The Criterion for Diastolic Pressure-Revolution and Counterrevolution

THE PUBLICATION in this issue of the new recommendations of a committee of the American Heart Association on the clinical determination by sphygmomanometer of the blood pressure represents, as to the best criterion for diastolic pressure, not a revolution but a counterrevolution. On the many other important matters discussed in the report there is likely to be little controversy. The original International Committee of 1939 quite definitely stated that the point of "muffling," not of "'disappearance," of the Korotkoff sounds was the more reliable. In 1951, a committee of the American Heart Association, this time exclusively a U. S. committee rather than an International committee, put out its report. This was published simultaneously in three different journals and given to all U. S. medical students as a pamphlet. This second report reversed the original opinion, stating that "muffling" was to be regarded as less reliable than "disappearance" as an index of diastolic pressure. This U. S.