Optimizing Input Feature Sets Using Catch-22 and Personalization for an Accurate and Reliable Estimation of Continuous, Cuffless Blood Pressure

Nocturnal monitoring of continuous, cuffless blood pressure (BP) can unleash a whole new world for the prognostication of cardiovascular and other diseases due to its strong predictive capability. Nevertheless, the lack of an accurate and reliable method, primarily due to confounding variables, has prevented its widespread clinical adoption. Herein, we demonstrate how optimized machine learning using the Catch-22 features, when applied to the photoplethysmogram waveform and personalized with direct BP data through transfer learning, can accurately estimate systolic and diastolic BP. After training with a hemodynamically compromised VitalDB "calibration-free" dataset (n = 1293), the systolic and diastolic BP tested on a distinct VitalDB dataset that met AAMI criteria (n = 116) had acceptable error biases of -1.85 mm Hg and 0.11 mm Hg, respectively [within the 5 mm Hg IEC/ANSI/AAMI 80601-2-30, 2018 standard], but standard deviation (SD) errors of 19.55 mm Hg and 11.55 mm Hg, respectively [exceeding the stipulated 8 mm Hg limit]. However, personalization using an initial calibration data segment and subsequent use of transfer learning to fine-tune the pretrained model produced acceptable mean (-1.31 mm Hg and 0.10 mm Hg) and SD (7.91 mm Hg and 4.59 mm Hg) errors for systolic and diastolic BP, respectively. Levene's test for variance found that the personalization method significantly outperformed (<i>p</i> < 0.05) the calibration-free method, but there was no difference between three machine learning methods. Optimized multimodal Catch-22 features, coupled with personalization, demonstrate great promise in the clinical adoption of continuous, cuffless blood pressure estimation in applications such as nocturnal BP monitoring.