Benchmarking and Enhancing PPG-Based Cuffless Blood Pressure Estimation Methods

Cuffless blood pressure screening based on easily acquired photoplethysmography (PPG) signals offers a practical pathway toward scalable cardiovascular health assessment. Despite rapid progress, existing PPG-based blood pressure estimation models have not consistently achieved the established clinical numerical limits such as AAMI/ISO 81060-2, and prior evaluations often lack the rigorous experimental controls necessary for valid clinical assessment. Moreover, the publicly available datasets commonly used are heterogeneous and lack physiologically controlled conditions for fair benchmarking. To enable fair benchmarking under physiologically controlled conditions, we created a standardized benchmarking subset NBPDB comprising 101,453 high-quality PPG segments from 1,103 healthy adults, derived from MIMIC-III and VitalDB. Using this dataset, we systematically benchmarked several state-of-the-art PPG-based models. The results showed that none of the evaluated models met the AAMI/ISO 81060-2 accuracy requirements (mean error $<$ 5 mmHg and standard deviation $<$ 8 mmHg). To improve model accuracy, we modified these models and added patient demographic data such as age, sex, and body mass index as additional inputs. Our modifications consistently improved performance across all models. In particular, the MInception model reduced error by 23\% after adding the demographic data and yielded mean absolute errors of 4.75 mmHg (SBP) and 2.90 mmHg (DBP), achieves accuracy comparable to the numerical limits defined by AAMI/ISO accuracy standards. Our results show that existing PPG-based BP estimation models lack clinical practicality under standardized conditions, while incorporating demographic information markedly improves their accuracy and physiological validity.

Noninvasive Intracranial Pressure Estimation Using Subspace System Identification and Bespoke Machine Learning Algorithms: A Learning-to-Rank Approach

Objective: Accurate noninvasive estimation of intracranial pressure (ICP) remains a major challenge in critical care. We developed a bespoke machine learning algorithm that integrates system identification and ranking-constrained optimization to estimate mean ICP from noninvasive signals. Methods: A machine learning framework was proposed to obtain accurate mean ICP values using arbitrary noninvasive signals. The subspace system identification algorithm is employed to identify cerebral hemodynamics models for ICP simulation using arterial blood pressure (ABP), cerebral blood velocity (CBv), and R-wave to R-wave interval (R-R interval) signals in a comprehensive database. A mapping function to describe the relationship between the features of noninvasive signals and the estimation errors is learned using innovative ranking constraints through convex optimization. Patients across multiple clinical settings were randomly split into testing and training datasets for performance evaluation of the mapping function. Results: The results indicate that about 31.88% of testing entries achieved estimation errors within 2 mmHg and 34.07% of testing entries between 2 mmHg to 6 mmHg from the nonlinear mapping with constraints. Conclusion: Our results demonstrate the feasibility of the proposed noninvasive ICP estimation approach. Significance: Further validation and technical refinement are required before clinical deployment, but this work lays the foundation for safe and broadly accessible ICP monitoring in patients with acute brain injury and related conditions.

Externally Validated Longitudinal GRU Model for Visit-Level 180-Day Mortality Risk in Metastatic Castration-Resistant Prostate Cancer

Metastatic castration-resistant prostate cancer (mCRPC) is a highly aggressive disease with poor prognosis and heterogeneous treatment response. In this work, we developed and externally validated a visit-level 180-day mortality risk model using longitudinal data from two Phase III cohorts (n=526 and n=640). Only visits with observable 180-day outcomes were labeled; right-censored cases were excluded from analysis. We compared five candidate architectures: Long Short-Term Memory, Gated Recurrent Unit (GRU), Cox Proportional Hazards, Random Survival Forest (RSF), and Logistic Regression. For each dataset, we selected the smallest risk-threshold that achieved an 85% sensitivity floor. The GRU and RSF models showed high discrimination capabilities initially (C-index: 87% for both). In external validation, the GRU obtained a higher calibration (slope: 0.93; intercept: 0.07) and achieved an PR-AUC of 0.87. Clinical impact analysis showed a median time-in-warning of 151.0 days for true positives (59.0 days for false positives) and 18.3 alerts per 100 patient-visits. Given late-stage frailty or cachexia and hemodynamic instability, permutation importance ranked BMI and systolic blood pressure as the strongest associations. These results suggest that longitudinal routine clinical markers can estimate short-horizon mortality risk in mCRPC and support proactive care planning over a multi-month window.

Cuffless, calibration-free hemodynamic monitoring with physics-informed machine learning models

Wearable technologies have the potential to transform ambulatory and at-home hemodynamic monitoring by providing continuous assessments of cardiovascular health metrics and guiding clinical management. However, existing cuffless wearable devices for blood pressure (BP) monitoring often rely on methods lacking theoretical foundations, such as pulse wave analysis or pulse arrival time, making them vulnerable to physiological and experimental confounders that undermine their accuracy and clinical utility. Here, we developed a smartwatch device with real-time electrical bioimpedance (BioZ) sensing for cuffless hemodynamic monitoring. We elucidate the biophysical relationship between BioZ and BP via a multiscale analytical and computational modeling framework, and identify physiological, anatomical, and experimental parameters that influence the pulsatile BioZ signal at the wrist. A signal-tagged physics-informed neural network incorporating fluid dynamics principles enables calibration-free estimation of BP and radial and axial blood velocity. We successfully tested our approach with healthy individuals at rest and after physical activity including physical and autonomic challenges, and with patients with hypertension and cardiovascular disease in outpatient and intensive care settings. Our findings demonstrate the feasibility of BioZ technology for cuffless BP and blood velocity monitoring, addressing critical limitations of existing cuffless technologies.

PMB-NN: Physiology-Centred Hybrid AI for Personalized Hemodynamic Monitoring from Photoplethysmography

Continuous monitoring of blood pressure (BP) and hemodynamic parameters such as peripheral resistance (R) and arterial compliance (C) are critical for early vascular dysfunction detection. While photoplethysmography (PPG) wearables has gained popularity, existing data-driven methods for BP estimation lack interpretability. We advanced our previously proposed physiology-centered hybrid AI method-Physiological Model-Based Neural Network (PMB-NN)-in blood pressure estimation, that unifies deep learning with a 2-element Windkessel based model parameterized by R and C acting as physics constraints. The PMB-NN model was trained in a subject-specific manner using PPG-derived timing features, while demographic information was used to infer an intermediate variable: cardiac output. We validated the model on 10 healthy adults performing static and cycling activities across two days for model's day-to-day robustness, benchmarked against deep learning (DL) models (FCNN, CNN-LSTM, Transformer) and standalone Windkessel based physiological model (PM). Validation was conducted on three perspectives: accuracy, interpretability and plausibility. PMB-NN achieved systolic BP accuracy (MAE: 7.2 mmHg) comparable to DL benchmarks, diastolic performance (MAE: 3.9 mmHg) lower than DL models. However, PMB-NN exhibited higher physiological plausibility than both DL baselines and PM, suggesting that the hybrid architecture unifies and enhances the respective merits of physiological principles and data-driven techniques. Beyond BP, PMB-NN identified R (ME: 0.15 mmHg$\cdot$s/ml) and C (ME: -0.35 ml/mmHg) during training with accuracy similar to PM, demonstrating that the embedded physiological constraints confer interpretability to the hybrid AI framework. These results position PMB-NN as a balanced, physiologically grounded alternative to purely data-driven approaches for daily hemodynamic monitoring.

Deep Learning-Driven Quantitative Spectroscopic Photoacoustic Imaging for Segmentation and Oxygen Saturation Estimation

Spectroscopic photoacoustic (sPA) imaging can potentially estimate blood oxygenation saturation (sO2) in vivo noninvasively. However, quantitatively accurate results require accurate optical fluence estimates. Robust modeling in heterogeneous tissue, where light with different wavelengths can experience significantly different absorption and scattering, is difficult. In this work, we developed a deep neural network (Hybrid-Net) for sPA imaging to simultaneously estimate sO2 in blood vessels and segment those vessels from surrounding background tissue. sO2 error was minimized only in blood vessels segmented in Hybrid-Net, resulting in more accurate predictions. Hybrid-Net was first trained on simulated sPA data (at 700 nm and 850 nm) representing initial pressure distributions from three-dimensional Monte Carlo simulations of light transport in breast tissue. Then, for experimental verification, the network was retrained on experimental sPA data (at 700 nm and 850 nm) acquired from simple tissue mimicking phantoms with an embedded blood pool. Quantitative measures were used to evaluate Hybrid-Net performance with an averaged segmentation accuracy of >= 0.978 in simulations with varying noise levels (0dB-35dB) and 0.998 in the experiment, and an averaged sO2 mean squared error of <= 0.048 in simulations with varying noise levels (0dB-35dB) and 0.003 in the experiment. Overall, these results show that Hybrid-Net can provide accurate blood oxygenation without estimating the optical fluence, and this study could lead to improvements in in-vivo sO2 estimation.

Generalizable Blood Pressure Estimation from Multi-Wavelength PPG Using Curriculum-Adversarial Learning

Accurate and generalizable blood pressure (BP) estimation is vital for the early detection and management of cardiovascular diseases. In this study, we enforce subject-level data splitting on a public multi-wavelength photoplethysmography (PPG) dataset and propose a generalizable BP estimation framework based on curriculum-adversarial learning. Our approach combines curriculum learning, which transitions from hypertension classification to BP regression, with domain-adversarial training that confuses subject identity to encourage the learning of subject-invariant features. Experiments show that multi-channel fusion consistently outperforms single-channel models. On the four-wavelength PPG dataset, our method achieves strong performance under strict subject-level splitting, with mean absolute errors (MAE) of 14.2mmHg for systolic blood pressure (SBP) and 6.4mmHg for diastolic blood pressure (DBP). Additionally, ablation studies validate the effectiveness of both the curriculum and adversarial components. These results highlight the potential of leveraging complementary information in multi-wavelength PPG and curriculum-adversarial strategies for accurate and robust BP estimation.

Gaze into the Heart: A Multi-View Video Dataset for rPPG and Health Biomarkers Estimation

Progress in remote PhotoPlethysmoGraphy (rPPG) is limited by the critical issues of existing publicly available datasets: small size, privacy concerns with facial videos, and lack of diversity in conditions. The paper introduces a novel comprehensive large-scale multi-view video dataset for rPPG and health biomarkers estimation. Our dataset comprises 3600 synchronized video recordings from 600 subjects, captured under varied conditions (resting and post-exercise) using multiple consumer-grade cameras at different angles. To enable multimodal analysis of physiological states, each recording is paired with a 100 Hz PPG signal and extended health metrics, such as electrocardiogram, arterial blood pressure, biomarkers, temperature, oxygen saturation, respiratory rate, and stress level. Using this data, we train an efficient rPPG model and compare its quality with existing approaches in cross-dataset scenarios. The public release of our dataset and model should significantly speed up the progress in the development of AI medical assistants.

A Dataset and Toolkit for Multiparameter Cardiovascular Physiology Sensing on Rings

Smart rings offer a convenient way to continuously and unobtrusively monitor cardiovascular physiological signals. However, a gap remains between the ring hardware and reliable methods for estimating cardiovascular parameters, partly due to the lack of publicly available datasets and standardized analysis tools. In this work, we present $\tau$-Ring, the first open-source ring-based dataset designed for cardiovascular physiological sensing. The dataset comprises photoplethysmography signals (infrared and red channels) and 3-axis accelerometer data collected from two rings (reflective and transmissive optical paths), with 28.21 hours of raw data from 34 subjects across seven activities. $\tau$-Ring encompasses both stationary and motion scenarios, as well as stimulus-evoked abnormal physiological states, annotated with four ground-truth labels: heart rate, respiratory rate, oxygen saturation, and blood pressure. Using our proposed RingTool toolkit, we evaluated three widely-used physics-based methods and four cutting-edge deep learning approaches. Our results show superior performance compared to commercial rings, achieving best MAE values of 5.18 BPM for heart rate, 2.98 BPM for respiratory rate, 3.22\% for oxygen saturation, and 13.33/7.56 mmHg for systolic/diastolic blood pressure estimation. The open-sourced dataset and toolkit aim to foster further research and community-driven advances in ring-based cardiovascular health sensing.

Generalizable deep learning for photoplethysmography-based blood pressure estimation -- A Benchmarking Study

Photoplethysmography (PPG)-based blood pressure (BP) estimation represents a promising alternative to cuff-based BP measurements. Recently, an increasing number of deep learning models have been proposed to infer BP from the raw PPG waveform. However, these models have been predominantly evaluated on in-distribution test sets, which immediately raises the question of the generalizability of these models to external datasets. To investigate this question, we trained five deep learning models on the recently released PulseDB dataset, provided in-distribution benchmarking results on this dataset, and then assessed out-of-distribution performance on several external datasets. The best model (XResNet1d101) achieved in-distribution MAEs of 9.4 and 6.0 mmHg for systolic and diastolic BP respectively on PulseDB (with subject-specific calibration), and 14.0 and 8.5 mmHg respectively without calibration. Equivalent MAEs on external test datasets without calibration ranged from 15.0 to 25.1 mmHg (SBP) and 7.0 to 10.4 mmHg (DBP). Our results indicate that the performance is strongly influenced by the differences in BP distributions between datasets. We investigated a simple way of improving performance through sample-based domain adaptation and put forward recommendations for training models with good generalization properties. With this work, we hope to educate more researchers for the importance and challenges of out-of-distribution generalization.