This paper presents subcutaneous and continuous blood pressure (BP) monitoring using aluminum nitride (AlN) piezoelectric micromachined ultrasonic transducers (PMUTs) in an ambulatory sheep. A 37 \(\times\) 45 PMUTs array with a footprint of 5 \(\times\) 5 mm2 has been designed and fabricated as a prototype device. The deep reactive ion etching (DRIE) process to open the backside holes on the silicon substrate has been optimized to create active device diaphragms with a radius of 29 μm. The resulting PMUT unit has a measured resonant frequency of 6.5 MHz in water, an output acoustic pressure of 28 kPa at a distance of 10 mm, and a 6-dB bandwidth of about 33%. The BP monitoring scheme is validated through both in vitro and in vivo experiments to illustrate the correlation between the diameter of the blood vessel and pressure. Simulations indicate that possible issues in misalignment between the device and the blood vessel can result in a 60% reduction in signal strength with only 1 mm in misalignment. This highlights the advantage of subcutaneous implantation in maintaining a stable interface and consistent alignment for reliable long-term BP monitoring, in contrast to similar approaches via wearable system setups. The in vivo testing result shows BP wave fine features such as dicrotic notches and the averaged systolic/diastolic pressure errors are −1.2 \(\pm\) 2.1 and −2.9 \(\pm\) 1.4 mmHg, respectively, which meets the clinical standard as calibrated by a gold-standard arterial line pressure sensor. As such, this system highlights the potential applications in silent, continuous, and highly accurate BP monitoring for hypertension patients using this implantable MEMS-based technology.
