Assessing hemodynamics from the photoplethysmogram to gain insights into vascular age: a review from VascAgeNet

Peter Charlton, Birutė Paliakaitė, Kristjan Pilt, Martin Bachler, Serena Zanelli, Daniel Kulin, John Allen, Magid Hallab, Elisabetta Bianchini, Christopher Mayer, Dimitrios Terentes-Printzios, Verena Dittrich, Bernhard Hametner, Dave Veerasingam, Dejan Žikić, Vaidotas Marozas

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    The photoplethysmogram (PPG) signal is widely measured by clinical and consumer devices, and it is emerging as a potential tool for assessing vascular age. The shape and timing of the PPG pulse wave are both influenced by normal vascular aging, changes in arterial stiffness and blood pressure, and atherosclerosis. This review summarizes research into assessing vascular age from the PPG. Three categories of approaches are described: 1) those which use a single PPG signal (based on pulse wave analysis), 2) those which use multiple PPG signals (such as pulse transit time measurement), and 3) those which use PPG and other signals (such as pulse arrival time measurement). Evidence is then presented on the performance, repeatability and reproducibility, and clinical utility of PPG-derived parameters of vascular age. Finally, the review outlines key directions for future research to realize the full potential of photoplethysmography for assessing vascular age.
    Original languageEnglish
    Pages (from-to)H493-H522
    Number of pages30
    JournalAJP - Heart and Circulatory Physiology
    Issue number4
    Early online date7 Feb 2022
    Publication statusPublished - 1 Apr 2022

    Bibliographical note

    Copyright © 2022 The Authors
    This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited..
    Licensed under Creative Commons Attribution CC-BY 4.0. Published by the American Physiological Society.


    This article is based upon work from COST ACTION “Network for Research in Vascular Ageing” CA18216 supported by COST (European Cooperation in Science and Technology): The work was supported in part by British Heart Foundation Grants PG/15/104/31913 and FS/20/20/34626 (to P. H. Charlton); in part by the European Regional Development Fund Project No. 01.2.2-LMT-K-718-01-0030 (to V. Marozas) under grant agreement with the Research Council of Lithuania; in part by the Estonian Ministry of Education and Research under personal post-doctoral research funding PUTJD815 (to K. Pilt); and in part by the Serbian Ministry of Education, Science and Technological Development Grants 32040 and 41022 (to D. Žikić).


    • arterial stiffness
    • arteriosclerosis
    • atherosclerosis
    • blood pressure
    • photoplethysmography
    • pulse wave velocity


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