UMMS Affiliation

Department of Psychiatry

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Document Type



Cardiology | Cardiovascular Diseases | Diagnosis | Telemedicine


Hypertension affects an estimated 1.4 billion people and is a major cause of morbidity and mortality worldwide. Early diagnosis and intervention can potentially decrease cardiovascular events later in life. However, blood pressure (BP) measurements take time and require training for health care professionals. The measurements are also inconvenient for patients to access, numerous daily variables affect BP values, and only a few BP readings can be collected per session. This leads to an unmet need for an accurate, 24-h continuous, and portable BP measurement system. Electrocardiograms (ECGs) have been considered as an alternative way to measure BP and may meet this need. This review summarizes the literature published from January 1, 2010, to January 1, 2020, on the use of only ECG wave morphology to monitor BP or identify hypertension. From 35 articles analyzed (9 of those with no listed comorbidities and confounders), the P wave, QTc intervals and TpTe intervals may be promising for this purpose. Unfortunately, with the limited number of articles and the variety of participant populations, we are unable to make conclusions about the effectiveness of ECG-only BP monitoring. We provide 13 recommendations for future ECG-only BP monitoring studies and highlight the limited findings in pregnant and pediatric populations. With the advent of convenient and portable ECG signal recording in smart devices and wearables such as watches, understanding how to apply ECG-only findings to identify hypertension early is crucial to improving health outcomes worldwide.


ECG, cardiology, digital health, health monitoring, hypertension

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Copyright © 2020 Bird, Chan, Lu, Greeff, Allen, Abbott, Menon, Lovell, Howard, Chan, Fletcher, Alian, Ward and Elgendi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

DOI of Published Version



Bird K, Chan G, Lu H, Greeff H, Allen J, Abbott D, Menon C, Lovell NH, Howard N, Chan WS, Fletcher RR, Alian A, Ward R, Elgendi M. Assessment of Hypertension Using Clinical Electrocardiogram Features: A First-Ever Review. Front Med (Lausanne). 2020 Dec 4;7:583331. doi: 10.3389/fmed.2020.583331. PMID: 33344473; PMCID: PMC7746856. Link to article on publisher's site

Journal/Book/Conference Title

Frontiers in medicine

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.