Noninvasive continuous beat-to-beat radial artery pressure via TL-200 applanation tonometry

The Tensys TL-200® noninvasive beat-to-beat blood pressure (BP) monitor displays continuous radial artery waveform as well as systolic, mean and diastolic BP from a pressure sensor directly over the radial artery at the wrist. It locates the site of maximal radial pulse signal, determines mean BP from maximal pulse waveform amplitude at optimal artery compression and then derives systolic and diastolic BP. We performed a cross-sectional study of TL-200 BP comparisons with contralateral invasive radial artery (A-Line) BP values in 19 subjects during an average 2.5 h of general anesthesia for a wide range of surgical procedures. Two hundred and fifty random sample pairs/patient resulted in 4,747 systolic, mean and diastolic BP pairs for analysis. A-Line BP ranged from 29 mm Hg diastolic to 211 mm Hg systolic, and heart rate varied between 38 and 210 beats/min. Bland–Altman analysis showed an average 2.3 mm Hg TL-200 versus A-Line systolic BP bias and limits of agreement (1.96 SD) were ± 15.3 mm Hg. Mean BP showed a 2.3 mm Hg TL-200 bias and ± 11.7 mm Hg limits of agreement, while diastolic BP showed a 1.7 mm Hg bias and ± 12.3 mm Hg limits of agreement. Coefficients of determination for TL-200 and A-Line BP regression were r² = 0.86 for systolic, r² = 0.86 for mean, and r² = 80 for diastolic BP, respectively, with no apparent change in correlation at low or high BP. Bland–Altman analysis suggested satisfactory agreement between TL-200 noninvasive beat-to-beat BP and invasive A-Line BP. Paired TL-200/A-Line BP comparisons showed a high coefficient of determination.