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Accuracy of commercial devices and methods for noninvasive estimation of aortic systolic blood pressure a systematic review and meta-analysis of invasive validation studies

Papaioannou, Theodore G.; Karageorgopoulou, Theofani D.; Sergentanis, Theodoros N.; Protogerou, Athanase D.; Psaltopoulou, Theodora; Sharman, James E.; Weber, Thomas; Blacher, Jacques; Daskalopoulou, Stella S.; Wassertheurer, Siegfried; Khir, Ashraf W.; Vlachopoulos, Charalambos; Stergiopulos, Nikolaos; Stefanadis, Christodoulos; Nichols, Wilmer W.; Tousoulis, Dimitrios

doi: 10.1097/HJH.0000000000000921

Background: Although compelling evidence has established the physiological and clinical relevance of aortic SBP (a-SBP), no consensus exists regarding the validity of the available methods/techniques that noninvasively measure it.

Objectives: The systematic review and meta-analysis aimed to determine the accuracy of commercial devices estimating a-SBP noninvasively, which have been validated by invasive measurement of a-SBP. Moreover their optimal mode of application, in terms of calibration, as well as specific technique and arterial site of pulse wave acquisition were further investigated.

Methods: The study was performed according to the PRISMA guidelines; 22 eligible studies were included, which validated invasively 11 different commercial devices in 808 study participants.

Results: Overall, the error in a-SBP estimation (estimated minus actual value) was −4.49 mmHg [95% confidence interval (CI): −6.06 to −2.92 mmHg]. The estimated (noninvasive) a-SBP differed from the actual (invasive) value depending on calibration method: by −1.08 mmHg (95% CI: −2.81, 0.65 mmHg) and by −5.81 mmHg (95% CI: −7.79, −3.84 mmHg), when invasively and noninvasively measured brachial BP values were used respectively; by −1.83 mmHg, (95% CI: −3.32, −0.34 mmHg), and by 7.78 mmHg (95% CI: −10.28, −5.28 mmHg), when brachial mean arterial pressure/DBP and SBP/DBP were used, respectively.

Conclusion: Automated recording of waveforms, calibrated noninvasively by brachial mean arterial pressure/DBP values seems the most promising approach that can provide relatively more accurate, noninvasive estimation of a-SBP. It is still uncertain whether a specific device can be recommended as ‘gold standard’; however, a consensus is currently demanding.

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aBiomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital

bDepartment of Hygiene, Epidemiology and Medical Statistics

cCardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece

dMenzies Institute for Medical Research, Tasmania, University of Tasmania, Hobart, Australia

eCardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria

fFaculty of Medicine, Paris-Descartes University, Hôtel-Dieu Hospital, AP-HP, Diagnosis and Therapeutic Center, Paris, France

gDivisions of Internal Medicine and Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada

hAustrian Institute of Technology, Health & Environment Department, Vienna, Austria

iBrunel Institute for Bioengineering, Brunel University, Uxbridge, UK

jLaboratory of Hemodynamics and Cardiovascular Technology, Institute of Biotechnology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland

kSchool of Medicine, Yale University, New Haven, Connecticut

lDivision of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA

Correspondence to Theodore G. Papaioannou, Biomedical Engineering Unit, First Department of Cardiology, Medical School, Hippokration Hospital, Vas. Sophias 114, Athens 115 27, Greece. Tel: +30 213 2088286; fax: +30 213 2088676; e-mail:

Abbreviations: a, aortic; br, brachial; BP, blood pressure; CAD, coronary artery disease; CI, confidence interval; MAP, mean arterial pressure

Received 18 September, 2015

Revised 26 December, 2015

Accepted 4 March, 2016

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