Background: This study was developed to determine whether a machine learning model could be developed to assess blood pressure with accuracy comparable to arm cuff measurements. Methods: A deep learning model was developed based on the UK Biobank dataset and was trained to detect both systolic and diastolic pressure. The hypothesis was formulated after data collection and before the development of the model. Comparison was conducted between arm cuff measurements, as ground truth, and results from the model, using Mean Absolute Error, Mean Squared Error, and Coefficient of Determination (R^2). Results: Systolic pressure was measured with 9.81 Mean Absolute Error, 165.13 Mean Squared Error and 0.36 R^2. Diastolic pressure was measured with 6.00 Mean Absolute Error, 58.21 and 0.30 R^2. Conclusions: This model improves on existing research and shows errors comparable to the variability of hand cuff measurements. The use of fundus images to assess blood pressure may be more indicative of long-term hypertension. Additional trials in clinical settings may be necessary, as well as additional prospective studies to validate results.

IB, DD, and RA are employees of AEYE Health. DM is COO of AEYE Health. ZDA is CEO of AEYE Health. TI serves on AEYE Health's board of directors. Professor Alon Harris is supported by NIH grants (R01EY030851 and R01EY034718), NYEE Foundation grants, and in part by a Challenge Grant award from Research to Prevent Blindness, NY. Professor Alon Harris would like to disclose that he received remuneration from AdOM, Qlaris, and Cipla for serving as a consultant, and he serves on the board of AdOM, Qlaris and SlitLed. Professor Alon Harris holds an ownership interest in AdOM, Oxymap, Qlaris, and SlitLed. If you have questions regarding paid relationships that your physician/researcher may have with industry, you are encouraged to talk with your physician/researcher, or check for industry relationships posted on individual faculty pages on our website at http://icahn.mssm.edu/.

Employees and board members of AEYE Health designed and carried out the study; managed, analysed and interpreted the data; prepared, reviewed, and approved the article; and were involved in the decision to submit the article.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Institutional Review Board exemption was obtained from the Sterling Independent Review Board under a category 2 exemption.

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This research has been conducted using the UK Biobank Resource under Application Number 75750. UK Biobank has been established as an open-access resource for public health research, with the intention of making the data as widely available as possible in an equitable and transparent manner.

https://www.ukbiobank.ac.uk/