IEEE/OSA/IAPR International Conference on Infonnatics, Electronics & Vision

Development of a Noninvasive Continuous Blood

Pressure Measurement and Monitoring System
i
i
Md. Manirul Islam , Fida Hasan Md. Rafi , Abu
l
l2
Farzan Mitul and Mohiuddin Ahmad ,

3
M. A. Rashid , Mohd Fareq bin Abd Malek 4

3,4School of Electrical Systems Engineering

University Malaysia Perlis (UNiMAP)
Periis, Malaysia
E-mail: abdurrashid@unimap.edu.my

Department of Electrical and Electronic Engineering

2Department of Biomedical Engineering
Khulna University of Engineering & Technology
Khulna, Bangladesh
Email: monir.yahoo@gmail.com.ahmad@eee.kuet.ac.bd
Abstract- Non invasive continuous blood pressure measurement
system

is

more

useful

than

conventional

blood

pressure

measurement systems. The arterial system is extraordinarily well

regulated blood delivery network in human body. It responds
very quickly according to the body movements like altered body
position, or in sudden excitation. So now a day's continuous

veins, arterioles, vacuoles and capillaries and out of the heart

into pulmonary and systemic arterial. The standard arterial
blood pressure curve is shown in Fig. 1.
Blood pressure measurement system can be classified into
two categories: (i) Invasive (direct) (ii) Noninvasive (indirect).

blood pressure monitoring devices are becoming more essential.

Many types of blood pressure measurement devices are available.

Those devices allow only few blood pressure readings in every 10

minutes.

In contrast to them,

noninvasive

continuous

blood

we develop a
pressure

very low cost

measurement

and

monitoring system. It measures blood pressure using volume

oscillometric

method

and

photoplethysmography

technique

during a long time period continuously. The rate of change of

blood volume in an organ such as finger has a linear relationship
with blood pressure. This rate of change of blood volume in
finger is measured by an optical sensor network which estimates
blood pressure. It displays the numerical value of systolic and

diastolic blood pressure in a mini LCD. Our developed system is

reliable, accurate and less expensive.

Keywords-Noninvassive

measurement;

continuous

pressure; monitoring system; oscillometric method;

I.

blood

INTRODUCTION

Arterial blood pressure is the force exerted by the blood on

the wall of a blood vessel as the heart pumps (contracts) and
relaxes. Blood pressure is comprised of two numbers: Systolic
pressure (the force of blood in arteries as the heart contracts
and pushes it out) and diastolic pressure (the force of blood in
arteries as the heart relaxes). Understanding circulation will
help about understanding and accurately measurement of blood
pressure. Circulating blood provides transportation and
communication system between the body's cells and serves to
maintain a relatively stable internal environment for optimum
cellular activity. Blood circulates because the heart pumps it
through a closed circuit of blood vessels. Blood flow through
the heart and the blood vessel is unidirectional, flowing mto the
heart from the pulmonary and systemic veins, and out of the
heart into pulmonary and systemic arteries.
Blood transports O2 and nutrients to tissues, and carries
metabolic waste away from the cells. The transportation is
made possible by a "pressurized vessel" system, the arteries,

978-1-4673-1154-0112/$31.00 2012 IEEE

Figure 1.

Standard Arterial blood pressure curve [10] .

Invasive techniques of BP Measurement involve insertmg a

catheter into the vascular system which brings high risks of
embolism, arrhythmia, heart attack and a certain percent of
mortality. This method is not convenient for everyday
application. It will only be used when absolutely necessary.
The non invasive devices are safer, easier to use and can be
utilized in most situations. Various nonmvasive methods are
available like Electronic Palpation method, Volume
Oscillometric (VO) method, Volume Compensation (VC)
method, Arterial Tonometry method etc. Among those
ascultatory methods, Oscillometric methods are continuous.
For conventional cuff-sphygmomanometer system the
blood pressure readings are not continuous. Moreover it uses
the invasive prmciple for blood pressure measurement which is
bothersome for patients. So we have designed a continuous
noninvasive blood pressure measurement and monitoring
system. The overall cost for this system is also being lower
than present devices.
It is troublesome to monitor a patient's blood pressure
continuously during surgeries or in critical situations using
conventional mechanical blood pressure measurement devices
due to their invasive method and several faulty readings m

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modem digital devices. But once our system is calibrated for a
patient it will continuously show BP readings using non
invasive measurement technique. The system is developed by
considering volume oscillometric method.
Volume-Oscillometric (VO) method is based on the
vascular unloading principle and the characteristics of the
pressure volume relationship in the artery. [t employs
photoelectric plethysmography [1] to detect the volume of
blood changes in the artery. The VO method is similar to the
oscillometric method except that it is based on arterial blood
volume oscillations instead of cuff pressure oscillations. [t can
measure Systolic Pressure, Diastolic pressure, Mean Arterial
Pressure and can be used for long term ambulatory monitoring.
The concept for this volume oscillometric method embedded
system is shown in Fig. 2.

Cover
Figure 2.

Photoplethysmography technique in finger.

A high intensity LED and a LOR (Light Dependent

Resistor) is placed at the edge of a finger as shown in Fig. 2.
The resistance of the LOR changes according to the light
intensity received by the LDR. The change in resistance is
proportional to the change of blood volume and as well as
blood pressure in the finger. This technique is used here.
The main contribution in our work is the use of visible light
instead of infra red (IR), ultrasonic sound or electromagnetic
wave (EMW). These other sources have some adverse effect on
human body if those are focused continuously on human body
for a long period of time. Also light sources (LED) and sensors
(LDR) are cheaper than previously mentioned sources.
Moreover we have implemented the amplifier circuit with Op
Amp 741 for high gain amplification and ATMEGA 8
microcontroller for compiling the blood pressure with
preloaded program. The micro controller has a built-in ADC.
Therefore no need for extra AID converter and this results low
cost compact BP measurement system. Our system kit can be
used in clinics, hospitals and personal usages. [t is very helpful
in situations like surgery where continuous and accurate BP
monitoring is needed.
Author in [[, 5] designed a wearable blood pressure sensor
that suits into the existing MEMSWEAR platform. The blood
pressure measurement was semi continuous and using
photoplethysmography technique. Author used a motor with a
small sensor in the design to measure blood pressure.
Authors in [3] developed a fully automated non-conscious
monitoring system for home health care. [n the paper, authors
described the structural detail of a newly developed toilet-seat
installed blood pressure measurement system and some results
were obtained by the system. Authors also described the
outline of a newly designed system for measuring hydrostatic

1086

pressure difference between the heart and the measuring site,

i.e., thigh, during blood pressure measurement.
Authors in [4] offered a novel alternative or companion to
existing oscillometric BP measurements that uses natural ann
motions to provide BP measurements. Their paper presented a
new principle for noninvasive blood pressure measurements
through a modified volume-oscillometric technique [2] that
eliminates an inflatable pressure cuff, and instead takes
advantage of natural hydrostatic pressure changes caused by
raising and lowering the subject's arm. This methodology
provided the advantage of using an absolute gauge pressure
reference for measurements, and does not necessarily require
additional actuation. Authors in [6] estimated the blood
pressure estimation method was based on a presumption that
there was a singular relationship between the pulse wave
propagation time in arterial system and blood pressure. The
parameter used in this study is pulse wave transit time. [n [7],
authors demonstrated a new method for continuous real-time
measurement of blood pressure during daily activities. This
method was based on blood pressure estimation from pulse
wave velocity calculation.
Authors in [8] developed a system using Korean traditional
medicine, the degree of the pulse depth to diagnosis & analysis
with pulse wave. Using clinical data Authors selected APm
(applied pressure which has a maximum value of pulse wave),
elasticity of wrist tissue, depth of blood vessel, cardiac output
and hI as parameters to estimate blood pressure. They also
showed the differences in sphygmomanometer data and their
system's data for SP, DP, MAP and PP, according to American
Standard.
Authors in [9] developed a new technique for detennining
servo reference value (Vo) for the volume-compensation
method. In their method, the period of time for Vo
detennination was significantly reduced compared with the
volume-oscillometric method. This result also indicates
availability of this method for swift resetting of Vo during non
invasive beat-by-beat BP measurement. Compared to this
method, we also get swift response of noninvasive
measurement due to use of photoplethysmography technique
BP using volume oscillometric method.
The performance of our developed system is better
compared to the perfonnance of previous works. Our
experiments result shows less mean difference (MD) and
standard deviation (SO).
This paper is organized as follows: Section II describes the
developed noninvasive blood pressure measurement system.
Section III explains the simulation results as well as calculation
of real results. Finally, section IV concludes the entire paper.
II.

PROPOSED DEVELOPED SYSTEM

Fig. 3 shows the block diagram of our developed system.

Fig. 4 illustrates the pictorial view of the developed system.
The detailed electronic circuit of the amplifier circuit with
automatic reference selector is shown in Fig. 5. The working
principle of the developed system for different blocks is
discussed below.

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[EEE/OSA/[APR International Conference on [nfonnatics, E[ectronics & Vision

[n our designed system, a high intensity LEO is placed at
one side of a fmger and a LDR (Light Dependent Resistor) is
placed at another side. The light is absorbed by the blood,
mussels, skin and bones of the fmger. With the change of blood
pressure the volume of blood vessels are varied. The volume of
other parts of the finger remains constant. So the light
absorption is varied only by the change of volume of blood.
We know the resistance of the LDR is high in dark and
becomes low when light falls on it. Its resistance is inversely
proportional with light intensity.

low frequency signal is received by the LOR. The change in

resistance of LDR is very low even in milliohm range.
Therefore, the output voltage from the LOR has a large
amount of dc component with a small amount of ac
component. For example if the pulse rate is 75 BPM then
frequency of ac signal is 75/60=[.25Hz. The electronic
equivalent circuit of weak bio-signal is shown in Fig. 6.

Ampli

2"" slage

,
,

Pl"

D
,
62Oi< ;' ...
, -- - - !
-'VO -

IOOuF
I

ADC

selector

Mini

...

D Vi

- - - -

Calibration
control

Figure 3.

!I!D

Block diagram of our developed system.

Rl.2

RI

tOK ....

?:'LI 25u5VHz. '" VIC

rVR'"""

Microcontroller

LCD

Vol

'C2
,
-

Automatic
reference

10
Rl

'

'

: :,

, __

10k

__________ a

J'
.

4SV

4SV

: L-jll' I
11__
a ,'
. lli--------------

IV -=-YJ

,
,

'
,

...
\!IJ

V2

VI

Dual power supply

,

-------,
Figure 5.

PSpice simulation of double stage amplifier.

LOR,,-

...J. -- - -- - -.- -- - - - - - -_ - -LO\N 0 ut:put: .s i g na I

-VEE

Figure 4.

Pictorial view of our developed system.

[n our designed system, a high intensity LEO is placed at

one side of a fmger and a LDR (Light Dependent Resistor) is
placed at another side. The light is absorbed by the blood,
mussels, skin and bones of the fmger. With the change of blood
pressure the volume of blood vessels are varied. The volume of
other parts of the finger remains constant. So the light
absorption is varied only by the change of volume of blood.
We know the resistance of the LDR is high in dark and
becomes low when light falls on it. Its resistance is inversely
proportional with light intensity.
When systolic blood pressure occurred in the human body,
the blood volume in the finger becomes maximum and light
absorption is also maximum. Therefore light falls on the LDR
is minimum and its resistance is maximum. Ouring systolic
pressure resistance of LDR is high (maximum). Similarly
during diastolic pressure resistance of LOR is low (minimum).
So, it can be concluded that blood pressure is directly
proportional to the resistance of LOR. A low magnitude and

1087

Figure 6.

Electronic equivalent of Weak bio signa\.

This weak bio signal is then amplified by a double stage

very high gain amplifier using Op Amp as shown in Fig. 5. But
the output voltage of the LOR has a large amount of dc
component as mentioned earlier and amplifying the signal
directly results in saturation of the amplified signal. So to avoid
this phenomenon, a subtractor circuit is used which can
automatically null the dc component. But filter can't be used
here as frequency of ac signal is 0.8 Hz to 1.4 Hz. Therefore
the subtractor circuit is made by an Op-amp which acts as
automatic reference selector to suppress the dc component.
For first stage (From Fig. 5),

VOl

- RFI (Vi - Vref)

Rl

'

Al (Vi - Vref
. )

When Rl=R2 and RF1=R3.

Here, RFl= 820KO and R\=\O KO, So A\=82

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IEEE/OSA/IAPR International Conference on Infonnatics, Electronics & Vision

For 2nd stage (From Fig. 5),

V02

RF2
--

R9

(VOl )

A2 (Vol )

Pulse Rate (BPM) = 601 Pulse to Pulse Interval (seconds).

The mini LCD display is interfaced with microcontroller as
shown in Fig.9.

(2)

Where RF2 =820 KO and R9=I KO.So the gain A2=820

Finally,

RFlxRF2

(Vi - Vref) A, (Vi - Vref)

RlxR9
820x820
(Vi - Vref) 67240(Vi - Vref)
10xl

V02

(3)

Sampling(xl, x2, x3)

Where AI is the total gain of the amplifier and AI= 67240. A

variable resistor may be used instead of RF2 and the total gain
of the amplifier can be varied from 82 to 67240. So we can
easily analyze the low amplitude (may be in micro volt range)
bio-signal from the LDR using this amplifier circuit.
The amplifier's output is then fed to a microcontroller
where it is sampled and quantized. To find out the largest
(represents SP) and the smallest (represents DP) value form the
output sampled and quantized voltage a program is written
using BASCOM-AVR software into the micro controller. The
microcontroller displays SP, DP and Pulse rate in mini LCD
using the following algorithm of Fig. 7.
Moreover the flow chart of the developed system is shown
in Fig. 8. In Fig. 8 xl, x2, x3 are continuous sampled data. As
systolic pressure is the largest value among the sampled data
for a particular period, so x2 must greater than xl and x3. For
diastolic pressure this condition is vice versa. More
measurements can be loaded to the micro controller using these
fonnulas.

Figure 8.

For continuous monitoring of blood pressure our developed

system is to be calibrated with a standard system before
measurement. The accuracy of this system depends mainly on
this calibration. After standard calibration for a subject the
micro controller takes data and display result continuously.

main 0
{
start:
get_adc_inputO;
store_inputO;
check_systolic_pressureO;
check_diastolicressureO;
checkulseJateO;
if (systolic){ display_systolic_pressureO;}
if (diastolic){ displaLdiastolicressureO;}
if (pulseJate){ displayulse_rateO;}
goto start;
}
Figure 7.

Figure 9.

Pulse Pressure (mm Hg) = Systolic Pressure - Diastolic

pressure.
Mean Arterial Pressure (MAP) (mm Hg)
pressure) + Diastolic pressure.

1088

Microcontroller interfaced with

III.

Algorithm for systolic and diastolic pressure and pulse rate

measurement in the microcontroller.

1/3 (Pulse

Flow chart for the developed system.

l6x2 LCD.

CALCULATIONS AND RESULTS

At first, the calibration for ADC is performed. We use 10

bit ADC. So its output varies from 0 to 1023. Human systolic
blood pressure varies from 230 mmHg to 50 mmHg and
diastolic blood pressure varies from 140 mmHg to 35 mmHg.
ADC is calibrated from 0 to 300 mmHg.
lactor=
Mu1
ymg ",
tlp1'
Pi

1023

--

300
0 +3.5 mmHg

= 3.41"" 3.50

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Where, Pi is instantaneous pressure at any instant and 0 is
the output 10 bit data of ADC. The input and output waveform
of the amplifier circuit is shown in Fig. 10.
E:] (0 Schematicl.dilt

Hg or less. So from the above table the difference in PP and

MAP of our system with sphygmomanometer is under standard
rule. Therefore, the proposed results are quite reliable and
according to international standards.
To verify our developed systems accuracy we have also
performed some test with 6 subjects using ring [mger, middle
finger, Thumb with our developed system and at the same time
using sphygmomanometer at the right arm. These readings are
shown in Table II and Table III.
TABLE II.

(a) Input

Ring finger

Snb.

Figure 10.

2nd stage output

(d) Input &outputs

DP

SP

121

80

93. 7

130

91

104

128

86

100

115

75

121

78

Snb.

MAP

77

94

120

79

92. 7

131

90

103.7

127

86

99. 7

88.3

116

74

88

92. 3

120

77

91. 3

SYSTOLIC PRESSURE (SP), DIASTOLIC PRESSURE (DP) AND

MEAN ATERIAL PRESSURE READINGS.
Thumb

SP

Figure 11. Amplifier input & output in oscilloscope.

We perform the blood pressure measurement with 3

subjects using sphygmomanometer and our developed system
and the results are shown in Table I.

SI
S2
S3

DP

SP
128

94

We have recorded several data after calibrating our

developed system for continuous monitoring of the proposed
system in normal condition and excited condition. And we
found that our proposed system displays rapid response
according of SP and OP according to different conditions and
we can get quite a variation between two different conditions
for same subject. Therefore we can say the developed system
works approximately accurate both in noninvasive and
continuous mode.
TABLE III.

Sub.

MAP

78

Input and output waveform of amplifier in PSpice.

According to amplifier gain Eq. (1), Eq. (2) and Eq. (3) we
can see the high gain characteristics of weak bio signal from
Fig. 10. The oscillographic representation of the amplifier
input-output is shown in Fig. 11 which is practically observed.
Simulated gain and observed gain of the amplifier have a slight
difference.

TABLE 1.

Middle finger

126

0
(c)

SYSTOLIC PRESSURE (SP), DIASTOLIC PRESSURE (DP) AND

MEAN ARTERIAL PRESSURE (MAP) READINGS.

128

B
C

DP

MAP

77

94

120

79

92. 7

131
127

90
86

103.7
99. 7

E
F

116
120

74
77

88
91.3

Arm pressure by
Sphygmomanometer
SP

125

DP

MAP

94. 3

122

79
81

94. 7

131
129

90
87

103.7
101

116
120

75
78

88. 7
92

SYSTOLIC PRESSURE (SP), DIASTOLIC PRESSURE (DP) AND

PULSE PRESSURE (PP) READINGS.
Sphygmomanometer
readings
DP
PP
SP

Proposed System
readings
DP
PP
SP

120
126

70
90

50
36

123
126

73
86

50
40

130

90

40

127

89

38

According to American National Standard for electronics or

automated sphygmomanometers, the mean difference should
be 5 mm Hg or less with a standard deviation (SD) of 8 mm

1089

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IEEE/OSA/IAPR International Conference on Infonnatics, Electronics & Vision

IV.

130

0;
I

120

110

FSP1
l:--:=QF'J

Q)
L...
::J 100
II)
II)
Q)
L...
CL 90
"0
0
0 80
in
70

50

100

150

200

250

300

Time (sec)
Figure 12. Systolic and Diastolic pressure in normal condition.

The variation of SP and DP for normal and excited

condition for a subject is shown in Fig. 12 and Fig. 13
respectively.

OJ

130

-------v-

I
125
E

120
Q)
L...
::J
II) 115
II)
Q)
L...
CL 110
"0
0
0 105
in
100

In this paper, we developed a low cost device for

noninvasive continuous measurement of blood pressure using
photoplethysmography technique. The blood pressure was
measured using volume oscillometric method continuously for
a long period of time with the small embedded system and
displayed the systolic and diastolic blood pressure on a mini
LCD. The results were further compared with existing devices
data like sphygmomanometer to verify the accuracy of the
developed system. The developed system shows less error in
BP readings compare to conventional devices. Moreover it has
no side effect on human body while running in continuous
mode. So the developed system is quite reliable and preferable
for continuous BP measurement. In near future we will connect
the system with computer and local area network (LAN).
Therefore further data analysis and remote monitoring will be
possible.
REFERENCES
[1]

C. K. Wei, "Photoplethysmography blood pressure measurement", M.

Sc. Engg. Thesis, Department of Mechanical Engineering, National
University of Singapore,2009.

[2]

H. Shimazu, H. Ito, H. Kobayashi, "Idea to measure diastolic arterial

pressure by volume oscillometric method in human fingers",
"department of physiology, Kyorin University school of medicine",
Mediccal & Biological Engineering & Computation, vol. 24, no 5, pp.
549-554, 1986.

[3]

S. Tanaka, M. Nogawa, and K. Yamakoshi, "Fully Automatic System

for Monitoring Blood Pressure from a Toilet-Seat Using the Volume
Oscillometric Method", Proceedings of the Annual Conference on
Engineering in Medicine and Biology, pp. 3939-3941, Shanghai, China,
September 1-4,2005.

[4]

P. A. Shaltis, A. T. Reisner, and H. H. Asada, "Cuflless Blood Pressure

Monitoring Using Hydrostatic Pressure Changes", IEEE Transactions
On Biomedical Engineering, vol. 55,no. 6,pp. 1775-1777,June 2008.

F=SP1

50

100

150

200

250

300

[5]

Time (sec)
Figure 13. Systolic and Diastolic pressure in excited condition.

The amplifier calibration using sphygmomanometer for

different patients is the limitation for our developed system.
We have to calibrate the amplifier every time for different
subjects. This is because our developed system works in
volume oscillometric method and different patients have
different blood volume in their fingers. So every time proper
calibration is required before recording accurate readings of
different patients. But once the calibration is done for a subject,
it can continuously display SP, DP of the subject without any
faulty results. The problem can be solved by measuring the
volume of blood in the fmger. The calibration is done by
varying a variable resistor. The calibration problem can be
solved by measuring the rate of change of blood volume in a
definite organ from optical sensor network signal. This signal
has a linear relationship with blood pressure as discussed
above.

1090

CONCLUSION

X. F. Teng and Y. T. Zhang, "Continuous and Noninvasive Estimation

of Arterial Blood pressure using a photoplethysmographic Approach",

Proceedings of the 25th Annual International Conference of the IEEE

EMBS, vol. 4,pp. 3153-3156,Cancun Mexico, September,2003.

[6 ]

[7]

J. Lass, I. C. Meigas and D. Karai, R. Kattai, J. Kaik, M Rossmann,

"Continuous blood pressure monitoring during exercise using pulse
wave transit time measurement", Proceedings of the 26th Annual
International Conference of the IEEE EMBS San Francisco, pp. 22392242,CA,USA,September 2004

G. Lopez, H. Ushida, K. Hidaka, M. shuzo, I. Yamada, "Continuous

Blood pressure measurement in daily activities", The University of
Tokyo. IEEE SENSOR 2009 conference.

[8]

M. Park, H. 1. Kang, Y. Huh, K. C. Kim, "Cuflless and Noninvasive

Measurement of systolic blood pressure, diastolic blood pressure, mean
arterial pressure and pulse pressure using Radial Artery Tonometry
pressure sensor with concept of Korean Traditional medicine",
Proceedings of the 29th Annual International Conference of the IEEE
EMBS, pp.3597-3600,2007.

[9]

S. Tanaka, M. Nogawa, Y. Sawanoi, T. Yamakoshi and K. Yamakoshi,

"A New Method for Determining the Servo Reference Value (Vo) of the
Volume-Compensation Method", Proceedings of the 29th Annual
International Conference of the IEEE EMBS, pp. 2354-2356, Lyon,
France,August 23-26,2007.

[10] K. Bynum, "Experimental laboratory physiology BIOPAC Lab exercise

manual", lesson16,lesson 17.

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