Cuffless Blood Pressure Measurement: Where Do We Actually Stand?

Area of Science:

• Biomedical Engineering
• Cardiovascular Technology
• Health Informatics

Background:

• Cuffless blood pressure (BP) measurement technology is rapidly advancing, with numerous devices utilizing pulse wave analysis (PWA) and pulse arrival time (PAT).
• These methods often rely on machine learning algorithms applied to pulsatile waveforms captured by mobile devices, aiming for convenient BP estimation.
• However, widespread adoption is hindered by the frequent need for individual user calibration with traditional cuff BP measurements or demographic data.

Purpose of the Study:

• To provide an update on the recent advancements and challenges in cuffless blood pressure (BP) measurement technologies.
• To critically evaluate the current state of devices and research employing pulse wave analysis (PWA) and pulse arrival time (PAT).
• To discuss the progress in developing validation standards and explore alternative cuffless BP measurement approaches.

Main Methods:

• Review of recent publications (last 2-3 years) on cuffless BP technologies, focusing on PWA and PAT.
• Analysis of current devices, including wristbands and smartphones, and their underlying methodologies.
• Examination of studies claiming accuracy and assessment of their testing procedures and validation standards.

Main Results:

• Despite significant research and device development, there is a lack of compelling evidence that PWA and PAT significantly enhance BP measurement accuracy beyond calibration with cuff BP or demographic data.
• Many studies claiming high accuracy have employed inadequate testing procedures, raising concerns about reliability.
• The proliferation of publications and regulatory-cleared devices may not fully reflect genuine technological breakthroughs in accuracy.

Conclusions:

• Skepticism is warranted regarding studies on PWA and PAT for cuffless BP measurement, especially those with uncertain validation procedures.
• There is a critical need to establish rigorous validation standards for cuffless BP devices that require individual calibration.
• Future research should prioritize developing cuffless and calibration-free BP measurement methodologies to overcome current limitations.