Toward Ubiquitous Blood Pressure Monitoring via Pulse Transit Time: Predictions on Maximum Calibration Period and Acceptable Error Limits

Objective: Pulse transit time (PTT) is being widely pursued for ubiquitous blood pressure (BP) monitoring. PTT-based systems may require periodic cuff calibrations but can still be useful for hypertension screening by affording numerous out-of-clinic measurements that can be averaged. The objective was to predict the maximum calibration period that would not compromise accuracy and acceptable error limits in light of measurement averaging for PTT-based systems. Methods: Well-known mathematical models and vast BP data were leveraged. Models relating PTT, age, and gender to BP were employed to determine the maximum time period for the PTT-BP calibration curve to change by <;1 mmHg over physiological BP ranges for each age and gender. A model of within-person BP variability was employed to establish the screening accuracy of the conventional cuff-based approach. These models were integrated to investigate the screening accuracy of the average of numerous measurements of a PTT-based system in relation to the accuracy of its individual measurements. Results: The maximum calibration period was about 1 year for a 30 year old and declined linearly to about 6 months for a 70 year old. A PTT-based system with a precision error of >12 mmHg for systolic BP could achieve the screening accuracy of the cuff-based approach via measurement averaging. Conclusion: This theoretical study indicates that PTT-based BP monitoring is viable even with periodic calibration and seemingly high measurement errors. Significance: The predictions may help guide the implementation, evaluation, and application of PTT-based BP monitoring systems in practice.