Novel blood pressure and pulse pressure estimation based on pulse transit time and stroke volume approximation

Abstract

Background Non-invasive continuous blood pressure monitors are of great interest to the medical community due to their value in hypertension management. Recently, studies have shown the potential of pulse pressure as a therapeutic target for hypertension, but not enough attention has been given to non-invasive continuous monitoring of pulse pressure. Although accurate pulse pressure estimation can be of direct value to hypertension management and indirectly to the estimation of systolic blood pressure, as it is the sum of pulse pressure and diastolic blood pressure, only a few inadequate methods of pulse pressure estimation have been proposed.

Methods We present a novel, non-invasive blood pressure and pulse pressure estimation method based on pulse transit time and pre-ejection period. Pre-ejection period and pulse transit time were measured non-invasively using electrocardiogram, seismocardiogram, and photoplethysmogram measured from the torso. The proposed method used the 2-element Windkessel model to model pulse pressure with the ratio of stroke volume, approximated by pre-ejection period, and arterial compliance, estimated by pulse transit time. Diastolic blood pressure was estimated using pulse transit time, and systolic blood pressure was estimated as the sum of the two estimates. The estimation method was verified in 11 subjects in two separate conditions with induced cardiovascular response and the results were compared against a reference measurement and values obtained from a previously proposed method.

Results The proposed method yielded high agreement with the reference (pulse pressure correlation with reference R ≥ 0.927, diastolic blood pressure correlation with reference R ≥ 0.854, systolic blood pressure correlation with reference R ≥ 0.914) and high estimation accuracy in pulse pressure (mean root-mean-squared error ≤ 3.46mmHg) and blood pressure (mean root-mean-squared error ≤ 6.31mmHg for diastolic blood pressure and ≤ 8.41mmHg for systolic blood pressure) over a wide range of hemodynamic changes.

Conclusion The proposed pulse pressure estimation method provides accurate estimates in situations with and without significant changes in stroke volume. The proposed method improves upon the currently available systolic blood pressure estimation methods by providing accurate pulse pressure estimates.