PROJECT SUMMARY/ABSTRACT
Hypertension is the most prevalent cardiovascular risk factor and disproportionately responsible for adverse
outcomes in African Americans. African Americans with hypertension are also more likely to be unaware of
elevated blood pressures, which further exacerbates complications of cardiovascular disease. Thus, detection
of accurate blood pressure in African Americans is a critical step towards alleviating hypertension disparate
outcomes. The objective of this project is to create an unobtrusive cuffless blood pressure monitor for
measurement and identification for masked hypertension in communities of color. Current state of the
technology that incorporates cuffs is cumbersome and does not allow for passive/frequent measurements. The
trends for cuffless solutions are primarily focused on photoplethysmography (PPG) which does not operate
well on darker skin tones and on participants with higher BMIs. This project leverages bioimpedance as a
sensing modality in the form of a finger-worn device, like smart rings. Our device provides robust and nearly
continuous bioimpedance readings, corresponding to blood volume and hemodynamic changes, that will be
translated to blood pressure using machine learning and AI algorithms. Bioimpedance does not have the
limitations of PPG; it is insensitive to varying skin tones and has deep penetration capabilities and therefore a
higher BMI (and a thicker layer of fat under the skin) does not impact the measurements. The principal focus of
our investigation is to gain insights into masked hypertension with the objective of capturing blood pressure
frequently during the day and at nighttime. Our proposed technology can help identify certain short-term
dynamics inclusive of variations of blood pressure and allows effective monitoring of response to medication
for African American in Atlanta, GA and African American and Latinx communities in College Station, TX. This
project incorporates two aims. Aim 1 intends to validate the smart ring technology that has been developed
at Texas A&M on African American and Latinx participants (N=60) with varying BMI in lab settings, with no
known pre-existing condition beyond obesity, in presence of various blood pressure maneuvers (cold pressor,
handgrip and exercise) and for three postures (supine, standing and sitting). Aim 2 expands the validation of
our technology in African American patients (N=144) with and without a history of hypertension in
Atlanta, GA in mixed lab and ambulatory settings with a unique focus to explore the reported phenomenon
of masked hypertension and to advance technology acceptance and social relevance in communities of color.
After nearly ten years of industrial and academic technology development to extract blood pressure indices
using PPG, to our knowledge, this effort for the first time addresses the limited effectiveness of PPG on darker
skin tones and those who have a higher BMI. The literature demonstrates the higher prevalence of
hypertension in African American communities and among those who have obesity, which further calls for BMI
independent technology development and validation.
