Exploring the limitations of blood pressure estimation using the photoplethysmography signal

Objetive.Hypertension, a leading contributor to cardiovascular morbidity, underscores the need for accurate and continuous blood pressure (BP) monitoring. Photoplethysmography (PPG) emerges as a promising approach for continuous BP monitoring. However, the precision of BP estimates derived from PPG signals has been the subject of ongoing debate, requiring a comprehensive evaluation of their efficacy. This paper aims to provide the potentials and limitations regarding BP estimation from single-site PPG signals.Approach.We developed a calibration-based Siamese ResNet model for BP estimation. We compared the use of normalized PPG (N-PPG) against the normalized invasive arterial BP (N-IABP) signals as input. N-IABP signals, while not directly presenting systolic (SBP) and diastolic (DBP) BP values, are expected to offer more precise estimations than PPG since it is a direct pressure sensor inside the body. Thus, if N-IABP poses challenges in BP estimation, predicting BP from PPG signals might be even more challenging.Main results.Our evaluation, conducted using the AAMI and BHS standards on the VitalDB dataset, revealed that inference using N-IABP signals meet with AAMI standards for both SBP and DBP, with errors of1.29±6.33mmHg for systolic pressure and1.17±5.78for diastolic pressure. In contrast, N-PPG based inference exhibited inferior performance than N-IABP, presenting1.49±11.82mmHg and0.89±7.27mmHg for systolic and diastolic pressure respectively in their best setup.Significance.Our findings establish a critical benchmark for PPG performance, providing realistic expectations for its BP estimation capabilities. We concluded that while PPG signals contain BP-correlated information, they may not suffice for accurate prediction.