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Hypertension is both a cause and consequence of chronic kidney disease (CKD). According to the Chinese national survey in 2007-2010, the prevalence of CKD was much higher in hypertensive patients (18.9%, n=16,691) than in the overall population sample (10.8%, n=47,204). CKD in hypertension confers risks to the kidneys as well as other organs. Probably because of high dietary salt intake, Asian hypertensive patients with CKD show high prevalence of non-dipping and reversed dipping blood pressure pattern, and may have even higher risks of cardiovascular disease. Therefore, out-of-office blood pressure evaluation and comprehensive cardiovascular evaluations are required. Most of current hypertension guidelines recommend intensive antihypertensive treatment in hypertensive patients with CKD. This is probably of particular relevance for cardiovascular prevention in Asia, because stroke, as a major complication of hypertension in Asia, is more closely related to blood pressure than coronary events. Intensive blood pressure control to 130/80 mmHg is often required to prevent CKD progression and cardiovascular complications. The inhibitors of the renin-angiotensin system (RAS) are recommended as the first line antihypertensive medications in patients with a glomerular filtration rate higher than 30 ml/min/1.73 m², which may more efficaciously prevent end-stage renal disease and cardiovascular events. Nonetheless, combination therapy of RAS inhibitors with other classes of antihypertensive drugs, such as calcium-channel blockers, diuretics, etc, is required to control blood pressure to the target.

Background: Wearable and unobtrusive sensing devices are rapidly evolving for long-term cardiovascular monitoring. However, most of the cardiovascular device requires multi-channel physiological signals acquisition, especially in continuous blood pressure (BP) measurement using pulse transition time (PTT) based methods. The multi-devices implementation could impede wearable applications. Objective: This study developed a wearable neck patch device using single-channel impedance plethysmography (IPG) sensing for cardiovascular monitoring, including continuous BP and heart rate (HR) measurement. Methods: IPG-based BP model was derived based on the Bramwell-Hill equation. A patch IPG device was designed and installed above the carotid artery of the subject neck. To validate the BP and HR functions of our device, the Bland-Altman plots were performed to evaluate the estimation error between the reference and the proposed devices within 20 healthy subjects. Results: The BP performance indicates that systolic BP (SBP) estimation error was-0.16 ± 2.97 mmHg and 2.43 ± 1.71 mmHg in terms of mean error (ME) and mean absolute error (MAE), and 0.09 ± 3.30 mmHg and 2.83 ± 1.68 mmHg for diastolic BP (DBP) estimation. Moreover, the HR accuracy has the ME and MAE of 0.02 ± 0.17 bpm and 0.14 ± 0.08 bpm; mean percentage error (MPE) and mean absolute percentage error (MAPE) obtained 0.04 ± 0.23 % and 0.19 ± 0.12 %. Based on statistical results, the BP and HR function of our device satisfied with AAMI/ANSI criteria below 5 ± 8 mmHg and ± 5 bpm or ± 10%. Conclusion: This study implemented a wearable neck patch device with singlechannel IPG acquisition that provided two significant cardiovascular parameters of continuous BP and HR, and its performance agreed with standard criteria based on validation with reference sensors. Significance: The proposed proof-of-concept IPG neck patch device has a high potential for wearable applications and lowcost manufacturing in cardiovascular monitoring.

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