Type-2 Fuzzy Classification of Blood Pressure Parameters

Usman Mahmood1, #Adel Al-Jumaily2, Mohamed Al-Jaafreh3

1, 2, 3

Faculty of Engineering, University of Technology, Sydney 1 Usman.Mahmood@student.uts.edu.au 2 adel@eng.uts.edu.au 3 maljaaf@eng.uts.edu.au automated blood pressure device only display crisp readings of blood pressure parameters, and many people do not know how the scoring works. To address such problems, many recent research studies employ photo-plethysmography (PPG) based wearable sensors for continuous, comfortable and non-invasive measurement of blood pressure. PPG signal is very useful to measure the systolic, diastolic and mean blood pressure as compared to conventional oscillometric method; which only measures the mean blood pressure and gives estimated values for systolic and diastolic blood pressures [3]. In reality, PPG signal is related to the arterial blood pressure (ABP), however, relationship between PPG and ABP is described as a static relationship [4], while Yan and Zhang establish more complex dynamic relationship between PPG and ABP [5]. Recent research study has showed that there is no simple relationship between continuous PPG and ABP, but if several serial heart beats are aggregated, a static relationship can be established between PPG signal frequency; Heart rate, and ABP [6]. Basically, most factors; which decouple the ABP and PPG, operate over a short time scales and when these factors are eliminated by averaging the beats, continuous estimation of ABP can be obtained from calibrated photo-plethysmography. However, if the time scale is more than 20 minutes, data obtained by PPG becomes less consistent, and PPG signal needs to be calibrated once again [6]. Mainly, the procedure of determine the systolic, mean and diastolic blood pressure from PPG pulse profiles is a difficult and highly sensitive task. The main difficulty is related to the strategy involved in the computational algorithm to extract these parameters from the pulse profiles. Moreover, pulse width of the signal was obtained by using the PPG based sensor varies depending on various factors, including the change in its relative vertical position from the heart. So while using PPG based sensor, it is necessary to compensate for location and position of the sensor with respect to patients heart [7]. As well known, Type-2 Fuzzy system is one of the most successful techniques to deal with high uncertainty, sensitive and non-linear problem [8], hence, Type-2 Fuzzy system is very suitable for our research problem, estimation and classification of blood pressure.

Abstract Blood pressure measurement is a highly sensitive task, because even breathing can cause variation as high as 10mmHg in reading of blood pressure. Due to the presence of high level of uncertainty; the linear model for blood pressure classification is not appropriate. Fuzzy Logic Systems are capable of producing precise solutions from vague, incomplete, or approximate information, by accommodating the ambiguities and logic. This paper presents a novel type-2 Fuzzy Logic System to estimate and classify blood pressure parameters in appropriate linguistic description. Firstly, a type-2 fuzzy logic system for the classification of blood pressure parameters is designed. Secondly, the proposed model is demonstrated by graphical user interface. The designed fuzzy model for the classification of blood pressure parameters gives more realistic results than linear model. The outcome of this paper is a friendly graphic user interface (GUI). The proposed model takes crisp value of heart rate as an input and generates crisp reading of blood pressure along with its appropriate linguistic classification, e.g., normal, low, or high etc; to provide more clear information to the general public about their cardiac health. The system has been tested and the computed percentage is less than 10% error values of all ten subjects systolic, diastolic and mean blood pressure. 1. INTRODUCTION

Nowadays, people suffering from blood pressure related diseases, such as hypertension, are increasing rapidly. Physicians predict that one third of the worlds population will be suffering from high blood pressure by 2025 [1]. Continuous monitoring of patients blood pressure is required during surgical operations and is very useful to diagnose many related blood pressure diseases. Existing standard blood pressure measuring devices uses invasive catheter; which inserted in patients artery or air filled cuff; which applies pressures on the patient's skin. Due to invasive and uncomfortable measuring procedures, these devices are not suitable for continuous blood pressure measurements [2]. Recently; many young people are also being diagnosed with high blood pressure, therefore, physicians advise people to regularly monitor their blood pressure at home. Available

1-4244-1502-0/07/$25.00 2007 IEEE

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This paper presents a novel type-2 fuzzy logic system to classify blood pressure parameters with heart rate; PPG signal frequency. This type-2 Fuzzy Logic System estimates crisp values of blood pressure parameters from heart rate. Moreover, it also gives classification of blood pressure in crisp value and linguistic terms to provide more useful information to general public than crisp values only; the use of linguistic word Normal and (75/114 mmHg) creates much better understanding for any public patient, compared to (75/114 mmHg) only. The conceptual model of the type-2 FLS is shown in Fig. 1.

corresponding to resistance (R). Therefore, as ohms law, the relationship between MBP with CO and TR is expressed as shown in equation (3) [9]: MBP=COTR------------ (3) Therefore, from equations (2) and (3) MBP is related to heart rate as shown in equation (4): MBP=SVTPR HR------------ (4) Besides, Blood Pressure is the force exerted by the blood against the walls of arteries. Traditionally, blood pressure is represented to Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and MBP. SBP is referred to the highest pressure exerted by the blood on the walls of arteries, when the heart beats and pumps blood into the arteries, while DBP is the lowest pressure exerted by the blood on the walls of arteries, when heart is relaxing between two beats. But MBP is calculated by combing SBP and DBP by using equation (5): MBP=DBP +1/3 (SBP-DBP) ----- (5) 3. FUZZY LOGIC

Fig. 1: Conceptual model of the our project

This paper is organized that the heart rate and blood pressure relation are highlighted in section two, Type-2 FLS is described and the methodology of designing Type-2 FLS is explained in section three, graphic user interface and some experimental results are illustrated in tables and figures in section four. Then, the paper will be summarized and concluded in section five. 2. HEART RATE AND BLOOD PRESSURE

Biologically, Heart rate is the number of heart beats per minute and it is equal to PPG signal frequency as shown in equation (1) [6]: h = 60 x f ----------------------- (1) Where (f) is frequency of PPG signal. The volume of blood per minute pumps by heart into the aorta artery is called cardiac output [9]. The cardiac output CO can be obtained by multiplying the stroke volume SV with the number of systolic intervals per minute or heart rate HR as shown in equation (2) [10]: CO = HR SV---------------- (2) Moreover, Dynamic flow of blood in body; cardiovascular system, can be considered as an electric circuit [8]. Therefore, Ohms law can be applied on the cardiovascular system; where the mean blood pressure (MBP) is corresponding to voltage potential difference (V), a blood flow within vessels or cardic output (CO) is corresponding to current (I) and the total blood vessels resistance (TR) against blood flow is

Fuzzy Logic (FL) was first introduced by Dr. Lotfi A. Zadeh in 1962 [11]. FL overcomes the deficiencies of bivalent logic by offering partial set memberships. Fuzzy sets are usually defined in terms of their membership functions. The membership function (MF) of a crisp set takes on only two values 0 or 1, while the MF of a fuzzy set can range between 0 and 1. The most commonly used membership functions are triangular, trapezoidal, and Gaussian. In 1975, the motivation of type-2 fuzzy set was extended by Zadeh [12] of an ordinary type-1 fuzzy set. Then, Mizumoto and Tanaka presented some properties of fuzzy sets of type-2 [13]. Later in 1998, Karnik and Mendel introduced Type-2 FS comprehensively [8]. Type-1 fuzzy sets have certain and crisp value for their membership. While type-2 fuzzy sets do not have any certain membership and their membership is a fuzzy number.

Fig. 2: General model of Fuzzy Rule Based FL

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A fuzzy Logic system that can be completely described in terms of type-1 fuzzy sets is called a type-1 FLS, whereas a FLS is a type-2 FLS as long as any one of its antecedent or consequent sets is a type-2 fuzzy set [14]. The design of novel type-2 fuzzy logic system for the classification of blood pressure parameters, as usual FLS, is consists of four steps, i.e. Fuzzification, Rules, Inference engine, and Output Process as Fig 2 shown. A. Fuzzification The process of describing crisp values into linguistic terms (fuzzy sets) is called Fuzzification. Firstly, the input HR is fuzzifed into Very Low, Low, Normal, High, and Very High type-1 membership functions as shown in Fig. 3. Each point in HR range may have one or more non-zero membership value; such as HR=63 has non-zero membership value in two membership functions, i.e. Normal and Low. The degree of membership is also referred to as the "truth" value. The HR=63 will be assigned fuzzy set with higher membership grade, i.e. Normal in this example.

B. Rules FLS Rules are extracted from the numerical data depend on the conducted experiment, as described in section 4, to map input with output. Each rule has to parts; IF part; which is called antecedent and Then part; which is called consequent. The extracted FLS Rules are given below; Rule 1: IF HR is Very Low THEN BP is Very Low Rule 2: IF HR is Low THEN BP is Low Rule 3: IF HR is Normal THEN BP is Normal Rule 4: IF HR is High THEN BP is High Rule 5: IF HR is Very High THEN BP is Very High C. Inference engine The fuzzy inference engine applies the fuzzy rules on truth values of input variables in order to determine a corresponding output. The most commonly used methods are minimum t-norm and product t-norm. The product t-norm inference implication method was used to scale the output membership function BP by the truth values of HR. For HR=63 which has non-zero membership value in two membership functions, i.e. 0.67 of Normal and 0.26 of Low as shown in Fig. 3, then the implementation of fuzzy rules and product t-norm method generate two corresponding membership values of MBP membership functions as shown in Fig. 5.

Fig. 3: Type-1 fuzzy sets to represent input values of HR

Secondly, the output mean blood pressure is represented into Very Low, Low, Normal, High, and Very High type-2 membership functions as shown in Fig. 4.
Fig. 5: Implementation of fuzzy rules

Then the product t-norm method is implemented on two corresponding membership values of MBP as shown in Fig.6.

Fig. 4: Type-2 fuzzy sets to represent output values of mean blood pressure

Fig. 6: Implementation of product t-norm method

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D. Output Process Firstly, Type-reducer reduces type-2 fuzzy sets into type-1 fuzzy sets. Most commonly used centre of sets method was used, which replaced each consequent type-2 fuzzy set by its centroid and scaled it by degree of firing as shown in Fig. 7.

Fig. 7: Implementation of centre of sets method

Secondly, the defuzzifier uses the mid point of type reduced sets as output crisp value. The Type-reduction and Defuzzification process is shown in figures shown in next column.

An experiment was conducted on ten adult age subjects, to measure their heart rate, systolic and diastolic blood pressure with a standard blood pressure measuring device; a digital automatic blood pressure monitor with intelli-sence, OMRON IAIB Model HEM-7000-C1L, made by OMRON Healthcare Japan was used to record the readings from people. These monitor automatically inflate with the push of a button and have intelliSence technology to automatically determine the correct amount of pressure required to quickly and comfortably measure accurate blood pressure reading. Three readings of ten adult age subjects were taken. Then the average heart rate and systolic, diastolic and mean blood pressure readings of each person are illustrated in table 1. Systolic, diastolic and mean blood pressure values are also estimated by using the designed type-2 FLS, depending on heart rate readings of ten subjects of table 1. The estimated values for systolic, diastolic and mean blood pressure of ten subjects are illustrated in table 2 with appropriate Linguistic Classification (LC) for each subject.
No. subjects 1 2 3 4 5 6 7 8 9 HR (b/m) 76.00 70.67 79.67 66.33 63.33 88.00 70.33 88.67 67.00 SBP (mmHg) 121.33 125.33 125.67 108.00 112.00 156.33 110.00 144.00 118.67 DBP (mmHg) 84.67 80.33 78.33 71.33 72.00 89.33 82.00 83.33 70.33 MBP (mmHg) 96.89 95.33 94.11 83.55 85.33 111.66 91.33 103.55 86.44

Fig. 8: Implementing mid point method

4.

GRAPHIC USER INTERFACE

79.00 129.00 85.00 99.67 10 TABLE 1: AVERAGE OF HR AND SYSTOLIC, DIASTOLIC AND MEAN BP READINGS OF 10 SUBJECTS No. subjects 1 2 3 4 5 6 7 8 9 HR (b/m) 76.00 70.67 79.67 66.33 63.33 88.00 70.33 88.67 67.00 SBP (mmHg) 130.06 120.66 135.36 113.00 107.70 151.23 120.06 152.41 114.18 DBP (mmHg) 78.60 73.23 81.63 68.00 65.84 90.70 74.89 91.37 70.33 MBP (mmHg) 95.76 89.40 99.54 83.00 79.80 110.88 88.61 111.70 84.40 Normal Normal Normal Normal Normal High Normal High Normal LC

The designed type-2 FLS which was used for classification blood pressure from heart rate was programmed as graphic user interface (GUI) for testing purposes. This GUI is illustrated in Fig. 9.

79.00 135.35 81.60 99.50 Normal 10 TABLE 2: HR READINGS AND ESTIMATED VALUES OF SBP, DBP AND MBP OF 10 SUBJECTS WITH APPROPRIATE LINGUISTIC CLASSIFICATION

Fig. 9: The GUI of the designed type-2 FLS

The estimated results are compared with real reading by computing the percentage absolute error (PAE) for all ten subjects systolic, diastolic and mean blood pressure readings as shown in equation (6) and the percentage error values are illustrated in table 3.

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Estimated MAP - Real MAP | 100% --- (6) PAE = | Real MAP
No. subjects 1 2 3 4 5 6 7 8 9 10 PAE of SBP (%) 7.20 3.73 7.71 4.63 3.84 3.26 9.15 5.84 3.78 4.92 PAE of DBP (%) 7.17 8.84 4.21 4.67 8.56 1.53 8.67 9.65 0.00 4.00 PAE of MBP (%) 1.17 6.22 5.77 0.66 6.48 0.70 2.98 7.87 2.36 0.17 HR (b/m) 76.00 70.67 79.67 66.33 63.33 88.00 70.33 88.67 67.00 79.00

very close to measured values and are illustrated with the appropriate Linguistic Classification (LC) for each reading as shown in table 2. Thus type-2 FLS has successfully classified and estimated blood pressure parameters crisp values.
10 9 8 PAE of DBP (%) 7 6 5 4 3 2 1 0 0 2 4 6 8 10 No. Subjects
Fig. 11: Comparison of measured and calculated Diastolic blood pressure

TABLE 3: THE PERCENTAGE ABSOLUTE ERROR VALUES FOR ALL TEN SUBJECTS SBP, DBP AND MBP READINGS

To clear whole picture, the PAE values of all ten subjects for SBP are illustrated in Fig. 10, the PAE values for DBP are illustrated in Fig. 11 and for the PAE values MBP are illustrated in Fig. 12.
PAE of MBP (%)

9 8 7 6 5 4 3 2 1 0 0 2 4 6 8 10 No. Subjects
Fig. 12: Comparison of measured and calculated Mean blood pressure

PAE of SBP (%)

10 9 8 7 6 5 4 3 2 1 0 0 2 4 6 8 10 No. Subjects

Fig. 10: Comparison of measured and calculated Systolic blood pressure

From figures 10, 11 and 12, the maximum PAE is less than 10% of all ten subjects systolic, diastolic and mean blood pressure. 5. CONCLUSION

In Future work, the designed type-2 FLS for BP classification can be programmed into a microcontroller and a PPG sensor can be incorporated to acquire heart rate directly from the patients to afford more obvious situation of cardiac health to the general public. This modification can result in a type-2 FL based standalone blood pressure measuring device. REFERENCE [1] Pravda RU, 2005, Hypertension today is in the global scale, Science and Culture news from Russia, accessed online on 13th June 2007, available at: http://www.newsfromrussia.com/science/2005/01/14/ 57840.html. [2] E. O'Brien and K. O'Malley, Essentials of blood pressure measurement, with a foreword by George E. Burch Edinburgh; New York, Churchill Livingstone, 1981.

The designed type-2 FLS for classification of blood pressure parameters is giving encouraging outcomes; where the computed percentage error values of all ten subjects systolic, diastolic and mean blood pressure are less than 10% as shown in Figures 10, 11 and 12. Moreover; the values of systolic, diastolic, and mean blood pressure calculated from heart rate by using type-2 FLS are

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[3] . Jobbgy, P. Csords and A. Mersich, Accurate Blood Pressure Measurement At Home, Proceedings of Medicon and Health Telematics conference, Ischia Italy, 31 July - 5 August, 2004. [4] Allen, J. and Murray, A., Modelling the relationship between peripheral blood pressure and blood volume pulses using linear and neural network system identification techniques, PhysiolMeas, vol. 20, no. 3, pp.: 287-301, 1999. [5] M. Yan and Y. Zhang, Noninvasive Estimation of Blood Pressure Using Photoplethysmographic Signals in the Period Domain, Proceedings of 27th Annual International Conference, Shanghai, China, Sept. 1-4, pp.: 3583 3584, 2005. [6] P. Shaltis, A. Reisner, H. Asada, 2005, Calibration of the Photoplethysmogram to Arterial Blood Pressure: Capabilities and Limitations for Continuous Pressure Monitoring, Proceedings of the 2005 IEEE, Engineering in Medicine and Biology 27th Annual Conference, Shanghai, China, September 1-4, 2005. [7] G.Y. Jeong, K.H. Yu, and N.G. Kim, Continuous Blood Pressure Monitoring using Pulse Wave Transit Time, ICCAS2005 Conference, KINTEX, Gyeonggi-Do, Korea , June 2-5,2005. [8] N. Karnik and J. M. Mendel, Introduction to type-2 fuzzy logic systems, Proceedings of IEEE

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