Cuffless blood pressure estimation, Cross-scenario, Model generalizability, Calibration-free, Distribution shift, Distribution imbalance, Medicine, Science

Abstract Accurate cuffless blood pressure (BP) estimation remains challenging, particularly under dynamic conditions with significant intra-individual BP variations. This study introduces UTransBPNet, a novel, calibration-free model for cuffless BP estimation. It integrates a squeeze-and-excitation-enhanced Unet architecture for short-range feature extraction with a transformer and cross attention module to capture long-range dependencies from high-resolution, multi-channel physiological signals, further refined through an optimized fine-tuning scheme. Comprehensive validations were conducted across multiple dynamic datasets—Dataset_Drink, Dataset_Exercise, and Dataset_MIMIC—in both scenario-specific and cross-scenario settings. Results demonstrate that UTransBPNet outperformed existing models in tracking BP variations under dynamic conditions, achieving individual Pearson’s correlation coefficients of 0.61 ± 0.17 and 0.62 ± 0.13 for systolic BP (SBP) and diastolic BP (DBP) in Dataset_Drink, 0.82 ± 0.11 and 0.72 ± 0.18 in Dataset_Exercise, and low mean absolute differences (MADs) of 4.38 and 2.25 mmHg in Dataset_MIMIC. The analysis also highlights the impact of dataset characteristics on model performance, such as distribution shift, distribution imbalance and individual BP variability, highlighting the need for well-curated data to ensure generalizability. This study advances the development of robust, cuffless BP estimation models for real-world applications.