This month, 100 years ago

The auscultatory technique of measuring blood pressure by pioneer Korotkoff has remained virtually unchanged for more than 100 years.

Issue: November 2005

ByFranz H. Messerli, MD

One hundred years ago on Nov. 8, 1905, the 31-year-old surgeon Nokolai Sergeevich Korotkoff, working in the clinic of Professor Sergei P. Fedorov, made a presentation at a scientific seminar of the Imperial Military Medical Academy in St. Petersburg, Russia. He described to an astonished audience a new method of measuring systolic and diastolic blood pressure.

Today, exactly one full century later, thousands of physicians, nurses, medical assistants and patients all over the globe continue to listen by stethoscope to the Korotkoff sounds in the brachial artery. Because of its simplicity, convenience and accuracy, the auscultatory technique of measuring blood pressure has remained virtually unchanged over 100 years and still remains the most useful clinical tool to gather this information.

Even the myriad electronic and digital instruments that have been developed over the past decade to monitor blood pressure work simply by listening to the Korotkoff sounds.

Observations in wounded soldiers

Korotkoff’s discovery originated from the observation that in wounded soldiers certain sounds could be auscultated during gradual decompression of the arteries. As a surgeon, Korotkoff was interested in predicting the outcome in a traumatized limb after ligation of arteries, which obviously depended on the collateral circulation.

Franz H. Messerli, MD [photo]
Franz H. Messerli

He therefore systematically auscultated the arteries in his patients and thereby coincidentally discovered what is now known as the Korotkoff sounds. In his subsequent experiments Korotkoff used the apparatus of Dr. Scipione Riva-Rocci, which was a simplified mercury sphygmomanometer with an inflatable cuff. Riva-Rocci estimated systolic blood pressure with this apparatus by simultaneously palpating the radial artery, thereby not being able to provide information about diastolic pressure.

Explanation of mechanism

Korotkoff documented that the compressed artery produced no sounds and that while the cuff pressure was gradually decreased, sounds appeared that allowed to identify systolic as well as diastolic pressure. By subsequently performing a few experiments in dogs, Korotkoff also conclusively demonstrated that the sounds heard during the compression of the artery did not originate from the heart but actually were generated locally in the brachial artery.

Not surprisingly, the auscultatory method for estimating blood pressure rapidly replaced the palpatory one. Following its discovery, numerous theories were put forward attempting to explain the pathophysiologic mechanism of the Korotkoff sounds, such as the water hammer theory, the turbulence theory, the arterial wall theory and the cavitation theory.

Quite in contrast to the ink wasted on these theories, Korotkoff’s report of his discovery was remarkably concise and took less than a page in the “Izvestie Imperial Voiennomedicinskoi Akademii” of St. Petersburg. As an example of crystal clear thinking of an astute physician, it is reprinted below:

“The cuff of Riva-Rocci is placed on the middle third of the upper arm; the pressure within the cuff is quickly raised up to complete cessation of circulation below the cuff. Then, letting the mercury of the manometer fall one listens to the artery just below the cuff with a children’s stethoscope. At first no sounds are heard. With the falling of the mercury in the manometer down to a certain height, the first short tones appear; their appearance indicates the passage of part of the pulse wave under the cuff. It follows that the manometric figure at which the first tone appears corresponds to the maximal pressure. With the further fall of the mercury in the manometer one hears the systolic compression murmurs, which pass again into tones (second). Finally, all sounds disappear. The time of the cessation of sounds indicates the free passage of the pulse wave; in other words at the moment of the disappearance of the sounds the minimal blood pressure within the artery predominates over the pressure in the cuff. It follows that the manometric figures at this time correspond to the minimal blood pressure.”

As Nov. 8 is the 100th anniversary of Korotkoff’s presentation, it behooves us not only to pay tribute to the ingenuity of the discovery but also to admire the unique clarity and brevity of his scientific report.

Franz H. Messerli, MD, is Director of the Hypertension Program at St. Luke’s-Roosevelt Hospital in New York and Section Editor of Cardiology Today’s Hypertension and Vascular Disease section.

For more information:

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Shlyakhto E, Conrady A. Korotkoff sounds: what do we know about its discovery? J of Hypertension. 2005 Jan;23(1):3-4.
Shevchenko YL, Tsitlik JE. 90th Anniversary of the development by Nikolai S. Korotkoff of the auscultatory method of measuring blood pressure. Circulation. 1996;94:116-118.
Riva-Rocci S. Un nuovo sfigmomanometro. Gazzetta Medica di Torino. 1896;47:981-96.
Korotkoff NS. Experiments for Determining the Strength of Arterial Collaterals. Saint Petersburg, Russia: Imperial Military Medical Academy;1910. Dissertation.
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