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Pulse Arrival Time Based Cuff-Less and 24-H Wearable Blood Pressure Monitoring and its Diagnostic Value in Hypertension

  • Mobile Systems
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Abstract

Ambulatory blood pressure monitoring (ABPM) has become an essential tool in the diagnosis and management of hypertension. Current standard ABPM devices use an oscillometric cuff-based method which can cause physical discomfort to the patients with repeated inflations and deflations, especially during nighttime leading to sleep disturbance. The ability to measure ambulatory BP accurately and comfortably without a cuff would be attractive. This study validated the accuracy of a cuff-less approach for ABPM using pulse arrival time (PAT) measurements on both healthy and hypertensive subjects for potential use in hypertensive management, which is the first of its kind. The wearable cuff-less device was evaluated against a standard cuff-based device on 24 subjects of which 15 have known hypertension. BP measurements were taken from each subject over a 24-h period by the cuff-less and cuff-based devices every 15 to 30 minutes during daily activities. Mean BP of each subject during daytime, nighttime and over 24-h were calculated. Agreement between mean nighttime systolic BP (SBP) and diastolic (DBP) measured by the two devices evaluated using Bland-Altman plot were −1.4 ± 6.6 and 0.4 ± 6.7 mmHg, respectively. Receiver operator characteristics (ROC) statistics was used to assess the diagnostic accuracy of the cuff-less approach in the detection of BP above the hypertension threshold during nighttime (>120/70 mmHg). The area under ROC curves were 0.975/0.79 for nighttime. The results suggest that PAT-based approach is accurate and promising for ABPM without the issue of sleep disturbances associated with cuff-based devices.

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References

  1. Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., et al., 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 34:2159–2219, 2013. doi:10.1093/eurheartj/eht151.

    Article  PubMed  Google Scholar 

  2. Fagard, R.H., Celis, H., Thijs, L., Staessen, J.A., Clement, D.L., De Buyzere, M.L., and De Bacquer, D.A., Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension. 51:55–61, 2008. doi:10.1161/hypertensionaha.107.100727.

    Article  CAS  PubMed  Google Scholar 

  3. Niiranen, T.J., Maki, J., Puukka, P., Karanko, H., and Jula, A.M., Office, home, and ambulatory blood pressures as predictors of cardiovascular risk. Hypertension. 64:281–286, 2014. doi:10.1161/hypertensionaha.114.03292.

    Article  CAS  PubMed  Google Scholar 

  4. Yi, J.E., Shin, J., Ihm, S.H., Kim, J.H., Park, S., et al., Not nondipping but nocturnal blood pressure predicts left ventricular hypertrophy in the essential hypertensive patients: the Korean ambulatory blood pressure multicenter observational study. J. Hypertens. 32:1999–2004, 2014. doi:10.1097/hjh.0000000000000272.

    Article  CAS  PubMed  Google Scholar 

  5. Mancia, G., Zanchetti, A., Agebiti-Rosei, E., Benemio, G., De Cesaris, R., et al., Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. Circulation. 95:1464–1470, 1997. doi:10.1161/01.cir.95.6.1464.

    Article  CAS  PubMed  Google Scholar 

  6. Karpettas, N., Destounis, A., Kollias, A., Nasothimiou, E., Moyssakis, I., and Stergiou, G.S., Prediction of treatment-induced changes in target-organ damage using changes in clinic, home and ambulatory blood pressure. Hypertens. Res. 37:543–547, 2014. doi:10.1038/hr.2014.24.

    Article  PubMed  Google Scholar 

  7. Baig, M.M., and Gholamhosseini, H., Smart Health Monitoring Systems: An Overview of Design and Modeling. J. Med. Syst. 37, 2013. doi:10.1007/s10916-012-9898-z.

  8. Steinhubl, S.R., Muse, E.D., and Topol, E.J., The emerging field of mobile health. Sci. Transl. Med. 7:1–6, 2015.

    Article  Google Scholar 

  9. Or C, Tao D (2016) A 3-Month Randomized Controlled Pilot Trial of a Patient-Centered, Computer-Based Self-Monitoring System for the Care of Type 2 Diabetes Mellitus and Hypertension. J Med Syst 40. doi:10.1007/s10916–016–0437-1

  10. Rudner J, McDougall C, Sailam V, Smith M, Sacchetti A Interrogation of Patient Smartphone Activity Tracker to Assist Arrhythmia Management. Annals of Emergency Medicine. doi:10.1016/j.annemergmed.2016.02.039 2016.

  11. Agarwal, R., and Light, R.P., The effect of measuring ambulatory blood pressure on nighttime sleep and daytime activity—implications for dipping. Clin. J. Am. Soc. Nephrol. 5:281–285, 2010.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Zhilin, Z., Photoplethysmography-based heart rate monitoring in physical activities via joint sparse Spectrum reconstruction. Biomed. Eng. IEEE Trans. on. 62:1902–1910, 2015. doi:10.1109/TBME.2015.2406332.

    Article  Google Scholar 

  13. Feissel, M., Aho, L.S., Georgiev, S., Tapponnier, R., Badie, J., Bruyere, R., and Quenot, J.P., Pulse Wave Transit Time Measurements of Cardiac Output in Septic Shock Patients: A Comparison of the Estimated Continuous Cardiac Output System with Transthoracic Echocardiography. Plos One:10, 2015. doi:10.1371/journal.pone.0130489.

  14. Ruiz-Rodríguez, J., Ruiz-Sanmartín, A., Ribas, V., Caballero, J., García-Roche, A., et al., Innovative continuous non-invasive cuffless blood pressure monitoring based on photoplethysmography technology. Intensive Care Med. 39:1618–1625, 2013. doi:10.1007/s00134-013-2964-2.

    Article  PubMed  Google Scholar 

  15. Mukkamala, R., Hahn, J.O., Inan, O.T., Mestha, L.K., Kim, C.S., Toreyin, H., and Kyal, S., Toward ubiquitous blood pressure monitoring via pulse transit time: theory and practice. IEEE Trans. Biomed. Eng. 62:1879–1901, 2015. doi:10.1109/TBME.2015.2441951.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Poon CCY, Zhang YT Cuff-less and noninvasive measurements of arterial blood pressure by pulse transit time. In: Proc. 27th Annu. Int. Conf. IEEE-EMBC, Shanghai, pp 5877–5880 2005

  17. Gesche, H., Grosskurth, D., Küchler, G., and Patzak, A., Continuous blood pressure measurement by using the pulse transit time: comparison to a cuff-based method. Eur. J. Appl. Physiol. 112:1–7, 2011. doi:10.1007/s00421-011-1983-3.

    Google Scholar 

  18. Kim, S.H., Song, J.G., Park, J.H., Kim, J.W., Park, Y.S., and Hwang, G.S., Beat-to-beat tracking of systolic blood pressure using noninvasive pulse transit time during anesthesia induction in hypertensive patients. Anesth. Analg. 116:94–100, 2013. doi:10.1213/ANE.0b013e318270a6d9.

    Article  PubMed  Google Scholar 

  19. Zheng YL, Leung B, Sy S, Zhang YT, Poon CCY A clip-free eyeglasses-based wearable monitoring device for measuring photoplethysmograhic signals. In: Proceedings of the 34th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, San Diego. pp 5022–5025 2012

  20. Winokur ES, He DD, Sodini, CG A wearable vital signs monitor at the ear for continuous heart rate and pulse transit time measurements. In: Proc. 34th Annu. Int. Conf. IEEE-EMBC, San Diego, CA, Aug. pp 2724–2727. doi:10.1109/embc.2012.6346527 2012.

  21. Lin, H., Xu, W., Guan, N., Ji, D., Wei, Y., and Yi, W., Noninvasive and continuous blood pressure monitoring using wearable body sensor networks. IEEE Intell. Syst. 30:38–48, 2015. doi:10.1109/MIS.2015.72.

    Article  Google Scholar 

  22. Dilpreet, B., Jean-Michel, R., and Mehmet Rasit, Y., A survey on signals and systems in ambulatory blood pressure monitoring using pulse transit time. Physiol. Meas. 36:R1, 2015.

    Article  Google Scholar 

  23. Jeong, I.C., and Finkelstein, J., Introducing contactless blood pressure assessment using a high speed video camera. J. Med. Syst. 40:1–10, 2016. doi:10.1007/s10916-016-0439-z.

    Article  Google Scholar 

  24. McCarthy, B., Vaughan, C., O'Flynn, B., Mathewson, A., and Mathúna, C.Ó., An examination of calibration intervals required for accurately tracking blood pressure using pulse transit time algorithms. J. Hum. Hypertens. 27:744–750, 2013.

    Article  CAS  PubMed  Google Scholar 

  25. Zheng, Y.L., Yan, B.P., Zhang, Y.T., and Poon, C.C.Y., An armband wearable device for overnight and cuff-less blood pressure measurement. IEEE. Trans. Biomed. Eng. 61:2179–2186, 2014. doi:10.1109/tbme.2014.2318779.

    Article  PubMed  Google Scholar 

  26. Pickering, T.G., Hall, J.E., Appel, L.J., Falkner, B.E., Graves, J., et al., Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on high blood pressure research. Hypertension. 45:142–161, 2005. doi:10.1161/01.HYP.0000150859.47929.8e.

    Article  CAS  PubMed  Google Scholar 

  27. Eguchi, K., Kuruvilla, S., Ogedegbe, G., Gerin, W., Schwartz, J.E., and Pickering, T.G., What is the optimal interval between successive home blood pressure readings using an automated oscillometric device? J. Hypertens. 27:1172, 2009.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hughes, D.J., Babbs, C.F., Geddes, L.A., and Bourland, J.D., Measurements of Young's modulus of elasticity of the canine aorta with ultrasound. Ultrason. Imaging. 1:356–367, 1979. doi:10.1177/016173467900100406.

    Article  CAS  PubMed  Google Scholar 

  29. Bussy, C., Boutouyrie, P., Lacolley, P., Challande, P., and Laurent, S., Intrinsic stiffness of the carotid arterial wall material in essential hypertensives. Hypertension. 35:1049–1054, 2000.

    Article  CAS  PubMed  Google Scholar 

  30. ANSI/AAMI SP10: Manual, electronic, or automated sphygmomanometers Association for the Advancement of Medical Instrumentation, United States of America 2003.

  31. Yan, I.R., Poon, C.C.Y., and Zhang, Y.T., Evaluation scale to assess the accuracy of cuff-less blood pressure measuring devices. Blood. Press. Monit. 14:257, 2009.

    Article  PubMed  Google Scholar 

  32. Liu, Q., Poon, C.C.Y., and Zhang, Y.T., Time-frequency analysis of variabilities of heart rate, systolic blood pressure and pulse transit time before and after exercise using the recursive autoregressive model. Biomed. Signal. Process. Control. 6:364–369, 2011.

    Article  Google Scholar 

  33. Hermida, R.C., Ayala, D.E., Fontao, M.J., Mojon, A., and Fernandez, J.R., Ambulatory blood pressure monitoring: importance of sampling rate and duration-48 versus 24 hours-on the accurate assessment of cardiovascular risk. Chronobiol. Int. 30:55–67, 2013. doi:10.3109/07420528.2012.701457.

    Article  PubMed  Google Scholar 

  34. Payne, R., Symeonides, C., Webb, D., and Maxwell, S., Pulse transit time measured from the ECG: an unreliable marker of beat-to-beat blood pressure. J. Appl. Physiol. 100:136–141, 2006.

    Article  CAS  PubMed  Google Scholar 

  35. Wong, M.Y.M., Pickwell-MacPherson, E., Zhang, Y.T., and Cheng, J.C.Y., The effects of pre-ejection period on post-exercise systolic blood pressure estimation using the pulse arrival time technique. Eur. J. Appl. Physiol. 111:135–144, 2011. doi:10.1007/s00421-010-1626-0.

    Article  PubMed  Google Scholar 

  36. Zhang, G., Gao, M., Xu, D., Olivier, N.B., and Mukkamala, R., Pulse arrival time is not an adequate surrogate for pulse transit time as a marker of blood pressure. J. Appl. Physiol. 111:1681–1686, 2011. doi:10.1152/japplphysiol.00980.2011.

    Article  PubMed  Google Scholar 

  37. Liu, Q., Yan, B.P., Yu, C., Zhang, Y., and Poon, C.Y.C., Attenuation of systolic blood pressure and pulse transit time hysteresis during exercise and recovery in cardiovascular patients. Biomed Eng. IEEE Trans.on. 61:346–352, 2013. doi:10.1109/tbme.2013.2286998.

    Google Scholar 

  38. Mancia, G., Grassi, G., Giannattasio, C., and Seravalle, G., Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. Hypertension. 34:724–728, 1999. doi:10.1161/01.hyp.34.4.724.

    Article  CAS  PubMed  Google Scholar 

  39. Esler, M., Hastings, J., Lambert, G., Kaye, D., Jennings, G., and Seals, D.R., The influence of aging on the human sympathetic nervous system and brain norepinephrine turnover. Am. J. Physiol. Regul. Integr. Comp. Physiol. 282:R909–R916, 2002.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

The authors are thankful to Mr. Billy Leung and Mr. Ruikai Zhang for their developments of the wearable system, Mr. Ruikai Zhang and Ms. Ruoxi Yu for their contribution on developing the mobile application, and Ms. Cecilia Chan for her assistance in collecting the data from the patients. This work was supported by the Hong Kong Innovation and Technology Commission (ITS/159/11).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from each participant in the study.

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Authors and Affiliations

  1. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

    Yali Zheng, Carmen C. Y. Poon & James Y. W. Lau

  2. Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

    Bryan P. Yan

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  1. Yali Zheng
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  2. Carmen C. Y. Poon
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Corresponding author

Correspondence to Carmen C. Y. Poon.

Additional information

Yali Zheng and Carmen C. Y. Poon contributed equally to this work.

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Zheng, Y., Poon, C.C.Y., Yan, B.P. et al. Pulse Arrival Time Based Cuff-Less and 24-H Wearable Blood Pressure Monitoring and its Diagnostic Value in Hypertension. J Med Syst 40, 195 (2016). https://doi.org/10.1007/s10916-016-0558-6

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