Reliability and device objectivity in oscillatory blood pressure measurement – a measurement error analysis to inform clinical decision making

Q: What are the key findings of this study?

BOSO medicus vital yielded systematically higher systolic blood pressure by 11-13 mmHg than Welch Allyn ProBP 2000, while insufficient rest elevated systolic readings by up to 7.7 mmHg.

Q: What is the clinical evidence from this study?

Population: Blood pressure measurement reliability in healthy young adults (n=65). Intervention: BOSO medicus vital oscillometric blood pressure monitor and standardized resting protocol (10-18 min rest) vs. Welch Allyn ProBP 2000 oscillometric blood pressure monitor and unstandardized baseline arrival measurement. Primary outcome: Systolic blood pressure (mmHg) at baseline on day 1 between devices (MD 12.5 mmHg, p=<0.001).

Q: What does this research mean for the field?

Insufficient pre-measurement rest significantly elevates blood pressure readings, and certified oscillometric devices exhibit substantial interdevice discrepancies exceeding 10 mmHg, creating a high risk of false-positive hypertension diagnoses. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the intraday, interday, and interdevice measurement error and reliability of certified oscillometric blood pressure monitors under real-world and standardized conditions.

Konstantin Warneke; Niklas Lebelt; Franz Liebermann; Benjamin Jöst; Marco Herbsleb

doi:10.48548/pubdata-3993

July 14, 2026Open Access

Reliability and device objectivity in oscillatory blood pressure measurement – a measurement error analysis to inform clinical decision making

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Key result

BOSO medicus vital measures systolic blood pressure ~13 mmHg higher than Welch Allyn ProBP 2000.

MD +12.5 mmHg
P<0.001
n=65

Why the study?

Different hypertension thresholds narrow diagnostic margins to 10mmHg, making measurement accuracy and reliability decisive for clinical decision-making. However, detailed information on systematic and random errors naturally occurring in clinical practice under repeated testing conditions remains widely limited.

Do insufficient pre-measurement rest periods and different validated oscillometric devices introduce clinically relevant systematic and random measurement errors in blood pressure assessment?

Key Points

To evaluate the intraday, interday, and interdevice measurement error and reliability of certified oscillometric blood pressure monitors under real-world and standardized conditions.
Sixty-five healthy adults (N = 65; 37 men and 28 women; mean age = 25.0 ± 8.5 years) attended four separate laboratory visits.
Each visit included an unstandardized arrival measurement (1–3 min seated time) followed by a 10-minute rest and four standardized measurements (T1–T4) spaced by 3-minute intervals.
Testing was performed using two certified oscillometric devices (BOSO medicus vital and Welch Allyn ProBP 2000) evaluated across visits in a randomized sequence.
Inadequate rest before initial measurements led to systematic blood pressure elevations, which decreased by about 10 mmHg across both devices after 10–18 min of seated rest.
The BOSO Medicus monitor recorded systematically higher readings, displaying blood pressure values 13 mmHg higher than the Welch Allyn monitor.
Substantial interdevice discrepancies and random errors persisted despite good interday reproducibility, indicating that unstandardized resting periods risk false-positive hypertension diagnoses.

Structured PICO

Do insufficient pre-measurement rest periods and different validated oscillometric devices introduce clinically relevant systematic and random measurement errors in blood pressure assessment?

P

Population

65 young, healthy, non-obese adults free of cardiovascular disease (mean age 25.0 years, 43.1% female) evaluated across 4 laboratory visits.

I

Intervention

Repeated oscillometric blood pressure measurements using BOSO medicus vital (cuff size 22-42 cm) and Welch Allyn ProBP 2000 (adapted cuff sizes) across 4 laboratory visits (5 measurements per visit: 1 unstandardized arrival baseline followed by 4 standardized resting measurements separated by 3-minute intervals after a 10-minute seated rest).

C

Comparator

Interdevice comparison (BOSO medicus vital vs. Welch Allyn ProBP 2000), intraday comparison (unstandardized baseline vs. standardized resting measurements T1-T4), and interday comparison (Day 1 vs. Day 2).

O

Outcome

Systolic and diastolic blood pressure (mmHg) evaluated for intraday reliability, interday reliability, device objectivity, systematic bias, and random measurement error (ICC, SEM, MDC, MAE, MAPE).surrogate

Main Result

Mean Difference: 12.5

Absolute Event Rate: 130.15% vs 117.63%

p-value: p=<0.001

Limitations

Only two validated oscillometric devices were examined, limiting generalizability to all oscillometric monitors
Differences in cuff selection and design (wide-range standard cuff for BOSO vs size-adapted cuffs for Welch Allyn) may have contributed to interdevice differences
Proprietary signal-processing algorithms of the devices are not publicly disclosed and could not be directly assessed
Sample consisted of young, healthy, non-obese adults without cardiovascular disease
Only two validated oscillometric devices were tested, so the ~13 mmHg interdevice difference cannot be generalized to all oscillometric monitors
Different cuff adaptation strategies between devices (wide-range cuff vs. three adapted cuff sizes) may have contributed to interdevice discrepancies
Proprietary device algorithms are undisclosed and could not be directly evaluated
Study population was restricted to young, healthy, non-obese adults without cardiovascular disease

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Implication

Even validated oscillometric blood pressure monitors can differ systematically by up to 13 mmHg systolic, and inadequate pre-measurement rest inflates readings by up to 7.7 mmHg, risking false-positive hypertension diagnoses under narrow 10 mmHg guideline thresholds.

Abstract

The implementation of different hypertension thresholds (e.g. ESC/ESH: 140:90 or ACC/AHH: 130:80) substantially increased hypertension prevalence donation of pharmacological treatment across various populations. Under narrow margins of only 10mmHg, measurement accuracy and reliability become decisive for clinical decision-making. However, detailed information on systematic and random errors naturally occurring in clinical practice under repeated testing conditions remain widely limited. To provide practically relevant insights, 65 participants were recruited for visited the lab four times with one un-standardized arrival measurement to mimic oftentimes observed clinical real-world scenarios followed by four standardized measurements performed in adherence with current guidelines. Tests were performed with two certified blood pressure devices, each on two testing days to quantify intra- and interday, as well as interdevice measurement errors via relative reliability and systematic and random measurement errors. Insufficient pre-measurement rest periods caused clinically relevant systematic blood pressure enhancements. Within a subsequent 10–18 min rest, the blood pressure was reliably reduced with about 10 mmHg on both days and both devices. However, the Boso Medicus testing device showed consistently higher blood pressure values with 13mmHg compared to the Welch Allyn monitor. Although measurements could be replicated inter-day in both devices, substantial interdevice discrepancies and clinically relevant random errors were observed, that can cause false-positive hypertension diagnoses, especially when pre-measurement rest was insufficient. Results underscore the relevance of performing several blood pressure assessments (per day and on different days) to account for random measurement errors and reduce the risk of inappropriate clinical decision-making and unnecessary treatment escalation.

Discussion

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Cite This Study

Warneke et al. (2026) studied Blood pressure measurement reliability in healthy young adults (n=65). BOSO medicus vital oscillometric blood pressure monitor and standardized resting protocol (10-18 min rest) vs. Welch Allyn ProBP 2000 oscillometric blood pressure monitor and unstandardized baseline arrival measurement was evaluated on Systolic blood pressure (mmHg) at baseline on day 1 between devices (MD 12.5 mmHg, p=<0.001). BOSO medicus vital yielded systematically higher systolic blood pressure by 11-13 mmHg than Welch Allyn ProBP 2000, while insufficient rest elevated systolic readings by up to 7.7 mmHg.

synapsesocial.com/papers/6a59c664a58755010b4718e1 https://doi.org/10.48548/pubdata-3993

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Reliability and device objectivity in oscillatory blood pressure measurement – a measurement error analysis to inform clinical decision making

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Reliability and device objectivity in oscillatory blood pressure measurement – a measurement error analysis to inform clinical decision making

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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