Causal inference based cuffless blood pressure estimation: A pilot study

Enabled by wearable sensing, e.g., photoplethysmography (PPG) and electrocardiography (ECG), and machine learning techniques, study on cuffless blood pressure (BP) measurement with data-driven methods has become popular in recent years. However, causality has been overlooked in most of current studies. In this study, we aim to examine the feasibility of causal inference for cuffless BP estimation. We first attempt to detect wearable features that are causally related, rather than correlated, to BP changes by identifying causal graphs of interested variables with fast causal inference (FCI) algorithm. With identified causal features, we then employ time-lagged link to integrate the mechanism of causal inference into the BP estimated model. The proposed method was validated on 62 subjects with their continuous ECG, PPG and BP signals being collected. We found new causal features that can better track BP changes than pulse transit time (PTT). Further, the developed causal-based estimation model achieved an estimation error of mean absolute difference (MAD) being 5.10 mmHg and 2.85 mmHg for SBP and DBP, respectively, which outperformed traditional model without consideration of causality. To the best of our knowledge, this work is the first to study the causal inference for cuffless BP estimation, which can shed light on the mechanism, method and application of cuffless BP measurement. © 2023 The Author(s).