Key result
PAT-based models fail international standards for continuous SBP monitoring and underperform baseline models.
Why the study?
The reliability of pulse arrival time-based models for non-invasive cuffless blood pressure monitoring remains uncertain due to calibration challenges and complex blood pressure regulation.
Do PAT-based models accurately estimate continuous blood pressure in ambulatory settings?
Observational (n=307)
Do PAT-based models accurately estimate continuous blood pressure in ambulatory settings?
Absolute Event Rate: 14.23% vs 13.04%
PAT-based models using portable ECG and PPG fail to meet international standards for continuous blood pressure monitoring in ambulatory settings, highlighting the need for more advanced approaches.
PAT-based models do not meet standards for ambulatory BP monitoring; leaves open whether advanced algorithms or modalities can achieve validation thresholds.
Blood pressure (BP) is a critical biomarker for cardiovascular health. Several proposals of surrogate measurements and methods, such as Pulse Arrival Time (PAT), aim to provide non-invasive cuffless alternatives to traditional BP monitoring. However, the reliability of PAT-based models remains uncertain due to calibration challenges and the complex nature of BP regulation. This study investigated the performance of PAT-based models using portable electrocardiograms and photoplethysmography to estimate systolic (SBP) and diastolic (DBP) BP in ambulatory settings with 307 participants from the AuroraBP dataset. The best-performing PAT-based models achieved a mean absolute error (MAE) of <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1 4. 2 3 ~ m m H g</tex> for SBP and 9.67 mmHg for DBP estimation. Both models failed to meet current international standards for BP monitoring. Additionally, the baseline models outperformed the best PAT-based model for SBP (MAE: <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1 3. 0 4 ~ m m H g</tex>) and achieved comparable performance to the top PAT-based model for DBP (MAE: 9.67). Despite promising results in previous studies, our findings highlight the poor performance of PAT-based models, particularly in dynamic and ambulatory conditions. These results highlight the limitation of multi-signal time-based models, which fail to generalize in complex dynamic situations. More advanced approaches that succeed in capturing the nonlinearities of BP variations and provide reliable, continuous BP monitoring in real-life settings are necessary.
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Cisnal et al. (2025) conducted an observational in Blood pressure monitoring (n=307). PAT-based models using portable electrocardiograms and photoplethysmography vs. Baseline models was evaluated on Mean absolute error (MAE) for systolic blood pressure (SBP) estimation. PAT-based models for continuous blood pressure monitoring failed to meet international standards, yielding a mean absolute error of 14.23 mmHg for SBP, which underperformed baseline models.
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