University Of Tasmania

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Comparison between cuff-based and invasive systolic blood pressure amplification

journal contribution
posted on 2023-05-21, 13:22 authored by Tan BuiTan Bui, Dean PiconeDean Picone, Martin SchultzMartin Schultz, Armstrong, MK, Peng, X, Black, JA, Nathan DwyerNathan Dwyer, Philip Roberts-ThomsonPhilip Roberts-Thomson, Heath AdamsHeath Adams, Hughes, AD, James SharmanJames Sharman

Objective:Accurate measurement of central blood pressure (BP) using upper arm cuff-based methods is associated with several factors, including determining the level of systolic BP (SBP) amplification. This study aimed to determine the agreement between cuff-based and invasively measured SBP amplification.

Methods:Patients undergoing coronary angiography had invasive SBP amplification (brachial SBP - central SBP) measured simultaneously with cuff-based SBP amplification using a commercially available central BP device (device 1: Sphygmocor Xcel; n = 171, 70% men, 60 +- 10 years) and a now superseded model of a central BP device (device 2: Uscom BP+; n = 52, 83% men, 62 +- 10 years).

Results:Mean difference (+-2SD, limits of agreement) between cuff-based and invasive SBP amplification was 4 mmHg (-12, +20 mmHg, P < 0.001) for device 1 and -2 mmHg (-14, +10 mmHg, P = 0.10) for device 2. Both devices systematically overestimated SBP amplification at lower levels and underestimated at higher levels of invasive SBP amplification, but with stronger bias for device 1 (r = -0.68 vs. r = -0.52; Z = 2.72; P = 0.008). Concordance of cuff-based and invasive SBP amplification across quartiles of invasive SBP amplification was low, particularly in the lowest and highest quartiles. The root mean square errors from regression between cuff-based central SBP and brachial SBP were significantly lower (indicating less variability) than from invasive regression models (P < 0.001).

Conclusions:Irrespective of the difference from invasive measurements, cuff-based estimates of SBP amplification showed evidence of proportional systematic bias and had less individual variability. These observations could provide insights on how to improve the performance of cuff-based central BP.


Royal Hobart Hospital Research Foundation


Publication title

Journal of Hypertension










Menzies Institute for Medical Research


Lippincott Williams & Wilkins

Place of publication

530 Walnut St, Philadelphia, USA, Pa, 19106-3621

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Socio-economic Objectives

Diagnosis of human diseases and conditions