Vellore Institute of Technology - SCOPE

Smart BP
A Deep Learning Approach for Continuous Blood
Pressure monitoring without Cuff

Dr. Vijayaprabhakaran K
Vellore Institute Of Tech. Chennai

Devansh Bhardwaj 21BCE5876

Vellore Institute Of Tech. Chennai

Abstract - This project centers on crafting an advanced deep learning model tailored for
continuous blood pressure monitoring, presenting a departure from traditional cuff-based
methods. Employing physiological signals like Photoplethysmography (PPG) and
Electrocardiography (ECG), our objective is to create a non-invasive, astronaut-centric solution.
The utilization of deep learning algorithms enables real-time insights into cardiovascular
dynamics, addressing the imperative need for continuous monitoring during space missions.
Beyond enhancing patient comfort, this model holds the potential to improve early detection of
cardiovascular issues. The distinct focus on astronaut well-being underscores the project's
significance, offering a pioneering solution for uninterrupted blood pressure monitoring in the
unique conditions of extended space expeditions. In summary, this endeavor marks a
technological breakthrough, with direct implications for safeguarding the health of astronauts
on extended space missions.

Introduction:
The traditional method of blood pressure detection, which involves the use of a cuff, has been
found to be inconvenient and intermittent. This has led to a growing need for a more continuous
and non-invasive monitoring system. In response to this need, scientists at the Indian Space
Research Organisation (ISRO) are working on developing a device that can continuously monitor
blood pressure. This is a critical requirement for astronauts during space missions, as
maintaining optimal health and well-being during extended space expeditions is of utmost
importance.Our project is focused on leveraging the advances in deep learning to revolutionize
blood pressure monitoring. We aim to develop a deep learning model that can accurately and
continuously detect blood pressure using physiological signals such as Photoplethysmogram
(PPG) and Electrocardiogram (ECG).
PPG is a non-invasive method that measures the volumetric change of an organ, in this case, the
heart, by measuring light transmission or reflection. On the other hand, ECG is a method that
measures the electrical activity of the heart using electrodes placed on the skin. Both these
signals provide valuable insights into the functioning of the heart and are crucial in our model’s
ability to accurately detect blood pressure.
The significance of our study lies in its potential to enhance patient comfort by eliminating the
need for a cuff, provide real-time insights into a patient’s health, and potentially improve the
early detection of cardiovascular issues. Continuous monitoring of blood pressure can help in
the early detection of hypertension and other cardiovascular diseases, thereby enabling timely
intervention and treatment.
In essence, our project aims to create a non-invasive and efficient solution for blood pressure
monitoring that not only ensures the well-being of astronauts during extended space
expeditions but also has the potential to revolutionize blood pressure monitoring for everyone.

Literature Review:

1. Investigation on the effect of Womersley number, ECG and PPG features for cuff less
blood pressure estimation using machine learning BY -GeerthyThambiraj, Uma Gandhi ,
UmapathyMangalanathan, V. JeyaMaria Jose, M. Anand

This research paper introduces an algorithm for continuous blood pressure monitoring in
intensive care units, aiming to predict cardiovascular ailments. The method extracts informative
features like Womersley number, QRS, QTc interval, and SDI from ECG and PPG signals,
employing regression techniques for continuous blood pressure estimation. The study finds that
a model built with both ECG and PPG time-domain features outperforms a model trained with
PPG features alone. The article discusses the drawbacks of existing continuous noninvasive
techniques and the emerging principle of pulse wave velocity-based blood pressure
measurement. Additionally, the study uses a genetic algorithm for feature selection and
evaluates various machine learning models' performance using metrics such as RMSE, MAE,
MSE, Bias, ICC, and correlation coefficient. The proposed method involves 43 features extracted
from ECG, PPG, and their combination, demonstrating the significance of ECG features in blood
pressure estimation. The study explores the interrelation between ECG features and blood
pressure, emphasizing the importance of incorporating both ECG and PPG features for accurate
continuous blood pressure assessment.

2. Assessment of Non-Invasive Blood Pressure Prediction from PPG and rPPG Signals
Using Deep Learning BY -Georg Osterhoff and Mirco Fuchs
The paper explores the prediction of arterial blood pressure (ABP) from electrocardiogram
(ECG) and photoplethysmography (PPG) signals. The authors propose an LSTM architecture for
ABP prediction and employ generative adversarial networks (GANs) to augment the ABP
training dataset. ECG and PPG are discussed as non-invasive methods for monitoring
cardiovascular conditions. The study highlights the importance of ABP in assessing the risk of
cardiovascular events. Traditional ABP measurement methods are prone to errors, leading to
the exploration of alternative modalities. The LSTM architecture, dense models, and GANs are
evaluated for their effectiveness in predicting ABP. The GAN is trained to create augmented ABP
data, potentially addressing challenges in obtaining ABP data for specific patient demographics.
Results show promising predictions of ABP signals, and the study suggests further
improvements for accuracy. The work aims to contribute to accurate cardiovascular disease
diagnosis and monitoring, especially for obese patients.

3. Translating Photoplethysmogram(PPG) Signals to Arterial Blood Pressure (ABP)

Waveforms BY -Mohamed ArseleneAyari , Anas M. Tahir and M. SohelRahman
This study addresses the challenges of continuous blood pressure monitoring, emphasizing the
invasive nature of existing methods and the inaccuracies of non-invasive techniques. The
authors propose PPG2ABP, a two stage cascaded deep learning-based method, for estimating
continuous arterial blood pressure (ABP) waveforms from non-invasive
Photoplethysmogram(PPG) signals. The method utilizes deep learning to overcome limitations
of handcrafted feature computation and accurately estimates ABP waveforms with a mean
absolute error of 4.604 mmHg. PPG2ABP's success extends to computed values of Diastolic
Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Systolic Blood Pressure (SBP),
outperforming existing methods. Notably, the proposed method achieves Grade A in the British
Hypertension Society (BHS) Standard for DBP and MAP. PPG2ABP is designed to translate PPG
signals into corresponding blood pressure waveforms, offering potential applications in
cardiovascular anomaly detection. The study compares favorably with BHS and AAMI standards,
showcasing the effectiveness of the proposed PPG2ABP pipeline in non-invasive continuous
blood pressure estimation.

4. Blind, Cuff-less, Calibration-Free and Continuous Blood Pressure Estimation using

Optimized Inductive Group Method of Data Handling BY -Mohammad Reza Mohebbian,
Anh Dinh, Khan Wahid, Mohammad Sami Alam
The paper addresses the significance of continuous blood pressure monitoring for health
assessment, particularly in managing hypertension and cardiovascular diseases. It introduces an
algorithm, OIGMDH, designed for non-invasive and continuous estimation of systolic and
diastolic blood pressure using only PPG signals. The algorithm is trained on the Multi-parameter
Intelligent Monitoring in Intensive Care dataset, and its performance is compared with four
widely-used regression algorithms that employ both ECG and PPG signals. The proposed
OIGMDH algorithm stands out as it provides continuous and precise blood pressure estimates
without relying on additional features or simultaneous ECG recordings. It leverages signal
processing and an optimized group method of data handling, emphasizing its cuff-less and
calibration-free approach. The dataset used for training includes diverse parameters, and the
algorithm successfully extracts relevant features from the PPG signal alone. Furthermore, the
study introduces an in-house device for recording ECG and PPG signals, demonstrating practical
implementation. The algorithm's effectiveness is showcased by achieving mean differences of
2.8 ± 6.8 mmHg for DBP and 0.9 ±5.6 mmHg for SBP. The algorithm surpasses existing methods
in terms of continuous, non-invasive blood pressure estimation, providing a promising avenue
for real-time health monitoring without the need for cumbersome equipment or invasive
procedures.
 5. BP-Net: Efficient Deep Learning for Continuous Arterial Blood Pressure Estimation
using Photoplethysmogram BY -Rishi Vardhan K, VedanthS, PoojahG, Abhishek K, Nitish
Kumar M and Vineeth Vijayaraghavan
Innovating beyond conventional approaches to cuffless continuous blood pressure monitoring,
BP-Net emerges as a groundbreaking end-to-end deep learning solution. This state-of-the-art
UNet architecture transcends explicit feature engineering, presenting a direct translation of PPG
signals into the complex and continuous ABP waveform. Its proficiency extends to estimating
critical blood pressure parameters, encompassing Systolic Blood Pressure (SBP), Diastolic Blood
Pressure (DBP), and Mean Arterial Pressure (MAP). Notably, BP-Net's versatility shines through
its successful deployment on a Raspberry Pi 4, demonstrating its potential for seamless
integration into real-world applications with an impressive inference time of 4.25 ms. The
methodological brilliance lies in BP-Net's ability to navigate the intricacies of blood pressure
estimation without resorting to invasive procedures, fostering a non-obtrusive and efficient
solution. A significant achievement is the adherence to international standards, ensuring the
robustness and accuracy of the model's continuous blood pressure monitoring capabilities. As
the focus of this work centers on continuous blood pressure monitoring, the expeditious time
taken by BP Net for the PPG-to-ABP signal conversion emerges as a pivotal facet. The model's
efficiency in seamlessly translating PPG signals into ABP waveforms further bolsters its
applicability in real-time scenarios, enhancing its potential for widespread use in health
monitoring and care.

6. Long-term Blood Pressure Prediction with Deep Recurrent Neural Networks BY -Peng
Su, Xiao-Rong Ding, Yuan-Ting Zhang, Fellow, IEEE, Jing Liu, Fen Miao, Ni Zhao
In the study, the authors emphasize the importance of accurate and continuous blood pressure
(BP) monitoring for the early detection and intervention of cardiovascular diseases. Existing
methods for BP estimation often lack the capability to model the underlying temporal
dependencies in BP dynamics, leading to accuracy decay over time and requiring frequent
calibration. To address this limitation, the paper introduces BP-Net, an end to-end deep learning
solution that utilizes photoplethysmogram(PPG) signals for estimating Systolic BP (SBP), Mean
Average Pressure (MAP), and Diastolic BP (DBP). BP-Net, deployed on a Raspberry Pi 4, achieves
efficient real-time translation of PPG waveforms to Arterial BP (ABP) waveforms. Furthermore,
the study proposes a signal-to-signal translation UNet architecture named BP-Net,
demonstrating its efficacy in estimating ABP waveforms from PPG signals. The model is trained
and evaluated on datasets, showcasing its ability to accurately predict SBP and DBP based on
international standards. The paper highlights the advantages of BP-Net over conventional
feature engineering methods, offering a promising approach for continuous and non-invasive BP
monitoring.

7. Cuffless Blood Pressure Estimation BY -Diogo Antunes, Diogo Batista, Pedro Osorio
The project aimed to derive blood pressure measures using features extracted from PPG and
ECG signals for continuous and cuffless blood pressure monitoring. MATLAB scripts were
developed to preprocess signals, extract 21 physiological parameters, and build multivariate
linear regression models for blood pressure estimation. A dataset from two patients was
utilized, and Principal Component Analysis (PCA) revealed no specific feature group dominating
variance. Stepwise linear regression identified three relevant features for prediction. The study
emphasized the need for accurate blood pressure measurement methods due to cardiovascular
disease prevalence. Various blood pressure estimation approaches, including cuff-based and
mobile-based methods, were discussed. The proposed model achieved promising results in
predicting systolic and diastolic blood pressure, demonstrating potential for continuous
monitoring. The study recognized the importance of reducing predictor dimensions for
computational efficiency. Overall, the study provided insights into feature extraction,
dimensionality reduction, and regression modeling for cuffless blood pressure estimation.

8. Blood Pressure Morphology Assessment from Photoplethysmogramand Demographic

Information Using Deep Learning with Attention Mechanism BY -Nicolas Aguirre, Edith
Grall-Maes, Ricardo L. Armentano
In the study, the authors emphasize the importance of accurate and continuous blood pressure
(BP) monitoring for the early detection and intervention of cardiovascular diseases. Existing
methods for BP estimation often lack the capability to model the underlying temporal
dependencies in BP dynamics, leading to accuracy decay over time and requiring frequent
calibration. To address this limitation, the paper introduces BP-Net, an end to-end deep learning
solution that utilizes photoplethysmogram(PPG) signals for estimating Systolic BP (SBP), Mean
Average Pressure (MAP), and Diastolic BP (DBP). BP-Net, deployed on a Raspberry Pi 4, achieves
efficient real-time translation of PPG waveforms to Arterial BP (ABP) waveforms. Furthermore,
the study proposes a signal-to-signal translation UNet architecture named BP-Net,
demonstrating its efficacy in estimating ABP waveforms from PPG signals. The model is trained
and evaluated on datasets, showcasing its ability to accurately predict SBP and DBP based on
international standards. The paper highlights the advantages of BP-Net over conventional
feature engineering methods, offering a promising approach for continuous and non-invasive BP
monitoring.

9. A benchmark for machine-learning based non-invasive blood pressure estimation

using photoplethysmogram BY –Sergio Gonzalez, Wan-Ting Hsieh & Trista Pei-
ChunChen
The paper presents a benchmark for machine-learning-based non-invasive blood pressure (BP)
estimation using photoplethysmogram(PPG). BP is a crucial cardiovascular health indicator, and
machine learning approaches offer the potential for continuous or intermittent BP estimation
with a single PPG measurement. The authors design a benchmark with four open datasets,
addressing challenges like information shift and leak, and employ the Mean Absolute Scaled
Error (MASE) for standardized model evaluation. The focus is on comparing three categories of
algorithms based on input and output types. The benchmark facilitates fair comparisons,
insights into different approaches, and aims to propel the development of non-invasive BP
estimation. The paper discusses data-driven ML approaches, addresses common caveats in
comparing methodologies, and emphasizes the importance of proper evaluation metrics and
dataset characteristics. The authors also share insights on model performances across different
datasets and propose MASE as a scale invariant evaluation measure. The study includes
comprehensive analyses of different machine learning models and deep learning architectures,
such as Feat2Lab, Sig2Lab, and Sig2Sig, to estimate BP from PPG signals. The benchmark
considers various features, algorithms, and datasets, promoting reproducibility and fair
comparisons within the research community.
 10. Imputation of the continuous arterial line blood pressure waveform from non-
invasive measurements using deep learning BY-Brian L. Hill, Nadav Rakocz, AkosRudas,
Jefrey N. Chiang
The study introduces a novel method for non-invasive and continuous imputation of the arterial
blood pressure (ABP) waveform using deep learning. In intensive care units (ICUs) and surgical
settings, ABP is often monitored non-invasively, but high-risk patients require continuous
monitoring due to the associated risks of hypotension. The proposed approach utilizes
electrocardiogram (ECG) and photoplethysmogram(PPG) waveforms, employing a deep learning
architecture designed for image segmentation. The model, trained on data from 463 patients,
accurately predicts continuous ABP waveforms, systolic, and diastolic blood pressure. The
method has potential applications in critical care, providing continuous and non-invasive blood
pressure monitoring without additional instrumentation. The study compares favorably with
existing approaches, showcasing its potential for clinical use. The deep learning model, named
1D V-Net, outperforms current methods by providing precise predictions of continuous ABP
waveforms with a low root mean square error. The approach utilizes ECG and PPG waveforms
from diverse patient populations in two separate health systems, enhancing its robustness.
Notably, the model surpasses the accuracy of the long short-term memory (LSTM) model and
PPG scaling, offering a significant advancement in imputing blood pressure waveforms. The
study's findings suggest a promising avenue for continuous blood pressure monitoring in acute
care settings, addressing the limitations of existing non invasive methods and potentially
improving patient outcomes.

11. Assessment of deep learning based blood pressure prediction from PPG and rPPG
signals BY –Fabian Schrumpf, Patrick Frenzel, Christoph Aust
The investigation scrutinizes diverse BP measurement techniques, including ultrasound and
tactile sensor based methods, emphasizing the potential of exploiting PPG signals for non-
invasive monitoring. The research introduces machine learning models, such as recurrent neural
networks (RNN) and dense neural networks (DNN), trained on PPG data to predict BP. Transfer
learning techniques are explored, bridging the gap between PPG and rPPG-based BP prediction.
The study compares the performance of various neural network architectures and highlights the
impact of personalization on prediction accuracy. While acknowledging the limitations and the
dependence of prediction errors on underlying BP, the research establishes a foundation for
advancing continuous BP monitoring, with a focus on refining methodologies for enhanced
accuracy and applicability. Furthermore, the study delves into camera-based rPPG signals for BP
estimation, showcasing the potential of supervised machine learning methods. Noteworthy
approaches include transdermal imaging and the utilization of principal component analysis
(PCA) on red color channels. The research also investigates the pulse arrival time (PAT) and
pulse transit time (PTT) for deriving pulse wave velocity (PWV) and subsequent BP inference.
Leveraging the MIMIC-III database and a custom-recorded dataset, the study meticulously
evaluates the neural network architectures, namely AlexNet and ResNet, emphasizing their
performance in predicting systolic and diastolic BP values. The findings contribute valuable
insights into the evolving landscape of continuous BP monitoring, integrating technological
advancements and machine learning methodologies.
 12. Generalized Deep Neural Network Model for Cuffless Blood Pressure Estimation
with PhotoplethysmogramSignal Only BY -Yan-Cheng Hsu, Yung-Hui Li , Ching-Chun
Chang and Latifa Nabila Harfiya
The paper delves into the development of a deep neural network model for blood pressure (BP)
estimation exclusively using photoplethysmogram(PPG) signals. Emphasizing the need for cost-
effective and user friendly solutions, the study proposes a model adept at extracting 32 features
from PPG signals. Rigorous performance evaluation, employing metrics such as root mean
square error (RMSE), mean absolute error (MAE), and adherence to medical standards like the
Association for the Advancement of Medical Instrumentation (AAMI) and British Hypertension
Society (BHS), underscores the model's remarkable accuracy. With achieved RMSEs of 4.643
mmHg (SBP) and 3.307 mmHg (DBP) across a substantial dataset of 9000 subjects, the model
showcases its effectiveness. The paper advocates for potential applications in wearables and
continuous BP monitoring, particularly for individuals at risk of hypertension. The study
meticulously details the preprocessing steps for enhancing PPG data quality, including noise
removal, normalization, feature point detection, and partitioning. Feature extraction involves 65
features deemed crucial for BP estimation, showcasing the model's comprehensive approach.
The proposed deep neural network, a six-layered structure, is evaluated against stringent AAMI
and BHS standards, demonstrating conformity and high accuracy. The paper concludes with a
call for future research to explore correlations between BP estimation and natural time analysis,
and the practical implementation of the model in wearable devices for continuous BP
monitoring in real-world scenarios.

13. Blood Pressure Estimation from PhotoplethysmogramUsing a Spectro-Temporal

Deep Neural Network BY -GasperSlapni, NejcMlakar and MitjaLustrek
This study addresses the challenges of continuous blood pressure monitoring, emphasizing the
invasive nature of existing methods and the inaccuracies of non-invasive techniques. The
authors propose PPG2ABP, a two stage cascaded deep learning-based method, for estimating
continuous arterial blood pressure (ABP) waveforms from non-invasive
Photoplethysmogram(PPG) signals. The method utilizes deep learning to overcome limitations
of handcrafted feature computation and accurately estimates ABP waveforms with a mean
absolute error of 4.604 mmHg. PPG2ABP's success extends to computed values of Diastolic
Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Systolic Blood Pressure (SBP),
outperforming existing methods. Notably, the proposed method achieves Grade A in the British
Hypertension Society (BHS) Standard for DBP and MAP. PPG2ABP is designed to translate PPG
signals into corresponding blood pressure waveforms, offering potential applications in
cardiovascular anomaly detection. The study compares favorably with BHS and AAMI standards,
showcasing the effectiveness of the proposed PPG2ABP pipeline in non-invasive continuous
blood pressure estimation.
 14. Cuffless Blood Pressure Estimation Algorithms for Continuous Health-Care
Monitoring by Mohammad Kachuee, Mohammad Mahdi Kiani, Hoda Mohammadzade,
and Mahdi Shabany
The research conducted by Mohammad Kachuee, Mohammad Mahdi Kiani, Hoda
Mohammadzade, and Mahdi Shabany emerges as a pivotal contribution, addressing the
imperative need for unobtrusive blood pressure (BP) monitoring methods. Regular monitoring
of BP is paramount, given its status as a key risk factor for cardiovascular diseases. However,
traditional cuff-based devices pose limitations, necessitating exploration into alternative
methodologies.
The authors propose a new framework that estimates the BP values through processing vital
signals and extracting two types of features, which are based on either physiological parameters
or whole-based representation of vital signals. Finally, the regression algorithms are employed
for the BP estimation. Although the proposed algorithm works reliably without any need for
calibration, an optional calibration procedure is also suggested, which can improve the system’s
accuracy even further.

15. A Nested Attention-guided BiConvLSTMnetwork for a robust prediction of Blood

Pressure components from reconstructed Arterial Blood Pressure waveforms using PPG
and ECG signals BY -SakibMahmud , Nabil Ibtehaz, AmithKhandakar
This research paper addresses the challenges associated with continuous blood pressure (BP)
monitoring, emphasizing the limitations of current cuff-based methods and the invasive nature
of most continuous monitoring techniques. The study proposes a novel approach for estimating
arterial blood pressure (ABP) waveforms by separating the task into BP prediction and
normalized ABP waveform estimation through segmentation from Photoplethysmogram(PPG),
PPG derivatives, and Electrocardiogram (ECG) signals. The proposed Nested Attention-guided
BiConvLSTMNetwork (NABNet) is introduced, utilizing LSTM blocks during segmentation for
improved handling of phase shifts between PPG, ECG, and ABP signals. The experiments
demonstrate that the framework robustly estimates ABP waveforms, achieving high Mean
Arterial Pressure (MAP) performance and low construction error while maintaining overall
Grade A performance for BP prediction. The study highlights the importance of estimating ABP
patterns alongside BP values and introduces NABNetas an efficient segmentation architecture.
The proposed method has the potential to provide early insights into cardiovascular anomalies
by leveraging PPG and ECG signals for accurate ABP waveform estimation. The article concludes
by emphasizing the significance of this approach in understanding common cardiovascular
diseases and notes the efficiency of using linear transformation for the final ABP waveform
generation
Refrences:
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using machine learning. Biomedical Signal Processing and Control, 60, 101942.
2. Schrumpf, F., Frenzel, P., Aust, C., Osterhoff, G., & Fuchs, M. (2021). Assessment of non-
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4. Mohebbian, M. R., Dinh, A., Wahid, K., & Alam, M. S. (2020). Blind, cuff-less, calibration-
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handling. Biomedical Signal Processing and Control, 57, 101682.

5. Vijayaraghavan, V. (2021). BP-Net: Efficient Deep Learning for Continuous Arterial Blood
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6 Su, P., Ding, X. R., Zhang, Y. T., Liu, J., Miao, F., & Zhao, N. (2018, March). Long-term blood
pressure prediction with deep recurrent neural networks. In 2018 IEEE EMBS International
conference on biomedical & health informatics (BHI) (pp. 323-328). IEEE.

7 Antunes, D., Batista, D., & Osorio, P. (2021). Cuffless Blood Pressure Estimation. PDSB 2021 –
Group B1.
https://wiki.laseeb.org/attachments/download/141/G5%20Cuffless%20Blood%20Pressure%
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8 Aguirre, N., Grall-Maes, E., Cymberknop, L. J., & Armentano, R. L. (2021). Blood pressure
morphology assessment from photoplethysmogram and demographic information using deep
learning with attention mechanism. Sensors, 21(6), 2167.
9 Gonzalez, S., Hsieh, W. T., & Chen, T. P. C. (2023). A benchmark for machine-learning based
non-invasive blood pressure estimation using photoplethysmogram. Scientific Data, 10(1), 149.
10 Hill, B. L., Rakocz, N., Rudas, A., Chiang, J. N., Wang, S., Hofer, I., ... & Halperin, E. (2021).
Imputation of the continuous arterial line blood pressure waveform from non-invasive
measurements using deep learning. Scientific reports, 11(1), 15755.
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learning based blood pressure prediction from PPG and rPPG signals. In Proceedings of the
IEEE/CVF Conference on Computer Vision and Pattern Recognition (pp. 3820-3830).
12 Hsu, Y. C., Li, Y. H., Chang, C. C., & Harfiya, L. N. (2020). Generalized deep neural network
model for cuffless blood pressure estimation with photoplethysmogram signal
only. Sensors, 20(19), 5668.

13. Slapnicar, G., Mlakar, N., & Lustrek, M. (2019). Blood pressure estimation from
photoplethysmogram using a spectro-temporal deep neural network. Sensors, 19(15), 3420.
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Farhan Fuad & Musharavati, Farayi & Chowdhury, Muhammad. (2023). NABNet: A Nested
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