School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States.
The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States.
JMIR Mhealth Uhealth. 2021 Aug 2;9(8):e27466. doi: 10.2196/27466.
Noninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities.
In this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)-based device for monitoring BP in a diverse population.
We recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP.
Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness.
Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity.
非侵入性和无袖带的血压（BP）监测方法，由于其便利性和准确性，为高血压的远程筛查和管理铺平了道路。然而，现有的非侵入性方法，基于机械、电气和光学传感模式，在人口统计学和种族多样化的人群中并没有得到彻底评估。因此，这些技术在可能产生最大影响的人群中的潜在准确性尚未得到充分解决。由于担心延续现有的健康差距，这给临床转化带来了挑战。
本文旨在介绍一种无袖带、腕戴、基于脉搏传输时间（PTT）的设备在多样化人群中监测 BP 的可行性研究结果。
我们通过与在佐治亚州为医疗服务不足地区服务的非营利组织合作，招募了一个多样化的人群。我们使用我们的定制、多模态、腕戴设备通过震动心电图测量 PTT，作为近端时间参考，以及光体积描记法，作为远端时间参考。此外，我们创建了一种新的数据驱动的拍选择算法，以减少噪声并提高方法的鲁棒性。我们在几个用于调节 BP 的扰动过程中比较了可穿戴 PTT 测量值与手指袖带连续 BP 设备的测量值。
我们的基于 PTT 的腕戴设备在一个多样化的人群（N=44 名参与者）中准确监测舒张压（DBP）和平均动脉压（MAP），经校准后，DBP 和 MAP 的平均绝对差值分别为 2.90mmHg 和 3.39mmHg。同时，我们的收缩压估计的平均绝对差值为 5.36mmHg，根据电子与电气工程协会标准，属于 B 级分类。我们进一步证明了我们的设备能够捕捉到常见的动脉僵硬的人口统计学差异。
使用方便的可穿戴设备进行准确的 DBP 和 MAP 估计，以及 B 级的收缩压估计，可以增强用户的能力，并促进医疗服务不足地区的远程 BP 监测，从而为健康公平提供广泛的高血压筛查和管理。
