration on which the respiration-corrected blood pressure value is based, here 5077 and 5078, and the blood pressure mean of the four respiration-corrected first and second blood pressures 5073, 5074, 5077, 5078.

[0337] The blood pressure values ​​5077 and 5078 refer to the systolic blood pressure at times 5087 and 5088, respectively. However, it would also be possible to use the respiration-corrected diastolic blood pressure values ​​instead. The standardized individual values ​​5477 and 5478 can be determined at these times in the relative blood pressure curve 5400. To obtain the absolute, continuous respiration-corrected blood pressure values, each individual value in the relative blood pressure curve 5400 is shifted linearly to obtain the values ​​for the blood pressure curve 5500, where BW stands for individual value, BPVK for blood pressure curve, BPW for blood pressure value, atmk. for respiration-corrected, syst. for systole or systolic, and diast. for diastole or diastolic:

[0338] Values ​​of the BDVK 5500 (as a function of time)

[0339] EW (for all times) of the relative BDVK 5400 standardized EW 5478 — standardized EW 5477

[0340] * (atmk. syst. BDW 5078 — atmk. syst. BDW 5077)

[0341] + 0.25 (atmk. syst. BDW 5078 + atmk. syst. BDW 5077

[0342] + atmk. diast. BDW 5073 + atmk. diast. BDW 5074)

[0343] This blood pressure curve 5500 has local maxima and local minima, whereby continuous systolic blood pressure values ​​5495, 5496 can be formed and determined by the local maxima of the normalized and scaled device width corrected intensity curve, i.e. the blood pressure curve 5500.

[0344] Furthermore, continuous diastolic blood pressure values ​​5493 and 5494 can also be derived. These are formed by the local minima of the normalized and scaled device-width-corrected intensity curve, i.e., the blood pressure curve 5500.

[0345] In Figure 6, the three subsections (a), (b), and (c) depict three different scenarios regarding a respiration curve 3500, which can result after determining a diastolic non-respiration-corrected blood pressure value at the second reference time 3181. Subsection (a) depicts an ideal case. In this case, there is no time offset between the recorded times of maximum inspiration 3583 and maximum expiration 3584 within the second phase segment 3571, e.g., because the respiration curve was determined from the individual value measurements, which also form the basis for calculating the blood pressure values.

[0346] A second scenario is shown in sub-area (b). In this case, the second reference time point 3181, at which the blood pressure value of the diastolic non-respiration-corrected blood pressure value was determined, is a later time point compared to the ideal case. This is not unusual, since the determination of the non-respiration-corrected blood pressure value according to the state of the art contains such inaccuracies. However, it is problematic if the respiration curve 3500 used and the associated times of maximum inspiration 3583 and maximum expiration 3584 have a time offset from the times on which the determination of the blood pressure values ​​is based. In such a case, the time point 3181 would be outside a phase segment that is determined solely on the basis of the times of maximum inspiration 3583 and maximum expiration 3584.For this reason, the end of the phase segment 3571 to be used is based on the time of the recorded maximum exhalation 3584, but a weighted time center 3589 between the time of the recorded maximum exhalation 3584 and the time of the subsequent recorded maximum inspiration is used. If the time 3181 does not coincide with a suitable phase segment, a weighted time center 3589 is determined, for example, between the maximum inspiration and exhalation (at the non-matching phase segment found). Depending on the position of the time 3181 relative to the time center 3589, the appropriate phase segment before or after is used for further processing.

[0347] In the scenario on which sub-area (b) was based, time 3181 is still before the averaged time center 3589. In the scenario on which sub-area (c) was based, time 3181 is after the averaged time center 3589, so that the subsequent phase segment is used.

[0348] Figure 7 shows a schematic diagram of a pressure curve 7000 of the blood in an artery under changing load conditions, here recovery as an example. Depending on the temporal perspective at which the pressure is analyzed, the individual influences on the pressure can be recognized. If the curve is analyzed with a high temporal resolution, the change in blood pressure 7100 due to the heart rate can be seen and variations 7010, namely maxima 7020 and minima 7030, can be recognized. With a medium temporal resolution (indicated by the dashed line 7200) the influence of breathing on the pressure can be seen and with a low temporal resolution (indicated by the dashed line 7300) the influence of the load can be seen. An influencing factor affects blood pressure in two ways. Firstly, an influencing factor changes blood pressure directly.The influence of pulse leads to a change in the heart rate, the influence of breathing leads to a change in the breathing cycle and the influence of exertion leads to a change in the level of exertion. One influencing factor also affects the other influencing factors and thus has an indirect effect on blood pressure. When exertion is high, the heart and breathing rate increase (increasing to the left). As exertion increases, the influence of breathing on blood pressure also decreases. There can be several reasons for this. A typical reason is that breathing is shallower under exertion. On the other hand, a high baseline pressure leads to the artery walls becoming stiffer and the pressure increase due to breathing is even smaller. Breathing also has an influence on the pulse: when you inhale, the pulse rate increases and when you exhale, it decreases.

[0349] Reference symbol:

[0350] 1000, 2000, 3000, 4000, 5000, 7000: trend curve of the individual values ​​of the individual value measurements, namely air pressure trend curve;

[0351] 1010, 2010, 3010, 4010, 5010, 7010: Variations in the air pressure curve;

[0352] 1 100, 2100, 3100 pressure-corrected intensity curve of the air pressure curve, obtained either by a suitable filter, e.g. bandpass filter or by subtracting a best-fit line;

[0353] 4200, 5200: intensity curve of the air pressure curve obtained by the first mathematical derivative over time;

[0354] 1 1 10, 21 10, 31 10, 4210, 5210: Variations in the intensity curve;

[0355] 21 1 1 , 21 12, 21 13: first, second and third groups in the variations respectively;

[0356] 31 20, 31 30: local maxima and minima in the pressurization-corrected intensity curve; 31 50, 31 60: upper fitting curve to the local maxima in the pressurization-corrected intensity curve and lower fitting curve to the local minima in the pressurization-corrected intensity curve;

[0357] 3170: Point of maximum distance between the upper regression curve and the lower regression curve;

[0358] 3171 : point of the distance between the upper compensation curve and the lower compensation curve, which is smaller by a predetermined ratio than the point 3170 towards lower pressures for determining the diastolic blood pressure value according to the state of the art;

[0359] 3172: Point of the distance between the upper compensation curve and the lower compensation curve, which is smaller by a predetermined ratio than the point 3170 towards higher pressures for determining the systolic blood pressure value according to the state of the art;

[0360] 3181 : Time of point 3171 , also reference time, sometimes second reference time;

[0361] 3182: Time of point 3172, also reference time, sometimes first reference time;

[0362] 3091 : Blood pressure value according to the state of the art determined from the air pressure curve at time 3181 ;

[0363] 3092: Blood pressure value determined according to the state of the art using the air pressure curve at time 3182;

[0364] 3500: Respiratory curve;

[0365] 3520: local maxima in the respiration curve;

[0366] 3530: local minima in the respiration curve;

[0367] 3571 : second phase section;

[0368] 3572: first phase section;

[0369] 3583: first time point of the second phase segment as the time point of maximum inspiration in the second phase segment;

[0370] 3584: second time point of the second phase segment as the time point of maximum exhalation in the second phase segment; 3585: second time point of the first phase segment as the time point of maximum exhalation in the first phase segment;

[0371] 3586: first time point of the first phase segment as the time point of maximum inspiration in the first phase segment;

[0372] 3589: End of a phase section;

[0373] 3093: Blood pressure value determined according to the method according to the invention on the basis of the air pressure curve at time 3583;

[0374] 3094: Blood pressure value determined according to the method according to the invention on the basis of the air pressure curve at time 3584;

[0375] 3095: Blood pressure value determined according to the method according to the invention on the basis of the air pressure curve at time 3585;

[0376] 3096: Blood pressure value determined according to the method according to the invention on the basis of the air pressure curve at time 3586;

[0377] 4220: local maxima of the variations in the intensity curve of the air pressure curve;

[0378] 4230: local minima of the variations in the intensity curve of the air pressure curve;

[0379] 4250: upper fitting curves to the local maxima in the intensity curve;

[0380] 4253, 4256: locally maximum value in the first, upper best-fit curve;

[0381] 4254, 4255: locally minimum values ​​in the first, upper best-fit curve;

[0382] 4260: second, lower fitting curves to the local minima in the intensity curve;

[0383] 4263,4266: locally minimum value in the second, lower fitting curve;

[0384] 4264, 4265: locally maximum values ​​in the second, lower fitting curve;

[0385] 4283, 4286: Times of the local maximum values ​​in the first, upper

[0386] best fit curve and the locally minimum value in the second, lower best fit curve;

[0387] 4284, 4285: Times of the locally minimum values ​​in the first, upper

[0388] Compensation curve and the locally maximum values ​​in the second, lower compensation curve; 5073, 5074: Results for the two respiration-corrected second diastolic blood pressures according to the invention, namely at maximum inspiration and expiration;

[0389] 5077, 5078: Results for the two respiration-corrected first systolic blood pressures according to the invention, namely at maximum inspiration and expiration;

[0390] 5087, 5088: Times of the two first systolic blood pressure values ​​in the air pressure curve, corrected according to the invention;

[0391] 5220: local maxima in the intensity curve;

[0392] 5230: local minima in the intensity curve;

[0393] 5251 : first upper approach line;

[0394] 5252: second upper approach straight line;

[0395] 5253: third upper approach straight line;

[0396] 5261 : first lower approach line;

[0397] 5262: second lower approach line;

[0398] 5263: third lower approach line;

[0399] 5280, 5281 : beginning and end of the first period;

[0400] 5281 , 5282: beginning and end of the second period;

[0401] 5282, 5283: beginning and end of the third period;

[0402] 5285, 5286: beginning and end of the fourth period;

[0403] 5286, 5287: beginning and end of the fifth period;

[0404] 5287, 5288: beginning and end of the sixth period;

[0405] 5289: mean of the times between the beginning of the second period and the beginning of the fourth period;

[0406] 5300: Device width corrected intensity curve;

[0407] 5320: local maxima in the device width corrected intensity curve;

[0408] 5330: local minima in the device width corrected intensity curve;

[0409] 5351 , 5352: first and second upper approximation lines respectively;

[0410] 5361 , 5362: first and second lower approximation lines respectively;

[0411] 5400: standardized device-width-corrected intensity curve; 5477, 5478: standardized individual values ​​at the maxima of the device-width-corrected intensity curve at the times of the two first systolic blood pressure values ​​in the air pressure curve, corrected according to the invention for respiration;

[0412] 5473, 5474: standardized individual values ​​at the minima of the device width-corrected intensity curve at the times of the two respiration-corrected first systolic blood pressure values ​​in the air pressure curve;

[0413] 5450: upper approximation line;

[0414] 5460: lower approximation line;

[0415] 5471 : Area in which the blood pressure curve does not allow a complete representation of the blood pressure curve in the arteries below the cuff due to the pressure conditions in the cuff;

[0416] 5472: Range in which the blood pressure curve can usually be displayed without errors;

[0417] 5495, 5496: first plurality of continuous, respiration-corrected first, systolic blood pressure values;

[0418] 5493, 5494: second plurality of continuous, respiration-corrected second, diastolic blood pressure values;

[0419] 7020, 7030: local maxima and minima in the pressure curve;

[0420] 7100: Air pressure curve;

[0421] 7200: Curve of the local maxima, as an indicator of the effect of breathing on the air pressure curve;

[0422] 7300: Curve over the entire course of the air pressure curve as an indicator of the effect of the load change on the air pressure curve;

Claims

Claims 1. A method for determining at least two respiration-corrected first blood pressure values of a person, wherein a plurality of individual value measurements (1000, 2000, 3000, 4000, 5000) of a value assigned to the blood pressure value of the person are recorded within a measurement period in a time-resolved manner by means of a first sensor of a first device, wherein within the measurement period the first device carries out a varying, in particular continuously monotonically decreasing or continuously monotonically increasing, pressure application to a part of the person used as a measurement range with a pressure application change rate predetermined over the time of the measurement period and the values of the individual value measurements at least partially comprise the varying pressure application, wherein a non-respiration-corrected first blood pressure value (3092, 3093, 5092) of the person is determined from the individual value measurements, wherein as a first reference time (3181,3182) the time of the non-respiration-corrected first blood pressure value is determined within the measurement period, wherein a first phase section (3571, 3572) of a person's respiration having a maximum value (3520), in particular a maximum inhalation, in a respiration curve (3500) at a first time point (3583, 3586) of the first phase section and a minimum value (3530), in particular a maximum exhalation, in the respiration curve (3500) at a second time point of the first phase section is recorded in a time-resolved manner within the measurement period, wherein the first phase section is selected such that the first reference time point falls within the period comprising the first phase section, and wherein for determining the respiration-corrected blood pressure value (3093, 3094, 3095, 3096; 5073, 5074, 5077, 5078, 5093, 5594, 5595, 5596) the blood pressure value (3093, 3096, 5074, 5078) assigned to the first time point of the first phase section in the individual value measurements or one, a blood pressure value (3093, 3096, 5074, 5078) determined on the basis of the blood pressure value assigned to the first time point of the first phase section is determined as the first of the at least two respiration-corrected first blood pressure values (3093, 3096, 5074, 5078), in particular the maximum inspiration, and the blood pressure value (3094, 3095, 5073, 5077) assigned to the second time point of the first phase section in the individual value measurements or a blood pressure value (3094, 3095, 5073, 5077) determined on the basis of the blood pressure value assigned to the second time point of the first phase section is determined as the second of the at least two respiration-corrected first blood pressure values, in particular the maximum expiration.

2. Method according to claim 1, characterized in that the value of the individual measurements is a pressure value, in particular an air pressure value or a pressure value determined on the basis of a measurement of an electrical voltage, in particular caused by the piezoelectric effect, or of the electrical resistance, and the first sensor has a pressure sensor, in particular an air pressure sensor, wherein the first device is in particular a pressure cuff, in particular an automated one, and in that the at least one phase section is determined by means of a second sensor, in particular a second device, wherein the second sensor or the second device is part of an ECG or an impedance sensor, a light wave-based sensor, in particular as part of a PPG or SpO2 measuring device, a microphone, an acceleration sensor, an ultrasonic sensor or a temperature sensor.

3. Method according to claim 1, characterized in that the value of the individual measurements is a pressure value, in particular an air pressure value or a pressure value determined on the basis of a measurement of an electrical voltage, in particular caused by the piezoelectric effect, or of the electrical resistance, and the first sensor has a pressure sensor, in particular an air pressure sensor, wherein the first device in particular has a, in particular automated, pressure cuff, and that the at least one phase section (3571, 3572), in particular the first and second time points, are determined from the values of the individual value measurements.

4. Method according to one of the preceding claims, characterized in that a pressure-corrected intensity curve (3100, 5300) is determined from the values of the individual value measurements by means of a regression line or by means of a bandpass filter for correcting the varying pressure application.

5. Method according to one of the preceding claims, characterized in that changes in the values of the first sensor present over time within the measuring period are determined from the values of the individual value measurements as a change curve (4200), in particular determined from the mathematical derivation of the values of the individual value measurements over time, a filter, in particular bandpass filtering or a subtraction of a best fit line, wherein the first and second points in time (3583, 3584, 3585, 3586, 4283, 4284, 4285, 4286), the phase section (3571, 3572) and / or the time span of the phase section, in particular the start and end of the phase section (3571, 3572), are determined from the change curve (4200).

6. Method according to the preceding claim and claim 3, characterized in that for the determination of the, in particular the first, phase section (3571, 3572) from the temporal change curve (4200), several local extrema (4210), namely local maxima (4220) and local minima (4230), are determined, wherein for the determination of the phase section, in particular the phase sections, (3571, 3572), in particular the first and second phase sections, a first and a second compensation curve (4250, 4260) are determined, wherein the first compensation curve (4250) is a compensation curve formed based on the points of the local maxima (4220) and wherein the second compensation curve (4260) is a compensation curve based on the points of the local minima (4230), wherein a plurality of local maximum distances (4253, 4263; 4256, 4266) and a plurality of local minimum distances (4254, 4264; 4255, 4265) are determined between the first compensation curve (4250) and second compensation curve (4260), wherein the phase section (3571, 3572), in particular its period of time, in particular the respective beginning and the respective end of the period of time, is determined by the time of two local minimum or maximum distances (4253; 4263; 4254, 4264; 4255; 4265; 4256, 4266) which follow one another in time.

7. Method according to one of the preceding claims, characterized in that a first plurality of respiration-corrected first blood pressure values (5493, 5494, 5495, 5496) of the person are determined as continuous blood pressure values, and in particular a third plurality of phase sections, wherein preferably each blood pressure value of the first plurality is assigned to a cardiac cycle, and in particular each phase section of the third plurality of phase sections has at least two of the at least two respiration-corrected first blood pressure values of the first plurality, wherein changes (5200, 5300), in particular gradients, of the values of the individual value measurements that are independent of the varying pressure application, in particular determined by means of a mathematical derivative with respect to time, are determined from the values (5000) of the individual value measurements, in particular having the varying pressure application, and an intensity curve (5200, 5300) is generated therefrom.comprising a plurality of local extrema (5220, 5320, 5230, 5330), wherein, optionally based on the intensity curve (5200), a device width-corrected, in particular cuff width-corrected, intensity curve (5300) comprising a plurality of local extrema (5320, 5330), namely a plurality of local maxima (5320) and a plurality of local minima (5330), is determined, wherein at least one, in particular at least two, upper approximation lines (5351, 5352) are formed for the local maxima (5320) of the intensity curve, in particular the device width-corrected one, present in the measurement period, in particular the third and / or the second time period or the first time period, and at least one, in particular at least two, lower approximation lines (5361, 5362) are formed for the local minima (5330) of the intensity curve, in particular the device width-corrected one, present in the measurement period, in particular the sixth and / or the fifth time period or the fourth time period, wherein, to determine the first plurality of respiration-corrected first blood pressure values, the individual values of the intensity curve, in particular the device width-corrected one (5300), are calculated on the basis of the difference between the upper approximation line (5351, 5352) and the lower approximation line present at the respective times of the second plurality (5361 ,5362) and scaled by a scaling constant, wherein the scaling constant is based on the difference between the standardized value (5477, 5478) of the intensity curve, in particular the device width-corrected one, present at the first and second time points of the first phase section (5087, 5088), and the first and second of the at least two respiration-corrected first blood pressure values (5077, 5078), wherein a blood pressure curve (5500) is determined from the standardized and scaled individual values, which has local maxima (5495, 5496) and local minima (5493, 5494), wherein the first plurality of respiration-corrected, continuous first Blood pressure values are determined.

8. Method according to one of the preceding claims, characterized in that at least two respiration-corrected second blood pressure values of the person are determined by a non-respiration-corrected second blood pressure value (3092, 3093, 5092) of the person is determined from the individual value measurements, wherein the time of the non-respiration-corrected second blood pressure value within the measurement period is determined as a second reference time, a second phase segment of the respiration having a minimum value (3520), in particular a maximum inhalation, in the respiration curve (3500) at a first time of the second phase segment and a maximum value (3530), in particular a maximum exhalation, in the respiration curve (3500) at a second time of the second phase segment within the measurement period is recorded in a time-resolved manner, wherein the second phase segment is selected such that the second reference time falls within the period comprising the second phase segment,and that the blood pressure value (3096) assigned to the first time point of the second phase segment in the individual value measurements or a blood pressure value (5078, 5074) determined at the first time point of the second phase segment is determined as the first of the at least two respiration-corrected second blood pressure values, in particular the maximum inspiration, and the blood pressure value (3095) assigned to the second time point of the second phase segment in the individual value measurements or a blood pressure value (5078, 5074) determined at the second time point of the second phase segment is determined as the second of the at least two respiration-corrected second blood pressure values, in particular the maximum expiration, wherein the respiration-corrected first blood pressure value and the non-respiration-corrected first blood pressure value are a systolic blood pressure value, and the respiration-corrected second blood pressure value and the non-respiration-corrected second blood pressure value are a diastolic blood pressure value.

9. Method according to the two preceding claims, characterized in that a second plurality of the at least two respiration-corrected second diastolic blood pressure values are determined as continuous diastolic blood pressure values, wherein the local maxima (5595, 5596) of the blood pressure curve (5400) are used to determine respiration-corrected, continuous, first systolic blood pressure values of the first plurality of the at least two respiration-corrected first systolic blood pressure values, and respiration-corrected, continuous, second diastolic blood pressure values of the second plurality of the at least two respiration-corrected second diastolic blood pressure values are used to determine the blood pressure values assigned to the local minima (5593, 5594) of the blood pressure curve (5400).

10. Method according to one of the preceding claims, in particular claims 7 to 9, characterized in that based on the values of the individual value measurements, in particular based on the intensity curve (5200), a device width-corrected, in particular cuff width-corrected, intensity curve (5300) is determined, comprising a plurality of local extrema (5320, 5330), namely a plurality of local maxima (5320) and a plurality of local minima (5330), wherein to determine the device width-corrected, in particular cuff width-corrected, intensity curve (5300), a first, a second and a third lower approximation line (5261, 5262, 5263) and a first, a second and a third upper approximation line (5251, 5252, 5253) are formed, wherein to form the device width-corrected intensity curve (5300) Individual values of the device width corrected intensity curve (5300) by multiplying the values of the individual value measurements,in particular the individual values of the intensity curve (5200), are formed with a time-dependent width correction factor, wherein the width correction factor is based on a standardized difference, wherein the difference is a difference between the values present at the respective times, in particular individual values, of the first, the second and the third lower approximation lines (5261, 5262, 5263) and the values present at the respective times, in particular individual values, of the first, the second and the third upper approximation lines (5251, 5252, 5253) and is standardized by a standardization parameter. 1 1 . Method according to the preceding claim, wherein the first upper approximation line (5251) is formed to the local maxima (5220) present in a first time period, the second upper approximation line (5252) is formed to the local maxima (5220) present in a second time period, the third upper approximation line (5253) is formed to the local maxima (5220) present in a third time period, the first lower approximation line (5261) is formed to the local minima (5230) present in a fourth time period, the second lower approximation line (5262) is formed to the local minima (5230) present in a fifth time period, and the third lower approximation line (5263) is formed to the local minima (5230) present in a sixth time period, wherein the beginning and the end of the first, second, third, fourth, fifth and sixth time periods are formed within the measurement period, and where the start (5280) of the first time period is before the start (5281, 5282) and end (5282,5283) of the second and third time periods and the beginning (5285) of the fourth time period is before the beginning (5286, 5287) and end (5287, 5288) of the fifth and sixth time periods, and wherein the end (5283) of the third time period is after the beginning (5280, 5281) and end (5281, 5282) of the first and second time periods and the end (5288) of the sixth time period is after the beginning (5285, 5286) and end (5286, 5287) of the fourth and fifth time periods, wherein the beginning (5280) of the first time period in particular coincides with the beginning (5285) of the fourth time period and the end (5283) of the third time period in particular coincides with the end (5288) of the sixth time period, and wherein the beginning (5281 ) of the second period of time to the end (5281 ) of the first period of time, the end (5282) of the second period of time to the beginning (5282) of the third period of time,the beginning (5286) of the fifth period corresponds to the end (5286) of the fourth period and the end (5287) of the fifth period corresponds to the beginning (5287) of the sixth period, wherein the end (5281) of the first time period and the beginning (5282) of the third time period are selected such that the second upper approximation line (5252) has the minimal deviation from the local maxima (5220) present within the second time period, and wherein the end of the fourth time period (5286) and the beginning of the sixth time period (5287) are selected such that the second lower approximation line (5262) has the minimal deviation from the local minima (5230) present within the fifth time period.

12. Method according to the two preceding claims, wherein the normalization parameters are based on the difference between the lower and upper approach lines (5251, 5252, 5253, 5261, 5262, 5263) at the beginning (5281) of the second time period and the difference between the lower and upper approach lines (5251, 5252, 5253, 5261, 5262, 5263) at the beginning (5286) of the fifth time period.

13. Cuff, in particular air pressure cuff with a wristband, an inflatable volume and a control unit, wherein the control unit is arranged and configured to carry out a method according to one of the preceding claims, in particular as dependent on claim 3.

14. Cuff according to the preceding claim, characterized in that the bracelet has a longitudinal extension, wherein the bracelet is designed to enclose a part of the body along its longitudinal extension, wherein the bracelet has a width extension with a width of less than 5 cm, in particular 4 cm or less, wherein the cuff is in particular a part of a wristwatch, in particular a smart watch.

Images