Blood Pressure Estimation Research Articles

Effects of Pulse Transit Time and Pulse Arrival Time on Cuff-less Blood Pressure Estimation: A Comparison Study with Multiple Experimental Interventions.

Pulse transit time (PTT) has shown a correlation with blood pressure (BP), and it is considered as a potential marker for cuff-less BP estimation. However, pulse arrival time (PAT) including pre-ejection period (PEP) has been utilized more widely because of its convenience to acquisition and calculation. In spite of this, whether PAT can surrogate PTT has been a controversial topic for many years. In this study, we designed an experiment on 55 subjects with multiple interventions, those may cause the changes in BP and PEP. We analyzed the linear and nonlinear correlations between BP and PTT/PAT, and also assessed the performances of PTT-based and PAT-based models on tracking the BP variation. Five typical BP estimation models were used for comparison. We found that PEP could change rapidly in response to the interventions related with physical stress. Although PTT had a better linear correlation with BP, most of the PAT-based models showed more accuracy than PTT-based models in all of the interventions, especially for the calibrated models. It is suggested that PAT has the potential to predict BP, and the inclusion of PEP in the measurement of PAT is necessary.

Boosting Algorithms based Cuff-less Blood Pressure Estimation from Clinically Relevant ECG and PPG Morphological Features.

Blood Pressure (BP) is often coined as a critical physiological marker for cardiovascular health. Multiple studies have explored either Photoplethysmogram (PPG) or ECG-PPG derived features for continuous BP estimation using machine learning (ML); deep learning (DL) techniques. Majority of those derived features often lack a stringent biological explanation and are not significantly correlated with BP. In this paper, we identified several clinically relevant (bio-inspired) ECG and PPG features; and exploited them to estimate Systolic (SBP), and Diastolic Blood Pressure (DBP) values using CatBoost, and AdaBoost algorithms. The estimation performance was then compared against popular ML algorithms. SBP and DBP achieved a Pearson's correlation coefficient of 0.90 and 0.83 between estimated and target BP values. The estimated mean absolute error (MAE) values are 3.81 and 2.22 mmHg with a Standard Deviation of 6.24 and 3.51 mmHg, respectively, for SBP and DBP using CatBoost. The results surpassed the Advancement of Medical Instrumentation (AAMI) standards. For the British Hypertension Society (BHS) protocol, the results achieved for all the BP categories resided in Grade A. Further investigation reveals that bio-inspired features along with tuned ML models can produce comparable results w.r.t parameter-intensive DL networks. ln(HR × mNPV), HR, BMI index, ageing index, and PPG-K point were identified as the top five key features for estimating BP. The group-based analysis further concludes that a trade-off lies between the number of features and MAE. Increasing the no. of features beyond a certain threshold saturates the reduction in MAE.

A Multi-modal Teacher-student Framework for Improved Blood Pressure Estimation.

Blood pressure (BP) is a critical vital sign that hypertensive patients regularly measure. In this study, we propose a novel BP estimation framework to distill the knowledge from a multi-modal model to a uni-modal BP estimation model through teacher-student training. The multi-modal BP estimation model consists of three components: first, a gated recurrent unit network that generates features from photoplethysmogram, electrocardiogram, age, height, and weight; second, an attention mechanism that integrates each feature into joint embeddings; and third, a regression layer that estimates BP from the joint embeddings. The uni-modal BP estimation model has similar components to the multi-modal model but uses only PPG signal. BP is predicted by the embeddings extracted from the uni-modal model, and these embeddings are trained to be as similar as possible to the joint embeddings extracted from the multi-modal model. The proposed method demonstrates absolute prediction errors of 5.24±6.41 and 3.49±3.85 mmHg for systolic blood pressure and diastolic blood pressure in the MIMIC-III dataset, satisfying the AAMI standard.

Analysis for calibration pre-post difference in BP estimation of Galaxy Watch.

The use of smartwatches has become increasingly common with the release of major products such as the Galaxy Watch by Samsung and the Apple Watch by Apple. The common aim of smartwatches is to target the healthcare market with a wearable, physically-attached device, with blood pressure at the core. As blood pressure is an important biomarker for cardiovascular-related diseases, it is a necessary index to inspect in hospitals when checking an individual's health state. Smartwatches are expected to provide a cuff-less, non-invasive method of estimating blood pressure. However, not many experiments have been conducted on blood pressure datasets obtained from smartwatches. Smartwatches are unique compared to other devices because they require "calibration" to sustain their accuracy.In this paper, we investigate the difference between before and after calibration to better understand the calibration pattern. Not only do we seek to understand the demographic differences in calibration, but we also analyze the possible variables that influence calibration differences. Our results show that hypertensive patients are more prone to high calibration differences, which implies that the calibration period should be adjusted by considering the average blood pressure of users.Clinical Relevance- This paper investigates the possibility for daily BP measurement to be used as clinical data while suggesting proper method to sustain its validity.

Non-invasive arterial blood pressure measurement and SpO2 estimation using PPG signal: a deep learning framework

BackgroundMonitoring blood pressure and peripheral capillary oxygen saturation plays a crucial role in healthcare management for patients with chronic diseases, especially hypertension and vascular disease. However, current blood pressure measurement methods have intrinsic limitations; for instance, arterial blood pressure is measured by inserting a catheter in the artery causing discomfort and infection.MethodPhotoplethysmogram (PPG) signals can be collected via non-invasive devices, and therefore have stimulated researchers’ interest in exploring blood pressure estimation using machine learning and PPG signals as a non-invasive alternative. In this paper, we propose a Transformer-based deep learning architecture that utilizes PPG signals to conduct a personalized estimation of arterial systolic blood pressure, arterial diastolic blood pressure, and oxygen saturation.ResultsThe proposed method was evaluated with a subset of 1,732 subjects from the publicly available ICU dataset MIMIC III. The mean absolute error is 2.52 ± 2.43 mmHg for systolic blood pressure, 1.37 ± 1.89 mmHg for diastolic blood pressure, and 0.58 ± 0.79% for oxygen saturation, which satisfies the requirements of the Association of Advancement of Medical Instrumentation standard and achieve grades A for the British Hypertension Society standard.ConclusionsThe results indicate that our model meets clinical standards and could potentially boost the accuracy of blood pressure and oxygen saturation measurement to deliver high-quality healthcare.

Beat to Beat Continuous Blood Pressure Estimation using the Transmission Coefficient Waveforms out of On-body Continuous Wave Antennas

Blood pressure (BP) is a clear sign of hypertension, a condition that can be hazardous and even fatal. Regular blood pressure monitoring is therefore crucial, but many people dislike cuff-based devices, and they can only be used while at rest. To address this need, this paper investigates the use of micro strip patch antenna technology to obtain BP values through an innovative technique. The change of transmission coefficient EM waveforms emitted by the antennas will be analyzed and correlated with brachial artery thickness to radius ratios and hence, blood pressure assessment at different pressure points. The suggested morphology based on simulations and data algorithms performed at couple of instances of brachial artery diameters to mimic the condition of blood flow. A dedicated analysis software provided to calculate the systolic and diastolic pressure levels.

Remote Estimation of Blood Pressure Using Millimeter-Wave Frequency-Modulated Continuous-Wave Radar.

This paper proposes to remotely estimate a human subject's blood pressure using a millimeter-wave radar system. High blood pressure is a critical health threat that can lead to diseases including heart attacks, strokes, kidney disease, and vision loss. The commonest method of measuring blood pressure is based on a cuff that is contact-based, non-continuous, and cumbersome to wear. Continuous remote monitoring of blood pressure can facilitate early detection and treatment of heart disease. This paper investigates the possibility of using millimeter-wave frequency-modulated continuous-wave radar to measure the heart blood pressure by means of pulse wave velocity (PWV). PWV is known to be highly correlated with blood pressure, which can be measured by pulse transit time. We measured PWV using a two-millimeter wave radar focused on the subject's chest and wrist. The measured time delay provided the PWV given the length from the chest to the wrist. In addition, we analyzed the measured radar signal from the wrist because the shape of the pulse wave purveyed information on blood pressure. We investigated the area under the curve (AUC) as a feature and found that AUC is strongly correlated with blood pressure. In the experiment, five human subjects were measured 50 times each after performing different activities intended to influence blood pressure. We used artificial neural networks to estimate systolic blood pressure (SBP) and diastolic blood pressure (SBP) with both PWV and AUC as inputs. The resulting root mean square errors of estimated blood pressure were 3.33 mmHg for SBP and 3.14 mmHg for DBP.

Spatial Feature Extraction for Acute Blood Pressure Fluctuations in Facial Visible Images Using Sparse Coding

Remote blood pressure measurement using visible images facilitates routine blood pressure monitoring and leads to early detection of hypertension, a risk factor for lifestyle diseases. The previous study that attempted to estimate blood pressure by applying CNN to facial thermal images found that facial images contain two types of features, physiological responses and expression changes, which need to be separated. In contrast, we found that these features could be separated by using sparse coding on facial thermal images. This study used sparse coding to extract physiological response areas during acute blood pressure fluctuations from facial visible images by examining preprocessing. The results indicated that sparse coding and the proposed preprocessing methods for images were effective. © 2023 Institute of Electrical Engineer of Japan and Wiley Periodicals LLC.

Noninvasive Cuffless Blood Pressure Estimation With Dendritic Neural Regression.

Blood pressure (BP) is one of the most important indicators of health. BP that is too high or too low causes varying degrees of diseases, such as renal impairment, cerebrovascular incidents, and cardiovascular diseases. Since traditional cuff-based BP measurement techniques have the drawbacks of patient discomfort and the impossibility of continuous BP monitoring, noninvasive cuffless continuous BP measurement has become a popular topic. The common noninvasive approach uses machine-learning (ML) algorithms to estimate BP by using the features extracted from simultaneous photoplethysmogram (PPG) and electrocardiogram (ECG) signals, such as the pulse transit time and pulse wave velocity. This study investigates the BP estimation performance of the novel dendritic neural regression (DNR) method proposed by us. Unlike conventional neural networks, DNR utilizes the multiplication operator as the excitation function in each dendritic branch, inspired by biological neuron phenomena, and can effectively capture nonlinear relationships between distinct input features. In addition, AMSGrad is used as the optimization algorithm to further enhance the dendritic neural model's performance. The experimental results show that by being fed a combination of the raw features extracted from the ECG and PPG signals and the components of the BP mathematical models, DNR can increase the accuracy of systolic BP, diastolic BP, and mean arterial pressure estimation significantly, which are superior to the state-of-the-art ML techniques. According to the British Hypertension Society protocol, DNR achieves a grade of A for the long-term BP estimation. Considering its architectural simplicity and powerful performance, the proposed method can be regarded as a reliable tool for estimating long-term continuous BP in a noninvasive cuffless way.

Fully convolutional neural network and PPG signal for arterial blood pressure waveform estimation

Objective. The quality of the arterial blood pressure (ABP) waveform is crucial for predicting the value of blood pressure. The ABP waveform is predicted through experiments, and then Systolic blood pressure (SBP), Diastolic blood pressure, (DBP), and Mean arterial pressure (MAP) information are estimated from the ABP waveform. Approach. To ensure the quality of the predicted ABP waveform, this paper carefully designs the network structure, input signal, loss function, and structural parameters. A fully convolutional neural network (CNN) MultiResUNet3+ is used as the core architecture of ABP-MultiNet3+. In addition to performing Kalman filtering on the original photoplethysmogram (PPG) signal, its first-order derivative and second-order derivative signals are used as ABP-MultiNet3+ enter. The model’s loss function uses a combination of mean absolute error (MAE) and means square error (MSE) loss to ensure that the predicted ABP waveform matches the reference waveform. Main results. The proposed ABP-MultiNet3+ model was tested on the public MIMIC II databases, MAE of MAP, DBP, and SBP was 1.88 mmHg, 3.11 mmHg, and 4.45 mmHg, respectively, indicating a small model error. It experiment fully meets the standards of the AAMI standard and obtains level A in the DBP and MAP prediction standard test under the BHS standard. For SBP prediction, it obtains level B in the BHS standard test. Although it does not reach level A, it has a certain improvement compared with the existing methods. Significance. The results show that this algorithm can achieve sleeveless blood pressure estimation, which may enable mobile medical devices to continuously monitor blood pressure and greatly reduce the harm caused by Cardiovascular disease (CVD).

A novel interpretable feature set optimization method in blood pressure estimation using photoplethysmography signals

Blood pressure (BP) estimation based on photoplethysmography (PPG) signals enables continuous and comfortable BP measurement, which is important for the clinical management of hypertension. The purpose of this study is to propose a novel and interpretable feature optimization method to improve the performance of the PPG-based model for BP estimation. The PPG signals of 152 subjects were selected from a public database. Feature detection was performed on the signals after FIR band-pass filtering. A total of 172 features extracted from ten feature dimensions were used to construct a feature set, including features from the raw PPG signals, PPG derivative signals, and statistical information. Light Gradient Boosting Machine (LightGBM) was used as this work's prediction model. To further improve the performance of the LightGBM model, Shapley Additive Explanations (SHAP) were utilized for feature optimization to achieve the purpose. The number of features corresponding to the lowest model error was defined as the optimal feature set, and this was utilized for training the model to obtain BP estimation. Compared to the validated BP, the mean and standard deviation (SD) of the estimation errors for systolic blood pressure (SBP) and diastolic blood pressure (DBP) were −0.73 ± 6.50 mmHg and 0.37 ± 3.83 mmHg, respectively. According to the British Hypertension Society (BHS) criteria, SBP and DBP are within the range of B and A grades, respectively. We propose a novel feature optimization method to reduce the feature dimension for BP estimation. The algorithm can effectively prevent overfitting and improve the model's performance.

Estimation of Physiologic Pressures: Invasive and Non-Invasive Techniques, AI Models, and Future Perspectives.

The measurement of physiologic pressure helps diagnose and prevent associated health complications. From typical conventional methods to more complicated modalities, such as the estimation of intracranial pressures, numerous invasive and noninvasive tools that provide us with insight into daily physiology and aid in understanding pathology are within our grasp. Currently, our standards for estimating vital pressures, including continuous BP measurements, pulmonary capillary wedge pressures, and hepatic portal gradients, involve the use of invasive modalities. As an emerging field in medical technology, artificial intelligence (AI) has been incorporated into analyzing and predicting patterns of physiologic pressures. AI has been used to construct models that have clinical applicability both in hospital settings and at-home settings for ease of use for patients. Studies applying AI to each of these compartmental pressures were searched and shortlisted for thorough assessment and review. There are several AI-based innovations in noninvasive blood pressure estimation based on imaging, auscultation, oscillometry and wearable technology employing biosignals. The purpose of this review is to provide an in-depth assessment of the involved physiologies, prevailing methodologies and emerging technologies incorporating AI in clinical practice for each type of compartmental pressure measurement. We also bring to the forefront AI-based noninvasive estimation techniques for physiologic pressure based on microwave systems that have promising potential for clinical practice.

Investigation of Data Leakage in Deep-Learning-Based Blood Pressure Estimation Using Photoplethysmogram/Electrocardiogram

Cuff-less blood pressure (BP) estimation methods using a deep learning model from photoplethysmogram (PPG) or electrocardiogram (ECG) have been actively studied in recent years. However, we found that most previous studies incur data leakage, where segments or records measured from the same subject appear in both the training and test datasets. Furthermore, many previous studies are suspected to have misinterpreted a record in the public dataset used for their evaluations as a subject. To investigate data leakage in BP estimation methods, this paper first organizes previous studies in terms of data leakage. We then quantitatively evaluate the effect of data leakage caused by the segment-level and the record-level train-test split using the public dataset, Cuff-Less Blood Pressure Estimation Data Set. Our experimental results showed that the segment-level split and record-level split erroneously improved the estimation accuracy of mean blood pressure from the (quasi-)subject-level split by the Pearson’s correlation coefficient of 0.56 and 0.40 when using PPG, and 0.82 and 0.69 when using ECG, respectively. These results confirmed that the train-test split used in many previous studies, including the one that described its evaluation as causing no data leakage, causes a high level of data leakage, and that a record in the Cuff-Less Blood Pressure Estimation Data Set, often misinterpreted as a subject in previous studies, is not a subject and that a high level of data leakage occurs when the record is considered as a subject.

Deep Learning-Based Non-Contact IPPG Signal Blood Pressure Measurement Research

In this paper, a multi-stage deep learning blood pressure prediction model based on imaging photoplethysmography (IPPG) signals is proposed to achieve accurate and convenient monitoring of human blood pressure. A camera-based non-contact human IPPG signal acquisition system is designed. The system can perform experimental acquisition under ambient light, effectively reducing the cost of non-contact pulse wave signal acquisition while simplifying the operation process. The first open-source dataset IPPG-BP for IPPG signal and blood pressure data is constructed by this system, and a multi-stage blood pressure estimation model combining a convolutional neural network and bidirectional gated recurrent neural network is designed. The results of the model conform to both BHS and AAMI international standards. Compared with other blood pressure estimation methods, the multi-stage model automatically extracts features through a deep learning network and combines different morphological features of diastolic and systolic waveforms, which reduces the workload while improving accuracy.

A mixed attention-gated U-Net for continuous cuffless blood pressure estimation

A mixed attention-gated U-Net for continuous cuffless blood pressure estimation

Cascade forest regression algorithm for non-invasive blood pressure estimation using PPG signals

The regression and classification performances of deep-learning algorithms depend on the tuning of the model and require significant intervention to train the model. A blood pressure prediction (BP) method – which is an improved cascade forest regression method based on a deep forest framework – is proposed in this study to mitigate the adverse effects of hyperparameters on deep learning algorithms and human errors. The impact of hyperparameters on the model can be reduced using random forest regression and extra tree regression as base estimators and by applying them to bootstrap aggregation strategies for learning data. The photoplethysmography (PPG) data and ambulatory blood pressure obtained from the MIMIC II database were evenly divided into 5 s segments to accurately estimate blood pressure. Nonlinear indices of the time domain, frequency domain, and heart rate variability were obtained from the PPG signal as training characteristic values. This process is similar to collecting data directly from a wearable device for rapid blood pressure prediction. This improves the predictive performance of the model and reduces additional memory consumption. Our proposed algorithm achieved mean absolute errors of 1.760 and 2.896 mmHg for systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. Additionally, our best model achieved R2 scores of 0.948 and 0.926 for SBP and DBP, respectively. According to the Association for the Advancement of Medical Instrumentation standards, the standard deviation and mean error of the predicted results for systolic and diastolic BPs were within the standard range. According to the British Hypertension Society standard, the results of the proposed algorithm reached grade A. This study confirmed the possibility of developing an algorithm that can accurately estimate blood pressure.

Physics-informed neural networks for modeling physiological time series for cuffless blood pressure estimation

The bold vision of AI-driven pervasive physiological monitoring, through the proliferation of off-the-shelf wearables that began a decade ago, has created immense opportunities to extract actionable information for precision medicine. These AI algorithms model input-output relationships of a system that, in many cases, exhibits complex nature and personalization requirements. A particular example is cuffless blood pressure estimation using wearable bioimpedance. However, these algorithms need training over significant amount of ground truth data. In the context of biomedical applications, collecting ground truth data, particularly at the personalized level is challenging, burdensome, and in some cases infeasible. Our objective is to establish physics-informed neural network (PINN) models for physiological time series data that would use minimal ground truth information to extract complex cardiovascular information. We achieve this by building Taylor’s approximation for gradually changing known cardiovascular relationships between input and output (e.g., sensor measurements to blood pressure) and incorporating this approximation into our proposed neural network training. The effectiveness of the framework is demonstrated through a case study: continuous cuffless BP estimation from time series bioimpedance data. We show that by using PINNs over the state-of-the-art time series models tested on the same datasets, we retain high correlations (systolic: 0.90, diastolic: 0.89) and low error (systolic: 1.3 ± 7.6 mmHg, diastolic: 0.6 ± 6.4 mmHg) while reducing the amount of ground truth training data on average by a factor of 15. This could be helpful in developing future AI algorithms to help interpret pervasive physiologic data using minimal amount of training data.

WIB : Real-time, Non-intrusive Blood Pressure Detection Using Smartphones

Blood pressure (BP) is an essential vital sign related to many severe diseases, such as heart failure, kidney failure. Frequent BP detection can provide doctors more information to treat the disease. However, conventional at-home BP detection devices require completely blocking blood flow, which can lead to discomfort and disruption of normal activity when users want to perform frequent assessments. So a convenient solution should reduce the trouble of detecting BP in the daily life. In this work, we have designed and evaluated a smartphone-based BP detection application named WIB . WIB utilizes the smartphone’s acoustic sensors to obtain the chest motion caused by the heart beating and the smartphone’s camera to capture the pulse at the fingertip. We have recruited 30 volunteers who come from the author’s institution, to carry out comprehensive evaluations of WIB . We perform BP perturbation experiments to obtain different blood pressure data from these volunteers. The experiment results show that the average of Pearson correlation coefficient across all volunteers of the blood pressure estimation is 0.42–0.74 (α =0.6, σ =0.12), the average of RMSE across all volunteers is 4.2–8.8 mmHg (α =5.8, σ =1.8).

Quantitative analysis of pulse arrival time and PPG morphological features based cuffless blood pressure estimation: a comparative study between diabetic and non-diabetic groups.

Pulse arrival time (PAT) and PPG morphological features have attracted much interest in cuffless blood pressure (BP) estimation, but their effects are not clearly understood when vascular characteristics are affected by diseases such as diabetes. This work quantitatively analyzes the effect of diabetic disease on the PAT and PPG morphological features-based BP estimation. We selected 112 diabetic patients and 308 non-diabetic subjects from VitalDB, and extracted 16 features including PAT, PPG morphological features, and heart rate. BP estimation performance was statistically compared between groups using linear regression models with several feature sets, and the relative importance of each feature in the optimal feature set was extracted. As a result, the standard deviation of the error and mean absolute error of PAT-based BP estimation were significantly higher in the diabetic group than in the non-diabetic group (p < 0.01). A feature set containing PAT and PPG morphological features achieved the best performance in both groups. However, the relative importance of each feature for BP estimation differed notably between groups. The results indicate that different features are important depending on the vascular characteristics, which could help to construct different models to accommodate specific diseases.

Deep-learning-based blood pressure estimation using multi channel photoplethysmogram and finger pressure with attention mechanism

Recently, several studies have proposed methods for measuring cuffless blood pressure (BP) using finger photoplethysmogram (PPG) signals. This study presents a new BP estimation system that measures PPG signals under progressive finger pressure, making the system relatively robust to errors caused by finger position when using the cuffless oscillometric method. To reduce errors caused by finger position, we developed a sensor that can simultaneously measure multi-channel PPG and force signals in a wide field of view (FOV). We propose a deep-learning-based algorithm that can learn to focus on the optimal PPG channel from multi channel PPG using an attention mechanism. The errors (ME ± STD) of the proposed multi channel system were 0.43±9.35 mmHg and 0.21 ± 7.72 mmHg for SBP and DBP, respectively. Through extensive experiments, we found a significant performance difference depending on the location of the PPG measurement in the BP estimation system using finger pressure.