• Hao-Min Cheng, Dora Lang, Catalin Tufanaru, and Alan Pearson.
• The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia. hao-min.cheng@adelaide.edu.au
• Int. J. Cardiol. 2013 Sep 1;167(5):1867-76.

Background And ObjectivesNon-invasive methods based on applanation tonometry have been proposed to estimate central blood pressure. However, the accuracy of these methods hasn't been systematically examined.MethodsWe performed a systematic review and meta-analysis of studies comparing estimated and invasively measured central BP.ResultsSufficient data were available in 22 studies for meta-analysis (857 subjects and 1167 measurements). Acquired arterial pressure waveforms in these studies were directly measured, calibrated to match invasive aortic mean BP and diastolic BP or calibrated to match brachial BP measured with a sphygmomanometer, cuff BP. Of the former 2 conditions, the errors of estimated central BP were small with a mean and standard deviation of difference -1.1 ± 4.1mm Hg (95% limits of agreement -9.1-6.9 mm Hg) for central systolic BP; -0.5 ± 2.1mm Hg (-4.6-3.6mm Hg) for central diastolic BP; and -0.8 ± 5.1mm Hg (-10.8-9.2mm Hg) for central pulse pressure. However, the errors inflated to -8.2 ± 10.3mm Hg (-28.4-12.0mm Hg) for central systolic BP, 7.6 ± 8.7 mm Hg (-9.5-24.6mm Hg) for central diastolic BP, and -12.2 ± 10.4mm Hg (-32.5-8.1mm Hg) for central pulse pressure, when calibrated to cuff BP. The findings were still evident in subgroup analysis conducted with different central BP estimating methods and validated cuff BP monitors.ConclusionPresent tonometry-based central BP estimating methods are acceptable in theory, with small errors. However, based on current available evidence, there is substantial room for improvement in measurement accuracy of central BP when cuff BP is used to calibrate the peripheral waveforms.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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