Using a new PPG indicator to increase the accuracy of PTT-based continuous cuffless blood pressure estimation.

Pulse transit time (PTT) has been identified as a potential indicator to estimate blood pressure (BP) continuously and cufflessly in the previous studies, but it is still unsatisfactory for clinical uses. In order to improve the BP estimation accuracy, another candidate signal, photoplethysmogram (PPG) has been used to estimate continuous BP. In this study, a new PPG indicator, the intensity ratio of the first derivative wave of PPG (1st dPIR), was proposed and a novel BP estimation algorithm by using both PTT and 1st dPIR was developed with an attempt to further increase the BP estimation accuracy. The performance of the proposed algorithm was examined and validated using the ECG and PPG recordings from 22 healthy subjects when they performed both mental arithmetic stress and Valsalva's manoeuvre tests that could induce their BP fluctuations. The continuous Finapres® BP were measured with a finger cuff as a referenced BP value. Our results showed that using the proposed BP estimation algorithm, the grand absolute mean and standard deviation (SD) errors between the estimated and referenced BP were 3.22±8.02 mmHg for systolic BP (SBP) and 3.13±4.82mmHg for diastolic BP (DBP). It could achieve a decrease of 0.34±0.27 mmHg in SBP and 0.33±0.44 mmHg in DBP on the grand absolute mean and SD estimation errors in comparison to the state-of-the-art PPT-based method. Findings from this study suggest that the newly proposed PPG indicator would be promising for improving the accuracy of current PTT-based continuous and cuffless BP estimation algorithms.