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Robust blood pressure estimation from finger photoplethysmography using age-dependent linear models

Objective: This work aims to develop an efficient and robust age-dependent multiple linear regression (MLR) model to estimate blood pressure (BP) from a single-source photoplethysmography (PPG) and biometrics, which could be embedded in the microcontroller of pulse oximeters. Approach: Hemodynamic features were extracted from the PPG signal using its waveform, derivatives, and biometrics. Whole-based, feature-based, and fusion models were evaluated and compared for different age groups. Their performance was tested using 1086 subjects with a leave-one-subject-out cross-validation. The improvement by adding biometrics and the long-term calibration effect were investigated in detail. The relative importance of each feature was compared between different age groups and the implication was discussed. Main results: The fusion model achieved the best performance in subjects with well-defined PPG features, whereas the feature-based method was better suited for subjects with damped signals. Adding age significantly improved both systolic BP (SBP) and diastolic BP (DBP) estimation accuracy for older subjects (> 50 years old) with well-defined features, while it only improved diastolic BP accuracy for older subjects with damped signals. For younger subjects (≤ 50 years old), the contribution of age was very small. A simple subtraction of subject-specific calibration factors significantly reduced biometric-related errors, which also improved the linearity of BP estimation. The relative importance analysis of input features suggests that separate models are indeed necessary for different age groups with different signal qualities, especially for DBP estimation in older subjects. Significance: This study shows a reasonable BP estimation accuracy with age-dependent MLR models, which may help to equip current pulse oximeters with additional functionalities.