Personalized and Explainable Blood Pressure Estimation from PPG via Hybrid CNN--Morphological Features

Continuous cuffless blood pressure (BP) monitoring remains challenging due to motion artifacts, physiological variability, and the limited robustness of conventional pulse transit time (PTT) models under dynamic conditions. Many prior approaches rely on multi-second windows to stabilize estimation, an assumption that is frequently violated during real-world monitoring with intermittent signal corruption. Here, we show that discriminative BP-related information is preserved at the single-beat level and present a lightweight multi-modal wearable framework for continuous BP estimation. The system integrates synchronized chest electrocardiography (ECG) and ear-clip reflectance photoplethysmography, each co-located with a 6-axis inertial measurement unit to provide motion context. We introduce a hybrid learning architecture in which a one-dimensional convolutional neural network extracts a 64-dimensional embedding from individual PPG beats and fuses it with 30 physiology-grounded features, including PTT statistics and heart rate variability, followed by LightGBM regression. The method was evaluated using a multi-phase stress protocol ($n=10$) and the PulseDB public dataset with subject-disjoint validation. Across 30 independent runs, the model achieved mean absolute errors of $4.02 \pm 0.21$~mmHg for systolic BP and $1.79 \pm 0.05$~mmHg for diastolic BP, corresponding to a 28.2% reduction in combined MAE relative to baseline models. By enabling beat-wise estimation without long temporal context, this framework supports computationally efficient cuffless BP monitoring suitable for wearable deployment under practical resource constraints. The source code for this work is available at https://github.com/SYMBIOX-Lab/BP-wireless.

Blood pressure (BP) is a key marker for cardiovascular risk assessment and therapeutic decision-making, and Photoplethysmography (PPG) enables low-cost, wearable-friendly cuffless BP estimation. However, even with recent progress, many PPG-based models are trained with BP regression alone and may rely on amplitude-dominated shortcuts. In addition, demographic covariates that systematically modulate vascular compliance are often incorporated only via late fusion, limiting subject-specific representation learning. We propose a Transformer-based network for cuffless BP estimation from PPG signal, leveraging self-attention to capture long-range dependencies across multiple cardiac cycles. To account for subject-specific vascular differences, the model is conditioned on demographics via FiLM-style feature modulation applied through the attention and feed-forward sublayers of Transformer blocks. In addition, we add an auxiliary morphology head to guide the model to attend to BP-relevant waveform morphology associated with arterial stiffness and wave reflection. Under calibration-based evaluation protocols on the large-scale PulseDB dataset, the proposed method achieves MAE of 4.56 mmHg for systolic BP and 2.62 mmHg for diastolic BP, reducing errors by 47% and 50% compared with prior demographic-enhanced PPG baselines. The resulting lightweight, single-sensor model supports scalable and clinically grounded cuffless BP estimation in calibration-enabled deployment settings.

Continuous cuffless blood pressure (BP) monitoring is essential for connected health systems and wearable devices, enabling early detection, longitudinal tracking, and personalized management of cardiovascular disease. Many prior approaches attempt to estimate BP indirectly by reconstructing electrocardiography (ECG) from photoplethysmography (PPG), assuming ECG provides a stronger physiological link to BP. However, ECG sensing is less accessible in wearable settings and may introduce unnecessary complexity. In this work, we first perform a large-scale physiological correlation analysis on the MIMIC-III waveform database, revealing that PPG exhibits substantially stronger coupling with arterial blood pressure (ABP) ($|r|=0.247$, $p<0.001$) than ECG does ($r=0.018$, $p=0.187$), challenging the assumption that ECG provides a superior intermediate representation. Motivated by this insight, we conduct a systematic comparison between direct PPG-to-BP prediction and ECG-mediated pipelines using multiple state-of-the-art deep learning models. Across 1.74M segments from 3,127 patients, direct PPG-to-BP prediction achieves British Hypertension Society Grade A performance ($\mathrm{MAE}_{\mathrm{SBP}} = 4.82 mmHg$, $\mathrm{MAE}_{\mathrm{DBP}} = 4.31 mmHg$), outperforming all ECG-mediated approaches, which achieve only Grade B accuracy. Our findings suggest that accurate continuous BP monitoring can be achieved directly from wearable PPG signals, enabling simpler, more efficient pipelines for real-world connected health systems.