Context-Augmented, Session-Calibrated Blood Pressure Tracking from Photoplethysmography

Objective.To distinguish the contributions of acquisition context and photoplethysmography (PPG) to session-calibrated blood pressure (BP) tracking.Approach. The original comparison used three repeats of five-fold participant-level cross-validation in 653 AuroraBP participants, excluding calibration-labelled prediction targets. Matched analyses separated context and PPG and removed elapsed-time terms. Later exploratory follow-ups retained PPG, accelerometer signals and three initial cuff readings. Separate studies evaluated pulse-rate fusion and an intraoperative VitalDB model. Main results.The original wearable-state model achieved participant-level mean absolute errors (MAEs) of 7.697/6.139 mmHg for systolic/diastolic BP (SBP/DBP). Added context reduced MAE by 0.436/0.126 mmHg (97.5% intervals 0.305-0.573/0.053-0.200). In the matched factorial without the external PPG prior, PPG improved on calibration, time and protocol-provided posture/activity by 0.214/0.135 mmHg; removing time left the DBP interval including zero. Standard PPG descriptors contributed, but additional nonlinear/attractor benefit was not established. In a separate follow-up series, a sensor-history ensemble achieved 7.299/5.445 mmHg versus its static-rich reference's 7.363/5.470, small gains of 0.064/0.025 mmHg. Larger DBP errors did not improve uniformly. Quality-weighted fusion reduced pulse-rate MAE from 3.985 to 3.690 beats per minute. VitalDB MAEs remained 15.375/8.833 mmHg despite small PPG gains. Significance. The contribution is a calibrated evaluation framework with explicit controls, reproducible feature-cache-to-results analyses and retained negative findings. The sensor-history gain is exploratory after repeated dataset reuse. Independently estimated wearable states, complete raw-signal reproduction of the supplied richer features, external transfer and clinical adequacy remain unestablished.