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In this brief review, we will introduce arterial stiffness, describe how it is currently measured and point to new developments that might lead towards arterial stiffness estimation outside of specialized clinics in the future. In almost all methods for measuring arterial stiffness, the arterial pulse plays an important role. Therefore, new developments are related to novel non-invasive sensors for acquiring the arterial pulse, simulation and modeling of the arterial pulse waves, parameter estimation of the stiffness parameters through physical models of the arterial pulse and machine learning methods for predicting the arterial stiffness. [ABSTRACT FROM AUTHOR]

Noninvasive blood pressure (BP) measurement is an important tool for managing hypertension and cardiovascular disease. However, automated noninvasive BP measurement devices, which are usually based on the oscillometric method, do not always provide accurate estimation of BP. It has been found that change in arterial stiffness (AS) is an underlying mechanism of disagreement between an oscillometric BP monitor and a sphygmomanometer. This problem is addressed by incorporating parameters related to AS in the algorithm for BP measurement. Pulse transit time (PTT) is first used to estimate AS parameters, which are fixed into a model of the oscillometric envelope. This model can then be used to perform curve fitting to the measured signal using only four parameters: systolic BP, diastolic BP, mean BP, and lumen area at zero transmural pressure. The proposed technique is independent of the experimentally determined characteristic ratios that are commonly used in existing oscillometric methods. The accuracy of the proposed technique was evaluated by comparing with the same model without incorporation of AS, and with reference BP device measurements. The new method achieved standard deviation of error less than 8 mmHg and mean error less than 5 mmHg. The results show consistency with ANSI/AAMI SP-10 standard for noninvasive BP measurement techniques. [ABSTRACT FROM AUTHOR]

Accuracy of blood pressure (BP) measurement is a challenging issue in oscillometry. Most of the automated noninvasive BP monitors estimate BP from envelope of the measured oscillometric pulses. The peak and the trough of the oscillometric pulses are very sensitive to noise caused by breathing, heart-rate variability, motion artifacts, muscle contraction, and environmental noise. Therefore, accuracy of the estimated BP based on the oscillometric waveform envelopes is not reliable in some cases. Recently, employing a modeling approach to estimate BP, we obtained the accurate results for a set of healthy subjects. The method is based on the lumen area oscillations model and estimates BP by comparing the actual and corresponding simulated waveforms. The method’s accuracy worsened when we tested it on a broader range of healthy subjects, while a significant drop was observed when the method was used for patients with chronic cardiovascular diseases. The work presented in this paper represents an improved version of our previous approach. We tested the proposed method on both healthy subjects and patients with chronic cardiovascular diseases, and compared the results to two popular BP estimation algorithms: maximum amplitude algorithm and maximum/minimum slope algorithm. We observed up to 56.7% and 57.3% improvements in mean absolute error, 98.9% and 64.4% improvements in mean error, 50% and 59% improvements in standard deviation of errors, and up to 57.6% and 55.8% in measurement uncertainty for the estimated systolic and diastolic pressures, respectively. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) readings in oscillometry are very sensitive to the posture of the body, arm, and body movements during the BP measurements, so measuring conditions are the first important factors for trusted BP readings. Next is the BP estimation algorithm, which is responsible to convert the cuff deflation curve (CDC) pressure signal to accurate BP readings. With proper measuring conditions and an accurate BP estimation algorithm one can expect trusted BP readings. Trustworthiness of the BP readings is still a challenging issue in automated oscillometric BP monitors, and patients need to see the doctor for trusted measurements. To this end, we have proposed a novel method called a Dynamic Threshold Algorithm (DTA) that evaluates trustworthiness of the BP readings immediately after the BP is estimated, such that the patient can decide whether to repeat the measurement or not. DTA employs the heart rate (HR) of the subject and determines a specific threshold (TR). TR is used to determine maximum and minimum limits for trustable pressures (SBP2, DBP2) of a given subject. The limits are called trusted boundaries (TB). Trusted boundaries are compared with the estimated systolic blood pressure (SBP) and diastolic blood pressure (DBP) to determine trustworthiness of the measured BP. BP readings are trusted if estimated SBP and DBP are inside the TB and untrusted or labeled an outlier if otherwise. In this research, DTA is applied on three different data- sets of healthy and sick subjects, outliers are determined and removed from the datasets, and remaining recordings are validated against references and compared with validated results of original datasets. According to observations, improvements were significant after outliers were removed from the datasets. [ABSTRACT FROM PUBLISHER]

An accurate noninvasive estimation of mean arterial pressure (MAP) is of great importance in the evaluation of circulatory function and prognosis of some cardiovascular diseases. This paper proposes a novel oscillometric MAP estimation method based on the dependence of pulse transit time (PTT) on cuff pressure (CP). The PTT computed as the time interval between the electrocardiogram (ECG) R-peaks and the maximum slope points on the oscillometric pulses is mathematically modeled by considering the cuff-arm-artery system and the blood flow dynamics. It is then analytically shown that MAP can be approximated as the CP at which the PTT is maximum. Based on our theoretical findings, a new method of MAP estimation from simultaneous ECG and oscillometric blood pressure measurements is proposed. Our proposed method is validated with a pilot study in which 150 recordings from 10 subjects are analyzed. The reference MAP is computed from the systolic and diastolic pressures measured by the Food and Drug Administration-approved Omron HEM-790IT monitor using three different formulas given in the literature. The performance of our proposed method is compared with the maximum amplitude and zero-crossing methods in terms of mean error (ME), mean absolute error, and standard deviation of error (SDE). It is found that our proposed method achieves improvements of more than 20% in SDE compared with the maximum amplitude method and more than 50% in ME compared with the zero-crossing method. [ABSTRACT FROM PUBLISHER]

Oscillometry is a popular technique for automatic estimation of blood pressure (BP). However, most of the oscillometric algorithms rely on empirical coefficients for systolic and diastolic pressure evaluation that may differ in various patient populations, rendering the technique unreliable. A promising complementary technique for automatic estimation of BP, based on the dependence of pulse transit time (PTT) on cuff pressure (CP) (PTT–CP mapping), has been proposed in the literature. However, a theoretical grounding for this technique and a nonparametric BP estimation approach are still missing. In this paper, we propose a novel coefficient-free BP estimation method based on PTT–CP dependence. PTT is mathematically modeled as a function of arterial lumen area under the cuff. It is then analytically shown that PTT–CP mappings computed from various points on the arterial pulses can be used to directly estimate systolic, diastolic, and mean arterial pressure without empirical coefficients. Analytical results are cross-validated with a pilot investigation on ten healthy subjects where 150 simultaneous electrocardiogram and oscillometric BP recordings are analyzed. The results are encouraging whereby the mean absolute errors of the proposed method in estimating systolic and diastolic pressures are 5.31 and 4.51 mmHg, respectively, relative to the Food and Drug Administration approved Omron monitor. Our work thus shows promise toward providing robust and objective BP estimation in a variety of patients and monitoring situations. [ABSTRACT FROM PUBLISHER]

Although estimation of average blood pressure is commonly done with oscillometric measurements, confidence intervals (CIs) for systolic blood pressure (SBP) and diastolic blood pressure (DBP) are not usually estimated. This paper adopts bootstrap methodologies to build CI from a small sample set of measurements, which is a situation commonly encountered in practice. Three bootstrap methodologies, namely, nonparametric percentile bootstrap, standard bootstrap, and bias-corrected and accelerated bootstrap are investigated. A two-step methodology is proposed based on pseudomeasurements using bootstrap principles to first derive the pseudomaximum amplitudes and then the pseudoenvelopes (PEs). The SBP and DBP are estimated using the new relationships between mean cuff pressure and PE and then the CIs for such estimates are obtained. In order to reduce the amount of processing, a single-step methodology that directly derives PE using bootstrap principles is also presented. Application of the proposed methodology on an experimental data set of 85 patients with five sets of measurements for each patient has yielded a narrower CI than the currently available conventional methods such as Student's t-distribution method. [ABSTRACT FROM PUBLISHER]

In this paper, we present a novel feature-based neural network (NN) approach for estimation of blood pressure (BP) from wrist oscillometric measurements. Unlike previous methods that use the raw oscillometric waveform envelope (OMWE) as input to the NN, in this paper, we propose to use features extracted from the envelope. The OMWE is mathematically modeled as a sum of two Gaussian functions. The optimum parameters of this model are found by minimizing the least squares error between the model and the OMWE using the Levenberg–Marquardt algorithm and are used as features. Two separate feed-forward NNs (FFNNs) are then designed to estimate the systolic and diastolic BPs using these features. The FFNNs are trained using the resilient backpropagation learning algorithm and tested on a data set of BP measurements recorded from 85 subjects. The performance is then compared with that of the conventional maximum amplitude algorithm, adaptive neuro-fuzzy inference system, and already published NN-based methods. It is found that the proposed approach achieves lower values of mean absolute error and standard deviation of error in the estimation of BP. In addition, the proposed approach has the following advantages: lower complexity with respect to the design parameters, smaller training data set, and lower computational load. [ABSTRACT FROM PUBLISHER]

Oscillometry is the most common measurement method used in electronic blood pressure (BP) monitors. However, most of the existing oscillometric algorithms employ empirical ratios on the oscillometric waveform envelope (OMWE) to determine the systolic pressure (SP) and diastolic pressure (DP). As these algorithms do not consider the cardiovascular system parameters that may vary due to health conditions or age, the pressure estimates are not always reliable. In this paper, we develop a new mathematical model for the OMWE by incorporating an existing model of the cuff-arm-artery system. [ABSTRACT FROM PUBLISHER]

This paper introduces a novel approach to estimate the systolic and diastolic blood pressure ratios (SBPR and DBPR) based on the maximum amplitude algorithm (MAA) using a Gaussian mixture regression (GMR). The relevant features, which clearly discriminate the SBPR and DBPR according to the targeted groups, are selected in a feature vector. The selected feature vector is then represented by the Gaussian mixture model. The SBPR and DBPR are subsequently obtained with the help of the GMR and then mapped back to SBP and DBP values that are more accurate than those obtained with the conventional MAA method. [ABSTRACT FROM PUBLISHER]