What does this research mean for the field?

Cuffless blood pressure estimation using pulse wave travel times derived from bio-impedance, impedance cardiography, and electrocardiography demonstrates high test-retest reliability but lacks sufficient construct and convergent validity for clinical or stress research use. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the reliability and validity of cuffless ambulatory blood pressure estimation using pulse wave travel times derived from bio-impedance, impedance cardiography, and electrocardiography across various conditions.

September 28, 2026European Journal of Applied PhysiologyOpen Access

Validation study on cuffless ambulatory blood pressure monitoring method using bio-impedance, impedance cardiography and electrocardiography

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Healthy (n=41). Intervention: Cuffless ambulatory blood pressure monitoring (pulse wave travel times) vs. Cuff-based blood pressure monitoring. Primary outcome: Convergent validity (Mean Absolute Error) and estimation accuracy within 10 mmHg of reference values (MAE 10.1-12.9 mmHg).

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Key result

Cuffless pulse wave BP estimators lack sufficient validity for clinical use despite person-specific calibration.

MAE 10.1-12.9 mmHg
n=41

Why the study?

Does cuffless blood pressure monitoring using pulse wave travel times accurately estimate systolic and diastolic blood pressure compared to cuff-based measurements in healthy adults?

Population

41 young, healthy participants, mean age 21.1 years, 66% female, based in the Netherlands. Exclusion…

Comparison

Cuffless ambulatory blood pressure monitoring… vs Ambulatory cuff-based blood pressure monitoring…

Design

Cross-sectional

Authors

MSMyrte SchoenmakersAcademic Center for Dentistry Amsterdam MGMartin GevondenVrije Universiteit Amsterdam BSBruno SauceVrije Universiteit Amsterdam

Discussion

Member takes

Implication

Cuffless PWTT BP estimators should not enter clinical use; leaves open need for prospective validation beyond person-specific calibration.

Key Points

To evaluate the reliability and validity of cuffless ambulatory blood pressure estimation using pulse wave travel times derived from bio-impedance, impedance cardiography, and electrocardiography across various conditions.
Assessed N=41 young, healthy individuals (66% female, mean age 21.1 years) undergoing 11 conditions including postural changes, physical activity (walking, jogging, wall squat), and mental stressors (serial subtraction task, cold pressor test).
Extracted pulse arrival time (PAT) and pulse transit time (PTT) to estimate systolic and diastolic blood pressure using three models: double-dipping, person-specific calibration, and person-invariant calibration-free models compared to cuff-based reference measurements.
Test-retest reliability was high across all modeling approaches for both PAT- and PTT-based blood pressure (ICC > 0.7), matching cuff-based measurements.
Construct validity was poor; models detected blood pressure changes during physical activity but failed to capture responses to mental stressors.
In the calibration approach, convergent validity with cuff-based blood pressure was moderate (MAE = 10.1–12.9 mmHg), with 59.2–68.5% of estimates falling within 10 mmHg of reference values, while person-invariant models exhibited the greatest deterioration.

Study Design

Type

Observational (n=41)

Multicenter

Structured PICO

Does cuffless blood pressure monitoring using pulse wave travel times accurately estimate systolic and diastolic blood pressure compared to cuff-based measurements in healthy adults?

Population

41 young, healthy adults (mean age 21.1 years, 66% female) without diagnosed hypertension underwent a protocol of postural changes, physical activity, and mental stress tasks to evaluate a cuffless blood pressure monitoring method.

Intervention

Cuffless ambulatory blood pressure monitoring using pulse wave travel times (pulse arrival time [PAT] and pulse transit time [PTT]) derived from bio-impedance, impedance cardiography, and electrocardiography. Evaluated using three modeling approaches: double-dipping, person-specific calibration, and calibration-free (person-invariant).

Comparator

Ambulatory cuff-based blood pressure monitoring (Novacor Diasys 3 Plus) serving as the reference standard.

Outcome

Test-retest reliability (Intraclass correlation coefficient [ICC]), construct validity (ability to detect BP changes during physical and mental stress), and convergent validity (Mean Absolute Error [MAE] and percentage of estimates within 10 mmHg of reference).surrogate

Main Result

Effect estimate: MAE 10.1-12.9 mmHg

Cuffless blood pressure monitoring using pulse wave travel times shows high reliability but insufficient validity for clinical or stress research use, even with person-specific calibration.

Limitations

Double-dipping approach likely reflects overfitting
Movement during physical activity conditions caused disturbances in the bio-impedance signal
Highly restricted laboratory conditions may not generalize to naturalistic circumstances

Cite This Study

Schoenmakers et al. (2026) conducted an observational in Healthy (n=41). Cuffless ambulatory blood pressure monitoring (pulse wave travel times) vs. Cuff-based blood pressure monitoring was evaluated on Convergent validity (Mean Absolute Error) and estimation accuracy within 10 mmHg of reference values (MAE 10.1-12.9 mmHg). Cuffless pulse wave travel time-based blood pressure estimators showed strong test-retest reliability (ICC > 0.7) but insufficient convergent validity (MAE 10.1-12.9 mmHg) for clinical use, even with person-specific calibration.

synapsesocial.com/papers/6ab9b4e37822ec8fc3d8f23a https://doi.org/10.1007/s00421-026-06404-5

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Implication

Cuffless PWTT BP estimators should not enter clinical use; leaves open need for prospective validation beyond person-specific calibration.

Validation study on cuffless ambulatory blood pressure monitoring method using bio-impedance, impedance cardiography and electrocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Validation study on cuffless ambulatory blood pressure monitoring method using bio-impedance, impedance cardiography and electrocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

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