Biomedical Signal Processing and Control 64 (2021) 102328

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Biomedical Signal Processing and Control

journal homepage: www.elsevier.com/locate/bspc

A Blood Pressure Prediction Method Based on Imaging

Photoplethysmography in combination with Machine Learning
Meng Rong , Kaiyang Li *
Department of Electronic Science and Technology, School of Physics and Technology, Wuhan University, China

A R T I C L E I N F O A B S T R A C T

Keywords: This paper proposes a non-contact blood pressure implement (NCBP) system based on imaging photo­
Non-contact measurement plethysmography (IPPG) The system collects facial videos through a webcam under ambient light, and extracts
Blood pressure (BP) pulse wave signals from the videos by means of IPPG technology. From the signals (also called IPPG signals), we
Imaging photolethysmography (IPPG)
extracted 26 features for estimating blood pressure (BP), and trained them through four machine learning al­
Webcam-based
Machine learning (ML)
gorithms. Finally, we selected the most accurate model for blood pressure prediction. By experimenting on 191
volunteers and comparing four models, support vector regression (SVR) is the best model for predicting blood
pressure. The results of SVR are that the standard deviation (STD) and mean absolute error (MAE) of systolic
blood pressure (SBP) are 3.35 mmHg, 9.97 mmHg, and those of diastolic blood pressure (DBP) are 2.58 mmHg,
7.59 mmHg respectively. We conclude that through our proposed system based on IPPG technology, blood
pressure can be accurately predicted in a non-contact way. In addition, this paper proposes two new methods, the
region of interest (ROI) selection method based on colormaps and robust peak extraction method, which solve
the key steps in IPPG technology. Finally, we discussed the influence of light intensity on the experiment, and
simplified the NCBP experimental device. The system has the potential of replacing the traditional cuff-based
sphygmomanometers, and has guiding significance to the future development of blood pressure measurement
devices.

1. Introduction person to accurately measure blood pressure. The electronic sphygmo­

Cardiovascular disease (CVD) has become the main causes that
contribute to a lower life expectancy in people [1]. But many CVD pa­
tients are not aware of their own diseases. Hypertension is the most
common cardiovascular disease, and the rise of blood pressure is the
main cause of cardiovascular disease [2]. Treatment for high blood
pressure can reduce the incidence of CVD [1], so blood pressure moni­
toring is a very important thing.
Modern blood pressure measuring devices are divided into mercury
and electronic sphygmomanometers. The mercury sphygmomanometer
consists of a manometer, an inflatable bladder in a cuff, and an inflation-
deflation device [3]. Mercury sphygmomanometer has high accuracy in
measuring blood pressure [4], but the device requires an experienced
manometer is wildly used in home, and measures blood pressure by
binding a cuff to patient’s arm. But the electronic sphygmomanometer
has many limitations including high requirements for sensor posi­
tioning, poor measurement comfort and difficulty in achieving contin­
uous monitoring.
For the past few years, many scholars have made exciting progress in
the field of non-invasive blood pressure measurement (NIBP). In this
field, one of the main methods is to measure blood pressure by photo­
plethysmography (PPG). The PPG method can obtain the pulse transit
time (PTT) by observing the two waveforms from the signals (the
combination of PPG signal and electrocardiograph (ECG) signal or the
PPG signal of two different parts). Studies have reported that blood
pressure has a certain correlation with pulse transit time [5,6], so that

Abbreviations: NCBP, non-contact blood pressure; IPPG, imaging photoplethysmography; BP, blood pressure; SVR, support vector regression; STD, standard
deviation; MAE, mean absolute error; SBP, systolic blood pressure; DBP, diastolic blood pressure; ROI, region of interest; ML, machine learning; CVD, cardiovascular
disease; NIBP, non-invasive blood pressure; PPG, photoplethysmography; PTT, pulse transit time; ECG, electrocardiograph; ANN, artificial neural network; FPS,
frames per second; RGB, red green and blue; HR, heart rate; MLR, multiple linear regression; RF, random forest; MLP, multi-layer perceptron; ME, mean bias; BHS,
British Hypertension Society; AAMI, Advancement of Medical Instrumentation.
* Corresponding author.
E-mail addresses: rm0233@163.com (M. Rong), lky@whu.edu.cn (K. Li).

https://doi.org/10.1016/j.bspc.2020.102328
Received 25 May 2020; Received in revised form 17 October 2020; Accepted 4 November 2020
Available online 21 November 2020
1746-8094/© 2020 Elsevier Ltd. All rights reserved.
M. Rong and K. Li
blood pressure can be estimated based on PTT. Joonnyong Lee et al. [7]
analyzed 2309 surgical patients to assess the correlation between PTT
and BP. Correlation analysis shows that the average correlation between
PTT and BP extracted from the intersection tangent point of PPG is the
highest. While estimating blood pressure through PTT, Vicent et al. [8]
introduced an artificial neural network method for analysis and ach­
ieved good results. By comparing the PPG signals obtained from the
wrist and fingers, Satu et al. [9] proved that the PPG signal at the wrist
can also be used to calculate PTT and then to estimate blood pressure.
Robert C et al. [10] analyzed the PPG signal (from fingers, toes and ears)
and ECG signal to obtain the PTT between different parts. The result
shows that the best correlation by a substantial extent was between toe
PTT via the PPG foot and systolic BP.
In the NIBP field, another analysis method is to establish a blood
pressure prediction model through PPG signal features and other related
features. Various studies [11–13] extracted dozens or hundreds of fea­
tures from PPG and ECG waveforms and personal information (such as
age, weight, etc.), and extracted features that are highly related to blood
pressure. The blood pressure prediction model is established through
these high correlation features, and got some good results. Although the
field of NIBP has made great progress, most of the work is to collect PPG
signals by directly or indirectly contacting the human body through
sensors. This will cause measurement inconvenience to a certain extent.
Recently, some scholars have studied on non-contact blood pressure
measurement (NCBP). The NCBP is to detect the physiological signals
without touching the human body through camera equipment. This
method can realize blood pressure estimation more conveniently, which
is a promising direction. Some studies [14–16] took videos from two
parts of body, and predicted blood pressure by PTT. However, their
methods are complicated. Firstly, in their works, the acquisition of PTT
requires photographing from multiple parts of human body, this will
cause a certain degree of inconvenience when shooting. Secondly, the
devices used in these methods are expensive and need external light
sources, which lead to poor practicality. Secerbegovic et al. [17]
established the model between PTT and blood pressure through simple
linear regression model. The error of this method did not meet the in­
ternational standards. Hong et al. [18] collected facial videos through a
smartphone camera. They extracted features related to blood pressure
by transdermal optical imaging technology, and used artificial neural
network (ANN) model for training and predicting. They did a lot of
experiments to prove the correlation between blood flow in the facial
vasculature and blood pressure. However, the experimental data of their
work were limited to the normotensive people, and only ANN model was
used for training and predicting. In addition, the system still required
external light sources.
Based on the above background, this paper proposes a non-contact
blood pressure measurement method by IPPG technology. This system
used a webcam to capture facial videos under ambient light without
extra light sources. IPPG signals extracted from the facial videos based
on imaging photoplethysmography technology. Anand et al. [19] veri­
fied that using photoplethysmography of other parts from human body
can accurately estimate blood pressure without brachial cuff for cali­
brating. The features related to blood pressure were extracted from IPPG
signal, and then several machine learning methods were used to build
the blood pressure prediction model. Our main contributions includes:
1) This paper uses a non-contact method to measure blood pressure.
Compared with NIBP, NCBP is more convenient in predicting blood
pressure because it does not need to contact the human body. At the
same time, compared with the current studies in the NCBP field, by
comparing various machine learning methods, we found the most
suitable model for blood pressure prediction under the condition of
small sample size. The analysis results are more convincing than
using a single algorithm.
2) We simplified the experimental equipment of NCBP. Through ex­
periments with different light intensity, we proved that under the
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Biomedical Signal Processing and Control 64 (2021) 102328
condition of sufficient light, NCBP measurement does not need
additional light source. Only one camera is needed to achieve blood
pressure prediction.
3) We proposed a method for selecting region of interest (ROI) based on
facial colormaps and human appearance features. This method
observe the distribution of light intensity on faces of volunteers by
means of colormaps. At the same time, combine the physical char­
acteristics of both man and women to find the most suitable area for
analysis.
4) A new peak detection algorithm was proposed. This new method can
accurately identify the peak and valley points, even if the waveform
has noises.
The rest of this paper is structured as follows. Section 2 is an over­
view of the whole system. Section 3 describes the IPPG signal processing
in detail. Section 4 shows the machine learning module. Section 5 is the
result of our works. Section 6 and Section 7 are discussion and conclu­
sion respectively.
2. System overview
This section provides an overview of the system from three aspects.
One is the description of the experimental equipment. The second is the
detailed information of the experimental data. The third is the flow chart
of the entire system.
2.1. Experimental device
The system uses Logitech C922 PRO webcam for video capture. The
webcam can reach a frame rate of 30FPS (frames per second) at 1080p
and 60 FPS at 720p. In our experiments, the frame rate of facial videos is
30FPS and the video resolution is 1280*720. Before taking videos, the
volunteers rested for five minutes to ensure a stable physiological state.
After that, each volunteer took a 40 seconds video through the webcam.
The volunteers were told to keep their heads stationary to ensure the
stability of IPPG signals. The video acquisition process was performed
under ambient light without auxiliary light sources. At the same time,
we collected blood pressure and heart rate through a sphygmomanom­
eter (OMRON HEM-1020, which complies with American Medical De­
vice Promotion Association standard) for comparison analysis. The
measurement system and device is shown in Fig. 1.
2.2. Experimental database
In our experiments, a total of 191 volunteers were collected in School
of Physical Science and Technology of Wuhan University (Wuhan,
China) and Wuhan Haobo Technology Co., Ltd. (Wuhan, China, a
Fig. 1. Measurement system and device. Collect video through a webcam and
transfer it to a computer. Sphygmomanometer simultaneously records blood
pressure for comparison.
M. Rong and K. Li
company focus on medical devices for measuring physiological param­
eters), including 141 males and 50 females, aged between 20-61 years.
After screening the data, 189 effective cases (including 17 volunteers
with hypertension and 10 volunteers with hypotension) were selected
for subsequent analysis. The data statistics are shown in Fig. 2. All
volunteers received the instructions for experimental tasks, and asked to
sign an informed consent before testing. It is worth mentioning that our
experimental data include both normal and abnormal blood pressure
groups.
2.3. System flow
The entire system includes the following steps:
1) Acquisition of facial videos through a webcam.
2) Obtain three RGB (red green and blue) channel signals from the
videos.
3) Filter and extract the peak points and valley points of IPPG signals.
4) Extract features from the clean IPPG signals.
5) Establish blood pressure prediction models through four machine
learning algorithms.
The system flow chart is shown in Fig. 3.
3. IPPG signal processing
For IPPG signal processing, it mainly includes three steps. Firstly,
extract the initial IPPG signal from the facial video. Secondly, filter the
IPPG signal to obtain the clean signal. Thirdly, the peak point detection
of IPPG signal.
3.1. Extraction of IPPG signal
3.1.1. IPPG signal extraction
IPPG technology is developed based on Lambert-Beer law and light
scattering theory. Lambert-Beer law describes the attenuation charac­
teristics of light passing through a homogeneous medium with absorp­
tion properties [apped1]. According to the law, when the
monochromatic light with wavelength λ shines on a certain solution
substance, the relationship between the transmitted light intensity I and
the emitted light intensity I0 is as follows:
I = I0 e− ε(λ)CL
(1)
Fig. 2. Blood pressure distribution histograms. (a) is the data distribution of SBP, where the minimum value is 92 and the maximum value is 148, (b) is the data
distribution of DBP, where the minimum value is 51 and the maximum value is 102.
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Biomedical Signal Processing and Control 64 (2021) 102328
Fig. 3. System block diagram. The workflow contains all the steps of
the system.
Where, ε(λ) is the absorption coefficient, C is the medium concentration,
and L is the travel distance of light in the material. When light irradiates
the skin tissue, with the periodic change of blood volume in the blood
vessel, the light intensity will also change accordingly, and the reflected
light intensity contains a lot of physiological information of human
body.
IPPG signal is obtained by averaging the pixel values of ROI region of
each frame according to the Eq. 2.
∑
M ∑
N
sippg (i, j, t)
(2)
i=1 j=1
Sippg (t) =
M∗N
Where t represents frame sequence, M and N are the height and width of
region of ROI.
After getting the facial videos, these videos were decomposed into
frame pictures, and then three components of RGB color channels of
each frame were extracted form the videos. Finally, three channel IPPG
signals are obtained by the above formula as shown in Fig. 4.
As the optical absorption property of hemoglobin reach the peak at
500nm-600 nm, which corresponds to the green channel signal [20],
[21]. Besides, in the period between systolic and diastolic, the signal of
green channel changes most obviously, so the green channel signal was
selected as IPPG signal in this paper. It is worth mentioned that our
method only needs to shoot one region of human body.
3.1.2. Region of interest selection
Generally, we will use the whole facial region as ROI, but this is
worth discussing. The choice of ROI will affect the quality of IPPG
M. Rong and K. Li
Fig. 4. IPPG signal extraction. Extract the red, green and blue signals from the face video separately. Because of the optical absorption property of hemoglobin reach
the peak at 500 nm–600 nm, which corresponds to the green channel signal. We choose the green channel signal as IPPG signal.
signals because of some factors such as facial motion artifacts (e.g.,
blinking, wrinkling nose, etc.), light intensity distribution, and human
appearance features. In our experiments, volunteers were required to
keep their heads stable. Thus, we discussed the problem of ROI selection
from the perspective of facial colormaps and human appearance
features.
IPPG signal is composed of the light intensity that transmitted
through human face. Facial light intensity is actually the size of pixel
values. The pixel values of the location are also large where the light
intensity is strong, and the intensity of IPPG signal is strong. We selected
six volunteers to observe the distribution of light intensity on their faces
by means of colormaps.
From Fig. 5, it can be observed that the light intensity distribution of
forehead and cheek areas are more strong than other areas (shown as the
color of the facial area is more inclined to red, purple and white),
indicating that the IPPG signals amplitude obtained from these regions
are higher. In addition, women’s hair frequently covers their forehead
(e.g., Fig. 5(C)). Although the light intensity distribution of forehead
area is strong, this area is not selected as ROI in this paper.
Finally, the ROI was finally selected as cheek and nose areas, as
shown by the red rectangle in Fig. 4.
3.2. Signal filtering
For non-contact blood pressure measurement, there are many types
of noises in IPPG signals, such as the noises caused by slight head
shaking, the power frequency noise produced by fluorescent lamps and
baseline drift, so we need to filter the IPPG signals. In this paper, wavelet
transform and band-pass filtering were used to filter the signals.
Wavelet transform method has outstanding time and frequency
domain properties. Besides, the method of wavelet transform will not
destroy the signals we need while eliminating noises. Discrete wavelet
transform of one-dimensional signal Sippg (t) is:
j
∫ +∞
(3)
−
Fψ s(x, y) = x0 2 Sippg (t)ψ (x−0 j t − y0 k)dt j, k ∈ Z
− ∞
Where, x and y are scale factor and translation factor respectively, j and
k are the parameters for discretizing x and y. In actual application, x0 =
2, y0 = 1, the above equation becomes a binary wavelet:
(4)
j
ψ j,k (t) = 2− 2 ψ (2− j t − k) j, k ∈ Z
Mallat algorithm is a kind of wavelet transform algorithm, which can
binary decompose and reconstruct signal quickly. The algorithm filters
signal through a low pass filter and a high pass filter, and then the output
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Biomedical Signal Processing and Control 64 (2021) 102328
signal is down-sampled. After sampling, the signal is decomposed into
two components: one is the low-pass filter component that approximate
to the original signal and the other is the high-pass filter component with
details of the original signal. Generally speaking, the baseline wander
phenomenon occurs in the low frequency region [22]. Besides, the frame
rate of video capture is 30FPS and the typical respiration rate is between
0.14 and 0.75 Hz [23], corresponding to the fifth layer of wavelet
decomposition. Based on the above analysis, we select Sym6 mother
wavelet to decompose IPPG signal in five layers, and take the fifth layer
as the baseline drift signal. We subtracted the fifth layer low-frequency
component of wavelet signals from the original IPPG signal, so as to
achieve the purpose of eliminating the baseline drift phenomenon.
Further, it was verified that the frequency range of heart rate is 0.7
Hz–4 Hz [24]. A Butterworth band-pass filter (0.7 Hz–4 Hz) was adopted
to remove the noise caused by involuntary shaking and fluorescent
lamps power frequency. This method can make the whole waveform
smoother, so as to facilitate the extraction of feature points. Besides, the
frequency response curve of Butterworth filter in the pass band is flat as
far as possible without fluctuation. The useful information in IPPG signal
can be retained to the greatest extent.
Finally, we got the clean IPPG signal. The filtering process of original
IPPG signal is shown in Fig. 6.
3.3. Peak point extraction
To distinguish the period of IPPG signal, the most important thing is
to find out the peak point of the signal. In this paper, we proposed a new
algorithm to distinguish pulse wave period. The algorithm diagram is
shown in Fig. 7.
The steps to obtain the peak point are as follows:
1) Suppose the IPPG signal to SIippg . First, the signal was normalized,
and then set a threshold τ near the midline of the signal. The value
that more than and equal to τ is set to 1, less than τ is set to 0, then we
get a new signal SIIippg .
⎧
⎨ 0, SIippg (t) < τ
II
Sippg (t) = , t ∈ (0, 1, ⋯, Nframe ) (5)
⎩ 1, SIippg (t) ≥ τ
Where Nframe is the total number of frames of a facial video.
2) Perform a point-by-point difference method on SIIippg , subtract the
previous point from the next point, and then form a new scattered
signal SIII
ippg , consisting of 1 and − 1.
M. Rong and K. Li Biomedical Signal Processing and Control 64 (2021) 102328

Fig. 5. Colormaps of facial area. The red to white area indicates that the light intensity distribution in this area is relatively strong. The strength of the IPPG signal
obtained from this area is also relatively strong.

5
M. Rong and K. Li Biomedical Signal Processing and Control 64 (2021) 102328

Similarly, the valley points can be obtained by setting SIII

ippg (t) = 1 to
divide the signal. This new algorithm can accurately identify the peak
and valley points of IPPG signals, even if the waveform has a lot of noise.
More description in the Supplementary Material I.

4. Machine learning module

The machine learning module includes three steps: feature extrac­

tion, feature selection and feature training. Each step is described in
detail below.

4.1. Feature extraction

Feature extraction is a key step of the whole algorithm, which

directly affects the accuracy of machine learning models. In this paper,
26 features were extracted from the time-domain (e.g., height, time,
area, etc.), energy-domain and human physiological parameters.

4.1.1. Time domain features

Fig. 6. IPPG signal filtering. (a) original signal, (b) signal after removing
baseline drift, (c) band-pass filtered signal.
By extracting the time-domain features, a total of 22 features were
obtained, including the features of wave height, time, area and slope.
The schematic diagram of feature division is shown in Fig. 8. The
numbers and definitions of these features are given in Table 1. The
calculation formula of time domain characteristics is shown in Supple­
mentary Material II.
4.1.2. Kaiser-Teager energy (KTE)
Kaiser-Teager energy operator is a signal analysis method [25]. It can
trace the instantaneous energy of signal by extracting envelope from
three adjacent sampling points, which is commonly used in speech and
signal processing. In this paper, KTE energy operator was applied for
obtaining the energy of IPPG signal at frame level. The KTE value is
calculated as follows:
( )2 ( )
KTE I I I
Sippg (t) = Sippg (t) − Sippg (t − 1) ∗ Sippg (t + 1), t ∈ 0, 1, ⋯, Nframe − 1
(8)

4.1.3. K value
Yang et al. have confirmed that there is a significant correlation
between K value and arterial blood pressure [26], so K value was used as
one of the features in this paper. The K value is calculated as follows:
oo’ I
Sippg − Sippg (to )
SKippg = I I
(9)
Sippg (to ) − Sippg (to’ )

In which
Fig. 7. Peak point extraction. The colored dots represent the peak points found
by the algorithm. 1 ∑
to ’
oo’
Sippg = SI (t) (10)
⎧ to’ − to t=to ippg
⎨ 1
III II II
Sippg (t) = Sippg (t + 1) − Sippg (t) = 0 , t ∈ (0, 1, ⋯, Nframe − 1) (6) Here o and o’ are the start and end points of each period of IPPG signal.
⎩
− 1

Since SIII
ippg (t) = 0 is unnecessary data, it is not shown in Fig. 7.

3) Corresponds the adjacent 1 or (− 1) to the original signal. The peak

point of each period is within this range. Suppose T = [t1 , t2 , ⋯tn ],
n ∈ (0, 1, ⋯, Nframe − 1). Here T refers to the set of abscissas corre­
sponding to each SIII ippg (t) = − 1. Set the length of T to NT , then all
peak points of IPPG signal can be obtained by the following formula:
MAX
Sippg (i) = max(Sippg (T(i)) : Sippg (T(i + 1))), i ∈ (0, NT − 1) (7)

Where SMAX
ippg represents the maximum points sequence of IPPG signal,
and max() is the sign that find the maximum values.
This is the solution to distinguish the peak points of IPPG signal. Fig. 8. Time-domain features of IPPG signal. From the IPPG waveform, we
obtained 22 features based on the shape of the waveform.

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M. Rong and K. Li Biomedical Signal Processing and Control 64 (2021) 102328

Table 1 The logarithm in this formula is for simplicity.

Feature description. The table shows the number and meaning of all features.
Indicators Number and Short description 4.1.5. Heart rate (HR)
symbol As the most important physiological parameter of human body.
F1: h1 Heart rate has been proved to be correlated with blood pressure in some
F2: (h2+h3)/2 The heights of peak and valley points of signal and literatures [28], [29]. We also took the heart rate as part of the features.
Height
F3: h1- the corresponding combinations Finally, we obtained a total of 26 original features. Statistical
(h2+h3)/2 description of these features is shown in Table 1.
F4: t1
F5: t2
Times of rising and falling branch of waveform and
Time F6: t1+t2 4.2. Feature selection
the corresponding combinations
F7: t1-t2
F8: t1/t2
Feature selection is an important part for machine learning. There
F9: s1
F10: s2 are many invalid features (e.g., collinear features) in original features.
F11: s1+s2 Areas of rising and falling branch of waveform and Redundant features will reduce the generalization ability of the models.
Area
F12: s1/(s1+s2) the corresponding combinations In addition, too many features will make the sample space sparse in the
F13: s2/(s1+s2) case of limited samples. We calculated the correlation between all fea­
F14: s1/s2
F15: p1
tures based on Pearson correlation coefficient, and then removed the
Slope Slopes of rising and falling branch of waveform collinear features. In this paper, the heat map was used to analyze the
F16: p2
F17: r25 correlation between features.
Width at 75%, 50% and 25% peak height between
RBW F18: r50 As can be seen from Fig. 9, the darker the color of the grid, the higher
rising branch and peak point
F19: r75
the degree of the correlation. Obviously, there is a very high correlation
F20: d25
DBW F21: d50
Width at 75%, 50% and 25% peak height between between descending point width features. These collinear features will
falling branch and peak points
F22: d75 reduce the accuracy of the model. We set the threshold of strong cor­
KTE F23 Instantaneous energy of waveform relation to 0.7 to delete features with high correlation. A total of 10
K F24 Pulse waveform characteristic quantity features [F6, F9, F10, F11, F12, F18, F19, F20, F21, F22] were deleted.
EN F25 Periodic energy of waveform
HR F26 Heart rate
Finally, 16 features [F1, F2, F3, F4, F5, F7, F8, F13, F14, F15, F16, F17,
F23, F24, F25, F26] were reserved for machine learning training.

4.1.4. Energy profile of IPPG signal 4.3. Feature training

The energy profile EN [27] is to calculate the energy of each cardiac
cycle. Unlike the instantaneous energy calculated by KTE, EN describes For training pulse wave features, we choose four different regression
the periodic energy. The calculation formula of EN is as follows: models to find the best one for blood pressure prediction. The models
(
to’ (
∑ )2
) selected in this paper are divided into the following:
EN
logSippg = log I
Sippg (t) (11)
t=to 1) Multiple linear regression (MLR). In this method, we establish a
∑n m
model Y m = αm0 + i=1 αi XF (i), where m = {SBP, DBP}, XF are the

Fig. 9. Correlation heat map, 1-26 on the axis represents F1-F26 features. The darker the square, the higher the correlation between the corresponding features, and
the lighter the square, the lower the correlation between the features.

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M. Rong and K. Li Biomedical Signal Processing and Control 64 (2021) 102328

eigenvectors after dimension reduction, and n is the number of ei­ 5. Result

genvectors. Gradient descent method was used to minimize the cost
function between predicted and reference values. It is worth noting For the models verification, this paper used standard deviation
that if there is a high correlation between features, the performance (STD), mean absolute error (MAE), and mean bias (ME) as evaluation
of the model will be reduced. Therefore, the characteristic dimension indicators to verify the accuracy of each model. Besides, the Bland-
reduction should be carried out before training. Altman analysis plot [33] and the scatter plot were used for consis­
2) Support vector regression (SVR). SVR is a supervised machine tency analysis. It should be noted that all the analysis results were based
learning model that has many advantages in dealing with small on the data of the 30% test set, a total of 56 cases.
samples and nonlinear problems. The number of samples and fea­
tures in this experiment is moderate, so we used Gaussian kernel
5.1. Comparison the results of different machine learning models
function in this model. For Gaussian kernel, the hyper-parameters
are C and gamma. Where C is the degree of penalty for the error
Among the indicators in Table 3, STD is used to evaluate the degree
and gamma is coefficient of kernel function. We normalized the
of discreteness of data. The definition of MAE is the absolute sum of
feature vectors, and then the parameters gamma and C in SVR were
differences between predicted values and actual values. This indicator
optimized by means of grid search method [30]. For SBP, the best
can avoid the problem of offsetting errors, and can accurately reflect the
values of C and gamma are 1 and 30 respectively. For DBP, the best
actual prediction errors. The definition of ME is the mean value of sum of
values of C and gamma are 0.5 and 20 respectively.
errors, which is also one of the international indicators for testing
3) Random forest (RF). Random forest is an integrated learning model
accuracy.
based on decision tree [31]. Data sets are randomly and put back
As can be seen from the Table 3, for SBP, the MAE, STD and mean
sampled to generate different data subsets, and the subset was
bias values of MLR model are 7.92 mmHg, 12.05 mmHg and 6.04 mmHg
trained on each sub trainer. The output of the system is a collection of
respectively. Compared with other methods, the prediction results of
forest tree outputs. There are three main hyper-parameters in the RF
MLR are not ideal. The probably reason is that MLR can only model
model, which are the number of trees in the forest (n_estimators) and
linear relationship. The accuracy of RF is similar to that of MLP algo­
the maximum number of features used by a single decision tree
rithm. The accuracy of these two methods is at a moderate level. The
(max_features). The best parameters were found by grid search
MAE, STD and mean bias of SVR model are the smallest for SBP. They
method. See Table 2 for the values.
are 3.35 mmHg, 9.97 mmHg, and 2.1 mmHg. Similarly, for DBP, the
4) Multi-layer perceptron (MLP). BP neural network has strong
prediction results of SVR are also the best among the four models. The
nonlinear mapping ability. In this paper, we created a simple neural
MAE, STD and mean bias values are 2.58 mmHg, 7.59 mmHg and 0.79
network model with two layers (one hidden layer and one output
mmHg respectively.
layer). In this model, several different nonlinear activation functions
Through the above analysis, the SVR model is the most accurate
are tested, and Relu activation function is finally selected. At the
model for blood pressure prediction. On the one hand, non-linear
same time, the other important hyper-parameters are also optimized
mapping is the theoretical basis of SVR method, SVR uses inner prod­
by grid search method. The parameters are shown in Table 2.
uct kernel function to replace the nonlinear mapping to high-
dimensional space. Therefore, SVR model can handle various combi­
These 16 features were then input into four machine learning models
nations of complex relationships other than linear relationship. On the
included MLR, SVR, RF and MLP to generate blood pressure relationship
other hand, SVR is a novel small sample learning method with a solid
models.
theoretical foundation. In essence, it avoids the traditional process from
The data were randomly divided into a train set (70% data) and a
induction to deduction, realizes efficient "transduction reasoning" from
testing set (30% data). We trained the train set by the four machine
training samples to forecast samples, and greatly simplifies the usual
learning models. The accuracy of these models are verified through the
classification and regression problems. Finally, we conclude that the
test set. Each model was trained for 300 iterations and the results of each
SVR model is the most accuracy model for our experimental data.
model were recorded. We took the average of these predictive values as
In the following section, we evaluated the accuracy of our system by
the final results in order to improve the generalization ability of the
comparing the results of SVR model.
models. Finally, the most accurate model for BP estimation was selected.
The implementation of above methods is based on Scikit-learn library
[32]. In this paper, we used standard deviation (STD), mean absolute 5.2. Compared with international standards
error (MAE) and mean bias (ME) as the indexes to evaluate these models.
The results of four machine learning models are shown in Section 5. In Table 4, the analysis results of SVR model were evaluated by the
British Hypertension Society (BHS) [34] standard. The BHS standard is
based on the proportion of the difference between the predicted and
Table 2 actual blood pressure values less than 5, 10, and 15 mmHg, respectively.
Model hyper-parameter values. The table shows the values of the hyper- It can be seen from the table that for SBP, it achieved grade C on the
parameters of the machine learning models.
index of < 5mmhg and grade B on other two indexes < 10mmhg and <
Model Types of BP Hyper-parameters Value

C 1 Table 3
SBP
Gamma 30 Four machine learning model results. It can be seen from the table, the accuracy
SVR
C 0.5 of MLR model is poor for predicting blood pressure, the accuracy of RF is similar
DBP
Gamma 20
to that of MLP algorithm, the MAE and mean bias of SVR model are the smallest.
n_estimators 22
SBP
max_features 5 Model SBP DBP
RF
n_estimators 16
DBP STD MAE Mean STD MAE Mean
max_features 5
(mmHg) (mmHg) Bias (mmHg) (mmHg) Bias
hidden_layer_sizes (12,1)
(mmHg) (mmHg)
SBP activation Relu
solver adma MLR 7.92 12.05 6.04 5.95 8.75 1.58
ANN
hidden_layer_sizes (12,1) SVR 3.35 9.97 2.1 2.58 7.59 0.79
DBP activation Relu RF 6.52 10.41 3.92 6.52 8.65 1.34
solver adma MLP 1.65 10.76 − 3.87 1.65 8.79 − 1.79

8
M. Rong and K. Li Biomedical Signal Processing and Control 64 (2021) 102328

Table 4
Comparison with BHS standard. It can be seen from the table, our experimental
results comply with BHS standards.
<5 mmHg <10 mmHg <15 mmHg

SBP Totals 27 44 53
DBP Totals 31 48 55
This paper
SBP (%) 48.2% 78.6% 94.6%
DBP (%) 55.4% 85.7% 98.2%
Grade A (%) 60% 85% 95%
BHS Grade B (%) 50% 75% 90%
Grade C (%) 40% 76% 85%

15mmhg. For DBP, it achieved grade B on the index of <5 mmHg and
grade A on the two indexes of <15 mmHg and <10 mmHg. The proposed
system accuracy is within the allowable range of the BHS standard.
Table 5 shows a comparison between the results of SVR model and
the Advancement of Medical Instrumentation (AAMI) [35] standard.
The standard requires that the ME and the STD for predicting blood
pressure values be less than 5 mmHg and 8 mmHg respectively. It can be
seen from the table that the ME and the STD of SBP are 2.1 mmHg and
3.35 mmHg respectively, the ME and the STD of DBP are 0.79 mmHg
and 2.58 mmHg respectively. For SBP and DBP, these two indicators
meet the requirements of AAMI standard. The results show that the
proposed system accuracy is completely in conformity with the AAMI
standard.

5.3. Analysis of blood pressure prediction scatter plot and Bland-Altman

plot

Fig. 10 shows the regression scatter plot of predicted values and

actual values blood pressure. As can be seen from Fig. 10, the predicted
blood pressure values are highly correlated with the reference blood
pressure values. The correlation coefficient between predicted and
reference values of SBP is 0.7, and the correlation coefficient between
predicted and reference values of DBP is 0.76. This result indicates that
there is a significant correlation between the two methods.
Fig. 11 shows a Bland-Altman analysis plot of predicted and refer­
ence blood pressure values. For SBP, 98.8% of the points fell within the
95% consistency interval. For DBP, 98.2% of the points fell within the
95% consensus interval. The results indicate that the system has strong
consistency with the reference values. This result shows that our method
has good consistency with the method of sphygmomanometer and can
be used interchangeably to a certain extent.
5.4. Different light intensity
For NCBP, the intensity of light is a very important factor. Therefore,
we used experiments to verify whether changes in light intensity will
affect the measurement results. In the experiment, we set three different
levels of light intensity. Three kinds of light intensity are 600 lx, 250 lx
and 20 lx. Where 600 lx is the brightness achieved by using additional
light source. The light intensity of 250 lx is the indoor ambient light, no
external light source. The light intensity of 20 lx is obtained by an
external light source in a dark room. Renderings of different light in­
tensities are shown in Fig. 12. A total of 20 healthy people participated
in the experiment.
Table 6 shows the error information between the predicted BP value
Table 5
Comparison with AAMI standard. It can be seen from the table, our experimental
results comply with AAMI standards.
ME (mmHg) STD (mmHg)
SBP 2.1 3.35
This paper
DBP 0.79 2.58
AAMI SBP and DBP <5 <8
Fig. 10. Regression plot for blood pressure. (a) For SBP, the correlation be­
tween the predicted value and the actual value is 0.7 (b) For DBP, the corre­
lation between the predicted value and the actual value is 0.76.
and the reference BP value under different light intensity. It can be seen
from the table that the statistical results under different light intensity
conditions have no obvious changes. This shows that under relatively
stable ambient light, the influence of light intensity changes on the
experimental results can be ignored. At the same time, the results also
prove that under the condition of stable ambient light, NCBP experiment
does not need additional light source, thus simplifying the experimental
equipment.
6. Discussion
It is worth noting that this system does not have an external light
source. The facial videos were collected under ambient light. However,
the ambient light was sufficient and uniform. In addition, applicability is
very important for people’s daily blood pressure monitoring. However,
the applicability of the system in different environments (such as
different temperatures and the people with different skin colors) have
not been considered in this paper.
It can be seen from the Bland-Altman analysis plot in Fig. 12. For the
cases of hypertension and hypotension, the errors of the prediction
values and reference values are big. The reason maybe that the pro­
portion of abnormal blood pressure is small in our experimental data, it
leads to the insufficient predictive ability of the models in the cases of
hypertension and hypotension. Although the experimental results of the
experiments meet the AAMI and BHS international standards. However,

9
M. Rong and K. Li Biomedical Signal Processing and Control 64 (2021) 102328

Table 6
Error information for the effect of the light intensity on BP
Statistic SBP(mmHg) DBP(mmHg)

20 lx 250 lx 600 lx 20 lx 250 lx 600 lx

MAE 7.31 6.69 7.03 5.81 5.84 6.21

STD 2.99 2.79 2.84 1.82 1.82 1.79
Mean Bias 2.21 1.14 − 1.80 0.39 − 0.51 − 0.87

internationally gold standard, but our system has not been verified.
Therefore, future experiments must use manual sphygmomanometers
for measurement, which is more convincing as a reference blood
pressure.

7. Conclusion

This paper proposed a non-contact blood pressure prediction system

based on IPPG technology. The system has a whole set of BP detection
steps, including video acquisition, signal extraction, filtering, feature
extraction and selection, feature training and BP predicting. In terms of
system accuracy, the results of SVR model fully consistent with the
AAMI and the BHS international standards. We conclude that through
our proposed system can accurately predict blood pressure in a non-
contact way.
This paper innovatively proposes a highly robust peak detection al­
gorithm and a heat map-based ROI selection method. These two aspects
are also key steps in the IPPG technology. Experiments show that the
peak detection algorithm proposed in this paper can accurately extract
the peak point and valley point even when the signal is noisy. Through
the analysis of the colormap of faces, we found that cheek and nose areas
of human face are the most suitable places for extracting IPPG signals. In
addition, through experiments with different light intensity, we proved
that under the condition of sufficient light, NCBP measurement does not
need additional light source.
Compared with the NIBP measurement, the system has the advan­
tages of simple operation, comfortable use and continuous measure­
ment. Compared with other NCBP measurement, this system is more
convenient for daily monitoring without external light sources. This new
Fig. 11. Bland-Altman plot for (a) SBP and (b) DBP. For most data points, they
framework will help the development of blood pressure measurement
are within the confidence interval. For individual high and low blood pressure
equipment.
points, it is outside the confidence interval. Is caused by insufficient data on
abnormal blood pressure in our experimental data.
Funding

This work was financially supported by grants from the National

Major Special Program of Scientific Instrument & Equipment Develop­
ment of China (No. 2012YQ160203).

Ethical approval

Ethical approval was given by School of Physics and Technology,

Wuhan University. The volunteers were informed of the specific
experiment process in advance, and data collection was carried out with
the consent of the volunteers. There are no conflicts of interest in this
study.
Fig. 12. Renderings of different light intensities. (a) The light intensity of 600
lx, obtained by using additional light source. (b) The light intensity of 250 lx, CRediT authorship contribution statement
indoor ambient light without light source. (c) The light intensity of 20 lx, ob­
tained by an external light source in a dark room.
Meng Rong: Conceptualization, Methodology, Validation, Formal
analysis, Investigation, Data curation, Writing - original draft, Visuali­
more volunteers with abnormal blood pressure should be added in zation. Kaiyang Li: Writing - review & editing.
subsequent experiments to enhance the generalization ability of the
model.
Acknowledgements
In addition, the reference blood pressure in this paper was measured
using an automatic sphygmomanometer. Although the automatic
Thank you for the support of all volunteers participating in the
sphygmomanometer has been calibrated according to the
experiments.

10
M. Rong and K. Li
Declaration of Competing Interest
The authors report no declarations of interest.
Appendix A. Supplementary data
Supplementary material related to this article can be found, in the
online version, at https://doi.org/10.1016/j.bspc.2020.102328.
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