Assessment of Hypertension Using Clinical Electrocardiogram Features: A First-Ever Review

K Bird, G Chan, H Lu, H Greef, John Allen, D Abbott, C Menon, Nigel H Lovell, W-S Chan, R Fletcher, A Alian, R Ward, M Elgendi

Research output: Contribution to journalReview articlepeer-review

17 Citations (Scopus)
74 Downloads (Pure)


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.

Original languageEnglish
Article number583331
Number of pages17
JournalFrontiers in Medicine
Publication statusPublished - 4 Dec 2020
Externally publishedYes

Bibliographical note

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.


NSERC grant RGPIN-2014-04462 and Canada Research Chairs (CRC) program. RW was supported by NPRP grant # NPRP12S-0305-190231 from the Qatar National Research Fund (a member of Qatar Foundation).


  • ECG
  • Digital Health
  • Cardiology
  • Hypertension
  • health moniroting
  • digital health
  • health monitoring
  • hypertension
  • cardiology

ASJC Scopus subject areas

  • Medicine(all)


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