Multimodal Photoplethysmography-Based Approaches for Improved Detection of Hypertension
Abstract
:1. Introduction
Combining Other Biosignals with PPG for BP Estimation
2. Methods
2.1. Literature Search
2.2. Statistical Analysis
3. Results
3.1. Global Distribution and Combinations of Biosignals Used in Literature
3.2. Sample Size and Patient Demographics
3.3. Appropriate Gold Standard
4. Discussion
4.1. Accuracy of Proposed Methods
- Synchronization between biosignals. If biosignals are not collected at the same time, PTT cannot be determined accurately. Unfortunately, this point is overlooked and therefore, there is inconsistency in reporting accuracy using PAT [86].
- Calibration. Current PTT-BP estimations require calibration of PTT (ms) to BP (mmHg), which is dependent on several patient-specific factors: distance between measurement sites, average cross-sectional area of arteries between measurement sites, blood density, and the compliance of arteries [87]. As the composition of arteries changes with age (elastin in central arteries is replaced with collagen, which contributes to the atherosclerotic processes and stiffening of arteries), these techniques require subject specific calibration using a BP cuff at intervals in-line with atherosclerotic aging processes [87]. Mukkamala and Hahn [88] identified the maximum calibration interval to be about one year at age 30 with a linear decline to roughly six months by age 70. The need for calibration greatly limits the feasibility of these technologies, however new techniques such as those from Kachuee et al. [59] have eliminated the need for calibration using a machine learning approach. To avoid the calibration step (i.e., the step taken to map feature(s) values to mmHg), risk stratification could be used as an alternative output. In other words, build a model to classify PPG-based features into three classes: normotensive, pre-hypertensive, and hypertensive, rather than proving a specific mmHg value [9,10,80,89].
4.2. Reporting of Patient Demographics
4.3. Testing Conditions
4.4. Recommendations for Future Advancements
- −
- implementation of the IEEE guidelines for research regarding cuff-less BP devices, which includes information pertaining to observer training and measurement, validation procedures and appropriate gold standards, validation criteria, subject recruitment, and data reporting [93];
- −
- inclusion of hypertensive and pregnant populations with improved reporting of gender and health status;
- −
- appropriate definition and application of PAT and PTT that account for PEP to improve the measurement accuracy and decrease error;
- −
- continued research on wearable devices that tests subjects during various ambulation activities, especially research on noise- and calibration-reducing algorithms.
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
BP | Blood pressure | M1 | Modality 1 (PPG + ECG) |
PPG | Photoplethysmography | M2 | Modality 2 (PPG + BCG) |
PTT | Pulse transit time | M3 | Modality 3 (PPG + SCG) |
PAT | Pulse arrival time | M4 | Modality 4 (PPG + IPG) |
PWV | Pulse wave velocity | M5 | Modality 5 (PPG + SBS) |
PEP | Pre-ejection period | M6 | Modality 6 (PPG + ICG) |
AO | Aortic opening | M7 | Modality 7 (PPG + ECG + ICG) |
ECG | Electrocardiography | M8 | Modality 8 (PPG + ECG + BCG) |
ICG | Impedance cardiography | M9 | Modality 9 (PPG + SCG + GCG) |
BCG | Ballistocardiography | M10 | Modality 10 (PPG + ECG + SCG) |
SCG | Seismocardiography | ME | Mean error |
GCG | Gyrocardiography | SD | Standard deviation |
IPG | Impedance plethysmography | MIMIC | Medical Information Mart for Intensive Care |
SBS | Strain based sensor | AAMI | Association for the Advancement of Medical Instrumentation |
MAP | Mean arterial pressure | HTN | Hypertension |
SBP | Systolic blood pressure | NTN | Normotension |
DBP | Diastolic blood pressure | ABP | Arterial invasive blood pressure |
HR | Heart rate | CBP | Cuff blood pressure |
PIR | PPG intensity ratio | FABP | Finger arterial blood pressure |
HRPS | Heart-power spectrum ration | IEEE | Institute of Electrical and Electronics Engineers |
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Publication | # Subjects (M:F) | BP Status | Comorbidities | Gold Standard | Modality Category | ME ± SD (mmHg) | Pearson’s Coefficient (r) |
---|---|---|---|---|---|---|---|
Baek et al. (2010) [25] | 15 (11:4) | NTN | Yes | ABP, FABP | M1 | SBP = N/R DBP = N/R | SBP = 0.815 DBP = 0.779 |
Chua et al. (2010) [26] | 18 (14:4) | NTN | No | FABP | M1 | SBP = N/R DBP = N/R | SBP = 0.73 DBP = N/R |
Proença et al. (2010) [12] | 20 (14:6) | NTN | No | FABP | M7 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Wong et al. (2011) [13] | 22 (14:8) | NTN | No | ABP | M7 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Mase et al. (2011) [27] | 33 (19:14) | NTN, HTN | Yes | CBP | MI | SBP = N/R DBP = N/R | SBP = 0.89 DBP = 0.78 |
Gesche et al. (2012) [28] | 63 (36:27) | NTN | No | CBP | M1 | SBP = N/R DBP = N/R | SBP = 0.83 DBP = N/R |
Kato et al. (2012) [29] | 1 (1:0) | NTN | No | CBP | M8 | SBP = N/R DBP = N/R | SBP = 0.805 DBP = 0.633 |
Baek et al. (2012) [30] | 5 (5:0) | NTN | No | FABP | M1 | SBP = N/R DBP = N/R | SBP = 0.848 DBP = N/R |
Kim et al. (2013) [31] | 23 (17:6) | HTN | Yes | ABP | M1 | SBP = N/R DBP = N/R | SBP = 0.81 DBP = 0.81 |
Spießhöfer et al. (2013) [32] | 29 (27:2) | N/R | Yes | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Chen et al. (2013) [33] | 5 (N/R) | NTN | No | CBP | M2 | SBP = 9.0 ± 5.6 DBP = 1.8 ± 1.3 | SBP = N/R DBP = N/R |
Puke et al. (2013) [34] | 4 (3:1) | N/R | N/R | CBP | M1 | SBP = 6.91 ± 4.23 DBP = N/R | SBP = N/R DBP = N/R |
Couceiro et al. (2013) [35] | 43 (23:20) | N/R | Yes | FABP | M7 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Solà et al. (2013) [36] | 15 (15:0) | NTN | No | CBP | M7 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Jeong & Finkelstein (2013) [37] | 5 (2:3) | NTN | No | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Wang et al. (2014)[38] | 6 (N/R) | N/R | N/R | CBP | M1 | SBP = 0.04 ± 3.78 DBP = −0.01 ± 4.34 | SBP = N/R DBP = N/R |
Thomas et al. (2014) [39] | 4 (N/R) | N/R | N/R | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Ma, HT (2014) [40] | 30 (N/R) | NTN | No | CBP | M1 | SBP = N/R DBP = N/R | SBP R2 = 0.96 DBP R2 = 0.71 |
Zhang et al. (2014) [41] | 2 (N/R) | N/R | Yes | ABP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Vlahandonis et al. (2014) [42] | 25 (12:18) | NTN | Yes | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Younessi heravi et al. (2014) [21] | 25 (15:10) | N/R | N/R | CBP | M1 | SBP = 6.73 ± 2.68 DBP = 8.13 ± 3.18 | SBP = 0.89 DBP = 0.82 |
Gomez Garcia et al. (2014) [43] | 30 (20:10) | NTN, HTN | Yes | CBP | M1 | SBP = −0.2 ± 2.4 DBP = N/R | SBP = 0.88 DBP = 0.58 |
Wibmer et al. (2014) [44] | 20 (14:6) | NTN, HTN | Yes | CBP | M1 | SBP = N/R DBP = N/R | SBP R2 = 0.92 DBP R2 = 0.46 |
Zheng et al. (2014) [45] | 10 (N/R) | NTN | No | CBP | M1 | SBP = 2.8 ± 8.2 DBP = N/R | SBP = N/R DBP = N/R |
Liu et al. (2014) [46] | 46 (34:7) | NTN, HTN | Yes | CBP, FABP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Liu et al. (2015) [47] | 10 (6:4) | NTN | No | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Tang et al. (2015) [48] | 9 (9:0) | NTN | No | CBP, FABP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Ding & Zhang (2015) [16] | 5 (N/R) | NTN | No | FABP | M1 + PIR | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Tamura et al. (2015) [49] | 9 (9:0) | NTN | No | FABP | M1 | 0.7 ± 3.65 (Unclear if SBP or DBP) | SBP = N/R DBP = N/R |
Kim et al. (2015) [15] | 15 (10:5) | NTN | No | PAT | M2 | SBP = N/R DBP = N/R | SBP = 0.81 DBP = 0.83 |
Wibmer et al. (2015) [50] | 18 (11:7) | NTN, HTN | Yes | CBP | M1 | SBP = N/R DBP = N/R | SBP = 0.93 DBP = N/R |
Ding et al. (2016)[51] | 27 (14:13) | NTN | No | FABP | M1 + PIR | SBP = −0.037 ± 5.21 DBP = −0.08 ± 4.06 | SBP = 0.91 DBP = 0.88 |
Thomas et al. (2016) [52] | 11 (N/R) | NTN | No | CBP | M1 | SBP = N/R DBP = N/R | SBP = 0.72 DBP = 0.70 |
Sun et al. (2016) [53] | 19 (14:5) | N/R | No | FABP | M1 | SBP = 0.43 ± 13.52 DBP = N/R | SBP = 0.93 DBP = N/R |
Ding et al. (2016) [22] | 85 (37:48) | NTN, HTN | Yes | CBP | M1 | SBP = −1.55 ± 13.79 DBP = 0.07 ± 8.49 | SBP = N/R DBP = N/R |
Martin et al. (2016) [5] | 22 (19:3) | NTN | No | FABP | M2 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Dai et al. (2016) [54] | 7 (N/R) | NTN | No | FABP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Zhang et al. (2016) [11] | 2 (N/R) | NTN | N/R | CBP | M8 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Shahrbabaki et al. (2016) [55] | 10 (N/R) | N/R | N/R | CBP | M1 | SBP = N/R DBP = N/R | SBP R2 = 0.59 DBP R2 = 0.42 |
Gholamhosseini et al. (2016) [56] | 13 (N/R) | N/R | N/R | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Schoot et al. (2016) [57] | 37 (18:19) | NTN, HTN | Yes | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Jain et al. (2016) [58] | 72 (N/R) | N/R | N/R | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Liu et al. (2016) [7] | 20 (N/R) | NTN, HTN | Yes | FABP | M1 | SBP = N/R DBP = N/R | SBP R2 = 0.95 DBP = N/R |
Kachuee et al. (2017) [59] | 1000 (N/R) | N/R | N/R | ABP | M1 | SBP = −0.06 ± 9.88 DBP = 0.36 ± 5.7 | SBP = 0.54 DBP = 0.57 |
Tang et al. (2017)[60] | 12 (11:1) | NTN, HTN | No | ABP | M1 | SBP = 0.2 ± 5.8 DBP = 0.4 ± 5.7 | SBP = 0.92 DBP = 0.64 |
Seeberg et al. (2017) [61] | 18 (15:3) | N/R | Yes | CBP, FABP | M7 | SBP = N/R DBP = N/R | SBP = 0.69 DBP = 0.38 |
Janjua et al. (2017) [62] | 11 (9:2) | NTN | No | CBP | M8 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Liu et al. (2017) [63] | 20 (N/R) | NTN | No | CBP | M7 | SBP = N/R DBP = N/R | SBP = 0.7 DBP = N/R |
Chen et al. (2017)[64] | 10 (5:5) | NTN | No | FABP | M1 | SBP = −0.91 ± 3.84 DBP = −0.36 ± 3.36 | SBP = N/R DBP = N/R |
Ahmaniemi et al. (2017) [65] | 30 (N/R) | NTN | No | CBP | M1 | SBP = N/R DBP = N/R | SBP = 0.42 DBP = 0.06 |
Zhang et al. (2017) [66] | 10 (7:3) | N/R | N/R | CBP | M1 | SBP = 1.63 ± 4.4 DBP = N/R | SBP = N/R DBP = N/R |
Lin et al. (2017) [67] | 22 (N/R) | NTN | No | CBP | M1 + PIR | SBP = 3.22 ± 8.02 DBP = 3.13 ± 4.82 | SBP = 0.93 DBP = 0.95 |
Bhattacharya et al. (2017) [68] | 6 (N/R) | N/R | N/R | CBP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Ding et al. (2017)[69] | 33 (N/R) | NTN, HTN | Yes | FABP | M1 + PIR | SBP = 1.17 ± 5.72 DBP = 0.46 ± 5.49 | SBP = N/R DBP = N/R |
Pflugradt et al. (2017) [70] | N/R (N/R) | N/R | N/R | ABP | M1 | SBP = 0.015 ± 4.41 DBP = N/R | SBP = N/R DBP = N/R |
Ding et al. (2017) [71] | 6 (N/R) | N/R | N/R | ABP | M1 + PIR | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Xu et al. (2017)[72] | 10 (8:2) | N/R | N/R | CBP | M1 | SBP = 4.5 ± 6.13 DBP = 3.4 ± 3.37 | SBP = N/R DBP = N/R |
Ibrahim et al. (2017) [19] | 3 (N/R) | N/R | N/R | PTT, FABP | M6 | SBP = N/R DBP = N/R | SBP = 0.84 DBP = N/R |
Lo et al. (2017) [73] | 25 (N/R) | N/R | N/R | ABP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Yang & Tavassolian (2018) [17] | 10 (10:0) | NTN | No | CBP | M3 | SBP = N/R DBP = N/R | SBP = 0.58 DBP = 0.57 |
Rajala et al. (2018) [74] | 30 (19:11) | NTN | No | CBP | MI | SBP = N/R DBP = N/R | SBP = 0.37 DBP = N/R |
Wang et al. (2018) [75] | 59 (N/R) | N/R | N/R | CBP | M5 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Lin et al. (2018) [76] | 22 (N/R) | NTN | No | FABP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Kim et al. (2018) [77] | N/R (N/R) | N/R | N/R | PAT | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Sharifi et al. (2018) [78] | 1000 (N/R) | N/R | N/R | ABP | M1 + PIR | SBP = −0.29 ± 9.1 DBP = −0.1 ± 8.62 | SBP = N/R DBP = N/R |
Ahmaniemi et al. (2018) [79] | 10 (9:1) | NTN | No | FABP | MI | SBP = 9.8 DBP = N/R | SBP = 0.75 DBP = N/R |
Liang et al. (2018) [80] | 121 (N/R) | NTN, HTN | Yes | ABP | M1 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Yang et al. (2018) [18] | 10 (N/R) | NTN | No | PTT | M9 | SBP = N/R DBP = N/R | SBP = N/R DBP = N/R |
Xu et al. (2018) [81] | 41 (21:21) | NTN | No | CBP | M1 | SBP = N/R DBP = N/R | SBP = 0.817 DBP = 0.757 |
Chen et al. (2018) [82] | 60 (40:20) | NTN, HTN | Yes | CBP | M1 + PIR, HPSR | SBP = 0.61 ± 9.36 DBP = 0.68 ± 6.67 | SBP = 0.93 DBP = 0.89 |
Lee et al. (2018) [23] | 11 (11:0) | NTN | No | FABP | M10 | SBP = N/R DBP = N/R | SBP = 0.915 DBP = 0.854 |
Feng et al. (2018)[83] | 28 (15:13) | N/R | Yes | ABP | M1 | SBP = −0.98 ± 6.0 DBP = 0.02 ± 4.98 | SBP = N/R DBP = N/R |
Huynh et al. (2018) [20] | 15 (10:5) | NTN | No | CBP | M4 | SBP = N/R DBP = N/R | SBP = 0.88 DBP = 0.88 |
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Welykholowa, K.; Hosanee, M.; Chan, G.; Cooper, R.; Kyriacou, P.A.; Zheng, D.; Allen, J.; Abbott, D.; Menon, C.; Lovell, N.H.; et al. Multimodal Photoplethysmography-Based Approaches for Improved Detection of Hypertension. J. Clin. Med. 2020, 9, 1203. https://doi.org/10.3390/jcm9041203
Welykholowa K, Hosanee M, Chan G, Cooper R, Kyriacou PA, Zheng D, Allen J, Abbott D, Menon C, Lovell NH, et al. Multimodal Photoplethysmography-Based Approaches for Improved Detection of Hypertension. Journal of Clinical Medicine. 2020; 9(4):1203. https://doi.org/10.3390/jcm9041203
Chicago/Turabian StyleWelykholowa, Kaylie, Manish Hosanee, Gabriel Chan, Rachel Cooper, Panayiotis A. Kyriacou, Dingchang Zheng, John Allen, Derek Abbott, Carlo Menon, Nigel H. Lovell, and et al. 2020. "Multimodal Photoplethysmography-Based Approaches for Improved Detection of Hypertension" Journal of Clinical Medicine 9, no. 4: 1203. https://doi.org/10.3390/jcm9041203