Cuff-Less and Continuous Blood Pressure Monitoring: A Methodological Review
Open accessAbstract
Blood pressure (BP) is one of the most important monitoring parameters in clinical medicine. For years, the cuff-based sphygmomanometer and the arterial invasive line have been the gold standards for care professionals to assess BP. During the past few decades, the wide spread of the oscillometry-based BP arm or wrist cuffs have made home-based BP assessment more convenient and accessible. However, the discontinuous nature, the inability to interface with mobile applications, the relative inaccuracy with movement, and the need for calibration have rendered those BP oscillometry devices inadequate for next-generation healthcare infrastructure where integration and continuous data acquisition and communication are required. Recently, the indirect approach to obtain BP values has been intensively investigated, where BP is mathematically derived through the “Time Delay” in propagation of pressure waves in the vascular system. This holds promise for the realization of cuffless and continuous BP monitoring systems, for both patients and healthy populations in both inpatient and outpatient settings. This review highlights recent efforts in developing these next-generation blood pressure monitoring devices and compares various mathematical models. The unmet challenges and further developments that are crucial to develop “Time Delay”-based BP devices are also discussed.
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The results for HR and SpO2 are within FDA regulatory guidelines, which require errors less than ±10% or ±5 bpm for HR and less than 3.5% for Arms for reflectance mode SpO2.
“The results for HR and SpO2 are within the regulatory guidelines set by the US Food and Drug Administration (FDA), which require errors less than ± 10 % or ± 5 bpm for HR and less than 3.5 % for Arms for reflectance mode SpO226,27.”
From Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units (2020) · cites this paper as [26]
Section 3.5 discusses heart rate as an input to blood-pressure estimation and reports whether blood-pressure errors meet AAMI standards. Our copy does not report the cited HR or reflectance-mode SpO2 FDA limits, or the citing study’s HR and SpO2 results (searched for FDA heart-rate accuracy and reflectance-mode SpO2 accuracy). (LLM, conf=0.75)
Experimental — accuracy not yet measuredUsing a larger cuff, or overcuffing, is common in children and leads to blood pressure underestimation.
“whereas using a larger cuff (overcuffing) is common in children and leads to BP underestimation [4,90,98,99].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [99]
The discussion of cuff-based devices (section 4, p. not provided) says they are not error-free, but does not address cuff size or measurement bias. The passage about a smaller finger cuff (p. 2) likewise says nothing about overcuffing in children. Searches for overcuffing, children, cuff size, and underestimation found no passage supporting the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredUsing a small bladder, or undercuffing, is common in obese adults and leads to overestimation of blood pressure.
“Using a small bladder (undercuffing) is common in obese adults and leads to overestimation of BP”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [99]
The passage on p. 2 mentions a smaller finger cuff used by a monitoring device, but does not discuss an undersized bladder, obese adults, or overestimation of blood pressure. Searches for undercuffing, obesity, and cuff-size-related overestimation found no passage addressing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredThere is some inconsistency in the recommendations by scientific societies on the issue of miscuffing.
“However, there is some inconsistency in the recommendations by scientific societies on the issue of miscuffing [1,4,90,98–100].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [99]
The Discussion (page unavailable) mentions different standards for validating cuffless blood-pressure devices and says cuff-based devices are not error-free. It does not address miscuffing or compare scientific societies’ recommendations on cuff sizing; searches for those terms found no relevant passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSeveral models relating BP to PTT or PAT have been proposed, including models that incorporate additional variables such as HR.
“Several models relating BP to PTT or PAT have been proposed [156], including models that incorporate additional variables, such as HR [157].”
From Wearable Photoplethysmography for Cardiovascular Monitoring (2022) · cites this paper as [156]
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- Authors
- Sharma, M., Barbosa, K., Ho, V., Griggs, D., Ghirmai, T., Krishnan, S., Hsiai, T., Chiao, J.-C., & Cao, H.
- Affiliations
- University of Washington Bothell (US)
- University of Washington (US)
- University of California, Los Angeles (US)
- The University of Texas at Arlington (US)
- Corresponding author
- Cao, Hung
- ORCID
- Venue
- Technologies
- Publisher
- MDPI AG
- Published
- 2017-05-09
- Volume
- 5
- Issue
- 2
- Pages
- 21
- ISSN
- 2227-7080 (ISSN-L)
- OpenAlex
- W2613121856
- Cited by
- 226
- References
- 134
- Citations by year
- 2026: 8 · 2025: 20 · 2024: 26 · 2023: 25 · 2022: 35 · 2021: 29 · 2020: 33 · 2019: 35 · 2018: 14 · 2017: 1
- FWCI
- 10.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Technologies (publishedVersion, cc-by)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- cuffless blood pressure measurement, continuous blood pressure monitoring, time delay method, pressure wave propagation, oscillometry
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