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To the Editor:—
The report by the Committee for the Standardization of Blood Pressure Readings of the American Heart Association (The Journal, July 22, 1939, p. 294) contains the following statement: "If the radial pulse is felt at a higher level than that at which the auscultatory sound is heard, the palpatory reading should be accepted as the systolic pressure; otherwise the auscultatory reading should be accepted."The natural inference from this must be that if the auscultatory reading is higher than the palpatory, the former is correct. I wish to call attention to one important exception to this general rule: There are instances in which the heart beat is so violent that sounds are transmitted from the top of the cuff downward, so that they are audible below the cuff for 50, 100, 200 or more millimeters higher than the level at which the pulse comes through at the
Levine SA. STANDARDIZATION OF BLOOD PRESSURE READINGS. JAMA. 1940;114(16):1576. doi:10.1001/jama.1940.02810160078032
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