scholarly journals Multi-Site Photoplethysmography Technology for Blood Pressure Assessment: Challenges and Recommendations

2019 ◽  
Vol 8 (11) ◽  
pp. 1827 ◽  
Author(s):  
Chan ◽  
Cooper ◽  
Hosanee ◽  
Welykholowa ◽  
Kyriacou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulse Wave ◽  
Blood Pressure Monitoring ◽  
New Technology ◽  
Pulse Transit Time ◽  
Time Of Day ◽  
White Coat Hypertension ◽  
Future Research ◽  
Site Location ◽  
Arterial Blood

Hypertension is one of the most prevalent diseases and is often called the “silent killer” because there are usually no early symptoms. Hypertension is also associated with multiple morbidities, including chronic kidney disease and cardiovascular disease. Early detection and intervention are therefore important. The current routine method for diagnosing hypertension is done using a sphygmomanometer, which can only provide intermittent blood pressure readings and can be confounded by various factors, such as white coat hypertension, time of day, exercise, or stress. Consequently, there is an increasing need for a non-invasive, cuff-less, and continuous blood pressure monitoring device. Multi-site photoplethysmography (PPG) is a promising new technology that can measure a range of features of the pulse, including the pulse transit time of the arterial pulse wave, which can be used to continuously estimate arterial blood pressure. This is achieved by detecting the pulse wave at one body site location and measuring the time it takes for it to reach a second, distal location. The purpose of this review is to analyze the current research in multi-site PPG for blood pressure assessment and provide recommendations to guide future research. In a systematic search of the literature from January 2010 to January 2019, we found 13 papers that proposed novel methods using various two-channel PPG systems and signal processing techniques to acquire blood pressure using multi-site PPG that offered promising results. However, we also found a general lack of validation in terms of sample size and diversity of populations.

scholarly journals A novel art of continuous non-invasive blood pressure measurement

2019 ◽  
Author(s):  
Jürgen Fortin ◽  
Dorothea Rogge ◽  
Christian Fellner ◽  
Doris Flotzinger ◽  
Julian Grond ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
Wearable Sensors ◽  
Pulse Transit Time ◽  
Control Technique ◽  
Volume Control ◽  
Flow Monitoring ◽  
Non Invasive ◽  
Arterial Blood

AbstractWearable sensors to continuously measure blood pressure (BP) and derived cardiovascular variables have the potential to revolutionize patient monitoring. Current wearable methods analyzing time components (e.g., pulse transit time) still lack clinical accuracy, whereas existing technologies for direct BP measurement are too bulky. Here we present a new art of continuous non-invasive arterial blood pressure monitoring (CNAP2GO). It directly measures BP by using a new “volume control technique” and could be used for small wearable sensors integrated in a finger ring. As a software prototype, CNAP2GO showed excellent BP measurement performance in comparison with invasive BP in 46 patients having surgery. The resulting pulsatile BP signal carries information to derive cardiac output and other hemodynamic variables. We show that CNAP2GO can be miniaturized for wearable approaches. CNAP2GO potentially constitutes the breakthrough for wearable sensors for blood pressure and flow monitoring in both ambulatory and in-hospital clinical settings.

scholarly journals Pulse Transit Time Derivation Using Xiphoidal and Carotid Seismocardiograms

2017 ◽  
Author(s):  
Ajay K. Verma ◽  
John Zanetti ◽  
Reza Fazel-Rezai ◽  
Kouhyar Tavakolian
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Transit Time ◽  
Pulse Wave ◽  
Blood Pressure Measurement ◽  
Pulse Transit Time ◽  
Non Invasive ◽  
Arterial Blood ◽  
Pressure Estimation ◽  
Blood Pressure Estimation

Blood pressure is an indicator of a cardiovascular functioning and could provide early symptoms of cardiovascular system impairment. Blood pressure measurement using catheterization technique is considered the gold standard for blood pressure measurement [1]. However, due its invasive nature and complexity, non-invasive techniques of blood pressure estimation such as auscultation, oscillometry, and volume clamping have gained wide popularity [1]. While these non-invasive cuff based methodologies provide a good estimate of blood pressure, they are limited by their inability to provide a continuous estimate of blood pressure [1–2]. Continuous blood pressure estimate is critical for monitoring cardiovascular diseases such as hypertension and heart failure. Pulse transit time (PTT) is a time taken by a pulse wave to travel between a proximal and distal arterial site [3]. The speed at which pulse wave travels in the artery has been found to be proportional to blood pressure [1, 3]. A rise in blood pressure would cause blood vessels to increase in diameter resulting in a stiffer arterial wall and shorter PTT [1–3]. To avail such relationship with blood pressure, PTT has been extensively used as a marker of arterial elasticity and a non-invasive surrogate for arterial blood pressure estimation. Typically, a combination of electrocardiogram (ECG) and photoplethysmogram (PPG) or arterial blood pressure (ABP) signal is used for the purpose of blood pressure estimation [3], where the proximal and distal timing of PTT (also referred as pulse arrival time, PAT) is marked by R peak of ECG and a foot/peak of a PPG, respectively. In the literature, it has been shown that PAT derived using ECG-PPG combination infers an inaccurate estimate of blood pressure due to the inclusion of isovolumetric contraction period [1–3, 4]. Seismocardiogram (SCG) is a recording of chest acceleration due to heart movement, from which the opening and closing of the aortic valve can be obtained [5]. There is a distinct point on the dorso-ventral SCG signal that marks the opening of the aortic valve (annotated as AO). In the literature, AO has been proposed for timing the onset of the proximal pulse of the wave [6–8]. A combination of AO as a proximal pulse and PPG as a distal pulse has been used to derive pulse transit time and is shown to be correlated with blood pressure [7]. Ballistocardiogram (BCG) which is a measure of recoil forces of a human body in response to pumping of blood in blood vessels has also been explored as an alternative to ECG for timing proximal pulse [5, 9]. Use of SCG or BCG for timing the proximal point of a pulse can overcome the limitation of ECG-based PTT computation [6–7, 9]. However, a limitation of current blood pressure estimation systems is the requirement of two morphologically different signals, one for annotating the proximal (ECG, SCG, BCG) and other for annotating the distal (PPG, ABP) timing of a pulse wave. In the current research, we introduce a methodology to derive PTT from seismocardiograms alone. Two accelerometers were used for such purpose, one was placed on the xiphoid process of the sternum (marks proximal timing) and the other one was placed on the external carotid artery (marks distal timing). PTT was derived as a time taken by a pulse wave to travel between AO of both the xiphoidal and carotid SCG.

scholarly journals Home Blood Pressure Monitoring

2015 ◽  
Vol 10 (2) ◽  
pp. 95 ◽  
Author(s):  
Jacob George ◽  
Thomas MacDonald ◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
New Technology ◽  
Home Blood Pressure ◽  
White Coat Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Self Monitoring ◽  
Reading Accuracy ◽  
The Impact

Hypertension is the most common preventable cause of cardiovascular disease. Home blood pressure monitoring (HBPM) is a self-monitoring tool that can be incorporated into the care for patients with hypertension and is recommended by major guidelines. A growing body of evidence supports the benefits of patient HBPM compared with office-based monitoring: these include improved control of BP, diagnosis of white-coat hypertension and prediction of cardiovascular risk. Furthermore, HBPM is cheaper and easier to perform than 24-hour ambulatory BP monitoring (ABPM). All HBPM devices require validation, however, as inaccurate readings have been found in a high proportion of monitors. New technology features a longer inflatable area within the cuff that wraps all the way round the arm, increasing the ‘acceptable range’ of placement and thus reducing the impact of cuff placement on reading accuracy, thereby overcoming the limitations of current devices.

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