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Pulse Arrival Time Based Cuff-Less and 24-H Wearable Blood Pressure Monitoring and its Diagnostic Value in Hypertension

  • Mobile Systems
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Abstract

Ambulatory blood pressure monitoring (ABPM) has become an essential tool in the diagnosis and management of hypertension. Current standard ABPM devices use an oscillometric cuff-based method which can cause physical discomfort to the patients with repeated inflations and deflations, especially during nighttime leading to sleep disturbance. The ability to measure ambulatory BP accurately and comfortably without a cuff would be attractive. This study validated the accuracy of a cuff-less approach for ABPM using pulse arrival time (PAT) measurements on both healthy and hypertensive subjects for potential use in hypertensive management, which is the first of its kind. The wearable cuff-less device was evaluated against a standard cuff-based device on 24 subjects of which 15 have known hypertension. BP measurements were taken from each subject over a 24-h period by the cuff-less and cuff-based devices every 15 to 30 minutes during daily activities. Mean BP of each subject during daytime, nighttime and over 24-h were calculated. Agreement between mean nighttime systolic BP (SBP) and diastolic (DBP) measured by the two devices evaluated using Bland-Altman plot were −1.4 ± 6.6 and 0.4 ± 6.7 mmHg, respectively. Receiver operator characteristics (ROC) statistics was used to assess the diagnostic accuracy of the cuff-less approach in the detection of BP above the hypertension threshold during nighttime (>120/70 mmHg). The area under ROC curves were 0.975/0.79 for nighttime. The results suggest that PAT-based approach is accurate and promising for ABPM without the issue of sleep disturbances associated with cuff-based devices.

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Acknowledgment

The authors are thankful to Mr. Billy Leung and Mr. Ruikai Zhang for their developments of the wearable system, Mr. Ruikai Zhang and Ms. Ruoxi Yu for their contribution on developing the mobile application, and Ms. Cecilia Chan for her assistance in collecting the data from the patients. This work was supported by the Hong Kong Innovation and Technology Commission (ITS/159/11).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from each participant in the study.

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Authors and Affiliations

  1. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

    Yali Zheng, Carmen C. Y. Poon & James Y. W. Lau

  2. Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

    Bryan P. Yan

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  1. Yali Zheng
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  2. Carmen C. Y. Poon
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Correspondence to Carmen C. Y. Poon.

Additional information

Yali Zheng and Carmen C. Y. Poon contributed equally to this work.

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Zheng, Y., Poon, C.C.Y., Yan, B.P. et al. Pulse Arrival Time Based Cuff-Less and 24-H Wearable Blood Pressure Monitoring and its Diagnostic Value in Hypertension. J Med Syst 40, 195 (2016). https://doi.org/10.1007/s10916-016-0558-6

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