Your Smartwatch and Blood Pressure: New Guidelines Say "Not Yet" for Diagnosis and Management - Dr Prem Aggarwal

Are you relying on your smartwatch to monitor your blood pressure? Well, it may not be the right option as recently released guidelines for doctors have suggested not to depend on such devices for diagnosis or management of blood pressure

In a significant update affecting millions of users, the latest "2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" has clarified the role of emerging blood pressure (BP) technologies.

While smartwatches and other cuffless devices offer convenience, the new guidelines explicitly state they are not recommended for diagnosing or managing high blood pressure.

Why Aren't Cuffless Devices Recommended?

The primary reason behind this recommendation is the current limitations in the accuracy and validation of these devices. Here's a closer look:

• Accuracy Concerns: Cuffless devices, such as smartwatches, estimate blood pressure using various methods like pulse wave velocity or pulse wave analysis. However, these methods often require calibration with traditional cuff-based BP measurements or demographic data.

• Lack of Rigorous Validation: The guideline highlights that many of these devices haven't undergone the rigorous, standardised validation protocols required for medical devices. While some studies show "promising" results, there's a "marked heterogeneity in the devices being tested," leading to a risk of underestimating or overestimating blood pressure.

• Insufficient Data for Clinical Use: Despite efforts to develop validation protocols for continuous noninvasive devices, there's still "scarce data" on using these protocols to test cuffless BP devices for outpatient use.

In essence, while these technologies are innovative, they haven't yet proven to be consistently precise and reliable enough for healthcare professionals to trust them for making critical decisions about your blood pressure and its treatment.

What Should You Use for Accurate Blood Pressure Measurement?

For accurate diagnosis and management of high blood pressure, the guidelines continue to recommend cuff-based devices. This includes:

• In-office blood pressure measurements: Taken by a healthcare professional using standardised methods and validated oscillometric devices.

• Out-of-office blood pressure monitoring: This includes ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). HBPM, where you measure your own blood pressure at home using a validated oscillometric device, is particularly useful for confirming diagnosis and monitoring medication effectiveness.

It's important to ensure that any out-of-office BP measurement device you use has been validated with a rigorous, standardized protocol and uses the appropriate cuff size for accuracy.

What Does This Mean for patients?

If you're currently using a smartwatch or another cuffless device to track your blood pressure, it's important to understand its limitations for medical decisions. While it might offer some general insights, do not rely on it for diagnosing hypertension or guiding your treatment plan.

Always consult with your doctor or healthcare provider for accurate blood pressure readings and to discuss the best approach for monitoring and managing your hypertension. They can guide you on using validated cuff-based devices and interpreting your readings correctly.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.