PATIENT FACING SYSTEMS Continuous Blood Pressure Monitoring as a Basis for Ambient Assisted Living (AAL) – Review of Methodologies and Devices Aleksandra Stojanova 1 & Saso Koceski 1 & Natasa Koceska 1 Received: 13 March 2018 /Accepted: 9 December 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Blood pressure (BP) is a bio-physiological signal that can provide very useful information regarding human’ s general health. High or low blood pressure or its rapid fluctuations can be associated to various diseases or conditions. Nowadays, high blood pressure is considered to be an important health risk factor and major cause of various health problems worldwide. High blood pressure may precede serious heart diseases, stroke and kidney failure. Accurate blood pressure measurement and monitoring plays fundamental role in diagnosis, prevention and treatment of these diseases. Blood pressure is usually measured in the hospitals, as a part of a standard medical routine. However, there is an increasing demand for methodologies, systems as well as accurate and unobtrusive devices that will permit continuous blood pressure measurement and monitoring for a wide variety of patients, allowing them to perform their daily activities without any disturbance. Technological advancements in the last decade have created opportunities for using various devices as a part of ambient assisted living for improving quality of life for people in their natural environment. The main goal of this paper is to provide a comprehensive review of various methodologies for continuous cuff-less blood pressure measurement, as well as to evidence recently developed devices and systems for continuous blood pressure measurement that can be used in ambient assisted living applications. Keywords Blood pressure . Electrocardiogram . Photoplethysmogram . Ambient assisted living . Signal processing Introduction Blood pressure (BP), defined as the pressure made by circu- lating blood upon the walls of blood vessels, is an important biomarker of cardiovascular health and indicator for general health of a person [1]. It is considered as one of the most important vital signs of the cardiovascular system [2]. Blood pressure can variate due to some physical activity, anxiety, medication and different emotions. Frequent changes in blood pressure can be a sign of some health issue, especially if they are accompanied by an increased blood pressure. High blood pressure or hypertension, presents a global public health issue. It is the most common cause of death and disability in the world, and a major risk factor for aneurysms of the arteries, stroke and peripheral arterial disease [3, 4]. According to World Health Organization (WHO) report, high blood pres- sure directly or indirectly causes deaths of nine million people every year [5]. Hypertension rarely causes symptoms in the early stages, so most of the patients with hypertension are not even aware of its existence. Those who are diagnosed usually not have access to early-stage treatment and therefore cannot successfully control their illness over the long term. Having high blood pressure for an extended period of time can dam- age the vital organs such as kidneys, brain, heart, eyes, or viscus. Because of this, hypertension is also called a silent killer [6]. Daily measurement and monitoring of blood pres- sure is crucial for early detection of health problems especially heart problems and stroke. Blood pressure is usually represented with three values: systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP). Systolic pressure, is the blood pressure made on the wall of blood vessels while the ventricles squeeze pushing blood out to the rest of the body. The SBP is the maximum pressure that occurs when the blood is pumped from the left This article is part of the Topical Collection on Patient Facing Systems * Aleksandra Stojanova aleksandra.stojanova@ugd.edu.mk Saso Koceski saso.koceski@ugd.edu.mk Natasa Koceska natasa.koceska@ugd.edu.mk 1 Faculty of Computer Science, University Goce Delcev – Stip, Štip, Republic of Macedonia Journal of Medical Systems (2019) 43:24 https://doi.org/10.1007/s10916-018-1138-8