Deep-Tissue Hemodynamic Sensing: Comparing Impedance and Photoplethysmography for Wearable Blood Pressure Estimation

The pursuit of continuous, cuffless blood pressure (BP) monitoring is constrained by the superficial sensing depth of photoplethysmography (PPG). Impedance plethysmography (IPG) offers deeper tissue penetration, but its comparative value over PPG remains unquantified at scale. In this comparative study of 261 participants (130 hypertensive, 131 non-hypertensive), we utilized a custom dual-modality wearable prototype to capture simultaneous IPG and PPG signals. Over 150,000 cardiac cycles were analyzed using an unsupervised archetype discovery pipeline to quantify beat-to-beat morphological heterogeneity. IPG resolved up to three distinct morphological modes per participant, whereas co-located PPG converged into highly conserved, uniform profiles. IPG captured specific signatures of pathological arterial remodeling and physiological habitus; ventral forearm IPG pulse amplitude exhibited a significant main effect for BP status (p = 0.024), a relationship absent in the co-located PPG signal. Furthermore, increasing body mass index (BMI) significantly attenuated the prevalence of steep-upstroke archetypes in IPG (p = 0.035), quantifying a likely damping effect of adipose tissue. Deep-tissue bioimpedance captures rich, heterogeneous hemodynamic signatures including arterial-dominant morphologies that are invisible to optical sensors. Transitioning from optical pulse wave analysis to bioimpedance-based models may offer a promising pathway for accurate wearable cardiovascular monitoring.