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Advances in Blood Pressure Measurement Techniques
Continuous Blood Pressure Estimation Using Pulse Transit Time (PTT)
Continuous blood pressure (BP) estimation using pulse transit time (PTT) has emerged as a promising method for unobtrusive BP measurement. Recent studies have proposed various innovative approaches to enhance the accuracy and reliability of PTT-based BP estimation. One such approach combines data mining techniques with traditional mechanism-driven models, utilizing features derived from electrocardiogram (ECG) and photoplethysmogram (PPG) signals. This method has shown excellent accuracy in static and dynamic BP estimation, with a correlation coefficient of 0.852 for systolic BP and 0.790 for diastolic BP. Another study introduced a nonlinear model based on PTT and pulse arrival time (PAT), achieving high correlation coefficients of 0.89 and 0.84 for systolic and diastolic BP, respectively.
Oscillometric Devices and Ambulatory BP Monitoring
The American Heart Association emphasizes the importance of accurate BP measurement for diagnosing and managing hypertension. Oscillometric devices, which reduce human errors associated with the auscultatory approach, have been validated for office settings. Fully automated oscillometric devices can take multiple readings without an observer, potentially providing more accurate measurements. Ambulatory BP monitoring (ABPM) is considered the reference standard for out-of-office BP assessment, offering continuous BP data and identifying conditions like white-coat and masked hypertension. ABPM is particularly valuable for detecting high nighttime BP, which is associated with increased cardiovascular risk .
Deep Learning Techniques for Continuous BP Measurement
Deep learning techniques have been applied to continuous BP measurement using one-channel ECG signals. A novel approach combining a residual network and long short-term memory (LSTM) was developed to capture the spatial-temporal information of ECG signals. This method demonstrated compliance with the Association for the Advancement of Medical Instrumentation (AAMI) standards, achieving an estimation error of 0.07 ± 7.77 mmHg for mean arterial pressure (MAP) and 0.01 ± 6.29 mmHg for diastolic BP. This approach enables continuous BP monitoring using wearable devices, making it suitable for ubiquitous healthcare applications.
Multi-Sensor Fusion and Cuffless BP Measurement
A multi-sensor fusion approach has been proposed for cuffless BP measurement, integrating ECG and pulse pressure wave sensors. This method extracts multiple features from the collected signals and employs a multi-instance regression algorithm for BP estimation. The approach demonstrated good accuracy across a diverse population, with an estimation error of 1.62 ± 7.76 mmHg for systolic BP and 1.49 ± 5.52 mmHg for diastolic BP. The robustness of this method was validated over a two-month follow-up period, indicating its potential for reliable long-term BP monitoring.
Photoplethysmogram Intensity Ratio (PIR) for Improved Accuracy
To address the limitations of PTT in tracking low-frequency BP variations, a new indicator called the photoplethysmogram intensity ratio (PIR) has been introduced. PIR is affected by changes in arterial diameter and can trace low-frequency BP variations. Combining PTT and PIR in a novel BP estimation algorithm improved accuracy, with mean absolute differences of 4.09 mmHg for systolic BP and 3.18 mmHg for diastolic BP. This method outperformed traditional PTT algorithms, demonstrating its potential for continuous and accurate BP measurement.
Conclusion
The advancements in BP measurement techniques, including PTT-based methods, oscillometric devices, deep learning approaches, multi-sensor fusion, and PIR, have significantly improved the accuracy and reliability of continuous BP monitoring. These innovations offer promising solutions for unobtrusive, real-time BP measurement, essential for diagnosing and managing hypertension and associated cardiovascular risks. As these technologies continue to evolve, they hold the potential to revolutionize remote healthcare and provide more accessible and accurate BP monitoring solutions.
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