Measurement of Blood Pressure Using Photoplethysmography

M.Asif-Ul-Hoque
1
, Md Sabbir Ahsan
2
, Bijoy Mohajan
3
Deporrmenr oj Llecrricol onJ Llecrronic Lnqineerinq,
BonqloJesl Universiry oj Lnqineerinq onJ Teclnoloqy (BULT), Dlo|o, BonqloJesl

1
bapon87gmail.com
2
ahsan_1170yahoo.com
3
bijoymohajangmail.com
Abstract A simple and effective method of displaying blood
pressure measurement from photoplethysmography has been
developed. The method is developed to be incorporated as
noninvasive monitoring of blood pressure from a patient in a
intensive care unit. This implementation includes finger tip pulse
oximetry probe, differential amplifier, data acquisition card,
software filtering, amplification and blood pressure
measurement from pulse transit time calculation continuously by
microcomputer correlation of pulse transit time to blood
pressure. It is expected that the method will be incorporated to a
low cost portable personal computer based ICU monitoring
system that will also display temperature, pulse rate and ECG of
the patient continuously in future.
Keywords photoplethysmogrphy, blood pressure
measurement, pulse oximetry, pulse transit time
I. INTRODUCTION
Photoplethysmography which is known as PPG, is an
optically obtained plethysmograph and a volumetric
measurement of an organ. PPG is often obtained by using
infrared or pulse oximeter which illuminates the skin and
measures changes in light absorption. A convential pulse
oximeter monitors the profusion of blood the dermis and
subcutaneous tissue of the skin. With each cardiac cycle the
heart pumps the blood to the periphery. Even though this
pressure is some-what damped by the time it reaches the skin
enough to distend the arterioles in the subcutaneous tissue. If
the pulse oximeter is attached without compressing the skin, a
pressure pulse can be seen from the venous plexus move
secondary peak. The change in volume caused by the pressure
is detected by illuminating the skin with the light from a light
emitting diode and then measuring the amount of light either
transmitted or reflected to a photo diode. Each cardiac cycle
appears as a peak. Because blood flows to the skin can be
modulated by multiple other physiological systems, the PPG
can also be used to monitor blood pressure, breathing,
hypovolemia and other circulatory condition. The shape of
PPG differs from subject to subject and varies with location
and manner in which the pulse oximeter is located or attached.
In the paper use of correlation between pulse transit time
and systolic period for monitoring blood pressure is reported
which is intended to use in intensive care unit monitor
noninvasively in a continuous fashion. It is a part of an effort
to develop low cost intensive care units monitors for
underdeveloped countries like Bangladesh which will be used
in incentive care unit (ICU) in hospital.
II. PULSE TRANSIT TIME(PTT)
The PTT model [1| assumes laminar blood flow from the
heart chamber to the fingertip through a rigid pipe, the artery.
While it is well known that artery wall expands and contracts,
its small compliance of 0.0018 liter/mmHg on average [2| is
justified assumption. The model estimates the pressure
difference between the two sites, the heart and the fingertip by
the pulse wave velocity. A pulse wave travels from the heart
to the fingertip along the artery and its velocity can be
calculated from the distance travelled divided by the PTT. The
relationship between the PTT and BP is demonstrated in the
following postulate [1|. The work done by the pulse wave can
be expressed in terms of the kinetic energy of the wave and
the gravitational potential energy:
(1)
Where Fforce exerted from blood
d distance from heart to fingertip
mmass of blood
vpulse wave velocity
g9.8 m/s
2
hheight difference between two sites,
The force can also be written in terms of pressure difference
F BP.a (2)
Where a is defined as the cross section area of the artery.
Substitute equation (2) into (1) and after rearrangement:
(3)
( )p is the density of blood and v can be expressed by ,
So, (4)
The average The pressure drop in the arterial side of
circulation accounts for roughly 70% of the total pressure
drop in the body [2|, therefore the patient's overall BP is
approximately.

(3)
In summary, the BP can be written in terms of PTT, with two
variables namely A and B. A can be estimated from the
subject height.
(6)
2011 UKSim 13th International Conference on Modelling and Simulation
978-0-7695-4376-5/11 $26.00 2011 IEEE
DOI 10.1109/UKSIM.2011.16
32
From the above calculations, BP can be estimated from PTT
and average empirical values. Recursive calibration between
the estimated BP and the BP measured by a cuff is necessary
in order to obtain the absolute BP of the patient using
estimated values. Calibration is performed by using total least
squares as it is an optimum methodFor reducing the
uncertainty of two noisy signals [4|. Since A does not vary
significantly between subjects and performing adaptation on
A may lead to unstable estimation, the calibration will adapt
B only. The adaptation of B may still absorb some of the
mismatch in A. A and B are time invariant so the
adaptation should converge to a single set of values. The BP
in equation (3) describes the mean BP assuming laminar and
non-pulsatile flow. The cuff measurement of diastolic blood
pressure, and hence the estimation of mean blood pressure,
may be impossible in pregnancy due to the changes induced in
the arterial wall by gestational hormones. When the BP cuff
operates in continuous mode during the treatment of
hypotension induced by spinal anaesthesia for Cesarean
Section, the constraint of measuring mean blood pressure
would result in a significant reduction in data points.
Therefore, based on the assumption that systolic BP is highly
correlated with mean BP, PTT is used to infer systolic BP.
III. METHOD OF OBTAINING BLOOD PRESSURE
The approach taken to measure blood pressure consists of
mainly three part. Hardware part, software part, data
acquisition part. Hardware part consists of infrared transmitter
and receiver pair, current to voltage converter, operational
amplifier. Operational amplifier, filter implementation is done
by software. Appropriate code for signal processing is done
using MATLAB 7.0. For data acquisition Advantech data
acquisition card is used. The operation of which is comp-
atible with MATLAB.
The finger is placed between the infrared transmitter and
receiver. The circulation of blood flow through the finger is
detected as the infrared ray passed through the fingertip. From
the collected signal many bio-medical behavior of human
Body can be analyzed. As the receiver and transmitter is
spatial type we get current as a receiver signal. Current to
voltage converter with a transfer ratio KVout/Iin is used a
proper gain is set to amplify the milli range voltage.

Figure 1. Oscilloscope version of MATLAB which is known
as softscope used here as data acquisition card.
Figure 2. Typical flow diagram to measure blood pressure..
IV. FILTERING THE DATA
Butterworth band stop filter is used for removing unwanted
frequency components. It is difficult to calculate the actual
systolic period from the unfiltered signal. For this is necessary
to filter the signal for the benefit of signal processing. We
have used butterworth band stop filter or notch filter is used
.The reason for choosing this filter is that the filter has
adjustable parameters. Such as order, frequency band etc. By
adjusting these parameters desired signal can be obtained. I
has been found the butterworth band stop filter very effective
as it has the ability to eliminate most of the unwanted
frequency components. We have chosen filter of order N4
and frequency band Wn[.001 .9| have been chosen for this
work. Typical unfiltered and filtered signals are shown in
Fig.3 and Fig.4 respectively.
33
Figure 3. Before filtering data.
Figure 4. After filtering data.
V. APPROXIMATE RELATIONSHIP BETWEEN PTT 8
SYSTOLIC PERIOD
The pulse transit time (PTT) consists of two components
[4| the PEP, which corresponds to the timing from the onset of
ventricular depolarization to the onset of ventricular ejection,
and the ventricular transit time (VTT) which defines the
period for the arterial pulse wave to travel from the aortic
valve to the peripheral arteries. The PEP is considered to be a
measure for the time delay between the electrical and
mechanical activation of the heart. The ICG-PEP is defined as
the time difference between the Q-point in the ECG and the
B-point in the ICG signal. The PTT was reported to reflect
variation in PEP originating from changes in thoracic blood
volume in head-tilt experiments [4|. The definition is PTT
PEP VTT. Pharmacological studies showed that ICG-PEP is
shortened as sympathetic activity increases, for example when
beta-adrenergic agonists like nor epinephrine was
administered. In concordance, ICG-PEP increases when a
sympathetic antagonist ( e.g. metoprolol) was used [3|.
However, the marker points used to measure the ICG-PEP are
not always present in the signals and may be obscured by
noise, therefore making them difficult to detect in an
automated way. From experimental observation it was found
that PTT is almost equal to the width of the systolic period
and has neglect the pre-injection time (PEP) can be neglected.
So from the above discussions we can make an effective
assumption that there is a strong relationship between the
pulse transit time and systolic period which is the main
innovation of our research.
VI. CALCULATION OF BLOOD PRESSURE 8 COMPARISON OF
RESULT
The average blood density p is 1033, Knowing the constant
A 8 B from equation (3), we can easily measure the Blood
pressure of a person. The distance d can be approximated
from patients height. PTT is the pulse transit time in seconds.
The following table1 and fig.3 shows the comparison between
our experimental value and the blood pressure measured by
cuff meters.
No of observation Experimental
(mm/Hg)
Measurement by cuff
(mm/Hg)
1 113 118
2 119 121
3 124 123
4 129 131
3 133 133
6 138 142
7 140 143
8 142 144
9 148 147
10 130 133
Table 1. comparison table between our value and obtained
from cuff meters.
Figure 3. Comparison between our experimental value and
measurement from cuff meter.
34
VII. CONCLUSION
Photoplethysmographic method uses infrared laser to sense
and respond to the system. The advantage of infrared sensor is
fast response and ambient pressure independent. A simplistic
yet practical model was developed to relate PTT and BP. With
a more sophisticated calibration and noise filtering method,
the algorithm can easily be converted into a real time
application. It is clear that the BP estimated by PTT is capable
of capturing the hypotension and hypertension caused by spinal
anesthesia and phenylephrine respectively. Continuous monitoring
of blood pressure will result in earlier treatment of induced
hypotension and avoidance of hypertension due to by careful
titrated administration of phenylephrine .
ACKNOWLEDGMENT
We are very grateful to our project and thesis supervisor
Dr. Mohammad Ali Choudhury, Professor, Department of
Electrical and Electronic Engineering, BUET, whose friendly
guidance, tenacious patience, kind support have made our
project into a reality.
REFERENCES
[1| Parry Fung, Guy Dumont, Craig Ries, Chris Mott, Mark Anserine,
Continuous Noninvasive Blood Pressure Measurement by Pulse
Transit Time, Proceedings of the 26th Annual Interna-tional
Conference of the IEEE EMBS San Fran-cisco, CA, USA September
1-3, 2004
[2| | J. Keener and J. Sneyd, Mathematical Physio- logy. New
York,USA: Springer-Verlag, 1998.
[3| D. Boley and K. Sutherland, Recursive total least squares: An
alternative to the discrete Kalman filter, 1993.
[4| Chan GSH, Middleton PM, Celler BG, Wang L, Lovell NH. Change in
pulse transit time and pre-ejection period during head-up tilt-induced
prog-ressive central hypovolaemia. J Clin Monit Comput 2007,21:283-
93
[3| Jan H. Meijer, Annemieke Smorenberg , Erik J. Lust , Rudolf M.
Verdaasdonk and A. B. Johan Groeneveld, Assessing cardiac preload
by the Initial Systolic Time Interval obtained from impe-dance
cardiography, J Electr Bioimp, vol. 1, pp. 8083, 2010
35