title: Accuracy of commercial devices and methods for noninvasive estimation of aortic systolic blood pressure a systematic review and meta-analysis of invasive validation studies.
abstract: Although compelling evidence has established the physiological and clinical relevance of aortic SBP (a-SBP), no consensus exists regarding the validity of the available methods/techniques that noninvasively measure it.
  
  
  
  The systematic review and meta-analysis aimed to determine the accuracy of commercial devices estimating a-SBP noninvasively, which have been validated by invasive measurement of a-SBP. Moreover their optimal mode of application, in terms of calibration, as well as specific technique and arterial site of pulse wave acquisition were further investigated.
  
  
  
  The study was performed according to the PRISMA guidelines; 22 eligible studies were included, which validated invasively 11 different commercial devices in 808 study participants.
  
  
  
  Overall, the error in a-SBP estimation (estimated minus actual value) was -4.49 mmHg [95% confidence interval (CI): -6.06 to -2.92 mmHg]. The estimated (noninvasive) a-SBP differed from the actual (invasive) value depending on calibration method: by -1.08 mmHg (95% CI: -2.81, 0.65 mmHg) and by -5.81 mmHg (95% CI: -7.79, -3.84 mmHg), when invasively and noninvasively measured brachial BP values were used respectively; by -1.83 mmHg, (95% CI: -3.32, -0.34 mmHg), and by 7.78 mmHg (95% CI: -10.28, -5.28 mmHg), when brachial mean arterial pressure/DBP and SBP/DBP were used, respectively.
  
  
  
  Automated recording of waveforms, calibrated noninvasively by brachial mean arterial pressure/DBP values seems the most promising approach that can provide relatively more accurate, noninvasive estimation of a-SBP. It is still uncertain whether a specific device can be recommended as 'gold standard'; however, a consensus is currently demanding.
authors.affiliation: aBiomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital bDepartment of Hygiene, Epidemiology and Medical Statistics cCardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece dMenzies Institute for Medical Research, Tasmania, University of Tasmania, Hobart, Australia eCardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria fFaculty of Medicine, Paris-Descartes University, Hôtel-Dieu Hospital, AP-HP, Diagnosis and Therapeutic Center, Paris, France gDivisions of Internal Medicine and Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada hAustrian Institute of Technology, Health & Environment Department, Vienna, Austria iBrunel Institute for Bioengineering, Brunel University, Uxbridge, UK jLaboratory of Hemodynamics and Cardiovascular Technology, Institute of Biotechnology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland kSchool of Medicine, Yale University, New Haven, Connecticut lDivision of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA.
authors.forename: Theodore G
authors.initials: TG
authors.lastname: Papaioannou
authors.forename: Theofani D
authors.initials: TD
authors.lastname: Karageorgopoulou
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.forename: Athanase D
authors.initials: AD
authors.lastname: Protogerou
authors.forename: Theodora
authors.initials: T
authors.lastname: Psaltopoulou
authors.forename: James E
authors.initials: JE
authors.lastname: Sharman
authors.forename: Thomas
authors.initials: T
authors.lastname: Weber
authors.forename: Jacques
authors.initials: J
authors.lastname: Blacher
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
authors.forename: Siegfried
authors.initials: S
authors.lastname: Wassertheurer
authors.forename: Ashraf W
authors.initials: AW
authors.lastname: Khir
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Stergiopulos
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.forename: Wilmer W
authors.initials: WW
authors.lastname: Nichols
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D001011:Aorta / Q000502:physiology*; D062186:Arterial Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation* / Q000379:methods / Q000592:standards*; D001916:Brachial Artery / Q000502:physiology; D002138:Calibration; D006801:Humans; D015203:Reproducibility of Results; D013599:Systole