An apparatus and methods for performing a circulatory measurement on an extremity, such as a hand, of a subject. The circulatory measurement results in the derivation of an output circulatory metric that may encompass
blood pressure or various other circulatory
metrics. An indicator of an input circulatory metric at a locus on the extremity is measured, such as a
pulse transit time. To determine the
pulse transit time, a first plethysmographic
signal may be obtained at a first position on the extremity, while a second plethysmographic
signal may be obtained at a second position on the extremity of the subject. A
transit time characterizing a circulatory
pressure wave is calculated based on the first and second plethysmographic signals, leading to derivation of a
wave speed. A calibration is then applied to provide the circulatory measurement based at least on the derived
wave speed and a measured indicator of a hydrostatic component of
blood pressure. Calibration is provided, in certain described embodiments, by derivation of two calibration parameters, a
gain and a
pulse transit time at zero pressure. Methods for deriving the calibration parameters include performing measurements under distinct
hydrostatic pressure conditions, and based upon a measured derivative with respect to pressure of the
pulse wave velocity.