Cuffless Single-Site Photoplethysmography for Blood Pressure Monitoring

Manish Hosanee, Gabriel Chan, Kaylie Welykholowa, Rachel Cooper, Panayiotis A Kyriacou, Dingchang Zheng, John Allen, Derek Abbott, Carlo Menon, Nigel H Lovell, Newton Howard, Wee-Shian Chan, Kenneth Lim, Richard Fletcher, Rabab Ward, Mohamed Elgendi, Manish Hosanee, Gabriel Chan, Kaylie Welykholowa, Rachel Cooper, Panayiotis A Kyriacou, Dingchang Zheng, John Allen, Derek Abbott, Carlo Menon, Nigel H Lovell, Newton Howard, Wee-Shian Chan, Kenneth Lim, Richard Fletcher, Rabab Ward, Mohamed Elgendi

Abstract

One in three adults worldwide has hypertension, which is associated with significant morbidity and mortality. Consequently, there is a global demand for continuous and non-invasive blood pressure (BP) measurements that are convenient, easy to use, and more accurate than the currently available methods for detecting hypertension. This could easily be achieved through the integration of single-site photoplethysmography (PPG) readings into wearable devices, although improved reliability and an understanding of BP estimation accuracy are essential. This review paper focuses on understanding the features of PPG associated with BP and examines the development of this technology over the 2010-2019 period in terms of validation, sample size, diversity of subjects, and datasets used. Challenges and opportunities to move single-site PPG forward are also discussed.

Keywords: PPG signal; biomedical engineering; biomedical signal analysis; blood pressure measurement; digital health; digital medicine; hypertension assessment; hypertension diagnosis; photoplethysmogram; photoplethysmography; pulse oximetry; wearable devices; wearable technology.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Photoplethysmogram features and measurement sites of single-source photoplethysmography (PPG) in studies conducted between January 2010 and January 2019.
Figure 2
Figure 2
Flow diagram of the exclusion criteria used in this study. From the initial search total (n = 5217), 5192 studies were excluded, and 25 studies were identified.
Figure 3
Figure 3
Overall trend of publications that utilized single-measurement PPG to estimate BP from January 2010 to January 2019.
Figure 4
Figure 4
Pie chart of the hemodynamic status of participants in single-measurement PPG studies from January 2010 to January 2019.
Figure 5
Figure 5
Top 5 countries contributing single-site measurement PPG studies between January 2010 and January 2019. We recommend collaboration between research groups in these countries to identify an optimal approach to BP measurement using single-measurement PPG.
Figure 6
Figure 6
Pie chart of the percentage of studies published between January 2010 and January 2019 that used an automated BP (ABP) cuff, manual BP cuff, or invasive approach as a gold standard. Studies that did not disclose their gold standard method were classified as “not reported” (N/R). Usage of the ABP cuff as the gold standard could be used to assess the validity of PPG in estimating BP from an outpatient setting, while the use of intra-arterial catheters could be used to assess the validity of PPG in an inpatient hospitalized setting (e.g., in critical care units).

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