A Flexible, Low-Cost and Algorithm-Independent Calibrator for Automated Blood Pressure Measuring Devices

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1. Where is ‘flexible’? I did not see any flexibility of your calibrator. More importantly, please measure its flexibility and other mechanical properties of this calibrator.

2. Please change all the figures from black/white into RGB.

3. Please redo the table 1, now it is a mess.

4. I could not see any detailed message from figure 8. Please redraw.

5. Please improve the resolution of all figures.

6. Why did you do this, I mean what is your novelty here? Actually, there are so many devices reported in many literature. Why do you do this?

7. Every commercial blood pressures could be affected by environmental factors. Seriously, if you just do this calibrator. That is not enough for publication.

Comments on the Quality of English Language

So many typos and grammar errors are needed to be revised.

Author Response

REVIEWER 1

 

Before answering, I would like to thank all comments and suggestions for their significant contribution to clarify and to improve the quality of the paper, as I hope. Thank you very much.

 

 

Comments and Suggestions for Authors

 

1. Where is ‘flexible’? I did not see any flexibility of your calibrator. More importantly, please measure its flexibility and other mechanical properties of this calibrator.

 

ANS:

In the introduction part of the paper several paragraphs justifying the flexibility of the proposed calibrator were included, namely, the following: it is possible to specify the calibration mode, manual or automatic, and to configure the calibration, to be performed, with any of the most common oscillometric algorithms (systolic/diastolic rates or maximum/minimum slope) and to define the different parameters of the pulse envelope pressure signal; it is possible to generate artificial pulse waveforms and pulse envelopes that mimic physiological BP signals with specific characteristics, such as, typical oscillometric pulse envelopes BP of people that suffer of heart arrhythmia, arteriosclerosis, or very high or low BP values, or other heart diseases, and it is also possible to perform ABPMD sensitivity tests using variable maximum envelope amplitudes that can vary between 1 and 50 mmHg, with 0.1 mmHg resolution.

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2. Please change all the figures from black/white into RGB.

ANS:

All figures were changed from black/white into RGB.

 

3. Please redo the table 1, now it is a mess.

ANS:

Original table 1 was removed and its contents are now included in the figure 9.

[Changes can be found in the following line numbers range: 275-278]

 

 

 

4. I could not see any detailed message from figure 8. Please redraw.

ANS:

I tried to remake the figures associated with the LabVIEW block diagrams but it is very difficult to obtain good results since the usage of graphical program languages, such as LabVIEW, in large programs originates that the display of the block diagrams becomes too short and the elementary programming blocks and labels becomes not readable. Thus, to better explain the developed software, figures 8 and 9 were replaced by new ones and the following paragraphs were introduced after figure 9: the main routines that were developed to generate the calibration signal are the following: synthesis of the complete BP signal that includes the inflation pressure variation, the deflation pressure variation plus the small amplitude BP pulses, and the pressure variation of the measuring release  phase. All timing and amplitude parameters of the synthesized cuff pressure curve, represented in figure 2, can be adjusted by the user according to the purpose of the calibration to be performed. On the other hand, the main routines that were developed to acquire the BP signal are the following: signal filtering and outliers’ removal, extraction of the BP pulse envelope, either the fixed ratio algorithm or the derivative algorithm, and routines associated with signals’ display, data storage and data transmission.

[Changes can be found in the following line numbers range: 247-290]

 

5. Please improve the resolution of all figures.

ANS:

The resolution of all figures was increased to 300x300 dpi.

 

6. Why did you do this, I mean what is your novelty here? Actually, there are so many devices reported in many literature. Why do you do this?

ANS:

Besides the aspects, previously referred in the answer of comment 1, the proposed calibrator has the main capabilities: test ABPMD without being affected by proprietary oscillometric BP algorithm manufacturers’ dependent and not disclosed in the technical specification of their devices; to perform tests and to perform the calibration with stand-alone capability because it can generate not only the oscillometric, small amplitude oscillation, but also the complete pressure signal that corresponds to the sum of the oscillometric pulses with the pressure variations associated with cuff inflation and deflation; to perform the calibration of an ABPMD varying, automatically, BP parameters values in a previously specified range; to identify and characterize the oscillometric algorithm used by a particular ABPMD and to perform not only the ABPMD test, but also the complete test of the pressure measuring channel, that includes the pneumatic channel, devices’ connecting tubing and pneumatic loads, as it is the case of the BP measuring cuff.

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7. Every commercial blood pressures could be affected by environmental factors. Seriously, if you just do this calibrator. That is not enough for publication.

 

ANS:

A deep revision of the paper was performed to include additional information, clarify its contents and to justify better the flexibility, specificities and novelties of the proposed calibrator.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This study presents a flexible, low-cost and algorithm independent calibrator prototype that can be used for static and dynamic calibration of automated blood pressure measuring devices (ABPMD). It contains a hardware parts and a software/ algorithms that are typically used to evaluate systolic, diastolic and mean arterial pressure values. Simulation and experimental results that were obtained validate theoretical expectations and show a very acceptable level of accuracy and performance of the presented non-invasive blood pressure (NIBP) calibrator prototype. This is an interesting study, and I have following comments:

1) Patient-specific blood pressure waveform is more versatile. Did the authors have validated their algorithm using patient’s data or real human data? 

The authors validated their algorithm against a commercial and certified BP calibrator (DATATREND) as shown in Figure 11 and Figure 12. Could the author perform some more extreme cases, high BP conditions or low BP conditions?

2) In Table 3, the authors says, when AMP value is low, like 1 mmHg, the absolute error in BP values would be high. The reviewer is very curious why this high error situation does not occur in validation process as shown in Figure 11 and Figure 12?

3) The reviewer is confused by the value of MAP. In most cases, like Table 1-3, MAP was roughly defined as 1/2*(SBP + DBP). But in the validation process with the cases 60-30-40; 80-50-60;100-65-77; 120-80-93; 150-100-117 and 200-150-167, MAP = 1/3*SBP + 2/3*DBP. The latter is more often used. why the authors used the first one in their representation.

4) there are some minor typos in the manuscripts:

Should define BMP when first appeared;

Define in H_D, H_S, H_MAP is the formulas;

Figure 11 and 12 are very hard to understand, please present the data and error in a more proper way.

Author Response

REVIEWER 2

 

Before answering, I would like to thank all comments and suggestions for their significant contribution to clarify and to improve the quality of the paper, as I hope. Thank you very much.

 

This study presents a flexible, low-cost and algorithm independent calibrator prototype that can be used for static and dynamic calibration of automated blood pressure measuring devices (ABPMD). It contains a hardware parts and a software/ algorithms that are typically used to evaluate systolic, diastolic and mean arterial pressure values. Simulation and experimental results that were obtained validate theoretical expectations and show a very acceptable level of accuracy and performance of the presented non-invasive blood pressure (NIBP) calibrator prototype. This is an interesting study, and I have following comments:

 

1) Patient-specific blood pressure waveform is more versatile. Did the authors validate their algorithm using patient’s data or real human data? 

The authors validated their algorithm against a commercial and certified BP calibrator (DATATREND) as shown in Figure 11 and Figure 12. Could the author perform some more extreme cases, high BP conditions or low BP conditions?

 

ANS:

Thank you for your comment. The main objective of the paper is to evaluate the performance of the proposed calibrator with a commercial and certified calibrator, such as the ones that are commonly used in clinical units. Thus, the experimental part of the paper focuses on the performance evaluation of the developed prototype comparing the experimental results with the ones that are obtained with a previously calibrated ABPMD. Regarding more extreme cases, very high BP and very low BP values were considered and the graphics were updated with two more BP values extreme cases, with the following values of systolic and diastolic BP values, predefined in DATREND calibrator: SYS/DIAS=35/15 (neonatal very low values) and SYS/DIAS=255/195 (adult very high values). The graphs of Figures 11 and 12 were modified and, to make them clearer, a single vertical scale is used in each graph. A few typos in the graphs related to HBR values and SYS/DIAS labels were also detected and corrected. Thus, till now, real patients’ data was not considered in this study, but it is an important target for future work. A reference to this objective was included in the conclusions and future work.

 

 

 

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2) In Table 3, the authors says, when AMP value is low, like 1 mmHg, the absolute error in BP values would be high. The reviewer is very curious why this high error situation does not occur in validation process as shown in Figure 11 and Figure 12?

 

ANS:

The test results represented in Table 3 are associated with the prototype loop test and, in this configuration, the maximum amplitude of the peaks BP pulses is adjustable easily by using the developed software. As you correctly refer, the error, in this test, for a very low maximum amplitude, of 1 mmHg, can cause an error of 11,6 mmHg in BP parameters evaluation if a sampling rate of 50 S/s is used, but if, in the same conditions, the sampling rate is incremented to 100 S/s that error is reduced to 3 mmHg. Basically, this error is associated with the interpolation error of the curve fitting algorithms that increase when the number of envelope peaks is lower, and their amplitude is very low. This situation does not occur in the results presented in Figures 11 and 12 because the sampling rate used in the DATREND comparative test is higher and above all because the minimum peak amplitude of the envelope is about 2.5 mmHg, being its maximum value about 50 mmHg.

[Changes can be found in the following line numbers range: xx-yy]

 

3) The reviewer is confused by the value of MAP. In most cases, like Table 1-3, MAP was roughly defined as 1/2*(SBP + DBP). But in the validation process with the cases 60-30-40; 80-50-60;100-65-77; 120-80-93; 150-100-117 and 200-150-167, MAP = 1/3*SBP + 2/3*DBP. The latter is more often used. why the authors used the first one in their representation.

 

ANS:

Effectively the most used empirical equation for is MAP=1/3*SBP + 2/3*DBP, and the default test values, used with DATREND comparative performance evaluation, for SBP/MAP/DBP pressure agree with that equation. Thus, those default values stored in the DATREND calibrator were used in experimental tests of session 4.2. and they agree with the referred empirical equation. By its turn, the MAP values used in the experimental tests of session 4.1, associated with the prototype loop test we take for MAP the average values of SBP and DBP since the main purpose of these test was to evaluate the stand-alone prototype performance evaluation.

[Changes can be found in the following line numbers range: xx-yy]

 

4) there are some minor typos in the manuscripts:

Should define BMP when first appeared;

Define in H_D, H_S, H_MAP is the formulas;

Figure 11 and 12 are very hard to understand, please present the data and error in a more proper way.

 

ANS:

Abbreviation BPM is now defined before its first usage;

Abbreviations H_D, H_S, H_MAP are now defined in Figure 1 caption;

As previously referred, the graphs of Figures 11 and 12 were modified and, in order to make them more clear, a single vertical scale is used in each graph. A few typos in the graphs related with HBR values and SYS/DIAS labels were also detected and corrected.

[Changes can be found in the following line numbers range: 36-37; 117-119; 383-386]

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I'll provide a comprehensive review of this article, analyzing the strengths and weaknesses of each major section:

 

Introduction:

 

Positives:

- Effectively establishes the significance of the topic by citing recent WHO statistics about hypertension's global impact

- Clearly identifies the research gap regarding the need for accurate blood pressure measurement device calibration

- Provides good background on current challenges with automated blood pressure measuring devices (ABPMD)

- Logically presents the progression from problem to proposed solution

 

Negatives:

- Could have included more recent statistics beyond the 2023 WHO report

- The transition between different aspects of the introduction could be smoother

- Some technical terms are introduced without sufficient explanation for broader audience

 

Materials and Methods:

 

Positives:

- Detailed description of both hardware and software components

- Clear explanation of the three different pulse envelope profiles (triangular, trapezoidal, parabolic)

- Well-organized presentation of the system architecture

- Comprehensive documentation of equipment specifications and calibration procedures

- Good use of diagrams and figures to illustrate methodological approaches

 

Negatives:

- Some technical specifications could be better organized in tables rather than within paragraphs

- The LabVIEW implementation details could be more detailed

- More information about the validation process could be included

- Testing procedures could be more systematically presented

 

Discussion:

 

Positives:

- Thorough analysis of experimental results

- Good comparison between commercial calibrator and prototype performance

- Clear presentation of error margins and statistical significance

- Effective use of graphs and tables to support findings

 

Negatives:

- Limited discussion of potential limitations

- Could have included more comparison with similar studies

- More analysis of unexpected results or anomalies could be valuable

- Statistical analysis could be more comprehensive

 

Conclusions:

 

Positives:

- Clearly summarizes the main achievements

- Links back to initial objectives

- Identifies practical applications

- Provides direction for future research

 

Negatives:

- Could elaborate more on practical implications

- More specific recommendations for implementation could be helpful

- Limited discussion of potential improvements

- Could better address limitations identified in the study

 

Overall, this is a well-structured technical paper that makes a valuable contribution to the field of blood pressure measurement calibration. The main strength lies in its detailed technical description and experimental validation. The primary areas for improvement would be in providing more context for non-specialist readers and more comprehensive discussion of limitations and practical implementations.

 

The article successfully achieves its objective of presenting a novel calibration approach for automated blood pressure measuring devices, though some aspects of the presentation could be enhanced for better clarity and broader impact.​​​​​​​​​​​​​​​​

Author Response

REVIEWER 3

 

Before answering, I would like to thank all comments and suggestions for their significant contribution to clarify and to improve the quality of the paper, as I hope. Thank you very much.

 

Comments and Suggestions for Authors

I'll provide a comprehensive review of this article, analyzing the strengths and weaknesses of each major section:

 

Introduction:

 

Positives:

- Effectively establishes the significance of the topic by citing recent WHO statistics about hypertension's global impact

- Clearly identifies the research gap regarding the need for accurate blood pressure measurement device calibration

- Provides good background on current challenges with automated blood pressure measuring devices (ABPMD)

- Logically presents the progression from problem to proposed solution

 

Negatives:

- Could have included more recent statistics beyond the 2023 WHO report

- The transition between different aspects of the introduction could be smoother

- Some technical terms are introduced without sufficient explanation for broader audience

 

ANS:

More recent statistics beyond the 2023 WHO report were included in the text, an additional reference with 2024 statistics was included in the paper, and the first paragraph of the introduction was modified accordingly:

The last World Health Organization (WHO) report on hypertension, dated March 2023, emphasizes that this disease affects over one billion people worldwide. According to that report, only 54% of adults with hypertension are diagnosed, 42% receive treatment, and only 21% have their hypertension controlled, being hypertension a major cause of premature death worldwide [1-1A-1B-2]. Moreover, globally, the age-standardized prevalence of uncontrolled hypertension declined slightly from 28.6% in 2010 to 26.2% in 2019, but this pace of decline is insufficient to achieve the global target of 25% by 2025.

[1] World Health Organization. Global report on hypertension: the race against a silent killer. Geneva: World Health Organization. 2023.

[1A] World health statistics 2024: monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization, 2024.

[1B] Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al.. Blood

pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet, 2016, 387, pp. 957–67.

The transition between different aspects of the introduction has become smoother and some technical terms were explained better for a broader audience, such as, the following paragraph about O’Curves that was inserted in the introduction:

Those curves, obtained during the deflation phase of the cuff, are a graphical representation of the sensed pressure oscillation amplitude variations during the linear decreasing cuff air pressure [7-8].

All the text was revised, new figures were introduced, others were modified, and a more detailed explanations were given, for example about the developed software, to better explain the contents of the paper for a broader audience. Topics related to protype flexibility, specific capabilities and novelties of the proposed calibrator were also underlined in the paper.

[Changes can be found in the following line numbers range: 56-84, plus additional and updated references]

 

Materials and Methods:

 

Positives:

- Detailed description of both hardware and software components

- Clear explanation of the three different pulse envelope profiles (triangular, trapezoidal, parabolic)

- Well-organized presentation of the system architecture

- Comprehensive documentation of equipment specifications and calibration procedures

- Good use of diagrams and figures to illustrate methodological approaches

 

Negatives:

- Some technical specifications could be better organized in tables rather than within paragraphs

- The LabVIEW implementation details could be more detailed

- More information about the validation process could be included

- Testing procedures could be more systematically presented

 

ANS:

A new table, table 1 was created to include the specification of the different components and devices:

 

COMPONENT/DEVICE/REFERENCE	MAIN SPECIFICATIONS
Pressure Sensor NXP SEMICONDUCTORS MP3V5050	measuring pressure range between 0 and 50 kPa; 2.5% maximum error relative to VFSS, whose typical value is equal to 2.7 V; sensitivity equal to 54 mV/kPa; response time equal to 1.0 ms and temperature compensation capabilities, in the temperature range between -40 °C and +125 °C
Electro-Pneumatic Pressure Regulator (EPPR) PARKER-OEM-P	pressure range between 0 and 5 p.s.i.; control voltage 0-5 V; monitor output voltage 0-5 V; pressure accuracy of ±1.5% of full-scale maximum; response time lower than 15 ms; linearity better than 1.5% of full-scale maximum; availability of internal vent
Pressure Calibrator DRUCK DPI611	pressure range between -1 and 1 bar; accuracy of 0.0185% of FS; total uncertainty of 0.025% of FS
Release Valve KOGE KSV05	exhaust time lower than 6.0 s for a pressure reduction from 300 mmHg to 15 mmHg; resistance 100 W±10%; leakage maximum of 3 mmHg/min for a pressure equal to 300 mmHg
Data Acquisition Board National Instruments MYDAQ	two differential analog input channels with 16 bits resolution; maximum sampling rate of 200 kS/s; timing resolution of 10 ns; analog input range ±2 V and ±10 V; typical accuracy of 4.9 mV for analog input range ±2 V
Digital Multimeter Keithley 2000 SERIES	6 ½ digits; minimum voltage resolution of 0.1 m for 100 mV scale; linearity for 10 V DC range equal to: ±(1ppm of reading + 2ppm of range); accuracy for a DC voltage range from 100 nV to 1kV is equal to 0.002%

 

 

I tried to remake the figure associated with the LabVIEW block diagram, but it is very difficult to obtain good results, since the usage of graphical program languages, like LabVIEW, in large programs, originates that the display of the LabVIEW elementary blocks becomes too short and not readable. Thus, to better explain the developed software, figures 8 and 9 were replaced by new ones and the following paragraphs were introduced after figure 9: the main routines that were developed to generate the calibration signal are the following: synthesis of the complete BP signal that includes the inflation pressure variation, the deflation pressure variation plus the small amplitude BP pulses, and the pressure variation of the measuring release  phase. All timing and amplitude parameters of the synthesized cuff pressure curve, represented in figure 2, can be adjusted by the user according to the purpose of the calibration to be performed. On the other hand, the main routines that were developed to acquire the BP signal are the following: signal filtering and outliers’ removal, extraction of the BP pulse envelope, either the fixed ratio algorithm or the derivative algorithm, and routines associated with signals’ display, data storage and data transmission.

 

ANS.:

An effort was developed to clarify the testing procedures presented in the results section. The introduction of this section was carefully revised (and some typos detected in the tests’ descriptions were removed. In subsection 4.2, more extreme cases of very high and very low BP values were considered, and the graphics were updated with two tests for those extreme BP values. Thus, the graphs of Figures 11 and 12 were updated, accordingly to the results that were obtained for BP tests. Moreover, to clarify experimental results representations, graphs of figures 11 and 12 were modified and a single vertical axis is used in each of them. Some typos in the graphs, related to HBR values and SYS/DIAS labels, were also detected and corrected.

 

 

 

Several paragraphs were introduced in section 4 and an effort was developed to better present and explain the testing procedures associated with the prototype loop tests and the prototype performance evaluation. New figures 8 and 9 were also included in the paper to better explain some details and capabilities of the software developed.

 

• (b)

Figure 8. Example of two graphics contained in LabVIEW front panel (a) cuff pressure variation during the three phases of a BP measurement; (b) BP oscillometric pulse for a trapezoidal pulse envelope associated with a maximum pulse amplitude equal to 3 mmHg and a MAP equal to 120 mmHg.

 

Figure 9. Graphical representation of the pressure peaks of the oscillometric signal and numerical values evaluated for different BP parameters for the simulated cuff pressure signal (PM=180 mmHg; Pm=50 mmHg; dT=30 s; SBP=150 mmHg; DBP=100 mmHg; MAP=120 mmHg; HBR=90 b.p.m.; amp=3 mmHg).

[Changes can be found in the following line numbers range: 229-232; 252-301; 405-428]

 

Discussion:

 

Positives:

- Thorough analysis of experimental results

- Good comparison between commercial calibrator and prototype performance

- Clear presentation of error margins and statistical significance

- Effective use of graphs and tables to support findings

 

Negatives:

- Limited discussion of potential limitations

 

ANS.:

Potential limitations of the proposed calibrator of ABPMD are related with oscillometric method, itself, that was assumed to be used, since this method does not measure systolic and diastolic pressures directly but estimates their values from the value of the mean arterial pressure (MAP), using empirical algorithms that are manufacturers’ dependent. Moreover, this BP pressure measurement method cannot provide real-time monitoring, unlike invasive intra-arterial methods, which could be crucial in some clinical cases. Nevertheless, regarding the focus of the paper, beside the reliability and accuracy of the different devices and components that were used to implement the hardware part of the prototype, the experimental results that were obtained did not identify potential limitations and if them appear in the future, particularly if those limitations are related with the developed software, it will be very easy to solve them since it is very easy do modify and update the software due to the advantages of the graphical programming language that was used.

 

- Could have included more comparison with similar studies

 

ANS:

Regarding comparisons with similar studies, it will be worth highlighting the EU funded research project adOSSIG [Adossig 1] that aims to improve the reliability and accuracy of blood pressure (BP) measurements by developing an interesting oscillometric signal generator (OSG). In this project an interesting hardware solution is presented for an oscillometric signal generator, capable of generating oscillometric blood pressure pulses indistinguishable from real physiological human signals [Adossig 2]. However, the research that is developed by adOSSIG is more centered in hardware issues than in software issues. The proposed simulator is developed considering a large database of physiological signals, recorded from living persons, and aims to achieve a reliable reproduction of those signals. Thus, the referred research project does not present any new methodologies to test ABPMS by proposing specific  oscillometric pulse envelopes to obtain an independent algorithm calibrator of ABPMD . There are also a significative number of papers [others studies 1-3] that present others solutions for the implementation of an ABPMD calibrator, but, almost in all of them, the performance evaluation of the proposed solutions requires clinical validation and the usage of a representative group of persons and trained medical staff being these requirements time consuming, expensive and not immune to different errors’ types.

[adOSSIG 1]

National Standards Authority of Ireland (NSAI). Developing an infrastructure for improved and harmonised metrological checks of blood-pressure measurements in Europe. National Metrology Laboratory (NML), Dublin. Available online: https://shop.standards.ie/en-ie/search/standard/?searchTerm=adOSSIG (accessed on 17 February 2025).

[adOSSIG 2]

Gregor Geršak et al.. Physiology-based patient simulator for blood pressure meter testing.

Measurement: Sensors, 2021, Volume 18, pp. 1-4.

[others studies 1]

16. Sedlák et al.. Evaluation of Sphygmomanometers Using an Advanced Oscillometric Signal Generator. Imeko TC11 & TC24 Joint Hybrid Conference, 2022, pp. 12-16.

[others studies 2]

2404. Balestrieri and S. Rapuano. Instruments and Methods for Calibration of Oscillometric Blood Pressure Measurement Devices. IEEE Transactions on Instrumentation and Measurement, 2010, vol. 59, no. 9, pp. 2391-2404.

[others studies 3]

Ratnadewi et al.. Automatic Blood Pressure Detector Using Arduino to Measure Blood Pressure in Indonesian People Age 19-27 Years Old. International Journal of Engineering & Technology, 2018, 7 (2.5), pp. 115-118.

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 - More analysis of unexpected results or anomalies could be valuable

- Statistical analysis could be more comprehensive

 

The future work must be targeted to validate the proposed prototype using a larger number of BP monitors and calibrators, from different certified manufacturers, and to validate their algorithm using patient’s data, real human data and available blood pressure datasets to obtain a more complete characterization of the proposed prototype, identified potential limitations and studying the best way to surpass them.

[Changes can be found in the following line numbers range: 450-454]

 

Conclusions:

 

Positives:

- Clearly summarizes the main achievements

- Links back to initial objectives

- Identifies practical applications

- Provides direction for future research

 

Negatives:

- Could elaborate more on practical implications

- More specific recommendations for implementation could be helpful

- Limited discussion of potential improvements

- Could better address limitations identified in the study

 

ANS:

The authors tried to minimize these negative points. As previously stated, in the answers to reviewer’s comments and suggestions, the revised version of the paper takes into consideration additional information and more detailed explanations about the hardware and software of the proposed prototype. Future work will address the need to validate their algorithm using patient’s data, real human data and available blood pressure datasets to obtain a more complete characterization of the proposed prototype, identified potential limitations and studying the best way to surpass them. Different parts of the text were introduced or modified to address these comments. Thank you for all of your comments and suggestions.

 

Overall, this is a well-structured technical paper that makes a valuable contribution to the field of blood pressure measurement calibration. The main strength lies in its detailed technical description and experimental validation. The primary areas for improvement would be in providing more context for non-specialist readers and more comprehensive discussion of limitations and practical implementations.

 

The article successfully achieves its objective of presenting a novel calibration approach for automated blood pressure measuring devices, though some aspects of the presentation could be enhanced for better clarity and broader impact.​​​​​​​​​​​​​​​​

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I still did not see any flexibility of this. And also, no novelty here.

Author Response

Comments 1: I still did not see any flexibility of this. And also, no novelty here 

Response 1: Thank you again for taking your time to review this manuscript. Regarding your comment, probably the context the word flexibility is used in the paper can make some misunderstanding. In this paper the flexibility of the proposed “Algorithm Independent Calibrator for Automated Blood Pressure Measuring Devices”, refers to its ability to adapt or change easily in response to different situations, in terms of calibration of ABPMD. This flexibility is related with the proposed algorithm that is designed to calibrate different ABPMD that use specific empirical algorithms, often, not disclosed in ABPMS specifications. Besides the justifying the flexibility already done in the first review round (changes can be found in the following line numbers range: 78-88 and 256-305, according to new line numbering sequence), it was included in the paper's abstract the following paragraph: “In the context of this paper, calibrator flexibility meaning is mainly related with its ability to adapt or change easily in response to different situations, in terms of calibration of ABPMD being possible to use a variety of calibration settings, without need to use specific oscillometric curves from the different ABPMD manufacturers” [changes can be found in the following line numbers range: 11-15, according to new line numbering sequence]. Thus, regarding novelty, the proposed algorithm can define different BP pulse envelope that can define, in a non-empirical way, the systolic, diastolic and mean arterial pressure, and the calibration results are not affected by the specificities of the evaluation algorithms used by the ABPMD manufacturers.  

Reviewer 2 Report

Comments and Suggestions for Authors

The reviewer has no further comments.  

Author Response

Comment 1: The reviewer has no further comments.

Response 1: I want to thank you very much for comments and suggestion that helped me, very much, to improve the quality of the paper.