Journal of International Pharmaceutical Research, ISSN: 1674-0440

Evaluation of hypertension using first derivative features of

photoplethysmography

T. Jayanthi1* and M. Sindhu2

1. Department of Biomedical Engineering, SRM Institute of Science and Technology. 2. Department of Biomedical
Engineering, SRM Institute of Science and Technology.
Correspondence author: T. Jayanthi, e-mail: t.jayanthi@gmail.com
Received: 12-04-2019, Revised: 16-05-2019, Accepted: 14-06-2019, Published online: 17-07-2019

How to cite this article: T. Jayanthi and M. Sindhu (2019) Evaluation of hypertension using first derivative features of
photoplethysmography, Journal of International Pharmaceutical Research 46(4): 93-96

Abstract
The photoplethysmography (PPG) signal is the standard technique to measure blood oxygen saturation and cardiac output,
but the complete diagnostic value of PPG signals is not being used presently in clinical applications. Therefore, we are
proposing a simple algorithm to extract blood flow parameters from the PPG signals and prove that blood vessels are
altered, losing their elasticity in hypertensive people. Hypertension is a serious medical condition where the force of blood
pumping through the arteries is strong as compared to the normal force. Hypertension is defined as blood pressure above
140/90mmHg and is considered to be severe if it exceeds 180/120mmHg. Blood pressure can be measured using various
methods like auscultatory method and palpatory method. The manual method of blood pressure measurements based on a
calibrated sphygmomanometer will be accurate only if performed precisely. A PPG sensor shows us the vascular condition
of a person by allowing us to calculate blood flow parameters like systolic amplitude, pulse interval, augmentation index
and stiffness index. Our study population includes 25 normal and 25 known hypertensive subjects. Parameters from PPG
signal like systolic amplitude, pulse interval, and stiffness index was calculated directly. After taking first derivative of the
signal features like i). Crest Time (CT), ii). Peak to peak time (ΔT) and iii). Stiffness index was also calculated. The
parameters were statistically analyzed to prove that there is vascular wall health deterioration in prolonged hypertensive
subjects.
Keywords: Hypertension, First Derivative, PPG, Systolic Amplitude, Diastolic Amplitude, Crest Time, Stiffness Index.

fingertip without the need for cuff. The PPG collected

Introduction
The most important vital signs of the body is blood
pressure besides heart rate, respiratory rate, and body
temperature. The risk of hypertension is slowly
extending even to younger adult population from
older population.[1]
Hypertension is a serious medical condition
wherein the force of blood pumping through the
arteries is strong as compared to the normal force.
Hypertension is defined as blood pressure above
140/90mmHg and is considered to be severe if it
exceeds 180/120mmHg.
When the blood pressure is high, an extra strain is
applied to the arteries leading to a loss in the elasticity
of vessel wall. Having high blood pressure for a short
duration is normal, but if it stays high for a long
duration of time, it can lead to several health issues
like heart attacks, kidney diseases or also dementia.
Much of the clinically used blood pressure measuring
devices require inflating and deflating the cuff for
determining the blood pressure values. This technique
requires skilled medical practitioners for the
measurement to be accurate and consistent.[2]
Photoplethysmogram (PPG) is a simple and non-
invasive method that can be carried out using a
Journal of International Pharmaceutical Research, ISSN: 1674-0440
from the fingertip can potentially be utilized to detect
the extent of damage on the blood vessel caused by
prolonged hypertension.
The recent advances in wearable sensor
technology allows the PPG to measured continuously
and the data can be stored and retrieved easily. The
same can be utilized for evaluating the condition of
the blood vessel. [3,4] The PPG waveform as shown
in figure 1 consists of the features like upstroke
pressure, peak systole, decreasing pressure during
systole, dicrotic notch. Researchers have used these
features for assessing the blood vessel wall health and
its dependence on age. [5]
Thus this work aims to diagnose hypertension
using the features extracted from PPG and its first
derivative. The other alternative methods based on
pulse transmit time is a statistical derivation of
formulae based on the origin of population considered.
[6, 7] Hence the aim of our work is to propose a direct
continuous method for evaluation of hypertension
using PPG.
93

Figure-1: PPG Signal Waveform obtained from Easy
Pulse Sensor
Materials and Method
Our study population comprised of 50 (25 normal
and 25 hypertensive subjects) volunteers aged
between 20 and 81 years. In this study, data from
subjects was collected with the verbal consent of the
volunteers, and a simple structured questionnaire was
used to obtain the following information:
• Demographic characteristics such as gender,
age, and height
• Lifestyle-related factors such as tobacco and
alcohol consumption
• The health status of the individual and any
history related to cardiovascular disease,
stroke, hypertension, and diabetes.
The hardware components which are used for
acquiring the PPG waveform are the Easy Pulse
Version.1 and the Arduino Uno board. The subjects
were made comfortable in a sitting position and were
asked to place their finger on the sensor for recording
their PPG signal (figure.2). They were also asked to
stay still during the procedure to avoid motion
artifacts. The signal was recorded for 30 seconds.
Immediately after recording their PPG signal, each
subject’s systolic and diastolic blood pressure were
measured using the automatic BP machine Omron
Hem 7112.
Hardware
The PPG sensor is a device which uses an infrared
light emitting diode (LED) and a photodetector to
measure blood volumes changes of an organ. The
sensor used in this work is Easy Pulse Sensor
compatible with Arduino. The change in blood
volume occurs when there is a pressure pulse arriving
at the organ. The infrared diode (LED) illuminates the
Journal of International Pharmaceutical Research, ISSN: 1674-0440
skin and the light transmitted or reflected is measured
by the photodiode. Arduino is an open-source
electronics platform based on easy-to-use hardware
and software. Arduino boards can be used with a wide
variety of sensors. The open-source Arduino Software
makes it easy to write code and upload it to the board.
The sensor output is read by the Arduino
board, which then transfers the data to the PC through
a USB interface. The Arduino data sampling rate is 18
ms. An Arduino code is written using processing
programming language to display the received PPG
signal on the Arduino serial plotter. Plx-Daq is used to
save the PPG signal obtained from the Arduino
software to make it easy to interface the signal with
Matlab.
Figure-2: Easy Pulse Sensor-Acquiring signal
Ppg Acquisition and Feature Extraction
The PPG device consists of an infrared light
source, a photodiode with wavelength around 900nm
and a phototransistor. The light source illuminates the
skin and a photodetector to measure the small
variations in light intensity associated with changes in
the blood vessels volume. The increase in blood
volume indicates a decrease in light intensity and vice
versa. The PPG signal is affected by various noises in
the patient’s environment, such as the patient
movement which affects the sensor at the fingertip.
The patient movement is usually filtered using
moving average filter [11]. Hence, a moving average
filter has been implemented in MATLAB to filter out
the PPG signals by taking into consideration that if
the order of the filter increases, the quality of the
signal can deteriorate.
The features derived from PPG:
a). Systolic amplitude: It is an indicator of the
pulsatile changes in blood volume caused by arterial
blood flow around the measurement site
b). Pulse interval: Pulse interval is the distance
between the beginning and the end of the PPG
waveform (ΔT).
c). Stiffness index: The stiffness index is one of
94
the parameter for accessing the health of blood vessels. the extensibility is lost the crest time in hypertensive
The forward going pressure wave from the left subjects is lesser than in normal subjects. The stiffness
ventricle of the heart contributes to systolic pressure index values are also higher in the hypertensive
waveform of the PPG signal. subjects.
The contribution from the smaller aorta causes
the diastolic pressure waveform transmitted along the Table-1: PPG features for normal and hypertensive
aorta to small arteries in the lower body, from where subjects
they are then reflected along the aorta as a reflected Normal Hypertensi-
wave. Waveform Parameter subjects ve subjects
The time difference between the systolic and (n=25) (n=25)
diastolic peaks is defined as transit time and it is Mean ± Std Mean ± Std
related to the transit time of pressure waves from the dev dev
root of subclavian artery to site of reflection and back PPG ∆T (ms) 898.4±462 270.8±4
to the subclavian artery. ∆T1 (ms) 553.6±128 479.2±19
An increase in the artery stiffness, reduces the Stiffness Index 0.29704 0.352308±
time interval between the peaks. This artery length is 0.12
assumed to be proportional to the subject height (h). First ∆T (ms) 2409.6±328 2085.2±47
The Stiffness Index (SI) of the large artery is defined Derivative 0.20
as [3] Stiffness Index 0.06589±0. 0.078434±
001 0.01
S= h/∆T
Crest Time 1617.6±59 1156.8±26
First Derivative Features (ms) 0.02

After obtaining the first derivative, the following Conclusion

features are calculated.[8, 9, 10]
a) Crest Time (CT): The time interval between
the feet of the waveform to the time taken to achieve
the peal value.
b) Peak to peak time (ΔT): The time interval
between the peaks. Using the ΔT and height of the
pulse the stiffness index is also calculated.
Photoplethysmography has the advantage of being
a low cost, simple and portable technology. In this
work features of the PPG like ∆T, ∆T1, stiffness index,
peak to peak time (∆T), and the crest time are used to
evaluate the condition of blood vessels in subjects
with hypertension. The parameters were statistically
analyzed to prove that there is vascular wall health
deterioration in prolonged hypertensive subjects. PPG
sensor using to calculate the parameter of normal
subjects and hypertensive subjects mean and stranded
deviation. The extracted features after comparison
between normal and the hypertensive subjects show
that the blood vessel wall is losing its ability to
maintain the pulsatile flow.

Figure-3: First Derivative PPG waveform and its
features
Results
The result obtained is as shown in table.1. The
values of ∆T in both PPG and its first derivative are
lesser in hypertensive subjects than in normal subjects.
This indicates that the vessel wall has lost its elasticity
and hence the pulsatile flow is not maintained. Since
References
1. Tadvi, A.Y. and Bandi, J. R. (2017). An epidemiological
cross-sectional study to assess the level of stress and its
association with hypertension in young adult population of
age group 20 to 40 years in an urban slum of Mumbai,
Maharashtra, India. International Journal of Community
Medicine and Public Health, 4(2): 348-351.
2. Netea, R. T., Lenders, J. W. M., Smits, P. and Thien, T.
(1999). Arm position is important for blood pressure
measurement. Journal of human hypertension, 13(2):
105-109.
3. Nitzan, M., Babchenko, A., Khanokh, B. and Landau, D.
(1998). The variability of the photoplethysmographic
signal-a potential method for the evaluation of the
autonomic nervous system. Physiological
measurement, 19(1): 93-102.
4. Laurent, C., Jönsson, B., Vegfors, M. and Lindberg, L. G.
(2005). Non-invasive measurement of systolic blood
pressure on the arm utilising photoplethysmography:
development of the methodology. Medical and Biological
Engineering and Computing, 43(1): 131-135.

Journal of International Pharmaceutical Research, ISSN: 1674-0440 95

5. Emerick, D.R. (2002). An evaluation of non-invasive
blood pressure (NIBP) monitoring on the wrist:
comparison with upper arm NIBP
measurement. Anaesthesia and intensive care, 30(1): 43-
47.
6. Lass, J., Meigas, I. C., Karai, D., Kattai, R., Kaik, J. and
Rossmann, M. (2004). Continuous blood pressure
monitoring during exercise using pulse wave transit time
measurement. 26th Annual International Conference of the
IEEE Engineering in Medicine and Biology Society, 1:
2239-2242.
7. Nitzan, M., Khanokh, B. and Slovik, Y. (2001). The
difference in pulse transit time to the toe and finger
measured by photoplethysmography. Physiological
measurement, 23(1): 85-93.
8. Takazawa, K., Tanaka, N., Fujita, M., Matsuoka, O., Saiki,
T., Aikawa, M. and Ibukiyama, C. (1998). Assessment of
vasoactive agents and vascular aging by the second
derivative of photoplethysmogram
waveform. Hypertension, 32(2): 365-370.
9. Jang, D.G., Park, S.H. and Hahn, M. (2014). Framework
for automatic delineation of second derivative of
Photoplethysmogram: A knowledge-based approach,”
Journal of Medical and Biological Engineering, 34(6):
547-553.
10. Jeong, I. and Finkelstein, J. (2013). Applicability of the
second derivative photoplethysmogram for non-invasive
blood pressure estimation during exercise. Pan American
Health Care Exchanges (PAHCE): 1-5.

Journal of International Pharmaceutical Research, ISSN: 1674-0440 96