Pulse Arrival Velocity for Tracking Exercise-Induced Blood Pressure Changes in Children and Adolescents

Area of Science:

• Pediatric cardiology
• Biomedical engineering
• Cardiovascular physiology

Background:

• Cuffless blood pressure (BP) monitoring in pediatric populations remains challenging.
• Pulse arrival time (PAT) based technologies are confounded by varying pulse propagation distances (L) during childhood growth.
• Pulse arrival velocity (PAV = L/PAT) is a novel metric proposed to address this variability.

Purpose of the Study:

• To investigate the potential of PAV for tracking exercise-induced BP changes in children and adolescents.
• To compare the performance of PAV against PAT in estimating BP variations during physical exertion.
• To evaluate whether PAV meets established BP monitoring validation standards.

Main Methods:

• 38 pediatric participants (mean age 12.3 years) underwent Bruce protocol exercise testing.
• Regression and leave-one-out cross-validation analyses were employed.
• Performance of PAT and PAV models were assessed for estimating exercise-induced systolic and diastolic BP changes.

Main Results:

• PAV-based models estimated systolic BP increases within AAMI criteria (0.0±7.6 mmHg, r=0.87), outperforming PAT models (0.0±9.1 mmHg).
• PAV also estimated diastolic BP changes within AAMI criteria (0.0±7.0 mmHg, r=0.51).
• Model performance was not improved by including heart rate, age, sex, or height.

Conclusions:

• PAV demonstrates significant potential for accurate systolic BP tracking during exercise in pediatric populations.
• By incorporating pulse propagation length, PAV may offer superior performance compared to PAT in cuffless BP monitoring devices.
• Further validation is warranted, particularly for diastolic BP estimation.