The paper presents the development of a new device for measuring continuous pulse pressure waveforms (PPW) from the radial artery via applanation tonometry. The development focuses on improved accuracy, open and affordable design using off-the-shelf components, and greater user control in setting operational and calibration parameters to address user variability. The device design parameters are optimized through a tissue device interaction study based on a computational model. The design incorporates modular components and includes a sensor module for arterial flattening and pressure pick-up, a differential screw mechanism and a related algorithm for controlled stepwise motion and data collection during flattening, and a brace for wrist-flexion adjustment. Maximum pulse amplitude (PA) was used as an indicator of the optimum level of arterial flattening for recording the PPW. The PPW was observed to distort due to changes in parameters like gel-head placement, hold-down pressure (HDP), and wrist extension. The pressure waveforms collected using the device were validated using limited data against established products and showed good correlation within ±1.96 standard deviation of the mean difference in a Bland–Altman plot. This paper thus details the development of a simple and validated mechanical design to measure PPW using arterial tonometry.

References

References
1.
Vierordt
,
K.
,
1855
,
Die Lehre vom Arterienpuls in gesunden und kranken zustanden: gegründet auf eine neue Methode der bildlichen Darstellung des menschlichen Pulses
,
Vieweg
, Kranzberg, Germany, p.
22
.
2.
Sesso
,
H. D.
,
Stampfer
,
M. J.
,
Rosner
,
B.
,
Hennekens
,
C. H.
,
Gaziano
,
J. M.
,
Manson
,
J. E.
, and
Glynn
,
R. J.
,
2000
, “
Systolic and Diastolic Blood Pressure, Pulse Pressure, and Mean Arterial Pressure as Predictors of Cardiovascular Disease Risk in Men
,”
Hypertension
,
36
(5), pp.
801
807
.
3.
O'Rourke
,
M. F.
,
Staessen
,
J. A.
,
Vlachopoulos
,
C.
,
Duprez
,
D.
, and
Plante
,
G. E.
,
2002
, “
Clinical Applications of Arterial Stiffness; Definitions and Reference Values
,”
Am. J. Hypertens.
,
15
(5), pp.
426
440
.
4.
Kelly
,
R.
, and
Fitchett
,
D.
,
1992
, “
Noninvasive Determination of Aortic Input Impedance and Outer Left Ventricular Power Output: A Validation and Repeatability Study of a New Technique
,”
J. Am. Coll. Cardiol.
,
20
(
4
), pp.
952
963
.
5.
Nakayama
,
Y.
,
Tsumura
,
K.
,
Yamashita
,
N.
,
Yoshimaru
,
K.
, and
Hayashi
,
T.
,
2000
, “
Pulsatility of Ascending Aortic Pressure Waveform is a Powerful Predictor of Restenosis After Percutaneous Transluminal Coronary Angioplasty
,”
Circulation
,
101
(5), pp.
470
472
.
6.
O'Rourke
,
M.
,
Pauca
,
A.
, and
Jiang
,
X.-J.
,
2001
, “
Pulse Wave Analysis
,”
Br. J. Clin. Pharmacol.
,
51
(6), pp.
507
522
.
7.
Phillippe
,
F.
,
Chemaly
,
E.
,
Blacher
,
J.
,
Mourad
,
J. J.
,
Dibie
,
A.
,
Larrazet
,
F.
,
Laborde
,
F.
, and
Safar
,
M. E.
,
2002
, “
Aortic Pulse Pressure and Extent of Coronary Artery Disease in Percutaneous Transluminal Coronary Angioplasty Candidates
,”
Am. J. Hypertens.
,
15
(8), pp.
672
677
.
8.
O'Rourke
,
M. F.
,
2009
, “
Time Domain Analysis of the Arterial Pulse in Clinical Medicine
,”
Med. Biol. Eng. Comput.
,
47
, pp.
119
129
.
9.
Chen
,
C.-Y.
,
Wang
,
W.-K.
,
Kao
,
T.
,
Yu, B. C.
, and
Chiang
,
B. C.
,
1993
, “
Spectral Analysis of Radial Pulse in Patients With Acute, Uncomplicated Myocardial Infarction
,”
Jpn. Heart J.
,
34
(2), pp.
37
49
.https://www.jstage.jst.go.jp/article/ihj1960/34/2/34_2_131/_pdf
10.
Tsuei
,
J.
,
Cheng
,
C. H.
,
Wang
,
Y. L.
, and
Wang
,
W. K.
,
1996
, “
Pulse Spectrum Analysis of Hospital Patient With Possible Liver Problems
,”
Am. J. Chin. Med.
,
14
(
3–4
), pp.
315
320
.http://www.fgu.edu.tw/~soma/teacher/luwanan/pulse_analysis.pdf
11.
Hsu
,
T. L.
,
Chao
,
P. T.
,
Hsiu
,
H.
,
Wang
,
W. K.
,
Li
,
S. P.
, and
Wang
,
Y. Y.
,
2006
, “
Organ-Specific Ligation-Induced Changes in Harmonic Components of the Pulse Spectrum and Regional Vasoconstrictor Selectivity in Wistar Rats
,”
Exp. Physiol.
,
91
(
1
), pp.
163
170
.
12.
Koen
,
M.
, and
Pascal
,
V.
,
2002
, “
Development and Modeling of Arterial Applanation Tonometry: A Review
,”
Technol. Health Care
,
10
(
1
), pp.
65
76
.https://dl.acm.org/citation.cfm?id=605581
13.
Parka
,
C. M.
,
Korolkovab
,
O.
,
Daviesa
,
J. E.
,
Parkerb
,
K. H.
,
Siggersb
,
J. H.
,
Marcha
,
K.
,
Tillina
,
T.
,
Chaturvedia
,
N.
, and
Hughesa
,
A. D.
,
2014
, “
Arterial Pressure: Agreement Between a Brachial Cuff-Based Device and Radial Tonometry
,”
J. Hypertens.
,
32
(
4
), pp.
865
872
.
14.
Birch
,
A. A.
, and
Morris
,
S. L.
,
2003
, “
Do the Finapres™ and Colin® Radial Artery Tonometer Measure the Same Blood Pressure Changes Following Deflation of Thigh Cuffs?
,”
Physiological Meas.
,
24
(
3
), pp.
653
660
.
15.
Nelson
,
M. R.
,
Stepanek
,
J.
,
Cevette
,
M.
,
Covalciuc
,
M.
,
Hurst
,
R. T.
, and
Tajik
,
A. J.
,
2010
, “
Noninvasive Measurement of Central Vascular Pressures With Arterial Tonometry: Clinical Revival of the Pulse Pressure Waveform?
,”
Mayo Clin. Proc.
,
85
(
5
), pp.
460
472
.
16.
Lee
,
B.
,
Jeong
,
J.
,
Kim
,
J.
,
Kim
,
B.
, and
Chun
,
K.
,
2014
, “
Cantilever Arrayed Blood Pressure Sensor for Arterial Applanation Tonometry
,”
IET Nanobiotechnol.
,
8
(
1
), pp.
37
43
.
17.
Kim
,
E. G.
,
Nam
,
K. C.
,
Heo
,
H.
, and
Huh
,
Y.
,
2009
, “
Development of an Arterial Tonometer Sensor
,” 31st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (
EMBS
), Minneapolis, MN, Sept. 3–6, pp. 3771–3774.
18.
Shioya
,
K.
, and
Dohi
,
T.
,
2013
, “
Blood Pressure Measurement Device Based on the Arterial Tonometry Method With Micro Triaxial Force Sensor
,” The 17th International Conference on Solid-State Sensors, Actuators and Microsystems (
TRANSDUCERS & EUROSENSORS XXVII
), Barcelona, Spain, June 16–20, pp.
2389
2392
.
19.
Ng
,
K.-G.
,
2011
, “
Review of Measurement Methods and Clinical Validation Studies of Noninvasive Blood Pressure Monitors: Accuracy of Requirements and Protocol Considerations for Devices That Require Patient-Specific Calibration by a Secondary Method or Device before Use
,”
Blood Pressure Monit.
,
16
(
6
), pp.
291
303
.
20.
Tyan
,
C. C.
,
Liu
,
S. H.
,
Chen
,
J. Y.
,
Chen
,
J. J.
, and
Liang
,
W. M.
,
2008
, “
A Novel Noninvasive Measurement Technique for Analyzing the Pressure Pulse Waveform of the Radial Artery
,”
IEEE Trans. Biomed. Eng.
,
55
(
1
), pp.
288
297
.
21.
Driscoll
,
M. D.
,
Arnold
,
J. M.
, and
Sherebrin
,
M. H.
,
1995
, “
Applied Recording Force and Noninvasive Arterial Pulses
,”
Clin. Invest. Med.
,
18
(
5
), pp.
370
379
.
22.
Driscoll
,
M. D.
,
Arnold
,
M. O.
,
Marchiori
,
G. E.
,
Harker
,
L. A.
, and
Sherebrin
,
M. H.
,
1997
, “
Determination of Appropriate Recording Force for Noninvasive Measurement of Arterial Pressure Pulses
,”
Clin. Sci.
,
92
(
6
), pp.
559
566
.
23.
Yoon
,
Y. Z.
,
Lee
,
M. H.
, and
Soh
,
K. S.
,
2000
, “
Pulse Type Classification by Varying Contact Pressure
,”
IEEE Eng. Med. Biol. Mag.
,
19
(
6
), pp.
106
110
.
24.
Reddy
,
K. S.
,
2002
, “
Cardiovascular Diseases in the Developing Countries: Dimensions, Determinants, Dynamics and Directions for Public Health Action
,”
Public Health Nutr.
,
5
(
1A
), pp.
231
237
.
25.
Singh
,
P.
,
Choudhury
,
I.
,
Roy
,
S.
, and
Prasad
,
A.
,
2016
, “
A Computational Study to Investigate Effect of Tonometer Geometry and Patient-Specific Variability on Radial Artery Tonometry
,”
J. Biomech.
,
58
, pp.
105
113
.
26.
Hollinger
,
A.
, and
Wanderley
,
M. M.
,
2006
, “
Evaluation of Commercial Force-Sensing Resistors
,” International Conference on New Interfaces for Musical Expression (
NIME
), Paris, France.https://pdfs.semanticscholar.org/d6a3/8535098c2a08479e67d068798474994c426c.pdf
27.
Baker
,
P. D.
,
Westenskow
,
D. R.
, and
Kuck
,
K.
,
1997
, “
Theoretical Analysis of Non-Invasive Maximum Pulse Amplitude Algorithm for Estimating Mean Blood Pressure
,”
Med. Bio. Eng. Comput.
,
35
(3), pp.
271
278
.
28.
Millasseau
,
S. C.
,
Kelly
,
R. P.
,
Ritter
,
J. M.
, and
Chowenczyk
,
P. J.
,
2002
, “
Determination of Age-Related Increases in Large Artery Stiffness by Digital Pulse Contour Analysis
,”
Clin. Sci.
,
103
(
4
), pp.
371
377
.
You do not currently have access to this content.