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Toward Ubiquitous Blood Pressure Monitoring via Pulse Transit Time: Theory and Practice
Open accessAbstract
Ubiquitous blood pressure (BP) monitoring is needed to improve hypertension detection and control and is becoming feasible due to recent technological advances such as in wearable sensing. Pulse transit time (PTT) represents a well-known potential approach for ubiquitous BP monitoring. The goal of this review is to facilitate the achievement of reliable ubiquitous BP monitoring via PTT. We explain the conventional BP measurement methods and their limitations; present models to summarize the theory of the PTT-BP relationship; outline the approach while pinpointing the key challenges; overview the previous work toward putting the theory to practice; make suggestions for best practice and future research; and discuss realistic expectations for the approach.
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“Models that require a single calibration cuff measurement are convenient but potentially less accurate than those that use multiple measurements to form a patient-specific calibration curve”
From Wearable Photoplethysmography for Cardiovascular Monitoring (2022) · cites this paper as [20]
In the citing paper
“Pulse wave propagation delay between the genders indicates baseline differences in arterial stiffness with women displaying lower degrees of pulse arrival latency delay indicating higher vascular stiffness [106,107].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [106]
In the citing paper
“New devices that promise to change the current paradigm of hypertension monitoring use either inflating wristband cuffs (e.g., Omron HeartGuide, currently undergoing clinical testing) or optical pulse wave-based metrics of BP [75,76].”
From Wearables and the Medical Revolution (2018) · cites this paper as [76]
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“12 shows the results where the PAT could be accurately calculated from an ECG signal and a PPG signal, allowing the system to determine the blood pressure.”
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“Nevertheless, PAT is widely used by researchers as a good approximation of PTT, mainly due to the ease of its measurement [13].”
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“Various methods have been proposed to determine the calibration between PTT and BP [16].”
BackgroundMethodInfluentialCuffless Blood Pressure Monitoring: Promises and Challenges
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Ganti, V. G., Carek, A. M., Nevius, B. N., Heller, J. A., Etemadi, M., & Inan, O. T. (2020) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2020.3021532 · Cited by 101
“linear models can have better accuracy, they tend to contain more than two unknown variables which dictates the need for more PTT and BP calibration points [6].”
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“However, recent advances in ambulant BP measurement based on the combination of ECG and PPG measurements through pulse transit time analysis, should allow ubiquitous BP measurements in the future [52].”
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“Oscillometric method is the most popular noninvasive, automatic method for blood pressure monitoring [14]–[16].”
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“13 and 14 we respectively show the RMSE vs CE performance for PPG and respiratory (RESP) signals from the PhysioNet MIMIC-II waveform database [74].”
MethodInfluentialHypertension Assessment Using Photoplethysmography: A Risk Stratification Approach
Liang, Y., Chen, Z., Ward, R. K., & Elgendi, M. (2018) · Journal of Clinical Medicine · doi:10.3390/jcm8010012 · Cited by 99
“Meanwhile, arterial wave propagation theory [16] and PPG morphological theory have also been researched: The former is based on ECGs or other physiological signals and the PPG signal, while the latter is based on PPG morphological features.”
BackgroundGonzález, S., Hsieh, W., & Chen, T. P.-C. (2023) · Scientific Data · doi:10.1038/s41597-023-02020-6 · Cited by 99
“Many studies have shown interest in extending the use of PPG to BP monitoring 5–7 .”
BackgroundMethodMieloszyk, R. J., Twede, H., Lester, J., Wander, J., Basu, S., Cohn, G., Smith, G., Morris, D., Gupta, S., Tan, D., et al. (2022) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2022.3153259 · Cited by 101
“Cuffless BP devices allow for indirect BP measurement by leveraging hemodynamic phenomena that are known to change in conjunction with changes in BP [28], specifically pulse wave velocity and morphological characteristics of the pulsatile pressure or volume waveform in the arterial tree.”
BackgroundMethodInfluentialXing, X., Ma, Z., Zhang, M., Zhou, Y., Dong, W., & Song, M. (2019) · Scientific Reports · doi:10.1038/s41598-019-45175-2 · Cited by 101
Pulse arrival time as a surrogate of blood pressure
Finnegan, E., Davidson, S. M., Harford, M., Jorge, J., Watkinson, P., Young, D., Tarassenko, L., & Villarroel, M. (2021) · Scientific Reports · doi:10.1038/s41598-021-01358-4 · Cited by 105
A Chair–Based Unobtrusive Cuffless Blood Pressure Monitoring System Based on Pulse Arrival Time
Tang, Z., TAMURA, T., Sekine, M., Huang, M., Chen, W., Yoshida, M., Sakatani, K., Kobayashi, H., & Kanaya, S. (2016) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2016.2614962 · Cited by 91
“Although thesewearable BPmeasurement systemsmake it possible to perform ambulatory BP measurement, there are still shortcomings that need to be improved, such as discomfort of wear, restriction on activities, and hydrostatic effects on accuracy due to changes of measurement postures [10], [11], [15].”
BackgroundLiang, Y., Abbott, D., Howard, N., Lim, K. I., Ward, R. K., & Elgendi, M. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8030337 · Cited by 94
Rong, M., & Li, K. (2020) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2020.102328 · Cited by 89
Javaid, A. Q., Ashouri, H., Dorier, A., Etemadi, M., Heller, J. A., Roy, S., & Inan, O. T. (2016) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2016.2600945 · Cited by 88
“, cardiac output and systolic time intervals (STIs) [3]), blood pressure [4], and vascular health (e.”
BackgroundGao, M., Olivier, N. B., & Mukkamala, R. (2016) · Physiological Reports · doi:10.14814/phy2.12768 · Cited by 86
“As outlined in (Mukkamala et al. 2015), few studies have assessed noninvasive PTT estimates as markers of BP over a wide physiological BP range.”
BackgroundMethodResultInfluentialSelf-citationCuff-Less Blood Pressure Estimation Using Pulse Waveform Analysis and Pulse Arrival Time
Yoon, Y.-Z., Kang, J. M., Kwon, Y., Park, S., Noh, S., Kim, Y., Park, J., & Hwang, S. W. (2017) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2017.2714674 · Cited by 90
“However, the variances of each parameter correlation to BP were larger, because each subject has different higher correlated parameters to BP. aPWA T1 −0.23 ± 0.33 −0.17 ± 0.37 −0.20 ± 0.35 −0.20 ± 0.29 T2 −0.09 ± 0.36 −0.20 ± 0.36 −0.15 ± 0.42 0.01 ± 0.32 Tn 0.00 ± 0.30 0.16 ± 0.35 0.08 ± 0.33 −0.12 ± 0.29 Tmax −0.22…”
BackgroundInfluentialDevelopment and Validation of a Novel Cuff-Less Blood Pressure Monitoring Device
Watanabe, N., Bando, Y., Kawachi, T., Yamakita, H., Futatsuyama, K., Honda, Y., Yasui, H., Nishimura, K., Kamihara, T., Okumura, T., et al. (2017) · JACC Basic to Translational Science · doi:10.1016/j.jacbts.2017.07.015 · Cited by 88
“For cuff-less BP monitoring to be user-friendly (11), the use of multiple sensors should not limit portability or flexibility.”
BackgroundMukkamala, R., & Hahn, J. (2017) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2017.2756018 · Cited by 86
“However, smooth muscle contraction is a significantly greater factor in the periphery [1].”
BackgroundMethodInfluentialBi-Modal Arterial Compliance Probe for Calibration-Free Cuffless Blood Pressure Estimation
Nabeel, P. M., Joseph, J., Srinivasa, K., Sivaprakasam, M., & Chenniappan, M. (2018) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2018.2866332 · Cited by 83
“In this approach, BP estimation is often performed using theoretical or heuristic regressionmodels that relate transit time estimates such as pulse arrival time (PAT), pulse transit time (PTT), and pulse wave velocity (PWV) with arterial pressure [9], [10].”
MethodCuff-Less Methods for Blood Pressure Telemonitoring
Bard, D. M., Joseph, J. I., & van Helmond, N. (2019) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2019.00040 · Cited by 84
Gurel, N. Z., Huang, M., Wittbrodt, M. T., Jung, H., Ladd, S. L., Shandhi, M. M. H., Ko, Y., Shallenberger, L. H., Nye, J. A., Pearce, B. D., et al. (2019) · Brain stimulation · doi:10.1016/j.brs.2019.08.002 · Cited by 87
“This is an interesting result considering the relationship of PPG and BP waveforms [56,83].”
Bed-Based Ballistocardiography: Dataset and Ability to Track Cardiovascular Parameters
Carlson, C., Turpin, V. G., Suliman, A., Ade, C. J., Warren, S., & Thompson, D. E. (2020) · Sensors · doi:10.3390/s21010156 · Cited by 90
“The average correlation coefficient for PAT-estimated systolic blood pressure was 0.48 +/− 0.25.”
BackgroundMethodInfluentialBarvik, D., Černý, M., Penhaker, M., & Noury, N. (2021) · IEEE Reviews in Biomedical Engineering · doi:10.1109/rbme.2021.3109643 · Cited by 85
The Microsoft Research Aurora Project: Important Findings on Cuffless Blood Pressure Measurement
Mukkamala, R., Shroff, S. G., Landry, C., Kyriakoulis, K. G., Avolio, A. P., & Stergiou, G. S. (2022) · Hypertension · doi:10.1161/hypertensionaha.122.20410 · Cited by 82
Continuous Non-Invasive Blood Pressure Monitoring: A Methodological Review on Measurement Techniques
Le, T., Ellington, F., Lee, T.-Y., Vo, K., Khine, M., Krishnan, S. K., Dutt, N. D., & Cao, H. (2020) · IEEE Access · doi:10.1109/access.2020.3040257 · Cited by 84
“, physical exercises, valsalva maneuvers, and cold pressor) deployed that would perturb an individual’s BP and resulted in large variations of BP values induced by a set of interventions [9].”
BackgroundMethodInfluentialIbrahim, B., & Jafari, R. (2022) · Scientific Reports · doi:10.1038/s41598-021-03612-1 · Cited by 86
Estimating blood pressure trends and the nocturnal dip from photoplethysmography
Radha, M., de Groot, K., Rajani, N. B., Wong, C. C. P., Kobold, N., Vos, V., Fonseca, P. M., Mastellos, N., Wark, P. A., Velthoven, N., et al. (2019) · Physiological Measurement · doi:10.1088/1361-6579/ab030e · Cited by 90
“The main track of research is based on the Moens-Korteweg equations, which relate the propagation velocity of the blood pulse within arteries to BP [6,37,41].”
BackgroundMethodWearable Millimeter-Wave Device for Contactless Measurement of Arterial Pulses
Johnson, J. E., Shay, O., Kim, C., & Liao, C. (2019) · IEEE Transactions on Biomedical Circuits and Systems · doi:10.1109/tbcas.2019.2948581 · Cited by 78
“Much of the work in this area involves measuring arterial pulsations to obtain a high-quality pulse signal with minimal artifacts [6] and then”
BackgroundRastegar, S., GholamHosseini, H., & Lowe, A. (2019) · Physical and Engineering Sciences in Medicine · doi:10.1007/s13246-019-00813-x · Cited by 83
Zheng, Y., Poon, C. C. Y., Yan, B. P., & Lau, J. Y. W. (2016) · Journal of Medical Systems · doi:10.1007/s10916-016-0558-6 · Cited by 82
Nabeel, P. M., Jayaraj, J., & Sivaprakasam, M. (2017) · Physiological Measurement · doi:10.1088/1361-6579/aa9550 · Cited by 80
Gurel, N. Z., Wittbrodt, M. T., Jung, H., Shandhi, M. M. H., Driggers, E. G., Ladd, S. L., Huang, M., Ko, Y., Shallenberger, L. H., Beckwith, J., et al. (2020) · Neurobiology of Stress · doi:10.1016/j.ynstr.2020.100264 · Cited by 82
“PEP is responsive to tasks requiring effortful active coping (Kelsey, 2012), similar to the speech task, N.Z. Gurel et al. Neurobiology of Stress 13 (2020) 100264 potentially indicating tcVNS helps to recover increased cardiac contractility.”
BackgroundInfluentialFinnegan, E., Davidson, S. M., Harford, M., Watkinson, P., Tarassenko, L., & Villarroel, M. (2023) · Scientific Reports · doi:10.1038/s41598-022-27170-2 · Cited by 87
An Accurate Bioimpedance Measurement System for Blood Pressure Monitoring
Huynh, T. H., Jafari, R., & Chung, W. (2018) · Sensors · doi:10.3390/s18072095 · Cited by 80
“Another reason is that detection points at the peak may be more accurate than the middle and the foot points, as can be seen in the ensemble average BI waveforms [1].”
BackgroundLin, W.-H., Wang, H., Samuel, O. W., Liu, G., Huang, Z., & Li, G. (2018) · Physiological Measurement · doi:10.1088/1361-6579/aaa454 · Cited by 78
“…can be approximately calculated as the time interval from a character point of electrocardiogram (ECG) to a character point of photoplethysmogram (PPG), and was also named as pulse arrival time (PAT) in some other studies (Payne et al 2006, Solà et al 2013, Mukkamala et al 2015, Martin et al 2016).”
ResultMaqsood, S., Xu, S., Tran, S. N., Garg, S., Springer, M., Karunanithi, M., & Mohawesh, R. (2022) · Expert Systems with Applications · doi:10.1016/j.eswa.2022.116788 · Cited by 83
Metadata
- Authors
- Mukkamala, R., Hahn, J.-O., Inan, O. T., Mestha, L. K., Kim, C.-S., Toreyin, H., & Kyal, S.
- Affiliations
- Michigan State University (US)
- University of Maryland, College Park (US)
- Georgia Institute of Technology (US)
- Palo Alto Research Center (US)
- Corresponding author
- Mukkamala, Ramakrishna
- Venue
- IEEE Transactions on Biomedical Engineering
- Published
- 2015-08
- Volume
- 62
- Issue
- 8
- Pages
- 1879-1901
- ISSN
- 0018-9294 (ISSN-L)
- 1558-2531
- PMC
- PMC4515215
- OpenAlex
- W2294418644
- Cited by
- 935
- References
- 212
- Citations by year
- 2026: 92 · 2025: 93 · 2024: 96 · 2023: 89 · 2022: 93 · 2021: 87 · 2020: 84 · 2019: 92 · 2018: 83 · 2017: 71 · 2016: 50 · 2015: 4
- FWCI
- 34.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- IEEE Transactions on Biomedical Engineering (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Biomedical Imaging and Bioengineering
- National Institutes of Health (U01 EB018818)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- blood pressure monitoring, pulse transit time, ubiquitous health monitoring, wearable sensors, hypertension detection, non-invasive blood pressure estimation
- MeSH terms
- Blood Pressure, Blood Pressure Determination, Clothing, Equipment Design, Humans, Signal Processing, Computer-Assisted, Pulse Wave Analysis
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