3 BloodPressure Aliasing

DEPARTMENT OF ENGINEERING SCIENCE
INSTITUTE OF BIOMEDICAL ENGINEERING
Monitoring Blood Pressure

Biomedical Signal Processing
marco.pimentel@eng.ox.ac.uk
Marco F Pimentel,
Graduate Student,
Centre for Doctoral Training in Healthcare Innovation,
Institute of Biomedical Engineering,
University of Oxford September 6, 2018
Outline
 Short history
 Definition of Blood Pressure
 What is hypertension?
 Various methods used for measurements of blood

pressure
 How often should we measure blood pressure?
 Sampling and Aliasing
 New resources – An Oxford University Project
September 6, 2018
M F Pimentel Blood Pressure - Biomedical Signal Processing
Page 2
The first to measure BP
 1733 - Reverend Stephen

Hales first to measure BP
 Measured the height of a

column of blood after
cannulating the carotid
artery in a horse with a
brass pipe.
I’m that
good!!!
September 6, 2018
Page 3
The first measurement of BP
 The brass pipe was

attached to a 12 inch glass
tube
 Tube was connected to the

pipe via a trachea of a
goose
September 6, 2018
Page 4
A second try…
 100 years later: a mercury manometer connected to the

artery was used to measure the BP
 However:
 Both of these methods are invasive
… And maybe… a
bit uncomfortable
for the patient!
September 6, 2018
Page 5
Eureka!
 In late 1890s, an Italian physician – Scipione Riva Rocci

invented the Sphygmomanometer
Shygmo (from the Greek) => pulse

Manometer => pressure meter
- Consisted of a mercury column

Manometer, a rubber sleeve which
is filled with air, and a squeeze bag
to inflate the rubber sleeve I had an
idea!
September 6, 2018
Page 6
Nowadays BP monitors
September 6, 2018
Page 7
What is Blood Pressure?
 Blood Pressure is a measurement of the force against the

walls of the arteries as the heart pumps blood throughout
the body
 Blood pressure is measured in mmHg (millimeters of

mercury)
September 6, 2018
Page 8
 Blood Pressure is a measurement of the force against the

walls of the arteries as the heart pumps blood throughout
the body
 Blood pressure is measured in mmHg (millimeters of

mercury)
 1,000 Pa is about 7 mmHg!

September 6, 2018
Page 9
 The blood pressure reading is taken in 2 numbers:

systolic and diastolic.
Measure of
pressure as the
heart is beating Systolic
Diastolic Measure of
pressure while
the heart is at rest
between beating
September 6, 2018
Page 10
Hypertension
 Blood pressure changes all the time:

 It decreases when we sleep, or when we are at rest
 It increases when we are active, excited, practicing sports,
stressed and nervous
 Changing blood pressure is a vital part of a healthy cardiovascular

system
 Hypertension, or high blood pressure, happens when the blood

pressure stays too high over an extended period of time:
 Can cause the heart to have to work too hard and the force of
the blood flow can damage your arteries, heart, kidneys, brain
and eyes.
September 6, 2018
Page 11
Hypertension
Know your numbers:
September 6, 2018
Page 12
Hypertension
Hypertension depends on several factors:
Obesity
Age Activity
Gender Diet
Ethnicity
Stress
Diabetes
Tobacco
HYPERTENSION
September 6, 2018
Page 13
How to measure?
Invasive blood pressure (IBP):
 It measures the BP internally by using a sensitive IV
catheter inserted into an superficial artery. This is the
procedure taken where continuous BP monitoring is
required.
Non-invasive blood pressure (NIBP):

 Auscultation
 Oscillometry
 Doppler (determines the flow distal to the artery)
 Arterial tonometry, Arterial volume clamp are other types
of NIBP measure
September 6, 2018
Page 14
How to measure?
 Non-invasive blood pressure
 Auscultation
Mercury sphygmomanometer Mechanical manometer

+ stethoscope + stethoscope
 Oscillometry
September 6, 2018
Page 15
How to measure?
September 6, 2018
Page 16
The auscultation method
September 6, 2018
Page 17
September 6, 2018
Page 18
Systolic BP
Diastolic BP
September 6, 2018
Page 19
The oscillometric method
September 6, 2018
Page 20
 It is based on the
change of the
magnitude of
oscillation
 MAP – Mean
Arterial Pressure
September 6, 2018
Page 21
 It is based on the
change of the
magnitude of
oscillation
 MAP – Mean
Arterial Pressure
September 6, 2018
Page 22
How often should we measure?
Lets first consider an example…
MATLAB Demo
September 6, 2018
Page 22
Why is this important for blood pressure monitoring?

How much does your blood pressure vary in one day?
September 6, 2018
Page 22
Why is this important for blood pressure monitoring?

How much does your blood pressure vary in one day?
Kotsis et al. Hypertension, 2005

September 6, 2018
Page 22
BP
Treatment Treat
threshold
24hr mean Do not
SBP treat
DBP time
2pm
4am 8am 10pm 4am
September 6, 2018
Page 22
BP Under-sampling
Treatment Treat
threshold
24hr mean + + Do not
+ treat
time
2pm
4am 8am 10pm 4am
September 6, 2018
Page 22
BP Aliasing effect
Treatment Treat
threshold
+ + Do not
+ treat
time
2pm
4am 8am 10pm 4am
September 6, 2018
Page 22
Under-sampling and aliasing
September 6, 2018
Page 22
Sampling and Aliasing
 Under-sampling looses (important) wave details!
 It also may change the wave form/shape due to

Aliasing
 Sampling is a discrete observation or

measurement, while Aliasing is an
illusion, appearance of something that is
not, due to shortcomings of sampling
September 6, 2018
Page 22
New resources
http://www.worldlifeexpectancy.com/cause-of-death/hypertension/by-country
September 6, 2018
Page 22
Low-cost BP monitor
http://code.google.com/p/ewh-bp-project/
September 6, 2018
Page 22
Low-cost BP monitor
http://code.google.com/p/ewh-bp-project/
September 6, 2018
Page 22
Awards
September 6, 2018
Page 22
Break!
September 6, 2018
Page 22

3 BloodPressure Aliasing

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DEPARTMENT OF ENGINEERING SCIENCE

INSTITUTE OF BIOMEDICAL ENGINEERING

Monitoring Blood Pressure

 Various methods used for measurements of blood

 New resources – An Oxford University Project

 1733 - Reverend Stephen

 Measured the height of a

 The brass pipe was

 Tube was connected to the

 100 years later: a mercury manometer connected to the

 In late 1890s, an Italian physician – Scipione Riva Rocci

Shygmo (from the Greek) => pulse

- Consisted of a mercury column

 Blood Pressure is a measurement of the force against the

 Blood pressure is measured in mmHg (millimeters of

 Blood Pressure is a measurement of the force against the

 Blood pressure is measured in mmHg (millimeters of

 1,000 Pa is about 7 mmHg!

 The blood pressure reading is taken in 2 numbers:

 Blood pressure changes all the time:

 Changing blood pressure is a vital part of a healthy cardiovascular

 Hypertension, or high blood pressure, happens when the blood

Know your numbers:

Hypertension depends on several factors:

Non-invasive blood pressure (NIBP):

Mercury sphygmomanometer Mechanical manometer

Lets first consider an example…

Why is this important for blood pressure monitoring?

Why is this important for blood pressure monitoring?

Kotsis et al. Hypertension, 2005

 Under-sampling looses (important) wave details!

 It also may change the wave form/shape due to

 Sampling is a discrete observation or

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