Toward Ubiquitous Blood Pressure Monitoring via Pulse Transit Time: Predictions on Maximum Calibration Period and Acceptable Error Limits

Mukkamala, Ramakrishna; Hahn, Jin‐Oh

doi:10.1109/tbme.2017.2756018

Cited by 72 publications

(46 citation statements)

References 33 publications

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“…In practice, users may not always be so compliant. However, a key advantage of a smartphone-based BP monitoring device is that many measurements can be made over time with the ubiquitous system ( 23 ). These measurements could be averaged to eliminate error caused by random variations in finger placement on the sensor and in the height at which the device is held, as well as to mitigate error caused by imperfect BP computation.…”

Section: Discussionmentioning

confidence: 99%

Smartphone-based blood pressure monitoring via the oscillometric finger-pressing method

et al. 2018

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High blood pressure (BP) is a major cardiovascular risk factor that is treatable, yet hypertension awareness and control rates are low. Ubiquitous BP monitoring technology could improve hypertension management, but existing devices require an inflatable cuff and are not compatible with such anytime, anywhere measurement of BP. We extended the oscillometric principle, which is used by most automatic cuff devices, to develop a cuff-less BP monitoring device using a smartphone. As the user presses her/his finger against the smartphone, the external pressure of the underlying artery is steadily increased while the phone measures the applied pressure and resulting variable-amplitude blood volume oscillations. A smartphone application provides visual feedback to guide the amount of pressure applied over time via the finger pressing and computes systolic and diastolic BP from the measurements. We prospectively tested the smartphone-based device for real-time BP monitoring in human subjects to evaluate usability (n = 30) and accuracy against a standard automatic cuff-based device (n = 32). We likewise tested a finger cuff device, which uses the volume-clamp method of BP detection. About 90% of the users learned the finger actuation required by the smartphone-based device after one or two practice trials. The device yielded bias and precision errors of 3.3 and 8.8 mmHg for systolic BP and −5.6 and 7.7 mmHg for diastolic BP over a 40 to 50 mmHg range of BP. These errors were comparable to the finger cuff device. Cuff-less and calibration-free monitoring of systolic and diastolic BP may be feasible via a smartphone.

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Section: Discussionmentioning

confidence: 99%

Smartphone-based blood pressure monitoring via the oscillometric finger-pressing method

et al. 2018

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“…As the composition of arteries changes with age (elastin in central arteries is replaced with collagen, which contributes to the atherosclerotic processes and stiffening of arteries), these techniques require subject specific calibration using a BP cuff at intervals in-line with atherosclerotic aging processes [87]. Mukkamala and Hahn [88] identified the maximum calibration interval to be about one year at age 30 with a linear decline to roughly six months by age 70. The need for calibration greatly limits the feasibility of these technologies, however new techniques such as those from Kachuee et al [59] have eliminated the need for calibration using a machine learning approach.…”

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confidence: 99%

Multimodal Photoplethysmography-Based Approaches for Improved Detection of Hypertension

Welykholowa

Hosanee

Chan

et al. 2020

JCM

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Elevated blood pressure (BP) is a major cause of death, yet hypertension commonly goes undetected. Owing to its nature, it is typically asymptomatic until later in its progression when the vessel or organ structure has already been compromised. Therefore, noninvasive and continuous BP measurement methods are needed to ensure appropriate diagnosis and early management before hypertension leads to irreversible complications. Photoplethysmography (PPG) is a noninvasive technology with waveform morphologies similar to that of arterial BP waveforms, therefore attracting interest regarding its usability in BP estimation. In recent years, wearable devices incorporating PPG sensors have been proposed to improve the early diagnosis and management of hypertension. Additionally, the need for improved accuracy and convenience has led to the development of devices that incorporate multiple different biosignals with PPG. Through the addition of modalities such as an electrocardiogram, a final measure of the pulse wave velocity is derived, which has been proved to be inversely correlated to BP and to yield accurate estimations. This paper reviews and summarizes recent studies within the period 2010–2019 that combined PPG with other biosignals and offers perspectives on the strengths and weaknesses of current developments to guide future advancements in BP measurement. Our literature review reveals promising measurement accuracies and we comment on the effective combinations of modalities and success of this technology.

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“…However, with the introduction of these covariates, the amount of computation will increase sharply. Of equal importance to initial calibration, some investigations mentioned that periodic calibration should be considered to improve the reliability of BP measurement since the period between calibrations is short and possibly affected the accuracy of parameters [44]. Our fPTP method with adjusting and penalizing behavior proposed in this study provided an effective and practical way to solve the periodic calibration by introducing it into a specific model.…”

Section: Discussionmentioning

confidence: 97%

A Revised Point-to-Point Calibration Approach with Adaptive Errors Correction to Weaken Initial Sensitivity of Cuff-Less Blood Pressure Estimation

Shao

Shi

et al. 2020

Sensors

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Initial calibration is a great challenge for cuff-less blood pressure (BP) measurement. The traditional one point-to-point (oPTP) calibration procedure only uses one sample/point to obtain unknown parameters of a specific model in a calm state. In fact, parameters such as pulse transit time (PTT) and BP still have slight fluctuations at rest for each subject. The conventional oPTP method had a strong sensitivity in the selection of initial value. Yet, the initial sensitivity of calibration has not been reported and investigated in cuff-less BP motoring. In this study, a mean point-to-point (mPTP) paring calibration method through averaging and balancing calm or peaceful states was proposed for the first time. Thus, based on mPTP, a factor point-to-point (fPTP) paring calibration method through introducing the penalty factor was further proposed to improve and optimize the performance of BP estimation. Using the oPTP, mPTP, and fPTP methods, a total of more than 100,000 heartbeat samples from 21 healthy subjects were tested and validated in the PTT-based BP monitoring technologies. The results showed that the mPTP and fPTP methods significantly improved the performance of estimating BP compared to the conventional oPTP method. Moreover, the mPTP and fPTP methods could be widely popularized and applied, especially the fPTP method, on estimating cuff-less diastolic blood pressure (DBP). To this extent, the fPTP method weakens the initial calibration sensitivity of cuff-less BP estimation and fills in the ambiguity for individualized calibration procedure.

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Toward Ubiquitous Blood Pressure Monitoring via Pulse Transit Time: Predictions on Maximum Calibration Period and Acceptable Error Limits

Abstract: The predictions may help guide the implementation, evaluation, and application of PTT-based BP monitoring systems in practice.

Cited by 72 publications

References 33 publications

Smartphone-based blood pressure monitoring via the oscillometric finger-pressing method

Smartphone-based blood pressure monitoring via the oscillometric finger-pressing method

Multimodal Photoplethysmography-Based Approaches for Improved Detection of Hypertension

A Revised Point-to-Point Calibration Approach with Adaptive Errors Correction to Weaken Initial Sensitivity of Cuff-Less Blood Pressure Estimation

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