Change Point–Aware Evaluation and Re-Calibration of PPG-Based Blood Pressure Estimation

Yunwon Tae, Minje Park, Gyunho Rho, Dongjoon Yoo, Sunghoon Joo
Proceedings of the 11th Machine Learning for Healthcare Conference, PMLR 340:1921-1949, 2026.

Abstract

Non-invasive continuous blood pressure (BP) monitoring using photoplethysmography (PPG) is a promising alternative to cuff-based measurements. However, existing PPG-based BP estimation studies predominantly rely on aggregated performance metrics (e.g., mean absolute error) computed over entire evaluation intervals, which can obscure model failures during rapid BP fluctuations and limit clinical relevance. In this work, we propose a fluctuation-aware evaluation framework for PPG-based BP estimation based on time-series change point detection. Instead of heuristic BP thresholding (e.g., $\Delta\mathrm{BP} > 10\mathrm{mmHg}$), we identify BP change points by capturing abrupt distributional shifts in BP trajectories and evaluate estimation performance specifically during these fluctuation periods. Our analysis shows that several state-of-the-art models exhibit substantial performance degradation around BP change points, and that periodic test-time calibration is insufficient to handle such dynamic BP variations. To address this limitation, we introduce a targeted re-calibration framework triggered by detected BP change points, improving robustness without modifying model architectures. To the best of our knowledge, this is the first systematic evaluation of PPG-based BP estimation from a BP change point perspective, highlighting the importance of fluctuation-aware evaluation and calibration for real-world continuous BP monitoring.

Cite this Paper

BibTeX
@InProceedings{pmlr-v340-tae26a, title = {Change Point–Aware Evaluation and Re-Calibration of PPG-Based Blood Pressure Estimation}, author = {Tae, Yunwon and Park, Minje and Rho, Gyunho and Yoo, Dongjoon and Joo, Sunghoon}, booktitle = {Proceedings of the 11th Machine Learning for Healthcare Conference}, pages = {1921--1949}, year = {2026}, editor = {Krishnan, Rahul G. and van Amsterdam, Wouter A. C. and Chopra, Sumit and Overgaard, Shauna and Hughes, Michael and Ötleş, Erkin and Shen, Yiqiu and Shanmugam, Divya and Nayan, Madhur and Engelhard, Matthew and Fackler, Jim and Oberst, Michael}, volume = {340}, series = {Proceedings of Machine Learning Research}, month = {12--14 Aug}, publisher = {PMLR}, pdf = {https://raw.githubusercontent.com/mlresearch/v340/main/assets/tae26a/tae26a.pdf}, url = {https://proceedings.mlr.press/v340/tae26a.html}, abstract = {Non-invasive continuous blood pressure (BP) monitoring using photoplethysmography (PPG) is a promising alternative to cuff-based measurements. However, existing PPG-based BP estimation studies predominantly rely on aggregated performance metrics (e.g., mean absolute error) computed over entire evaluation intervals, which can obscure model failures during rapid BP fluctuations and limit clinical relevance. In this work, we propose a fluctuation-aware evaluation framework for PPG-based BP estimation based on time-series change point detection. Instead of heuristic BP thresholding (e.g., $\Delta\mathrm{BP} > 10\mathrm{mmHg}$), we identify BP change points by capturing abrupt distributional shifts in BP trajectories and evaluate estimation performance specifically during these fluctuation periods. Our analysis shows that several state-of-the-art models exhibit substantial performance degradation around BP change points, and that periodic test-time calibration is insufficient to handle such dynamic BP variations. To address this limitation, we introduce a targeted re-calibration framework triggered by detected BP change points, improving robustness without modifying model architectures. To the best of our knowledge, this is the first systematic evaluation of PPG-based BP estimation from a BP change point perspective, highlighting the importance of fluctuation-aware evaluation and calibration for real-world continuous BP monitoring.} }
Endnote
%0 Conference Paper %T Change Point–Aware Evaluation and Re-Calibration of PPG-Based Blood Pressure Estimation %A Yunwon Tae %A Minje Park %A Gyunho Rho %A Dongjoon Yoo %A Sunghoon Joo %B Proceedings of the 11th Machine Learning for Healthcare Conference %C Proceedings of Machine Learning Research %D 2026 %E Rahul G. Krishnan %E Wouter A. C. van Amsterdam %E Sumit Chopra %E Shauna Overgaard %E Michael Hughes %E Erkin Ötleş %E Yiqiu Shen %E Divya Shanmugam %E Madhur Nayan %E Matthew Engelhard %E Jim Fackler %E Michael Oberst %F pmlr-v340-tae26a %I PMLR %P 1921--1949 %U https://proceedings.mlr.press/v340/tae26a.html %V 340 %X Non-invasive continuous blood pressure (BP) monitoring using photoplethysmography (PPG) is a promising alternative to cuff-based measurements. However, existing PPG-based BP estimation studies predominantly rely on aggregated performance metrics (e.g., mean absolute error) computed over entire evaluation intervals, which can obscure model failures during rapid BP fluctuations and limit clinical relevance. In this work, we propose a fluctuation-aware evaluation framework for PPG-based BP estimation based on time-series change point detection. Instead of heuristic BP thresholding (e.g., $\Delta\mathrm{BP} > 10\mathrm{mmHg}$), we identify BP change points by capturing abrupt distributional shifts in BP trajectories and evaluate estimation performance specifically during these fluctuation periods. Our analysis shows that several state-of-the-art models exhibit substantial performance degradation around BP change points, and that periodic test-time calibration is insufficient to handle such dynamic BP variations. To address this limitation, we introduce a targeted re-calibration framework triggered by detected BP change points, improving robustness without modifying model architectures. To the best of our knowledge, this is the first systematic evaluation of PPG-based BP estimation from a BP change point perspective, highlighting the importance of fluctuation-aware evaluation and calibration for real-world continuous BP monitoring.
APA
Tae, Y., Park, M., Rho, G., Yoo, D. & Joo, S.. (2026). Change Point–Aware Evaluation and Re-Calibration of PPG-Based Blood Pressure Estimation. Proceedings of the 11th Machine Learning for Healthcare Conference, in Proceedings of Machine Learning Research 340:1921-1949 Available from https://proceedings.mlr.press/v340/tae26a.html.

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