A review of methods for non-invasive and continuous blood pressure monitoring: Pulse transit time method is promising?

Peter, Lukas; Noury, Norbert; Cerny, Martin

doi:10.1016/j.irbm.2014.07.002

Cited by 228 publications

(156 citation statements)

References 24 publications

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“…Moreover, PTT can be measured simply as the relative timing between proximal and distal waveforms indicative of arterial pulsations. For these reasons, PTT is being widely investigated at present to achieve convenient, cuff-less BP monitoring (see recent reviews123). …”

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confidence: 99%

Weighing Scale-Based Pulse Transit Time is a Superior Marker of Blood Pressure than Conventional Pulse Arrival Time

Martin

Carek

Kim

et al. 2016

Sci Rep

111

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Pulse transit time (PTT) is being widely pursued for cuff-less blood pressure (BP) monitoring. Most efforts have employed the time delay between ECG and finger photoplethysmography (PPG) waveforms as a convenient surrogate of PTT. However, these conventional pulse arrival time (PAT) measurements include the pre-ejection period (PEP) and the time delay through small, muscular arteries and may thus be an unreliable marker of BP. We assessed a bathroom weighing scale-like system for convenient measurement of ballistocardiography and foot PPG waveforms – and thus PTT through larger, more elastic arteries – in terms of its ability to improve tracking of BP in individual subjects. We measured “scale PTT”, conventional PAT, and cuff BP in humans during interventions that increased BP but changed PEP and smooth muscle contraction differently. Scale PTT tracked the diastolic BP changes well, with correlation coefficient of −0.80 ± 0.02 (mean ± SE) and root-mean-squared-error of 7.6 ± 0.5 mmHg after a best-case calibration. Conventional PAT was significantly inferior in tracking these changes, with correlation coefficient of −0.60 ± 0.04 and root-mean-squared-error of 14.6 ± 1.5 mmHg (p < 0.05). Scale PTT also tracked the systolic BP changes better than conventional PAT but not to an acceptable level. With further development, scale PTT may permit reliable, convenient measurement of BP.

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confidence: 99%

Weighing Scale-Based Pulse Transit Time is a Superior Marker of Blood Pressure than Conventional Pulse Arrival Time

Martin

Carek

Kim

et al. 2016

Sci Rep

111

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“…These two are subject-specific parameters [47][48][49]. Equation (2) estimates the central arterial pressure if α and E o are updated by accounting for the age and health impacts on the elasticity due to the change in the wall composition.…”

Section: Relationship Between Bp Pressure Wave Velocity (Pwv) and Timentioning

confidence: 99%

“…PEP is a delay that changes with stress, physical activity, age and emotion [48]. A study has attempted to estimate PEP as a percentage of the RR interval as, with a low heart rate, PEP becomes more significant [73].…”

Section: Pulse Arrival Time (Pat)mentioning

confidence: 99%

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Cuff-Less and Continuous Blood Pressure Monitoring: A Methodological Review

et al. 2017

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Blood pressure (BP) is one of the most important monitoring parameters in clinical medicine. For years, the cuff-based sphygmomanometer and the arterial invasive line have been the gold standards for care professionals to assess BP. During the past few decades, the wide spread of the oscillometry-based BP arm or wrist cuffs have made home-based BP assessment more convenient and accessible. However, the discontinuous nature, the inability to interface with mobile applications, the relative inaccuracy with movement, and the need for calibration have rendered those BP oscillometry devices inadequate for next-generation healthcare infrastructure where integration and continuous data acquisition and communication are required. Recently, the indirect approach to obtain BP values has been intensively investigated, where BP is mathematically derived through the "Time Delay" in propagation of pressure waves in the vascular system. This holds promise for the realization of cuffless and continuous BP monitoring systems, for both patients and healthy populations in both inpatient and outpatient settings. This review highlights recent efforts in developing these next-generation blood pressure monitoring devices and compares various mathematical models. The unmet challenges and further developments that are crucial to develop "Time Delay"-based BP devices are also discussed.

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“…PTT is the time for the pulse wave to travel between two arterial sites, which is highly related with PWV. Normally, PTT is calculated from the time distance between R wave of ECG signal and following peak of fingertip PPG signal [10]. PTT based methods [5]-[7], [11]- [13] have been demonstrated to achieve relatively high accuracy on BP estimation, but two devices are required for the measurement.…”

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confidence: 99%

Cuffless Blood Pressure Estimation Based on Photoplethysmography Signal and Its Second Derivative

Li¹,

Po²,

Fu³

2017

IJCTE

113

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I. INTRODUCTIONBlood pressure (BP) is one of the four vital signs of human body besides heart rate, respiratory rate, and body temperature. Recently, the risk of having hypertension is extending from older to younger groups of the population. This trend making the number of people who need daily monitoring of BP is significantly increased. In addition, the demand for public resources in the hospital is becoming more and more serious and the type of healthcare is tending to individual-centered rather than hospital-centered. The need of self-monitoring BP devices dramatically increases in the recent decades. However, most of the commercial BP measuring devices require to inflate and deflate a cuff for determining the BP values. This measurement has a high demand for the medical practitioner"s operation skills.Self-monitoring BP devices using cuffless and noninvasive detective methods are very attractive for personal healthcare applications. It was reported that Manuscript received August 4, 2016; revised December 9, 2016 cuff-less, noninvasive, and continuous measurement of BP could be achieved by photoplethysmography (PPG) [1]- [7]. PPG [8] is a simple, portable and low-cost optical pulse that can be used to detect blood volume changes. The waveform of PPG is formed by heartbeat and affected by the condition of cardiovascular system [9]. When BP increases, the volumetric elasticity of blood vessel increases. This makes vessel wall stiff and the pulse wave propagation velocity is increased. The pulse wave propagation velocity (PWV) is represented as the pulse wave propagation distance divided by Pulse transit time (PTT). PTT is the time for the pulse wave to travel between two arterial sites, which is highly related with PWV. Normally, PTT is calculated from the time distance between R wave of ECG signal and following peak of fingertip PPG signal [10]. PTT based methods [5]-[7], [11]- [13] have been demonstrated to achieve relatively high accuracy on BP estimation, but two devices are required for the measurement. This is inconvenient and requires high operation skill in practical usage. Moreover, synchronization between two devices is also a big challenge of PTT approach. Therefore, PPG waveform analysis approach using a single PPG signal is very attractive for continuous and noninvasive BP measurement. However, several reported PPG waveform analysis based BP estimation methods [14], [15] From the recent studies [17], [18] of vascular aging through the second derivative of PPG (SDPPG), Pulse Wave Velocity (PWV) and SDPPG contain the information about aortic compliance and stiffness. These factors highly correlated with blood pressure. Basically, SDPPG is the acceleration of PPG and its waveform is in "W" shape with five sequential waves normally, as shown in the lower part of Fig. 1. These five waves are named as Initial Positive Wave (IPW), Early Negative Wave (ENW), Late Upsloping Wave (LUW), Late Downsloping Wave (LDW), and Diastolic Positive Wave (DPW). The positions of "a", "b", "c", "d", and "e" are peaks...

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A review of methods for non-invasive and continuous blood pressure monitoring: Pulse transit time method is promising?

Cited by 228 publications

References 24 publications

Weighing Scale-Based Pulse Transit Time is a Superior Marker of Blood Pressure than Conventional Pulse Arrival Time

Weighing Scale-Based Pulse Transit Time is a Superior Marker of Blood Pressure than Conventional Pulse Arrival Time

Cuff-Less and Continuous Blood Pressure Monitoring: A Methodological Review

Cuffless Blood Pressure Estimation Based on Photoplethysmography Signal and Its Second Derivative

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