Hammond IW, Urbina EM, Watigney W, Bao, W, Steinmann WC, Berenson GS
Comparison of fourth and fifth Korotkoff diastolic blood pressures in 6-32 year old individuals. The Bogalusa Heart Study
AHA Council for High Blood Pressure Research
Hypertension (Sep) 26:545 (abst) 1995

Use of 4th Korotkoff (K4) sound (where the BP pulse sounds muffle) vs. 5th phase Korotkoff (K5) sounds (where the BP pulse sounds stop) for measurement of diastolic pressure is controversial. Results in 5117 young subjects (ages 5-30) were compared. The overall difference in blood pressure when using K4 versus K5 was about 10 mm Hg. The K4-K5 difference was greatest in children, with the spread becoming progressively smaller with age. Thus in children, K4 should probably be used; however, after age 15 there is no clinically important difference. (D. Leehey)

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AHA Council for High Blood Pressure Research
H: Exam and lab tests : Arm cuff
H: Pathophysiology : Age-related norms