Oscillometric blood pressure measurement: progress and problems.

Oscillometric blood pressure measurement has become very popular, but although a number of devices have now passed both the Association for the Advancement of Medical Instrumentation and British Hypertension Society criteria, complacency with the state of the technique is as yet premature. In individual subjects, a substantial number of readings may deviate more than a clinically relevant 5 mmHg in devices that have earned a British Hypertension Society grade A rating. The marketing of pressure-wave-simulating devices is a welcome development as monitors can now be tested for reproducibility; an intra-device standard deviation of less than 2 mmHg has been proposed as the limit. Authors suggest that these simulators are currently better suited to intra- than between-device testing since they are not yet fully confident that the simulated waveforms are indistinguishable from the man-made pressure waves. Simulators should, however, be incorporated into our standard validation protocols in order eventually to obviate the human, fallible, factor in the validation protocols. The currently employed maximal amplitude algorithm has many drawbacks as the parameter identification points for systolic and diastolic pressure depend on many factors, for example pulse pressure, heart rate and arterial stiffness. These errors have now been demonstrated in clinical studies. Modern pattern recognition algorithms are being constructed but have not yet produced convincing results. As repeatedly stated, the development of a more robust and more widely applicable algorithm than the maximal amplitude approach should be allocated a high priority.