Abstract
BackgroundNoninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities.ObjectiveIn this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)–based device for monitoring BP in a diverse population.MethodsWe recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP.ResultsOur PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness.ConclusionsAccurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity.
Highlights
BackgroundCurrent clinical practice regarding hypertension management and control hinges on the century-old approach of obtaining infrequent cuff-based measurements of blood pressure (BP) in clinical settings
To the best of our knowledge, noninvasive pulse transit time (PTT)-based BP estimation has yet to be examined in a diverse population—a gap in our scientific understanding that presents a formidable obstacle to its adoption
To amplify the SCG signal and prevent saturation of the alternating current components owing to the varying direct current levels, the analog front end (AFE) separated the direct current and alternating current components using a low pass and bandpass filter (BPF) in parallel
Summary
BackgroundCurrent clinical practice regarding hypertension management and control hinges on the century-old approach of obtaining infrequent cuff-based measurements of blood pressure (BP) in clinical settings. Existing wearable devices that incorporate noninvasive BP methodologies offer an affordable and efficient means of tracking out-of-office BP [8] They commonly use uncomfortable techniques (ie, oscillometry and tonometry) that demand imparting forces on blood vessels to achieve accurate measurements [9,10,11]. Results: Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Conclusions: Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, providing widespread hypertension screening and management for health equity
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