Wearable devices in the management of hypertension: Navigating the intersection between digital advancement and evidence-based practice

Hypertension remains the leading cause of premature mortality. Its effective management is hindered by sub-optimal monitoring from intermittent measurement of blood pressure, which often lacks important prognostic data such as patterns of blood pressure variability. This article provides a summary of the technologies used in wearable devices, an evaluation of their emerging role in the management of hypertension, and current challenges to their utility. Unlike traditional cuff-based devices, cuffless technology utilises range of sensors and physiological principles, including peripheral pulse wave characteristics and photoplethysmography, together with algorithms to estimate blood pressure. Cuffless devices are unobtrusive and can be worn continuously, providing longer-term data. As such, they can bridge gaps in identifying and monitoring high-risk hypertension profiles, sleep periods data, dipping status and blood pressure variability, which can guide individualised clinical decision making. However, due to rapid innovation and technological heterogeneity and associated lack of appropriate validation frameworks, there remain significant concerns on the accuracy and reliability of cuffless wearables for clinical use. Despite their potential and market availability, professional society guidelines do not recommend the use of cuffless devices for clinical decision making until more robust and complete real-world evidence is available.