S-37-6: THE PROMISE OF CUFFLESS BLOOD PRESSURE MONITORING IN MANAGING HYPERTENSION

Abstract

Although blood pressure measurement is perhaps the most common measurement done in clinical practice, many have started to challenge this procedure and calling for transformation in blood pressure monitoring. This is because blood pressure measurement in primary care has many problems, whether clinic, 24-hour ambulatory or home blood pressures are taken. Cuffless blood pressure measurement technologies have been knocking on the door for years, with the first patents already registered over 20 years ago. With advancements in data science, machine learning, artificial intelligence, and mobile phone technologies, many start-ups and major global tech giants are now presenting to the end-user an array of highly innovative technologies. Cuffless monitoring includes many devices from wrist-worn watch-type devices to mobile phone tech (transdermal optical facial video processing or oscillometric finger pressing), wearable ultrasound patches, temporary graphene electronic tattoos, glasses, and even from a toilet seat. These technologies has a major benefit, namely blood pressure being taken without any user awareness. But it also has the potential to harness long-term prognostic cardiovascular information over and beyond blood pressure that may become particularly useful. Continuous long-term cuffless monitoring will provide for the first time the opportunity to move from averaging snapshot readings to capturing the continuous dynamic fluctuations of blood pressure in a high-definition video recording. There are, however, still several hurdles that need to be overcome before cuffless technologies can be implemented in clinical care. While biomedical engineers may exert their energy on ensuring that a cuffless innovation can accurately reflect brachial blood pressure, this is not the only aspect to consider. Manufacturers of conventional cuff-based devices have to painstakingly follow the ISO 81060–2:2018 Universal Standard to validate the device for accuracy. The rules are different for cuffless devices. Novel cuffless technologies vary substantially and use many techniques such as pulse transit time, pulse wave analyses, and ultrasound. The key question is whether these devices can accurately track the dynamic changes in blood pressure over time. Currently, an ISO 81060–3 standard is being developed to validate cuffless devices but due to the heterogenous technologies used by cuffless manufacturers there are major challenges. For this and other reasons, the European Society of Hypertension has released a consensus statement that due to fundamental questions regarding the accuracy, performance and implementation of cuffless devices in practice, these devices cannot be recommended for clinical use, while recognising the considering potential.