Comment on 'New photoplethysmogram indicators for improving cuffless and continuous blood pressure estimation accuracy'
Related Experiment Video
Updated: Sep 29, 2026

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Noud van Helmond1,2, Jeffrey I Joseph1
1Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.
Objective:
A recent study investigated the potential utility of new photoplethysmogram (PPG) indicators to improve cuffless continuous blood pressure (BP) measurement.
Approach:
In this Comment we provide additional discussion of the physiology underlying PPG- and pulse arrival time (PAT)-based BP measurement. We also discuss validation of these measurements.
Main Results:
Changes in PPG features and PAT can occur independently of BP. Any study validating BP measurement based on PPG features or PAT should include a variety of calibration independent physiological challenges affecting BP.
Significance:
PPG/PAT-based BP measurement has been investigated extensively as an alternative to cuff-based BP measurement. We feel the inherent physiological confounding in PPG/PAT-based measurement makes it unlikely that it will be of clinical value.
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Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Pre-Procedural Guidelines for Assessing Blood Pressure