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We conclude that large intra-personal variability in Korotkoff signal morphology and amplitudes, as well as variations in the hearing acuity of the operator, make accurate NIBP measurements using sphygmomanometry difficult and should not be used as the gold standard against which automated NIBP devices are calibrated. We propose an alternative method of visualizing the energy of the Korotkoff sounds and applying simple algorithms to determine systolic and diastolic pressure points, which whilst mimicking classical sphygmomanometry eliminates the problems associated with operator hearing acuity and complex and variable Korotkoff signal morphology.

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