High blood pressure is the leading risk factor for death globally, affecting one in every two adults, yet only a quarter of those with hypertension have it under control. This underscores the need for more effective blood pressure management strategies. Now, a new study has evaluated a novel device that automatically measures blood pressure at the wrist and can quickly generate hundreds of readings, potentially enhancing how clinicians assess cardiovascular risk and manage hypertension. This research showcases the promising advancements in diagnosing hypertension, assessing risks, and managing treatment through the use of cuffless devices.

Conducted by researchers at Brigham and Women's Hospital (Boston, MA, USA), the study assessed a cuffless wrist monitor developed by Aktiia SA (Neuchatel, Switzerland), which utilizes optical sensors to continuously and effortlessly record blood pressure. Current medical guidelines advocate for integrating at-home blood pressure monitoring into the management and diagnosis of hypertension. This approach helps mitigate inaccuracies found in blood pressure readings taken in clinical settings, where some individuals may exhibit elevated readings due to anxiety ("white coat hypertension") or have normal readings in a clinical setting but elevated readings at home ("masked hypertension").

The concept of Time-in-Target-Range (TTR), which tracks the duration a patient’s blood pressure remains within the normal range, is increasingly recognized as a valuable indicator of cardiovascular risk. However, achieving a meaningful TTR calculation requires more frequent readings than what is practical with traditional cuffs, which many find inconvenient, cumbersome, and uncomfortable. In this evaluation, the researchers analyzed over 2.2 million blood pressure readings from 5,189 participants across Europe and the U.K. using the cuffless device. The Aktiia monitor averaged 29 readings daily, significantly more than the typical number obtained with home devices. Over 15 days, each participant averaged 434 readings.

The researchers calculated TTR over this period, allowing them to stratify the participants’ risk based on the percentage of readings within the target range. They compared these results with those obtained through traditional methods using either 24-hour or week-long daytime monitoring, which misclassified 26% and 45% of subjects, respectively. The findings suggest that continuous monitoring for a week is necessary to achieve over 90% accuracy in classifying hypertension risk, a level of frequency that may only be feasible with cuffless technology.

“For the first time, by using a cuffless device, we can collect continual out-of-office blood pressure readings and use these data to calculate a new metric, time-in-target-range, which shows great promise as a predictor of risk,” said Naomi Fisher, MD, of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital. “The use of cuffless devices could create a shift in the paradigm of blood pressure monitoring and hypertension management.” The study was published in Frontiers in Medicine on June 25, 2024. 

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