Demographic subgroup-aware analysis of blood pressure predictive models

Abstract

Blood pressure (BP) is an important cardiovascular health indicator, usually monitored non-invasively with a sphygmomanometer, which can be bulky and inconvenient for real-time monitoring. Blood pressure estimation using photoplethysmography (PPG) waveform analysis offers a promising alternative for intermittent or continuous cuff-less BP monitoring. However, changes in vascularization due to individual physiology and age can directly affect the morphology of the PPG waveform. Thus, prediction accuracy requires a demographic-aware approach. To address these challenges, we trained three conventional ML models for BP prediction and conducted a subgroup-aware analysis to evaluate model performance across individual and intersectional demographic groups. Additionally, we show that signal quality assessment is a pivotal step in the signal-processing pipeline before feature extraction to mitigate external perturbations (e.g., motion artifacts) in the PPG waveform. We achieve a mean absolute error (MAE) of 3.36 mmHg for systolic blood pressure (SBP) and 1.76 mmHg for diastolic BP (DBP) with models trained when signal quality assessment is incorporated.