Comparison between cuff-based and radial tonometry exercise-induced central blood pressure

  • Francisco Morales-AcunaEmail author
  • Brycen Ratcliffe
  • Caleb Harrison
  • Sierra Crowe
  • Evan Bockover
  • Robert Pawlak
  • Alvaro N. Gurovich
Original Article



Non-invasive central blood pressure assessed during exercise may provide better cardiovascular prognostic than measurements taken at rest. Radial tonometry is the only technique validated to perform this type of assessment; however, it relies on the experience of the tester. Cuff-based devices have been developed to avoid operator dependency, although these systems have yet to be validated during exercise. The purpose of this study was to compare exercise-induced central blood pressure estimations between a cuff-based device and radial tonometry.


Twenty young healthy subjects were recruited to perform a three-workload steady-state exercise test at blood lactate levels of < 2, 2–4, and > 4 mmol/L, respectively. Central systolic and diastolic blood pressure (cSBP and cDBP, respectively), central pulse pressure (cPP), and augmentation index (AIx) were assessed at rest and during each workload with a cuff-based device and radial tonometry. Statistical analysis included Bland–Altman analysis for agreement between techniques. Agreement was considered when 95% of the data set for each central blood pressure parameter was within 1.96 standard deviations from the mean difference. Significance was considered at α = 0.05.


Central blood pressure measurements with the cuff device were obtained only at rest and during low-intensity exercise. During low-intensity exercise, all measurements showed agreement between both devices (cSBP 95% CI [− 6.0 to 10.7], cDBP 95% CI [− 4.5 to 6.3], cPP 95% CI [− 4.7 to 8.3], and AIx (95% CI [− 20.1 to 22.2]).


A cuff-based device can estimate central blood pressure at low-intensity exercise, without operator dependency, and showing agreement to radial tonometry.


Exercise-induced central blood pressure Pulse wave analysis Cuff-based device Radial tonometer 



Analysis of variance


Augmentation index


Central systolic blood pressure


Central diastolic blood pressure


Heart rate


Central pulse pressure


Pulse wave analysis


Rate of perceived exertion


Standard deviation


Oxygen uptake


Author contributions

FMA and ANG conceived and designed the research; FMA, BR, CH, and RP performed experiments; FMA analyzed data; FMA and ANG interpreted results of experiments; FMA prepared figures; FMA, BR, CH, EV, and SC drafted manuscript; FMA and ANG edited and revised manuscript. All authors approved final version of manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Francisco Morales-Acuna
    • 1
    Email author
  • Brycen Ratcliffe
    • 2
  • Caleb Harrison
    • 2
  • Sierra Crowe
    • 2
  • Evan Bockover
    • 2
  • Robert Pawlak
    • 2
  • Alvaro N. Gurovich
    • 1
  1. 1.Department of Rehabilitation Sciences, College of Health SciencesThe University of Texas at El PasoEl PasoUSA
  2. 2.Department of Applied Medicine and Rehabilitation, College of Health and Human ServicesIndiana State UniversityTerre HauteUSA

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