New, wearable and mobile digital devices that continuously monitor blood pressure (BP) offer a promising alternative to the traditional cuff-based sphygmomanometers commonly now used in home and office settings. Their popularity is growing for several compelling reasons—both clinical and technological.
A review of this technology published in the American Journal of Hypertension aims to compare and contrast single point in time BP measurements with continuous beat-by-beat changes of, on average, 4,000 to 5,000 consecutive readings per hour that can reveal previously undetected abnormal BP patterns that happen during sleep, stress and physical activity.
Many consumers are already using these devices, said Donald E. Casey Jr., MD, MPH, the review paper’s lead author. Patients are going to present to physicians' offices with these devices and their data.
The review paper offers a guide to evaluating the accuracy of that data so that doctors and other health professionals can help patients make informed decisions, said Dr. Casey, who is associate professor of internal medicine at Rush Medical College in Chicago.
In an interview with the AMA, Dr. Casey said that real-time applications of this technology in the review offer a comprehensive picture of individual patients and their BP patterns.
The authors also offered a novel approach to making sense of such complex data by the use of “Time in the Target (or Therapeutic) Range” in accordance with the standard staging classification for high BP from the newly published 2025 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on high blood pressure.
Suboptimal BP measurements have persisted despite efforts to raise awareness and educate clinicians on appropriate techniques and consequences of incorrect measurements. Round-the-clock ambulatory blood pressure monitoring, a method that can effectively diagnose conditions such as “white coat” syndrome and masked hypertension, is rarely used by physicians.
The snapshot readings of traditional, cuff-based monitors often miss dangerous spikes or drops. Continuous BP monitoring, by comparison, captures real-time fluctuations.
Devices vary widely in design
Some devices use augmented intelligence (AI)—otherwise known as artificial intelligence—such as optical sensors and tonometric technologies to detect subtle arterial changes. These machine-learning algorithms refine accuracy by filtering noise and adapting to individual physiology. Other wearable BP-measurement devices encourage long-term use without disrupting routines. Skin-like wearable patches also eliminate the discomfort of repeated cuff inflation.
“Patients and their clinicians would soon be able to demystify their personal BP measurements and meaningfully correlate with daily and life activities as well as more effectively achieve” guideline-directed lifestyle modifications, Dr. Casey told the AMA.
He said that physicians and other health professionals “need to be ready and equipped to educate and guide patients with this personalized medical information.”
The US Blood Pressure Validated Device Listing (VDL™) is a free resource available at validatebp.org that administrators, physicians and care teams can use to identify BP devices that have been validated for clinical accuracy, ensuring that patients are using validated devices to share reliable readings back to them.
Some challenges remain
Even with these exciting possibilities, the tools have some limitations. The review article’s authors note that evidence-based international industry and regulatory standards for these devices remain sorely lacking.
“Forthcoming robust validation methods that closely align with the 2025ACC/AHA guidelines will ensure clear and consistent interpretation of aggregate data and provide meaningful guidance for patients, caregivers and their health care teams in achieving further improvement in cardiovascular health,” said Gregory D. Wozniak, PhD. He is the AMA’s vice president of health outcomes analytics and a co-author of the review.
A recent paper in published in JAMA Cardiology found that many devices available to consumers on phones, watches, rings and patches need further testing and validation. The devices also face challenges relating to accuracy and calibration and user variability. Factors such as body habitus, vascular stiffness and arrhythmias can affect measurement reliability, and some devices perform better in younger, healthier populations than in elderly or critically ill patients.
