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Type-2 Fuzzy Classification of Blood Pressure Parameters

Conference Paper · January 2008

DOI: 10.1109/ISSNIP.2007.4496910 · Source: IEEE Xplore

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 Type-2 Fuzzy Classification of Blood Pressure
Parameters
Usman Mahmood1, #Adel Al-Jumaily2, Moha’med 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
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 world’s population
will be suffering from high blood pressure by 2025 [1].
Continuous monitoring of patient’s 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 patient’s 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
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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 patient’s 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.
ISSNIP 2007
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.
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 vessel’s resistance (TR) against blood flow is
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corresponding to resistance (R). Therefore, as ohm’s law, the
relationship between MBP with CO and TR is expressed as
shown in equation (3) [9]:
MBP=CO×TR------------ (3)
Therefore, from equations (2) and (3) MBP is related to heart
rate as shown in equation (4):
MBP=SV×TPR ×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
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
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.
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. 4: Type-2 fuzzy sets to represent output values of mean blood pressure
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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. 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. 6: Implementation of product t-norm method
D. Output Process An experiment was conducted on ten adult age subjects, to
Firstly, Type-reducer reduces type-2 fuzzy sets into type-1 measure their heart rate, systolic and diastolic blood pressure
fuzzy sets. Most commonly used “centre of sets” method was with a standard blood pressure measuring device; a digital
used, which replaced each consequent type-2 fuzzy set by its automatic blood pressure monitor with intelli-sence,
centroid and scaled it by degree of firing as shown in Fig. 7. “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
Fig. 7: Implementation of “centre of sets” method
heart rate readings of ten subjects of table 1. The estimated
values for systolic, diastolic and mean blood pressure of ten
Secondly, the defuzzifier uses the mid point of type reduced
subjects are illustrated in table 2 with appropriate Linguistic
sets as output crisp value. The Type-reduction and
Classification (LC) for each subject.
Defuzzification process is shown in figures shown in next
column.
No. subjects HR SBP DBP MBP
(b/m) (mmHg) (mmHg) (mmHg)
1 76.00 121.33 84.67 96.89
2 70.67 125.33 80.33 95.33
3 79.67 125.67 78.33 94.11
4 66.33 108.00 71.33 83.55
5 63.33 112.00 72.00 85.33
6 88.00 156.33 89.33 111.66
7 70.33 110.00 82.00 91.33
8 88.67 144.00 83.33 103.55
9 67.00 118.67 70.33 86.44
Fig. 8: Implementing mid point method
10 79.00 129.00 85.00 99.67
TABLE 1: AVERAGE OF HR AND SYSTOLIC, DIASTOLIC AND MEAN BP
4. GRAPHIC USER INTERFACE
READINGS OF 10 SUBJECTS

The designed type-2 FLS which was used for classification No. subjects HR SBP DBP MBP LC
blood pressure from heart rate was programmed as graphic (b/m) (mmHg) (mmHg) (mmHg)
user interface (GUI) for testing purposes. This GUI is 1 76.00 130.06 78.60 95.76 Normal
illustrated in Fig. 9. 2 70.67 120.66 73.23 89.40 Normal
3 79.67 135.36 81.63 99.54 Normal
4 66.33 113.00 68.00 83.00 Normal
5 63.33 107.70 65.84 79.80 Normal
6 88.00 151.23 90.70 110.88 High
7 70.33 120.06 74.89 88.61 Normal
8 88.67 152.41 91.37 111.70 High
9 67.00 114.18 70.33 84.40 Normal
10 79.00 135.35 81.60 99.50 Normal
TABLE 2: HR READINGS AND ESTIMATED VALUES OF SBP, DBP AND MBP OF
10 SUBJECTS WITH APPROPRIATE LINGUISTIC CLASSIFICATION

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
Fig. 9: The GUI of the designed type-2 FLS illustrated in table 3.

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 very close to measured values and are illustrated with the
Estimated MAP - Real MAP appropriate Linguistic Classification (LC) for each reading as
PAE = | | ×100% --- (6)
Real MAP shown in table 2. Thus type-2 FLS has successfully classified
and estimated blood pressure parameters’ crisp values.
No. subjects PAE of SBP PAE of DBP PAE of MBP HR
10
(%) (%) (%) (b/m) 9
1 7.20 7.17 1.17 76.00 8

PAE of DBP (%)

2 3.73 8.84 6.22 70.67 7
3 7.71 4.21 5.77 79.67 6
4 4.63 4.67 0.66 66.33 5
5 3.84 8.56 6.48 63.33 4
6 3.26 1.53 0.70 88.00 3
7 9.15 8.67 2.98 70.33 2
1
8 5.84 9.65 7.87 88.67
0
9 3.78 0.00 2.36 67.00
0 2 4 6 8 10
10 4.92 4.00 0.17 79.00
TABLE 3: THE PERCENTAGE ABSOLUTE ERROR VALUES FOR ALL TEN No. Subjects
SUBJECTS’ SBP, DBP AND MBP READINGS
Fig. 11: Comparison of measured and calculated Diastolic blood pressure
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 9
illustrated in Fig. 12. 8
7
PAE of MBP (%)

6
10
9 5
8 4
3
PAE of SBP (%)

7
6 2
5 1
4 0
3 0 2 4 6 8 10
2
No. Subjects
1
0 Fig. 12: Comparison of measured and calculated Mean blood pressure
0 2 4 6 8 10
No. Subjects 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
Fig. 10: Comparison of measured and calculated Systolic blood pressure patients to afford more obvious situation of cardiac health to
the general public. This modification can result in a type-2 FL
From figures 10, 11 and 12, the maximum PAE is less than based standalone blood pressure measuring device.
10% of all ten subjects’ systolic, diastolic and mean blood
pressure. REFERENCE

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