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      A New Cuffless Device for Measuring Blood Pressure: A Real-Life Validation Study

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          Abstract

          Background

          Cuffless blood pressure (BP) monitoring devices, based on pulse transit time, are being developed as an easy-to-use, more convenient, fast, and relatively cheap alternative to conventional BP measuring devices based on cuff occlusion. Thereby they may provide a great alternative to BP self-measurement.

          Objective

          The objective of our study was to evaluate the performance of the first release of the Checkme Health Monitor (Viatom Technology), a cuffless BP monitor, in a real-life setting. Furthermore, we wanted to investigate whether the posture of the volunteer and the position of the device relative to the heart level would influence its outcomes.

          Methods

          Study volunteers fell into 3 BP ranges: high (>160 mmHg), normal (130–160 mmHg), and low (<130 mmHg). All requirements for test environment, observer qualification, volunteer recruitment, and BP measurements were met according to the European Society of Hypertension International Protocol (ESH-IP) for the validation of BP measurement devices. After calibrating the Checkme device, we measured systolic BP with Checkme and a validated, oscillometric reference BP monitor (RM). Measurements were performed in randomized order both in supine and in sitting position, and with Checkme at and above heart level.

          Results

          We recruited 52 volunteers, of whom we excluded 15 (12 due to calibration failure with Checkme, 3 due to a variety of reasons). The remaining 37 volunteers were divided into low (n=14), medium (n=13), and high (n=10) BP ranges. There were 18 men and 19 women, with a mean age of 54.1 (SD 14.5) years, and mean recruitment systolic BP of 141.7 (SD 24.7) mmHg. BP results obtained by RM and Checkme correlated well. In the supine position, the difference between the RM and Checkme was >5 mmHg in 17 of 37 volunteers (46%), of whom 9 of 37 (24%) had a difference >10 mmHg and 5 of 37 (14%) had a difference >15 mmHg.

          Conclusions

          BP obtained with Checkme correlated well with RM BP, particularly in the position (supine) in which the device was calibrated. These preliminary results are promising for conducting further research on cuffless BP measurement in the clinical and outpatient settings.

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          Most cited references5

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          A Blood Pressure Monitoring Method for Stroke Management

          Blood pressure is one important risk factor for stroke prognosis. Therefore, continuous monitoring of blood pressure is crucial for preventing and predicting stroke. However, current blood pressure devices are mainly air-cuff based, which only can provide measurements intermittently. This study proposed a new blood pressure estimation method based on the pulse transit time to realize continuous monitoring. The proposed method integrated a linear model with a compensation algorithm. A calibration method was further developed to guarantee that the model was personalized for individuals. Variation and variability of pulse transit time were introduced to construct the compensation algorithm in the model. The proposed method was validated by the data collected from 30 healthy subjects, aged from 23 to 25 years old. By comparing the estimated value to the measurement from an oscillometry, the result showed that the mean error of the estimated blood pressure was −0.2 ± 2.4 mmHg and 0.5 ± 3.9 mmHg for systolic and diastolic blood pressure, respectively. In addition, the estimation performance of the proposed model is better than the linear model, especially for the diastolic blood pressure. The results indicate that the proposed method has promising potential to realize continuous blood pressure measurement.
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            Clinical validation protocols for noninvasive blood pressure monitors and their recognition by regulatory authorities and professional organizations: rationale and considerations for a single unified protocol or standard.

            Kim-Gau Ng (2013)
            Standardized protocols for validating the clinical accuracy of noninvasive blood pressure (NIBP) monitors have been available since 1987. Some of them were developed by standards bodies and others by professional organizations. They have been well-tested through use and progressively improved through multiple revisions; however, many methodological differences exist between them. In addition, for the purpose of regulatory approval or marketing clearance, some protocols are recognized in some countries but not in others; thus, manufacturers have to validate their NIBP monitors to more than one protocol in order to market them worldwide. The use of different protocols not only makes it difficult to compare one device with another but also complicates the validation, regulatory approval, marketing, and public acceptance of NIBP monitors, creating undue burden on manufacturers and unnecessary confusion among users. There is a need for protocol developers, standards bodies, and regulatory authorities to work together to develop and agree on a single unified protocol or standard, one that builds on the strengths of the various protocols that have been developed so far. It is apparent that there is already a trend toward convergence of the various protocols into two protocols, namely, the ISO 81060-2:2009 standard and the 2010 European Society of Hypertension International Protocol. With further reconciliation and consensus, it should be possible to integrate the best features of the ISO, European Society of Hypertension, and other protocols, along with further improvements, into a single unified protocol or standard.
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              American National Standard: Non-invasive Sphygmomanometers—Part 2: Clinical Investigation of Automated Measurement Type (ANSI/AAMI/ISO 81060-2:2013)

              (2013)
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                May 2016
                05 May 2016
                : 18
                : 5
                : e85
                Affiliations
                [1] 1Radboud University Medical Center Department of Internal Medicine Radboud University NijmegenNetherlands
                [2] 2Radboud University Medical Center Department of Surgery Radboud University NijmegenNetherlands
                [3] 3Radboud REshape Innovation Center Radboud University Medical Center Radboud University NijmegenNetherlands
                [4] 4Radboud University Medical Center Department of Internal Medicine and Radboud REshape Innovation Center Radboud University NijmegenNetherlands
                Author notes
                Corresponding Author: Sebastian JH Bredie bas.bredie@ 123456radboudumc.nl
                Author information
                http://orcid.org/0000-0001-5575-617X
                http://orcid.org/0000-0002-0689-3669
                http://orcid.org/0000-0002-5401-8973
                http://orcid.org/0000-0002-8455-9367
                http://orcid.org/0000-0003-0323-4876
                http://orcid.org/0000-0002-6973-7540
                Article
                v18i5e85
                10.2196/jmir.5414
                4873623
                27150527
                4706ac36-883c-463e-826b-f3a7536ee7a6
                ©Tessa S Schoot, Mariska Weenk, Tom H van de Belt, Lucien JLPG Engelen, Harry van Goor, Sebastian JH Bredie. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.05.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 7 December 2015
                : 14 January 2016
                : 5 February 2016
                : 20 February 2016
                Categories
                Original Paper
                Original Paper

                Medicine
                hypertension,cuffless blood pressure monitor,wearable device,cardiovascular risk management,patient empowerment

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