Blood Pressure Estimation Using On-body Continuous Wave Radar and Photoplethysmogram in Various Posture and Exercise Conditions

Temporal complexity in photoplethysmography and its influence on blood pressure

Objective: The temporal complexity of photoplethysmography (PPG) provides valuable information about blood pressure (BP). In this study, we aim to interpret the stochastic PPG patterns with a model-based simulation, which may help optimize the BP estimation algorithms. Methods: The classic four-element Windkessel model is adapted in this study to incorporate BP-dependent compliance profiles. Simulations are performed to generate PPG responses to pulse and continuous stimuli at various timescales, aiming to mimic sudden or gradual hemodynamic changes observed in real-life scenarios. To quantify the temporal complexity of PPG, we utilize the Higuchi fractal dimension (HFD) and autocorrelation function (ACF). These measures provide insights into the intricate temporal patterns exhibited by PPG. To validate the simulation results, continuous recordings of BP, PPG, and stroke volume from 40 healthy subjects were used. Results: Pulse simulations showed that central vascular compliance variation during a cardiac cycle, peripheral resistance, and cardiac output (CO) collectively contributed to the time delay, amplitude overshoot, and phase shift of PPG responses. Continuous simulations showed that the PPG complexity could be generated by random stimuli, which were subsequently influenced by the autocorrelation patterns of the stimuli. Importantly, the relationship between complexity and hemodynamics as predicted by our model aligned well with the experimental analysis. HFD and ACF had significant contributions to BP, displaying stability even in the presence of high CO fluctuations. In contrast, morphological features exhibited reduced contribution in unstable hemodynamic conditions. Conclusion: Temporal complexity patterns are essential to single-site PPG-based BP estimation. Understanding the physiological implications of these patterns can aid in the development of algorithms with clear interpretability and optimal structures.

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.

Continuous Non-Invasive Blood Pressure Measurement Using 60 GHz-Radar-A Feasibility Study

Blood pressure monitoring is of paramount importance in the assessment of a human's cardiovascular health. The state-of-the-art method remains the usage of an upper-arm cuff sphygmomanometer. However, this device suffers from severe limitations-it only provides a static blood pressure value pair, is incapable of capturing blood pressure variations over time, is inaccurate, and causes discomfort upon use. This work presents a radar-based approach that utilizes the movement of the skin due to artery pulsation to extract pressure waves. From those waves, a set of 21 features was collected and used-together with the calibration parameters of age, gender, height, and weight-as input for a neural network-based regression model. After collecting data from 55 subjects from radar and a blood pressure reference device, we trained 126 networks to analyze the developed approach's predictive power. As a result, a very shallow network with just two hidden layers produced a systolic error of 9.2±8.3 mmHg (mean error ± standard deviation) and a diastolic error of 7.7±5.7 mmHg. While the trained model did not reach the requirements of the AAMI and BHS blood pressure measuring standards, optimizing network performance was not the goal of the proposed work. Still, the approach has displayed great potential in capturing blood pressure variation with the proposed features. The presented approach therefore shows great potential to be incorporated into wearable devices for continuous blood pressure monitoring for home use or screening applications, after improving this approach even further.

Wearable Continuous Blood Pressure Monitoring Devices Based on Pulse Wave Transit Time and Pulse Arrival Time: A Review

Continuous blood pressure (BP) monitoring is of great significance for the real-time monitoring and early prevention of cardiovascular diseases. Recently, wearable BP monitoring devices have made great progress in the development of daily BP monitoring because they adapt to long-term and high-comfort wear requirements. However, the research and development of wearable continuous BP monitoring devices still face great challenges such as obvious motion noise and slow dynamic response speeds. The pulse wave transit time method which is combined with photoplethysmography (PPG) waves and electrocardiogram (ECG) waves for continuous BP monitoring has received wide attention due to its advantages in terms of excellent dynamic response characteristics and high accuracy. Here, we review the recent state-of-art wearable continuous BP monitoring devices and related technology based on the pulse wave transit time; their measuring principles, design methods, preparation processes, and properties are analyzed in detail. In addition, the potential development directions and challenges of wearable continuous BP monitoring devices based on the pulse wave transit time method are discussed.

Recent Advances in Non-Invasive Blood Pressure Monitoring and Prediction Using a Machine Learning Approach

Blood pressure (BP) monitoring can be performed either invasively via arterial catheterization or non-invasively through a cuff sphygmomanometer. However, for conscious individuals, traditional cuff-based BP monitoring devices are often uncomfortable, intermittent, and impractical for frequent measurements. Continuous and non-invasive BP (NIBP) monitoring is currently gaining attention in the human health monitoring area due to its promising potentials in assessing the health status of an individual, enabled by machine learning (ML), for various purposes such as early prediction of disease and intervention treatment. This review presents the development of a non-invasive BP measuring tool called sphygmomanometer in brief, summarizes state-of-the-art NIBP sensors, and identifies extended works on continuous NIBP monitoring using commercial devices. Moreover, the NIBP predictive techniques including pulse arrival time, pulse transit time, pulse wave velocity, and ML are elaborated on the basis of bio-signals acquisition from these sensors. Additionally, the different BP values (systolic BP, diastolic BP, mean arterial pressure) of the various ML models adopted in several reported studies are compared in terms of the international validation standards developed by the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) for clinically-approved BP monitors. Finally, several challenges and possible solutions for the implementation and realization of continuous NIBP technology are addressed.

Blood Pressure Response and Pulse Arrival Time During Exercise Testing in Well-Trained Individuals

Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing.

Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests.

Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r² of 0.81 ± 17.

Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing.

Wearable Blood Pressure Sensing Based on Transmission Coefficient Scattering for Microstrip Patch Antennas

Painless, cuffless and continuous blood pressure monitoring sensors provide a more dynamic measure of blood pressure for critical diagnosis or continuous monitoring of hypertensive patients compared to current cuff-based options. To this end, a novel flexible, wearable and miniaturized microstrip patch antenna topology is proposed to measure dynamic blood pressure (BP). The methodology was implemented on a simulated five-layer human tissue arm model created and designed in High-Frequency Simulation Software “HFSS”. The electrical properties of the five-layer human tissue were set at the frequency range (2−3) GHz to comply with clinical/engineering standards. The fabricated patch incorporated on a 0.4 mm epoxy substrate achieved consistency between the simulated and measured reflection coefficient results at flat and bent conditions over the frequency range of 2.3−2.6 GHz. Simulations for a 10 g average specific absorption rate (SAR) based on IEEE-Standard for a human arm at different input powers were also carried out. The safest input power was 50 mW with an acceptable SAR value of 3.89 W/Kg < 4W/Kg. This study also explored a novel method to obtain the pulse transit time (PTT) as an option to measure BP. Pulse transmit time is based on obtaining the time difference between the transmission coefficient scattering waveforms measured between the two pairs of metallic sensors underlying the assumption that brachial arterial geometries are dynamic. Consequently, the proposed model is validated by comparing it to the standard nonlinear Moens and Korteweg model over different artery thickness-radius ratios, showing excellent correlation between 0.76 ± 0.03 and 0.81 ± 0.03 with the systolic and diastolic BP results. The absolute risk of arterial blood pressure increased with the increase in brachial artery thickness-radius ratio. The results of both methods successfully demonstrate how the radius estimates, PTT and pulse wave velocity (PWV), along with electromagnetic (EM) antenna transmission propagation characteristics, can be used to estimate continuous BP non-invasively.

Wearable cuffless blood pressure monitoring devices: a systematic review and meta-analysis

Aims

High blood pressure (BP) is the commonest modifiable cardiovascular risk factor, yet its monitoring remains problematic. Wearable cuffless BP devices offer potential solutions; however, little is known about their validity and utility. We aimed to systematically review the validity, features and clinical use of wearable cuffless BP devices.

Methods and results

We searched MEDLINE, Embase, IEEE Xplore and the Cochrane Database till December 2019 for studies that reported validating cuffless BP devices. We extracted information about study characteristics, device features, validation processes, and clinical applications. Devices were classified according to their functions and features. We defined devices with a mean systolic BP (SBP) and diastolic BP (DBP) biases of <5 mmHg as valid as a consensus. Our definition of validity did not include assessment of device measurement precision, which is assessed by standard deviation of the mean difference-a critical component of ISO protocol validation criteria. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. A random-effects model meta-analysis was performed to summarise the mean biases for SBP and DBP across studies. Of the 430 studies identified, 16 studies (15 devices, 974 participants) were selected. The majority of devices (81.3%) used photoplethysmography to estimate BP against a reference device; other technologies included tonometry, auscultation and electrocardiogram. In addition to BP and heart rate, some devices also measured night-time BP (n = 5), sleep monitoring (n = 3), oxygen saturation (n = 3), temperature (n = 2) and electrocardiogram (n = 3). Eight devices showed mean biases of <5 mmHg for SBP and DBP compared with a reference device and three devices were commercially available. The meta-analysis showed no statistically significant differences between the wearable and reference devices for SBP (pooled mean difference = 3.42 mmHg, 95% CI: -2.17, 9.01, I² 95.4%) and DBP (pooled mean = 1.16 mmHg, 95% CI: -1.26, 3.58, I² 87.1%).

Conclusion

Several cuffless BP devices are currently available using different technologies, offering the potential for continuous BP monitoring. The variation in standards and validation protocols limited the comparability of findings across studies and the identification of the most accurate device. Challenges such as validation using standard protocols and in real-life settings must be overcome before they can be recommended for uptake into clinical practice.

Diagnostic Features and Potential Applications of PPG Signal in Healthcare: A Systematic Review

Recent research indicates that Photoplethysmography (PPG) signals carry more information than oxygen saturation level (SpO2) and can be utilized for affordable, fast, and noninvasive healthcare applications. All these encourage the researchers to estimate its feasibility as an alternative to many expansive, time-wasting, and invasive methods. This systematic review discusses the current literature on diagnostic features of PPG signal and their applications that might present a potential venue to be adapted into many health and fitness aspects of human life. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. To this aim, papers from 1981 to date are reviewed and categorized in terms of the healthcare application domain. Along with consolidated research areas, recent topics that are growing in popularity are also discovered. We also highlight the potential impact of using PPG signals on an individual’s quality of life and public health. The state-of-the-art studies suggest that in the years to come PPG wearables will become pervasive in many fields of medical practices, and the main domains include cardiology, respiratory, neurology, and fitness. Main operation challenges, including performance and robustness obstacles, are identified.

Assessing hemodynamics from the photoplethysmogram to gain insights into vascular age: A review from VascAgeNet

The photoplethysmogram (PPG) signal is widely measured by clinical and consumer devices, and it is emerging as a potential tool for assessing vascular age. The shape and timing of the PPG pulse wave are both influenced by normal vascular aging, changes in arterial stiffness and blood pressure, and atherosclerosis. This review summarizes research into assessing vascular age from the PPG. Three categories of approaches are described: 1) those which use a single PPG signal (based on pulse wave analysis), 2) those which use multiple PPG signals (such as pulse transit time measurement), and 3) those which use PPG and other signals (such as pulse arrival time measurement). Evidence is then presented on the performance, repeatability and reproducibility, and clinical utility of PPG-derived parameters of vascular age. Finally, the review outlines key directions for future research to realize the full potential of photoplethysmography for assessing vascular age.

Brachialis Pulse Wave Measurements with Ultra-Wide Band and Continuous Wave Radar, Photoplethysmography and Ultrasonic Doppler Sensors

The measurement and analysis of the arterial pulse wave provides information about the state of vascular health. When measuring blood pressure according to Riva-Rocci, the systolic and diastolic blood pressure is measured non-invasively with an inflatable pressure cuff on the upper arm. Today's blood pressure monitors analyze the pulse wave in reference to the rising or falling cuff pressure. With the help of additional pulse wave analysis, one can determine the pulse rate and the heart rate variability. In this paper, we investigated the concept, the construction, and the limitations of ultrawideband (UWB) radar and continuous wave (CW) radar, which provide continuous and non-invasive pulse wave measurements. We integrated the sensors into a complete measurement system. We measured the pulse wave of the cuff pressure, the radar sensor (both UWB and CW), the optical sensor, and ultrasonic Doppler as a reference. We discussed the results and the sensor characteristics. The main conclusion was that the resolution of the pulse radar was too low, even with a maximum bandwidth of 10 GHz, to measure pulse waves reliably. The continuous wave radar provides promising results for a phantom if adjusted properly with phase shifts and frequency. In the future, we intend to develop a CW radar solution with frequency adaption.