A Survey on Blood Pressure Measurement Technologies: Addressing Potential Sources of Bias

Figures

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  Figure 2. The auscultatory method measures blood pressure based on Korotkoff sounds. Note the difference between the actual and reported systolic/diastolic blood pressures; adapted from [32] (CC-BY-3.0).

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  Figure 7. A future perspective of blood pressure (BP) monitoring. AI-assisted and ML-based technologies are anticipated to integrate into future generations of BP monitoring technologies. Large electronic health record (EHR) data can be leveraged to extract population-wide norms of BP, accounting for variations due to biological sex, age, and race (from a genetic variability standpoint) [183]. Natural language processing and large language models can assist in analyzing clinical literature and physicians’ notes from EHR data [187]. These data resources can be combined using an ML framework to detect and correct BP measurement biases and provide individualized BP-related risk factors.

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  Figure 1. The systolic, diastolic, mean arterial, pulse pressure, and overall blood pressure at different blood vessel points; adopted from [28] by OpenStax College (CC-BY-3.0). The color scheme acts as a visual guide, highlighting blood oxygenation levels and flow directions. The use of red symbolizes freshly oxygenated blood from the lungs, coursing through arteries to nourish body tissues. A gradual shift to blue indicates decreasing oxygen levels, signifying an increase in deoxygenated blood. Blue represents deoxygenated blood returning to the heart through veins after delivering oxygen to tissues.

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  Figure 3. The basic principles and important standards of blood pressure measurement; adapted from [55]. See STRIDE-BP (https://stridebp.org/, accessed on 1 March 2024) for validated electronic cuff-based blood pressure devices.

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  Figure 4. Schematic showing blood pressure variations across arterial sites (carotid, brachial, radial, femoral, posterior tibial) influenced by distance from the heart, artery type, and gravity in a standing position [145,146].

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  Figure 5. Comparison of male (a) vs. female (b) blood pressure values from various studies. Each ellipse represents a study, centered on the mean SBP and DBP, with horizontal and vertical radii representing the corresponding standard deviations. Gaussian mixture model (GMM) distributions are fitted over these reports in (c) and (d). For further clarification, each ellipse is assigned a specific color.

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  Figure 6. Comparison of blood pressure values by BMI from various studies. Each ellipse represents a study, centered on mean BMI and BP, with horizontal and vertical radii representing their respective standard deviations. For further clarification, each ellipse is assigned a specific color. Gaussian mixture model (GMM) distributions are fitted over these reports in (c) and (d).