HYPE: Predicting Blood Pressure from Photoplethysmograms in a Hypertensive Population

The state of the art for monitoring hypertension relies on measuring blood pressure (BP) using uncomfortable cuff-based devices. Hence, for increased adherence in monitoring, a better way of measuring BP is needed. That could be achieved through comfortable wearables that contain photoplethysmography (PPG) sensors. There have been several studies showing the possibility of statistically estimating systolic and diastolic BP (SBP/DBP) from PPG signals. However, they are either based on measurements of healthy subjects or on patients on intensive care units (ICUs). Thus, there is a lack of studies with patients out of the normal range of BP and with daily life monitoring out of the ICUs. To address this, we created a dataset (HYPE) composed of data from hypertensive subjects that executed a stress test and had 24-hours monitoring. We then trained and compared machine learning (ML) models to predict BP. We evaluated handcrafted feature extraction approaches vs image representation ones and compared different ML algorithms for both. Moreover, in order to evaluate the models in a different scenario, we used an openly available set from a stress test with healthy subjects (EVAL). The best results for our HYPE dataset were in the stress test and had a mean absolute error (MAE) in mmHg of 8.79 (SD 3.17) for SBP and 6.37 (SD 2.62) for DBP; for our EVAL dataset it was 14.74 (SD 4.06) and 7.12 (SD 2.32) respectively. Although having tested a range of signal processing and ML techniques, we were not able to reproduce the small error ranges claimed in the literature. The mixed results suggest a need for more comparative studies with subjects out of the intensive care and across all ranges of blood pressure. Until then, the clinical relevance of PPG-based predictions in daily life should remain an open question.