Electrocardiogram-Assisted Blood Pressure Estimation

• Published in: IEEE transactions on biomedical engineering Vol. 59; no. 3; pp. 608 - 618
• Main Authors: Ahmad, Saif, Chen, Silu, Soueidan, Karen, Batkin, Izmail, Bolic, Miodrag, Dajani, Hilmi, Groza, Voicu
• Format: Journal Article
• Language: English
• Published: New York, NY IEEE 01.03.2012; Institute of Electrical and Electronics Engineers; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Adult; Algorithm design and analysis; Algorithms; Biological and medical sciences; Biomedical monitoring; Blood Pressure Determination - instrumentation; Blood pressure estimation; Brachytherapy; Calibration; Computerized, statistical medical data processing and models in biomedicine; cuff pressure (CP); electrocardiogram (ECG); Electrocardiography; Electrocardiography - methods; Electrocardiography. Vectocardiography; Electrodes; Electrodiagnosis. Electric activity recording; Equipment Design; Estimation; FDA approval; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Linear Models; Male; Medical management aid. Diagnosis aid; Medical sciences; Middle Aged; oscillometric analysis; Oscillometry - instrumentation; Pilot Projects; Prototypes; Pulse; Pulse measurements; pulse transit time (PTT); Software; Sphygmomanometers - standards; Textiles; pulse transit time (PTT); Transit time; Arterial pulse; Blood pressure estimation; oscillometric analysis; Electrodiagnosis; electrocardiogram (ECG); Pressure wave; cuff pressure (CP); Electrocardiography; Arterial pressure; Blood pressure; Hemodynamics; Biomedical engineering
• ISSN: 0018-9294; 1558-2531
• DOI: 10.1109/TBME.2011.2180019

Accurate automatic noninvasive assessment of blood pressure (BP) presents a challenge due to conditions like arrhythmias, obesity, and postural changes that tend to obfuscate arterial amplitude pulsations sensed by the cuff. Researchers tried to overcome this challenge by analyzing oscillometric pulses with the aid of a higher fidelity signal-the electrocardiogram (ECG). Moreover, pulse transit time (PTT) was employed to provide an additional method for BP estimation. However, these methods were not fully developed, suitably integrated, or tested. To address these issues, we present a novel method whereby ECG-assisted oscillometric and PTT (measured between ECG R-peaks and maximum slope of arterial pulse peaks) analyses are seamlessly integrated into the oscillometric BP measurement paradigm. The method bolsters oscillometric analysis (amplitude modulation) with more reliable ECG R-peaks provides a complementary measure with PTT analysis (temporal modulation) and fuses this information for robust BP estimation. We have integrated this technology into a prototype that comprises a BP cuff with an embedded conductive fabric ECG electrode, associated hardware, and algorithms. A pilot study has been undertaken on ten healthy subjects (150 recordings) to validate the performance of our prototype against United States Food and Drug Administration approved Omron oscillometric monitor (HEM-790IT). Our prototype achieves mean absolute difference of less than 5 mmHg and grade A as per the British Hypertension Society protocol for estimating BP, with the reference Omron monitor.