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Preventing troublesome variability in clinical blood pressure measurement

Journal of Human Hypertension volume 39, pages 72–77 (2025)Cite this article

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Abstract

The importance of accurate blood pressure (BP) measurement is well-established. However, there is little quantitative comparative data on the influence of different measurement conditions on BP or the stability of the oscillometric pulse waveform from which BP is calculated. This study investigates the effect of six different measurement conditions (Quiet, Reading, Speaking, Deep Breathing, Moving, and Tapping) on BP readings in 30 healthy normotensive subjects. We hypothesize that non-standard conditions will result in significant deviations in BP measurements compared to the Quiet condition. Additionally, the quality and stability of the oscillometric waveform were assessed by evaluating the smoothness of the oscillometric pulse waveform characteristics during cuff deflation. Compared with the Quiet condition, all others resulted in significantly higher blood pressures, except for the respiratory condition, which resulted in significantly lower BPs. Average subject systolic BP (SBP) rose from 117.4 ± 6.0 mmHg for the Quiet condition to 129.7 ± 7.2 mmHg for the light finger tapping condition, P < 0.00001. Overall, changes for diastolic BP (DBP) were not significant. For the quality Noise indicator, all conditions in comparison with the Quiet condition were significantly noisier, increasing from 0.144 ± 0.024 to 1.055 ± 0.308 mmHg, P < 0.00001. Changes in SBP were significantly correlated to changes in quality Noise (r = 0.965, P < 0.001). This study confirms the importance of following international BP measurement guidelines, providing quantitative data showing significant changes in BP when guidelines are not followed. A method for assessing the quality of the measurement is also demonstrated, and shows that BP changes are significantly related to changes in the quality indicator.

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Fig. 1: The analysis steps are shown for an example recording.
Fig. 2: An example of the oscillometric pulse waveforms and Gaussian curves, from which BP and the BP Noise Indicator were derived, is shown for one subject on one day for all six conditions.
Fig. 3: The mean and 95% confidence intervals across all subjects are shown for all six conditions.
Fig. 4: The overall mean ± 95% confidence interval for the BP Noise Indicator for each measurement condition.

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Data availability

The data that support the findings of this study are available from the corresponding authors upon request.

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Acknowledgements

We would like to thank all the volunteers who participated in this study.

Funding

This research was funded by the National Natural Science Foundation of China (62171123), the National Key Research and Development Program of China (2023YFC3603600), the Engineering and Physical Sciences Research Council (EPSRC) UK (EP/N025342/1, EP/I027270/1 and EP/F012764/1).

Author information

Author notes

  1. These authors jointly supervised this work: Chengyu Liu, Alan Murray.

Authors and Affiliations

  1. State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China

    Chengyu Liu & Jianqing Li

  2. The Department of Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, 200433, China

    Jian Liu

  3. Medical Faculty and Engineering School, Newcastle University, Newcastle upon Tyne, UK

    Alan Murray

Authors
  1. Chengyu Liu
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  2. Jian Liu
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  3. Jianqing Li
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  4. Alan Murray
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Contributions

CYL revised the paper and participated in the experiments. JL collected and analysed the data with the support of CYL and JQL. JQL provided the venue and guided the experiments. AM guided the experiments. CYL and AM designed the experiments and drafted the paper. All authors reviewed and approved the manuscript.

Corresponding authors

Correspondence to Chengyu Liu or Alan Murray.

Ethics declarations

Competing interests

None declared. The patent for the technique is cited in the paper, but as yet there is no commercial agreement.

Ethics Statement

The investigation conformed with the Declaration of Helsinki, and all subjects gave their written informed consent to participate in the study. Ethical approval was granted by the Independent Ethics Committee (IEC) for Clinical Research of Zhongda Hospital, affiliated with Southeast University, under approval number 2021ZDSYLL206-P01.

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Liu, C., Liu, J., Li, J. et al. Preventing troublesome variability in clinical blood pressure measurement. J Hum Hypertens 39, 72–77 (2025). https://doi.org/10.1038/s41371-024-00978-3

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