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Hypertension
Hypertension Global Newsletter #9 2025

BLOOD PRESSURE MONITORING Hypertension

Cuffless blood pressure measurement: Where do we actually stand?
Mukkamala R, et al. Hypertension. 2025 Jun;82(6):957-970.

Cuffless BP measurement represents a popular and important market, recent data regarding pulse wave analysis (PWA) and
area of biomedical technology, driven by the clinical need for pulse arrival time (PAT), progress toward validation standards,
more convenient and comprehensive BP evaluation. Global and ultimately where the field stands. A central objective is
hypertension management demands regular monitoring, to address whether PWA and PAT have provided meaningful
especially since the most recent guidelines recommend advances or whether skepticism regarding their reported
targeting an SBP of about 120 mmHg, and the importance of accuracy is warranted.
monitoring BP during sleep for a complete profile. However,
conventional cuff devices are often inaccessible to all Current research is dominated by PWA and PAT technology,
potential users and can provide misleading readings in clinical which typically involves measuring pulsatile waveforms through
settings. Cuffless technology has the potential to overcome photoplethysmography (light) or tonometry (force) and applying
these limitations, and there has been an increase in related machine learning algorithms. While many studies report positive
publications and regulatory-cleared devices. With so much results, these are often undermined by methodological problems
growing evidence and technological advancement, why do like data leakage (where the variable to be predicted is included
almost all major BP device manufacturers still not offer cuffless or leaked into the data), the need for frequent individual user
BP devices? calibration, and small, homogenous study populations. Real-
world challenges, such as motion artifacts, skin tone differences,
Despite the rise in interest, the field remains fraught with vascular variability, and environmental conditions, further
controversy. The purpose of this review is to provide an complicate accuracy. Collectively, these factors overestimate
essential update on the intense activity and ongoing debate performance and make existing validation protocols, which
surrounding cuffless BP technologies over the last few years. were designed for cuff-based devices, inappropriate or even
It summarises the clinical need, the latest devices on the misleading for cuffless technologies.

Popular PWA with or without PAT for cuffless BP measurement

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