Continuous cuff-less blood pressure monitoring based on the pulse arrival time approach: The impact of posture

There is an unmet need for cuff-less blood pressure (BP) monitoring especially, in personal healthcare applications. The pulse arrival time (PAT) approach might offer a suitable solution to enable comfortable BP monitoring even at beat-level. However, the methodology is based on hemodynamic surrogate measures, which are sensitive to patient activities such as posture changes, not necessarily related to blood pressure variations. In this paper, we analyze the impact of posture on the PAT measure and related hemodynamic parameters such as the pre-ejection period in well-defined procedures. Additionally, the PAT of a monitored subject is investigated in an unsupervised scenario illustrating the complexity of such a measurement. Our results show the failure of blood pressure inference based on simple calibration strategies using the PAT measure only. We discuss opportunities to compensate for the observed effects towards the realization of wearable cuff-less blood pressure monitoring. These findings emphasize the importance of accessing context information in personal healthcare applications, where vital sign monitoring is typically unsupervised.