Journal of Clinical Monitoring and Computing

, Volume 32, Issue 4, pp 717–727 | Cite as

A novel non-invasive blood pressure waveform measuring system compared to Millar applanation tonometry

  • Sándor Földi
  • Tamás Horváth
  • Flóra Zieger
  • Péter Sótonyi
  • György Cserey
Original Research


The accurate, non-invasive, measuring of the continuous arterial blood pressure waveform faces some difficulties and an innovative blood pressure measurement technology is urgently needed. However, the arterial blood pressure waveform plays an essential role in health care by providing diagnostic information and base for calculating several heart function parameters. The aim of this study is to introduce a novel non-invasive measuring system that can measure the arterial blood pressure waveform with high accuracy in comparison to an applanation tonometry system. The applied measuring device utilizes a new measurement strategy enabled by the OptoForce 3D force sensor, which is attached to the wrist at the radial artery. To validate the accuracy, 30 simultaneous measurements were taken with a Millar tonometer. For the simultaneously recorded non-invasive signals, the similarity was high (the average correlation was \(0.9213\pm 0.063\)). The differences in the systolic and the diastolic blood pressure measured by the two systems are small. The average differences (\(\pm \hbox {SD}\)) for simultaneously recorded systolic, diastolic, mean arterial and incisura pressures were: \(0.35\pm 1.75\), \(0.02 \pm 0.19\), \(2.88\pm 2.42\) and \(3.84\pm 3.90 \,\text {mmHg}\), respectively. These results satisfy the AAMI criteria. Based on our results, this new system requires further development and validation against invasive arterial blood pressure monitoring in order to prove its usefulness in patient monitoring, emergency care, and pulse diagnosis.


Continuous blood pressure Applanation tonometry Patient monitoring Arterial pressure 



This research was supported by Pázmány Péter Catholic University (KAP-1.1-14/017, KAP15-058-1.1-ITK and KAP16-71045-1.1-ITK). We are also grateful for the support of the Roska Tamás Doctoral School of Science and Technology at the Faculty of Information Technology and Bionics (ITK - Research Faculty) of Pázmány Péter Catholic University (PPCU - University of National Excellence) as well as the technical assistance provided by OptoForce Ltd. and the MTA-SE Cardiovascular Imaging Research Group led by Dr. Pál Maurovich-Horvat. Tamás Horváth was sponsored by NKFIH postdoctoral program, grant number: PD 121186. The research has been partially supported by the European Union, co-financed by the European Social Fund (EFOP-3.6.3-VEKOP-16-2017-00002).

Compliance with ethical standards

Conflict of interest

None of the authors has any conflicts of interest to disclose. All authors approved the current version of the manuscript for publication.


  1. 1.
    Biais M, Martin A, Roullet S, Quinart A, Sztark F. Automated, continuous and non-invasive assessment of pulse pressure variations using cnap® system. J Clin Monit Comput. 2016;31(4):1–8.Google Scholar
  2. 2.
    Bilton K, Hammer L, Zaslawski C. Contemporary chinese pulse diagnosis: a modern interpretation of an ancient and traditional method. J Acupunct Meridian Stud. 2013;6(5):227–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Bland JM, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327(8476):307–10.CrossRefGoogle Scholar
  4. 4.
    Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17(4):571–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Chen Y, Zhang L, Zhang D, Zhang D. Wrist pulse signal diagnosis using modified gaussian models and fuzzy c-means classification. Medical Eng Phys. 2009;31(10):1283–9.CrossRefGoogle Scholar
  6. 6.
    Chung E, Chen G, Alexander B, Cannesson M. Non-invasive continuous blood pressure monitoring: a review of current applications. Front Med. 2013;7(1):91–101.CrossRefPubMedGoogle Scholar
  7. 7.
    Drzewiecki GM, Melbin J, Noordergraaf A. Arterial tonometry: review and analysis. J Biomech. 1983;16(2):141–52. doi: 10.1016/0021-9290(83)90037-4.CrossRefPubMedGoogle Scholar
  8. 8.
    Fortin J, Marte W, Grüllenberger R, Hacker A, Habenbacher W, Heller A, Wagner C, Wach P, Skrabal F. Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops. Comput Biol Med. 2006;36(9):941–57.CrossRefPubMedGoogle Scholar
  9. 9.
    Harju J, Vehkaoja A, Kumpulainen P, Campadello S, Lindroos V, Yli-Hankala A, Oksala N. Comparison of non-invasive blood pressure monitoring using modified arterial applanation tonometry with intra-arterial measurement. J Clin Monit Comput. 2017. doi: 10.1007/s10877-017-9984-3.Google Scholar
  10. 10.
    Ilies C, Bauer M, Berg P, Rosenberg J, Hedderich J, Bein B, Hinz J, Hanss R. Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. Br J Anaesth. 2012;108(2):202–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Janelle GM, Gravenstein N. An accuracy evaluation of the t-line® tensymeter (continuous noninvasive blood pressure management device) versus conventional invasive radial artery monitoring in surgical patients. Anesth Analg. 2006;102(2):484–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Martina JR, Westerhof BE, van Goudoever J, de Beaumont EMH, Truijen J, Kim YS, Immink RV, Jöbsis DA, Hollmann MW, Lahpor JR, et al. Noninvasive continuous arterial blood pressure monitoring with nexfin®. J Am Soc Anesthesiol. 2012;116(5):1092–103.CrossRefGoogle Scholar
  13. 13.
    OptoForce Ltd.: Optoforce 3 axis force sensor (2017).
  14. 14.
    Peng JY, Lu MS. A flexible capacitive tactile sensor array with cmos readout circuits for pulse diagnosis. Sens J IEEE. 2015;15(2):1170–7.CrossRefGoogle Scholar
  15. 15.
    Saugel B, Dueck R, Wagner JY. Measurement of blood pressure. Best Pract Res Clin Anaesthesiol. 2014;28(4):309–22.CrossRefPubMedGoogle Scholar
  16. 16.
    Saugel B, Meidert AS, Langwieser N, Wagner JY, Fassio F, Hapfelmeier A, Prechtl LM, Huber W, Schmid RM, Gödje O. An autocalibrating algorithm for non-invasive cardiac output determination based on the analysis of an arterial pressure waveform recorded with radial artery applanation tonometry: a proof of concept pilot analysis. J Clin Monit Comput. 2014;28(4):357–62.CrossRefPubMedGoogle Scholar
  17. 17.
    Stens J, Oeben J, Van Dusseldorp AA, Boer C. Non-invasive measurements of pulse pressure variation and stroke volume variation in anesthetized patients using the nexfin blood pressure monitor. J Clin Monit Comput. 2016;30(5):587–94.CrossRefPubMedGoogle Scholar
  18. 18.
    Sun J, Chen H, Zheng J, Mao B, Zhu S, Feng J. Continuous blood pressure monitoring via non-invasive radial artery applanation tonometry and invasive arterial catheter demonstrates good agreement in patients undergoing colon carcinoma surgery. J Clin Monit Comput. 2016. doi: 10.1007/s10877-016-9967-9.Google Scholar
  19. 19.
    Tar A, Cserey G. Development of a low cost 3d optical compliant tactile force sensor. In: Advanced intelligent mechatronics (AIM), 2011 IEEE/ASME International Conference on, pp. 236–240. IEEE. 2011Google Scholar
  20. 20.
    Velik R. An objective review of the technological developments for radial pulse diagnosis in traditional chinese medicine. Eur J Integr Med. 2015;7(4):321–31.CrossRefGoogle Scholar
  21. 21.
    Wagner JY, Negulescu I, Schöfthaler M, Hapfelmeier A, Meidert AS, Huber W, Schmid RM, Saugel B. Continuous noninvasive arterial pressure measurement using the volume clamp method: an evaluation of the cnap device in intensive care unit patients. J Clin Monit Comput. 2015;29(6):807–13.CrossRefPubMedGoogle Scholar
  22. 22.
    Wang P, Zuo W, Zhang D. A compound pressure signal acquisition system for multichannel wrist pulse signal analysis. IEEE Trans Instrum Meas. 2014;63(6):1556–65.CrossRefGoogle Scholar
  23. 23.
    Zong W, Heldt T, Moody G, Mark R. An open-source algorithm to detect onset of arterial blood pressure pulses. In: Computers in Cardiology, 2003, pp. 259–262. IEEE. 2003.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Faculty of Information Technology and BionicsPázmány Péter Catholic UniversityBudapestHungary
  2. 2.Department of Vascular SurgerySemmelweis UniversityBudapestHungary
  3. 3.Department of Hydrodynamic Systems, Faculty of Mechanical EngineeringBudapest University of Technology and EconomicsBudapestHungary

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