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REFLECTIONS
Hypertension
Hypertension Global Newsletter #9 2025

Despite the volume of research and development, this review concludes that there is still no compelling evidence that PWA or PAT
significantly improve accuracy beyond calibration data. Recent large-scale studies with regulatory-cleared devices often yield results
indistinguishable from calibration cuffs or show minimal improvement over baseline models, with some failing to detect BP changes
Hypertension
at all. Consequently, the previous ESH statement advising that cuffless BP devices should not be used for patient care remains valid.

Nevertheless, the clinical relevance of accurate cuffless BP measurement remains extremely high. To proceed effectively, two
major steps are necessary: first, the urgent establishment and enforcement of robust validation standards specifically designed for
cuffless technologies. Second, active pursuit of different measurement principles, particularly calibration-free methodologies, where
results can be trusted without adjustment. While skepticism toward PWA and PAT remains justified, early progress with calibration-
free approaches suggests a possible path forward if future research adopts rigorous, prospective testing and demonstrates clear
superiority over baseline models.

Tests recommended by the ESH for validating cuffless BP measurement devices

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