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AbstractPulse transit time (PTT) has attracted much interest I. INTRODUCTION
for cuffless blood pressure (BP) measurement. However, its
limited accuracy is one of the main problems preventing its
widespread acceptance. Arterial BP oscillates mainly at high B LOOD pressure (BP) is an important hemodynamic
parameter varying between systolic BP (SBP) to diastolic
BP (DBP) in each heartbeat. High BP, also known as
frequency (HF) because of respiratory activity, and at low
frequency (LF) because of vasomotor tone. Prior studies hypertension, is one of the major modifiable risk factors
suggested that PTT can track BP variation in HF range, but was leading to the development of cardiovascular diseases (CVDs)
inadequate to follow the LF variation, which is probably the main the number one killer in the world. Hypertension is highly
reason for its unsatisfactory accuracy. This paper presents a new
prevalent but poorly controlled because of the low awareness
indicator, the photoplethysmogram intensity ratio (PIR) which
can be affected by changes in the arterial diameter and thus trace and treatment rate [1], which enhances development of CVDs
the LF variation of BP. Spectral analysis of BP, PTT, PIR and and results in significant burdens on individuals and society.
respiratory signal confirmed that PTT was related to BP in HF at BP variability (BPV) has been reported to have prognostic
the respiratory frequency, while PIR was associated with BP in value for hypertension [2], and thus continuous BP
LF range. We therefore develop a novel BP estimation algorithm
by using both PTT and PIR. The proposed algorithm was measurement is crucial for early prevention, detection,
validated on 27 healthy subjects with continuous Finapres BP as evaluation and treatment of hypertension and related CVDs.
reference. The results showed that the mean standard deviation Conventional 24-hour ambulatory BP monitoring can facilitate
(SD) for the estimated systolic, diastolic and mean BP with the monitoring of BPV through measuring BP at regular intervals
proposed method against reference were -0.375.21 mmHg, with auscultatory or oscillometric approaches. However, it has
-0.084.06 mmHg, -0.184.13 mmHg, and mean absolute
limitations including the discontinuous nature and the
difference (MAD) were 4.09 mmHg, 3.18 mmHg, 3.18 mmHg,
respectively. Furthermore, the proposed method outperformed discomfort caused by the repeated cuff inflations.
the two most cited PTT algorithms for about 2 mmHg in SD and Compared with cuff-based BP techniques, pulse transit time
MAD. These results demonstrated that the proposed BP model (PTT) method has received much attention over the recent
using PIR and PTT can estimate continuous BP with improved decades because of its capability to track BP change, as well as
accuracy. its advantages as a noninvasive, continuous and most
importantly cuffless tool for BP measurement [3-5]. PTT is the
Index TermsArterial diameter change, cuffless blood
pressure, photoplethysmogram intensity ratio, pulse transit time, time taken by the arterial pulse propagating from the heart to a
respiration, vasomotion peripheral site, and can be calculated as the time interval
between the R wave peak of electrocardiogram (ECG) and a
characteristic point of photoplethysmogram (PPG). The
fundamental principle of PTT-based method is based upon the
pulse wave velocity (PWV) recording through the
This work was supported in part by the Guangdong Innovation Research Moens-Korteweg (M-K) equation:
Team Fund for Low-cost Healthcare Technologies in China, the External
Cooperation Program of the Chinese Academy of Sciences (Grant GJHZ1212).
Eh
Asterisk indicates corresponding author. PWV (1)
Xiao-Rong Ding, Yuan-Ting Zhang, Jing Liu, and Wen-Xuan Dai is with d
the Joint Research Centre for Biomedical Engineering, Department of
Electronic Engineering, The Chinese University of Hong Kong, Hong Kong
SAR, China (e-mail: xrding@ee.cuhk.edu.hk; ytzhangapple@icloud.com; which relates PWV with the elastic modulus of vessel wall E,
jingliu@ee.cuhk.edu.hk; wxdai@ee.cuhk.edu.hk) blood density and arterial dimension properties such as vessel
*Hon Ki Tsang is with the Department of Electronic Engineering, The
Chinese University of Hong Kong, Hong Kong SAR, China (e-mail:
thickness h and arterial diameter d. PWV is inversely related
hktsang@ee.cuhk.edu.hk). with PTT, i.e., PWV=K/PTT, where K is the distance between
Copyright (c) 2015 IEEE. Personal use of this material is permitted. heart and certain peripheral site; and E can be exponentially
However, permission to use this material for any other purposes must be
obtained from the IEEE by sending an email to pubs-permissions@ieee.org. correlated BP through the following equation [6]:
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1 (6)
PP C. Experiment
PTT 2
To validate the proposed BP estimation using both PTT and
With initial calibrated PP0 and PTT0, PP can be derived in PIR as given by (11) and (12), an experiment was conducted on
terms of measured PTT: 27 healthy adults (14 males) with mean age of 25.62.1 years
(range 21-29 years), who were nonsmokers with no history of
2
PTT0 cardiovascular disease. Reference BP was measured by
PP PP0 (7)
Finapres (Finapres Medical System), a noninvasive continuous
PTT
BP measurement system, with the finger cuff on the left thumb,
and brachial cuff on the left upper arm. ECG and PPG were
2) DBP Estimation with PIR based on Windkessel Model acquired with one-lead ECG electrodes placed on left and right
Two-element Windkessel model, originally proposed by arms, and PPG sensor on left index finger, respectively.
Frank, consists of peripheral resistance R and arterial Synchronous respiratory activity continuously monitored by
compliance C [39], as shown in Fig. 2. recording the chest movement with respiratory monitoring belt
(Vernier Software & Technology). All tests were performed
with subjects in the seated position, and the signals were
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recorded at the sampling rate of 1000 Hz for five minutes. All Furthermore, time series of PP, PTT and respiratory signal
the subjects gave their informed consent prior to the with their corresponding spectrums are presented in Fig. 4. As
experiments, in accordance with the guidelines of the can be observed from Fig. 4 (a)-(c), they have a similar
Institutional Research Ethics Board. variation pattern with almost the same frequency components
at 0.2-0.3 Hz. Moreover, from the PSD curves, the
respiration-synchronous variation is seen as peaks at the
D. Signal Processing and Data Analysis
respiratory frequency of PP spectrum, as well as in PTT. This
In order to verify the capability of PTT to track the HF indicates that the HF component of PP can be reflected by PTT,
component of SBP as well as respiratory activity, and PIR to which might be caused by the respiratory activity, as discussed
reflect LF fluctuations of BP, the power spectrum analysis of in the next section.
SBP, DBP, PP, respiratory signal, PTT and PIR were conducted Example recordings of DBP and PIR and their power spectra
in 0-0.5 Hz frequency range based on Lomb-Scargle are shown in Fig. 5. The variation of DBP is slower compared
periodogram method [40]. Difference mean and standard with PP, with its frequency range concentrated at
deviation (SD), as well as mean absolute difference (MAD) approximately 0.1 Hz. It can be seen from Fig. 5 (a) and (c) that
between estimated BP with the proposed method and reference the amplitude of DBP is inversely related with that of PIR on
BP were used as the evaluation metrics. The agreement the whole, and they have the similar spectral components. This
between reference BP and estimated BP with the proposed is in line with preliminary study about PIR which demonstrated
method were analyzed according to the Bland-Altman PIR could potentially evaluate the LF modulation of BP. But it
approach [41], with the agreement limits defined by mean is worth noting that there is also minor HF component appeared
1.96SD. In addition, the proposed method was compared in PIR spectrum.
with two most cited PTT-based algorithms [7, 9] for cuffless
BP estimation. Statistical significance was estimated using
Students t-test. P<0.05 is regarded as statistically significant.
III. RESULTS
A. Spectral Analysis of BP, Respiratory Signal, PTT and PIR
As can be seen in Fig. 3 (a), slow variability and fast
variability can be observed in a typical continuous BP signal.
Correspondingly, the variations of SBP, DBP and PP are shown
in Fig. 3 (b). Obviously, SBP contained both slow variation and
fast variation, whereas the DBP only showed slow variability,
with PP presented the fast variability. Power spectral density
(PSD) of SBP, DBP, and PP as illustrated in Fig. 2 (c)-(e) can
further describe this, where SBP showed LF variation centered
at around 0.1 Hz, with HF variation dominated between 0.2-0.3
Hz; and the LF spectrum components were more pronounced in
DBP, while PP mainly contained the HF variation. This is
Fig. 4. Time series and corresponding PSD of PP (a-b), PTT (c-d) and
consistent with previous study about BP variation. respiratory signal (e-f) of a representative subject.
Fig. 3. Continuous BP signal (a); beat-to-beat SBP, DBP and PP (b) of a Fig. 5. Typical time series and corresponding PSD of DBP (a-b) and PIR (c-d)
representative subject, with corresponding PSD of SBP (c), DBP (d) and PP (e). of a representative subject.
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B. Performance of Proposed BP Model with PTT and PIR algorithm and the Finapres, while the y-axis shows the
The estimation results of proposed BP model were compared difference between the two methods. The bias (mean) and the
with the continuous Finapres BP as the reference with regard to limits of agreement (bias1.96SD) are illustrated in red solid
correlation and agreement. The correlation and the line and black dash dot lines, respectively. It is observed that
Bland-Altman plot of the SBP, DBP and MBP estimation for the majority of the points lie within the limit of agreement,
our proposed method versus Finapres BP are given in Fig. 6. indicating that the estimated BP with the proposed method are
The Persons correlation coefficient between overall estimated in close agreement with those made by Finapres. The bias for
SBP, DBP, and MBP and that of Finapres is 0.91, 0.88, and SBP, DBP, and MBP estimates are -0.37, -0.08 and -0.18
0.89, respectively. For the Bland-Altman plot, the x-axis of the mmHg, respectively.
plots presents the average of the estimation with the proposed
Fig. 6. Correlation and Bland-Altman plots of SBP (a-b), DBP (c-d), and MBP (e-f) with the reference of Finapres BP.
C. Comparison of Proposed Model against Current PTT And the second PTT algorithm [9] can obtain SBP and DBP
Algorithms based on the following equation set:
To further evaluate the efficiency of the proposed method, 2
PTT0 1 PTT0
SBP0 DBP0
2 (14a)
we compared the proposed method with two of the most cited DBP MBP0 ln
PTT 3 PTT
PTT algorithms in the cuffless BP estimation area [7, 9].
The first PTT algorithm [7] estimates SBP in terms of relative 2
PTT0
PTT change through the following equation: SBP DBP SBP0 DBP0 (14b)
PTT
SBP SBP0
2
PTT PTT0 (13)
Fig. 7 shows a representative example from the subjects of
PTT0
the beat-to-beat Finapres SBP, estimated SBP by proposed
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Fig. 9. Estimated beat-to-beat MBP with proposed method (green) and PTT
algorithm (dash blue) with the reference of Finapres MBP (red) (a) and the
estimated errors (b) of one representative subject.
Fig. 7. Estimated beat-to-beat SBP with proposed method (green) and PTT
algorithms (solid blue and dash blue) with the reference of Finapres SBP (red) Furthermore, the overall performance was analyzed in terms
(a) and the estimated errors (b) of one representative subject.
of difference mean, SD and MAD. Difference mean is a
measure of the bias of BP estimates, while difference SD is a
The variation of MBP is also slow which is similar to that of measure of error variability. MAD is a measure of overall
DBP, with average value of 87.233.20 mmHg, as depicted in accuracy in estimating BP. The smaller MAD, the better overall
Fig. 9. The estimated MBP with proposed method and the PTT performance. Table I summarizes the values of mean, SD and
method are 85.782.32 mmHg and 93.185.26 mmHg, with MAD for our proposed BP estimation method and the PTT
corresponding estimation error of -1.452.27 mmHg and methods tested on 27 subjects, including 1713 heart beats. It is
5.945.37 mmHg, respectively, suggesting that the estimation observed that the difference mean of our proposed method in
with the proposed method correlates better with Finapres MBP estimating SBP, DBP, and MBP is within -0.37, -0.08, and
than that of the PTT method. -0.18 mmHg of the Finapres, respectively; the difference SD of
the proposed method in estimating SBP, DBP and MBP is
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within 5.21, 4.06, and 4.13 mmHg of the Finapres, respectively; pulmonary vascular and aortic pressure, thereby leading to the
and the MAD of the proposed method in estimating SBP, DBP cyclic variation in BP. Several researchers have found that the
and MBP is within 4.09, 3.18, and 3.18 mmHg of the Finapres, modulation of this HF component for SBP spectrum was
respectively. Comparing with the PTT methods, it is evident linearly related to the respiratory sinus arrhythmia (RSA),
that our proposed method in estimating SBP, DBP and MAP indicating that respiratory fluctuations in BP was attributable to
achieves smaller difference mean, SD, as well as MAD, and the RSA [43]. Moreover, Drinnan et al [44] quantified the
difference is significant, indicating a better accuracy. relation between heart rate and PTT through paced respiration,
and found that there was a strong relationship between PTT and
TABLE I heart rate interval. Johansson et al [45] confirmed that PTT
ACCURACY, PRECISION, AND AGREEMENT BETWEEN FINAPRES BP AND varied in pace with respiration and detected the respiration rate
ESTIMATED BP WITH PTT, AND THAT WITH PTT AND PIR
reliably from PTT. The result of present study about the
PTT PTT
Proposed coupled frequency between PTT and respiratory signal further
Method (1) Method (2)
Method
[7] [9] verified this. Besides, PTT has been used as a measure of
SBP 0.19 -0.11 -0.37 respiratory effort [46], because PTT is inversely proportional
Mean DBP
(mmHg)
N/A 0.19 -0.08 to BP, and BP falls with inspiration with the rise in PTT. This
MBP N/A 0.09 -0.18 can also be observed from time series of PP, PTT and
SBP 6.21 7.31 5.21* respiratory signal as depicted in Fig. 4. With these
SD DBP N/A 6.03 4.06
considerations, we thus reasoned that PTT could reflect the
(mmHg) effect of respiration activity on BP, and can be used to estimate
MBP N/A 6.25 4.13
the HF component of BP variation, particularly PP.
SBP 4.94 5.76 4.09*
MAD On the other hand, the LF component of BP is associated
DBP N/A 4.80 3.18
(mmHg) with vasomotion waves that result from an oscillation of the
MBP N/A 4.96 3.18 sympathetic vasomotor tone. Except for the respiratory
*Statistically significant at the level 0.05 compared with PTT method (1); synchronous oscillations in BP, the vasomotor tone is also an
statistically significant at the level 0.05 compared with PTT method (2).
essential determinant of BP. A number of investigators
evidenced that the oscillations of vasomotor tone is caused by
IV. DISCUSSION
local changes in smooth muscle constriction and dilation
In the present study, we proposed a new indicator, the PIR through the modulation of the sympathetic nervous activity
that can reflect the arterial diameter change, to trace the LF [35, 36]. Though the underlying mechanism has remained
variation of BP, and established a novel BP model with the elusive, the fluctuations in vasomotor tone are considered to
combination of PIR and PTT. We found that the beat-to-beat relate to the local adjustment of peripheral resistance to regulate
BP contained both the HF and LF variation components, where the blood flow thus to meet the local metabolic demand. The
the HF component was dominant in PP and similar to that of adjustment of the peripheral resistance is mainly determined by
PTT as well as respiratory signal, while the LF range was the arterial diameter change, which is the result of the variations
primarily in DBP and was also coupled with the PIR. The PTT in the tension exerted by the smooth muscle in the vessel walls
and PIR were therefore adopted to estimated PP and DBP, [47]. In other words, the arterial diameter change might be the
respectively, and SBP can be obtained accordingly. The
primary factor that affects the vasomotor tone. PIR is related to
preliminary results on 20 healthy subjects demonstrated the
the arterial diameter change, and thus is hypothesized to reflect
feasibility of using both PTT and PIR to enhance the accuracy
the vasomotor tone and further the LF oscillations in BP. The
of PTT-based BP estimation.
spectrum of PIR and BP in this study could explain the
A. Effect of Respiration and Vasomotor Tone on BP hypothesis, which is also consistent with earlier reported
It has been long recognized that arterial BP fluctuates on a results. Our previous study analyzed the relationship between
beat-to-beat basis, and the application of spectral techniques to PIR and BP under the influence of autonomic nervous
continuous BP has revealed the presence of spontaneous activities, such as deep breathing, Valsalva maneuver, and
fluctuations including the oscillations at the HF range similar to sustained handgrip, and showed that increase level of BP was
respiratory frequency, and vasomotion waves in the LF range associated with a shift of PIR spectral power toward the LF
slower than the respiratory frequency [35, 36]. Power spectral component, suggesting the capability of PIR to evaluate the
analysis of SBP in this study was consistent with this, i.e., SBP modulation of sympathetic nervous activity on BP [30]. In
spectrum contained both the HF peak at around 0.25 Hz, which addition, Nitzan et al [48] used a similar indicator, the relative
was coupled with the respiratory frequency, and the LF peaks amplitude variability of PPG signal, to evaluate autonomic
focused at approximately 0.1 Hz. nervous system, and claimed that the variation of PPG baseline
Previous investigations demonstrated that the HF component and amplitude were mainly concentrated in the LF range,
oscillation in BP is related to the respiratory activity [42]. The implying the influence of the sympathetic nervous activity.
underlying mechanisms of the fluctuation of BP with B. PTT Methods for BP Estimation
respiration is probably due to the intrathoracic pressure change
PTT has been extensively studied for continuous BP
with breathing which has a mechanical effect on venous return,
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estimation without a cuff. Despite of its theoretical feasibility, measurement should be the invasive intra-arterial method.
the PTT-based BP measurement method hasnt been widely Second, the beat-to-beat estimation with the proposed method
applied clinically because of several existed problems; and PTT methods were only within a short period of time. The
particularly the accuracy issue remains the overarching estimation with long-term period should be further validated.
challenge facing researchers. Prior studies have reported that Third, though the effects of breathing pattern on the respiratory
PTT mainly presents the HF component variation of BP, but is component of SBP spectrum have already been analyzed in
inadequate to follow the LF variation [28, 29], which we previous study [49], the pattern on PTT should be further
hypothesize to be the utmost reason leading to the investigated. Furthermore, the utilization of PIR to assess the
unsatisfactory accuracy of most current PTT-based BP vasomotor tone on BP should be further validated with more
measurement approaches. experiments. Finally, the proposed method was tested on 20
Continuous BP could be accurately tracked if the healthy subjects, where the sample size is not large enough and
noninvasive physiological parameters used for cuffless BP subjects with CVDs were not included.
estimation can not only follow the HF respiratory influence on
BP, but also its LF oscillation due to the sympathetic V. CONCLUSION AND FUTURE WORK
modulation of vasomotor tone. McCarthy et al [17] examined In summary, we have presented a new model for BP
two popular PTT-BP algorithms, which are also used in this estimation using PTT and PIR, and validated the model
study as contrast methods, and found that neither these two experimentally. We obtained more accurate results for the
algorithms could provide reliable BP estimations over a long cuffless BP estimation by using both PTT and the new
period. The reason for Chens method with acceptable accuracy indicator, the PIR. By means of one-point calibration, the
with intermittent calibration is probably due to the combination beat-to-beat SBP, DBP and MBP can be calculated. We found
of LF variation of cuff-based BP with HF variation of PTT. that PIR can indicate the LF variation of BP, whereas PTT
Without the intermittent calibration, the estimation accuracy of reflects the HF fluctuations of BP. In addition, a novel BP
SBP was reported to deteriorate from 0.641.55 mmHg to model was established with the combination of PIR and PTT,
-3.4229.22 mmHg within 10 min. As for Poons method, the which outperformed the compared PTT-based methods in
accuracy remained relatively stable, from 1.7910.50 mmHg to terms of accuracy on 27 subjects. Most notably, this is the first
1.249.74 mmHg within 10 min. The larger SD after the initial study to our knowledge to consider the use of PIR to estimate
calibration was potentially attributed to the HF variation of PTT the influence of vasomotor tone on BP. Our results provide
for DBP estimation, as can be seen in Fig. 9 (a). However, DBP evidence for BP variations in both the LF and the HF range
varies mainly in LF range, as shown in Fig. 5 (b). As a result, where PTT can mainly reflect HF component, and indicates
the accuracy of SBP estimation was decreased, because SBP that LF component of BP should be considered to improve the
was derived from DBP and PP. Besides, most of PTT-based estimation accuracy. Although the pilot study offers a potential
approaches estimated BP with PTT through linear or nonlinear method for estimating cuffless BP with better accuracy, it
regression method, mostly for SBP estimation, rather than should be further validated with larger sample following with
theoretical model based on physiological significance. And corresponding standard requirement, for example, the IEEE
DBP has been reported to correlate less with PTT than SBP, 1708 standard for wearable cuffless BP measuring devices.
which is probably a consequence of the smaller range of With better accuracy, we expect this method to provide insight
variations in DBP as found in those studies [10, 12, 16, 19]. for cuffless BP estimation technique. Moreover, through
Investigation by Liu et al [24] about the relationship continuous monitoring BP in an unobtrusive way with an
between PTT and BP during exercise and recovery revealed the acceptable accuracy permits better prevention and management
influence of the vascular smooth muscle tone on BP-PTT of hypertension, thus reducing the global burden generated by
relationship, suggesting that the vascular tone should be CVDs.
considered into PTT-based BP estimation. Nevertheless, few
studies have attempted to take account this factor into the ACKNOWLEDGMENT
PTT-based BP model to enhance the accuracy. The strengths of The authors would like to thank the student volunteers from
this study, compared with previous studies of PTT-based Dept. of Electronic Engineering, The Chinese University of
cuffless BP methods, are the introduction of a novel indicator to Hong Kong for their participation in the experiment, and Dr. W.
evaluate the LF variation of BP, and its combination with PTT Karlen from Mobile Health Systems Laboratory, ETH Zurich
to estimate BP to achieve more accurate estimations. With the for kindly helping to revise this manuscript.
LF and HF of BP evaluated by PIR and PTT, continuous BP is
supposed to be predicted accurately without frequent REFERENCES
calibration. Moreover, despite of SBP, estimations of DBP and [1] C. K. Chow, et al., "Prevalence, awareness, treatment, and control of
MBP have also been achieved with acceptable accuracy. hypertension in rural and urban communities in high-, middle-, and
low-income countries," JAMA, vol. 310, pp. 959-968, 2013.
C. Limitations [2] G. Parati, et al., "Assessment and management of blood-pressure
variability," Nat. Rev. Cardiol., vol. 10, pp. 143-155, 2013.
There are some limitations in this study. One concern is that
[3] D. Buxi, et al., "A survey on signals and systems in ambulatory blood
we validated our proposed method with Finapres monitor as the pressure monitoring using pulse transit time," Physiol. Meas., vol. 36,
reference, while the gold standard for continuous BP pp. R1-R26, 2015.
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[4] Y. L. Zheng, et al., "Unobtrusive sensing and wearable devices for Proc. 28th Annu. Int. Conf. IEEE Eng. Med. Biol. Soc., New York, USA,
health informatics," IEEE Trans. Biomed. Eng., vol. 61, pp. 1538 - 1554, 2006, pp. 3958-3961.
2014. [29] Q. Liu, et al., "Time-frequency analysis of variabilities of heart rate,
[5] L. Peter, et al., "A review of methods for non-invasive and continuous systolic blood pressure and pulse transit time before and after exercise
blood pressure monitoring: Pulse transit time method is promising?," using the recursive autoregressive model," Biomed. Signal. Proces., vol.
IRBM, vol. 35, pp. 271-282, 2014. 6, pp. 364-369, Oct 2011.
[6] D. J. Hughes, et al., "Measurements of Young's modulus of elasticity of [30] X. R. Ding and Y. T. Zhang, "Photoplethysmogram intensity ratio: a
the canine aorta with ultrasound," Ultrason. Imaging., vol. 1, pp. potential indicator for improving the accuracy of PTT-based cuffless
356-367, 1979. blood pressure estimation," To be published in Proc. 37th Annu. Int.
[7] M. W. Chen, et al., "Continuous estimation of systolic blood pressure Conf. IEEE Eng. Med. Biol. Soc., Milan, Italy, 2015.
using the pulse arrival time and intermittent calibration," Med. Biol. Eng. [31] Factors that affect blood pressure. Available:
Comput., vol. 38, pp. 569-574, 2000. http://www.edises.it/file/minicd/germ002/misc/assignmentfiles/cardiov
[8] J. Muehlsteff, et al., "Cuffless estimation of systolic blood pressure for ascular/Fact_Aff_Blood_Pressure.pdf
short effort bicycle tests: the prominent role of the pre-ejection period," [32] Y. L. Zhang, et al., "Radial pulse transit time is an index of arterial
in Proc. 27th Annu. Int. Conf. IEEE Eng. Med. Biol. Soc., Shanghai, stiffness," Hypertens. Res., vol. 34, pp. 884-887, 2011.
China, 2005, pp. 5088-5092. [33] G. Mancia, "Short-and long-term blood pressure variability present and
[9] C. C. Y. Poon and Y. T. Zhang, "Cuff-less and noninvasive future," Hypertension, vol. 60, pp. 512-517, 2012.
measurements of arterial blood pressure by pulse transit time," in Proc. [34] J. M. Karemaker and J. Strackee, "Hemodynamic fluctuations and
27th Annu. Int. Conf. IEEE Eng. Med. Biol. Soc., Shanghai, China, 2006, baroreflex sensitivity in humans: a beat-to-beat model," Am. J. Physiol.
pp. 5877-5880. Heart. Circ. Physiol., vol. 253, pp. H680-H689, 1987.
[10] J. S. Kim, et al., "Effect of confounding factors on blood pressure [35] A. Malliani, et al., "Cardiovascular neural regulation explored in the
estimation using pulse arrival time," Physiol. Meas., vol. 29, p. 615, frequency domain," Circ., vol. 84, pp. 482-492, 1991.
2008. [36] M. Pagani, et al., "Low and high frequency components of blood
[11] Y. Chen, et al., "Continuous and noninvasive blood pressure pressure variability," Ann. N. Y. Acad. Sci., vol. 783, pp. 10-23, 1996.
measurement: a novel modeling methodology of the relationship [37] R. W. de Boer, "Beat-to-beat blood-pressure fluctuations and heart-rate
between blood pressure and pulse wave velocity," Ann. Biomed. Eng., variability in man: physiological relationships, analysis techniques and a
vol. 37, pp. 2222-2233, 2009. simple model," Ph.D. Dissertation, Department of Physiology,
[12] M. Y. M. Wong, et al., "An evaluation of the cuffless blood pressure University of Amsterdam, Amsterdam, Netherland, 1985.
estimation based on pulse transit time technique: a half year study on [38] D. H. Bergel, "The dynamic elastic properties of the arterial wall," J.
normotensive subjects," Cardiovasc. Eng., vol. 9, pp. 32-38, 2009. Physiol., vol. 156, pp. 458-469, 1961.
[13] M. Mas, et al., "Feasibility of cuff-free measurement of systolic and [39] N. Westerhof, et al., "The arterial windkessel," Med. Biol. Eng. Comput.,
diastolic arterial blood pressure," J. Electrocardiol., vol. 44, pp. vol. 47, pp. 131-141, 2009.
201-207, 2011. [40] T. Ruf, "The Lomb-Scargle periodogram in biological rhythm research:
[14] H. Gesche, et al., "Continuous blood pressure measurement by using the analysis of incomplete and unequally spaced time-series," Biol. Rhythm.
pulse transit time: comparison to a cuff-based method," Eur. J. Appl. Res., vol. 30, pp. 178-201, 1999.
Physiol., vol. 112, pp. 309-315, 2012. [41] J. M. Bland and D. Altman, "Statistical methods for assessing agreement
[15] M. Forouzanfar, et al., "Coefficient-free blood pressure estimation based between two methods of clinical measurement," Lancet, vol. 327, pp.
on pulse transit time-cuff pressure dependence," IEEE Trans. Biomed. 307-310, 1986.
Eng., vol. 60, pp. 1814-1824, 2013. [42] A. C. Dornhorst, et al., "Respiratory variations in blood pressure," Circ.,
[16] A. Hennig and A. Patzak, "Continuous blood pressure measurement vol. 6, pp. 553-558, 1952.
using pulse transit time," Somnologie, vol. 17, pp. 104-110, 2013. [43] J. A. Taylor and D. L. Eckberg, "Fundamental relations between
[17] B. McCarthy, et al., "An examination of calibration intervals required short-term RR interval and arterial pressure oscillations in humans,"
for accurately tracking blood pressure using pulse transit time Circ., vol. 93, pp. 1527-1532, Apr 15 1996.
algorithms," J. Hum. Hypertens., vol. 27, pp. 744-750, 2013. [44] M. J. Drinnan, et al., "Relation between heart rate and pulse transit time
[18] J. Sola, et al., "Noninvasive and nonocclusive blood pressure estimation during paced respiration," Physiol. Meas., vol. 22, pp. 425-432, Aug
via a chest sensor," IEEE Trans. Biomed. Eng., vol. 60, pp. 3505-3513, 2001.
2013. [45] A. Johansson, et al., "Pulse wave transit time for monitoring respiration
[19] T. Wibmer, et al., "Pulse transit time and blood pressure during rate," Med. Biol. Eng. Comput., vol. 44, pp. 471-478, 2006.
cardiopulmonary exercise tests," Physiol. Res., vol. 63, pp. 287-296, [46] O. Contal, et al., "Pulse transit time as a measure of respiratory effort
2014. under noninvasive ventilation," Eur. Respir. J., vol. 41, pp. 346-353, Feb
[20] V. Chandrasekaran, et al., "Cuffless differential blood pressure 2013.
estimation using smart phones," IEEE Trans. Biomed. Eng., vol. 60, pp. [47] L. H. Peterson, "Regulation of blood vessels," Circ., vol. 21, pp.
1080-1089, Apr 2013. 749-759, 1960.
[21] J. H. Shin, et al., "Non-constrained monitoring of systolic blood pressure [48] M. Nitzan, et al., "The variability of the photoplethysmographic signal-a
on a weighing scale," Physiol. Meas., vol. 30, p. 679, 2009. potential method for the evaluation of the autonomic nervous system,"
[22] M. Y. M. Wong, et al., "The effects of pre-ejection period on Physiol. Meas., vol. 19, p. 93, 1998.
post-exercise systolic blood pressure estimation using the pulse arrival [49] D. Laude, et al., "Spectral-Analysis of Systolic Blood-Pressure and
time technique," Eur. J. Appl. Physiol., vol. 111, pp. 135-144, 2011. Heart-Rate Oscillations Related to Respiration," Clin. Exp. Pharmacol.
[23] C. Douniama, et al., "Blood pressure tracking capabilities of pulse transit Physiol., vol. 22, pp. 352-357, May 1995.
times in different arterial segments: a clinical evaluation," in Comput.
Cardiol., 2009, pp. 201-204.
[24] Q. Liu, et al., "Attenuation of systolic blood pressure and pulse transit
time hysteresis during exercise and recovery in cardiovascular patients,"
IEEE Trans. Biomed. Eng., vol. 61, pp. 346 - 352, 2013.
[25] A. Malliani, et al., "Physiology and Clinical Implications of Variability
of Cardiovascular Parameters with Focus on Heart Hate and
Blood-Pressure," Am. J. Cardiol., vol. 73, pp. C3-C9, Apr 7 1994.
[26] A. Malliani, et al., "Cardiovascular Neural Regulation Explored in the
Frequency-Domain," Circ., vol. 84, pp. 482-492, Aug 1991.
[27] G. Parati, et al., "Spectral analysis of blood pressure and heart rate
variability in evaluating cardiovascular regulation a critical appraisal,"
Hypertension, vol. 25, pp. 1276-1286, Jun 1995.
[28] H. T. Ma and Y. T. Zhang, "Spectral analysis of pulse transit time
variability and its coherence with other cardiovascular variabilities," in
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