Challenges presented by cuffless measurement of blood pressure if adopted for diagnosis and treatment of hypertension

The global health burden presented by hypertension is providing increased motivation for improved means of collection of blood pressure (BP) data. A growing area of research and commercial activity is the use of wearable devices to provide BP data using non-invasive cuffless techniques. The accelerated progress in recent years, particularly relating to connectivity of smartphone technology, has promoted the availability of consumer devices that provide values of BP. The main types of devices are wrist-worn, watch-type devices with sensors that typically record a photoplethysmography (PPG) signal, sometimes also with an electrocardiography (ECG) signal. The general underlying concept of the cuffless BP measurement in most device types is the association of BP and the travel time of the arterial pulse between two locations, determined from the time delay between the ECG and PPG signals. Other methods may involve additional analysis of the PPG waveform features. Experimental data are presented to illustrate the challenges presented by cuffless BP techniques in obtaining reliable BP measurements when the change in BP is caused by different stimuli affecting cardiac and vascular mechanisms. These effects influence the association of the measured and physiological BP change, thus presenting significant challenges and potential limitations in the use of cuffless BP devices for the diagnosis and treatment of hypertension.