Feasibility of Photoplethysmography in Detecting Arterial Stiffness in Hypertension

Asymptomatic peripheral artery disease (PAD) poses a silent risk, potentially leading to severe conditions if undetected. Integrating new screening tools into routine general practitioner (GP) visits could enable early detection. This study investigates the feasibility of photoplethysmography (PPG) monitoring for assessing vascular health across different blood pressure (BP) conditions. Custom femoral artery phantoms representing healthy (0.82 MPa), intermediate (1.48 MPa), and atherosclerotic (2.06 MPa) vessels were tested under hypertensive, normotensive, and hypotensive conditions to evaluate PPG’s ability to distinguish between vascular states. Extracted features from the PPG signal, including amplitude, area under the curve (AUC), median upslope–downslope ratio, and median end datum difference, were analysed. Kruskal–Wallis tests revealed significant differences between healthy and unhealthy vessels across BP states, supporting PPG as a screening tool. The fiducial points from the second derivative of the photoplethysmography signal (SDPPG) were analysed. The ratio was most pronounced between healthy and unhealthy phantoms under hypertensive conditions (ranging from –2.13 to –2.06), suggesting a change in vascular wall distensibility. Under normotensive conditions, the difference in ratios between healthy and unhealthy phantoms was smaller (0.01), and no meaningful difference was observed under hypotensive conditions, suggesting the reduced sensitivity of this metric at lower perfusion pressures. Intermediate states were challenging to detect, particularly under hypotension, suggesting a need for further research. Nonetheless, this study highlights the promise of PPG monitoring in identifying vascular stiffness.