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Wearable blood pressure measurement devices and new approaches in hypertension management: the digital era

Abstract

Out-of-office blood pressure (BP) measurement is considered an integral component of the diagnostic algorithm and management of hypertension. In the era of digitalization, a great deal of wearable BP measuring devices has been developed. These digital blood pressure monitors allow frequent BP measurements with minimal annoyance to the patient while they do promise radical changes regarding the diagnostic accuracy, as the importance of making an accurate diagnosis of hypertension has become evident. By increasing the number of BP measurements in different conditions, these monitors allow accurate identification of different clinical phenotypes, such as masked hypertension and pathological BP variability, that seem to have a negative impact on cardiovascular prognosis. Frequent measurements of BP and the incorporation of new features in BP variability, both enable well-rounded interpretation of BP data in the context of real-life settings. This article is a review of all different technologies and wearable BP monitoring devices.

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References

  1. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303:2043–50.

    Article  CAS  PubMed  Google Scholar 

  2. COVID-19 Surveillance Group Characteristics of COVID-19 Patients dying in Italy Report Based on Available Data on 24 March 2020; The Italian National Health Service: Rome, Italy, 27 March 2020.

  3. World Health Organization (WHO) -China Joint Mission. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19); World Health Organization (WHO): Geneva, Switzerland, 28 February 2020.

  4. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;2018:3021–104.

    Article  Google Scholar 

  5. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Himmelfarb CD, et al. ACC / AHA / AAPA / ABC / ACPM / AGS /APhA/ ASH / ASPC / NMA / PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017;00:e000–e000.

    Google Scholar 

  6. Kaplan NM. Commentary on the sixth report of the Joint National Committee (JNC-6). Am J Hypertens. 1998;11:134–6.

    CAS  PubMed  Google Scholar 

  7. Choi YM, Leopold D, Campbell K, Mulligan J, Grudic GZ, Moulton SL. Noninvasive monitoring of physiologic compromise in acute appendicitis: New insight into an old disease. J Pediatr Surg. 2018;53:241–6.

    Article  PubMed  Google Scholar 

  8. Ding XR, Zhao N, Yang GZ, Pettigrew RI, Lo B, Miao F, et al. Continuous blood pressure measurement from invasive to unobtrusive: celebration of 200th birth anniversary of carl ludwig. IEEE J Biomed Health Inf. 2016;20:1455–65.

    Article  Google Scholar 

  9. Kario K. Management of hypertension in the digital era: small wearable monitoring devices for remote blood pressure monitoring. Hypertension 2020;76:640–50.

    Article  CAS  PubMed  Google Scholar 

  10. Kario K. New insight of morning blood pressure surge into the triggers of cardiovascular disease-synergistic resonance of blood pressure variability. Am J Hypertens. 2016;29:14–16.

    Article  PubMed  Google Scholar 

  11. Kario K, Chirinos JA, Townsend RR, Weber MA, Scuteri A, Avolio A, et al. Systemic hemodynamic atherothrombotic syndrome (SHATS) - coupling vascular disease and blood pressure variability: proposed concept from pulse of Asia. Prog Cardiovasc Dis. 2020;63:22–32.

    Article  PubMed  Google Scholar 

  12. Kario K, Tomitani N, Kanegae H, Yasui N, Nishizawa M, Fujiwara T, et al. Development of a new ICT-based multisensory blood pressure monitoring system for use in hemodynamic biomarker-initiated anticipation medicine for cardiovascular disease: the National IMPACT Program Project. ProgCardiovascDis. 2017;60:435–49.

    Google Scholar 

  13. Kuwajima I, Mitani K, Miyao M, Suzuki Y, Kuramoto K, Ozawa T. Cardiac implications of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time. Am J Hypertens. 1995;8:29–33.

    Article  CAS  PubMed  Google Scholar 

  14. Yano Y, Hoshide S, Inokuchi T, Kanemaru Y, Shimada K, Kario K. Association between morning blood pressure surge and cardiovascular remodeling in treated elderly hypertensive subjects. Am J Hypertens. 2009;22:1177–82.

    Article  PubMed  Google Scholar 

  15. Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M, et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens. 2002;20:2183–9.

    Article  CAS  PubMed  Google Scholar 

  16. Mauck GW, Smith CR, Geddes LA, Bourland JD. The meaning of the point of maximum oscillations in cuff pressure in the indirect measurement of blood pressure - part ii. J Biomech Eng. 1980;102:28–33.

    Article  CAS  PubMed  Google Scholar 

  17. Arakawa T. Recent research and developing trends of wearable sensors for detecting blood pressure. Sensors. 2018;18:2772. 23

    Article  PubMed Central  Google Scholar 

  18. Kuwabara M, Harada K, Hishiki Y, Kario K. Validation of two watch-type wearable blood pressure monitors according to the ANSI / AAMI / ISO81060-2: 2013 guidelines: Omron HEM-6410T-ZM and HEM-6410T-ZL. J Clin Hypertens. 2019;21:853–8.

    Article  Google Scholar 

  19. Kikuya M, Chonan K, Imai Y, Goto E, Ishii M. Research group to assess the validity of automated blood pressure measurement devices in Japan. Accuracy and reliability of wrist ‐ cuff devices for self ‐ measurement of blood pressure. J Hypertens. 2002;20:629–38.

    Article  CAS  PubMed  Google Scholar 

  20. Kario K, Shimbo D, Tomitani N, Kanegae H, Schwartz JE, Williams B. The first study comparing a wearable watch-type blood pressure monitor with a conventional ambulatory blood pressure monitor on in-office and out-of-office settings. J Clin Hypertens. 2020;22:135–41.

    Article  Google Scholar 

  21. Penaz J Photo-electric measurement of blood pressure, volume and flow in the finger. In Proceedings of the Digest of the Tenth International Conference on Medical Biological Engineering, Dresden, Germany, 13–17 August 1973.

  22. Parati G, Casadei R, Groppelli A, Di Rienzo M, Mancia G. Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing. Hypertension. 1989;13:647–55. 6 Pt 1.

    Article  CAS  PubMed  Google Scholar 

  23. Van Egmond J, Hasenbos M, Crul JF. Invasive v. non-invasive measurement of blood pressure. Comparison of two automatic methods and simultaneously measured direct intra-arterial pressure. Br J Anaesth. 1985;57:434–44.

    Article  PubMed  Google Scholar 

  24. Imholz BP, Langewouters GJ, van Montfrans GA, Parati G, van Goudoever J, Wesseling KH, et al. Feasibility of ambulatory, continuous 24-hour finger arterial pressure recording. Hypertension. 1993;21:65–73.

    Article  CAS  PubMed  Google Scholar 

  25. Pressman GL, Newgard PM. A transducer for the external measurement of arterial blood pressure. IEEE Trans Biomed Eng. 1963;10:73–81.

    CAS  PubMed  Google Scholar 

  26. Sato T, Nishinaga M, Kawamoto A, Ozawa T, Takatsuji H. Accuracy of a continuous blood pressure monitor based on arterial tonometry. Hypertension. 1993;21:866–74.

    Article  CAS  PubMed  Google Scholar 

  27. Nair D, Tan SY, Gan HW, Lim SF, Tan J, Zhu M, et al. The use of ambulatory tonometric radial arterial wave capture to measure ambulatory blood pressure: the validation of a novel wrist-bound device in adults. J Hum Hypertens. 2008;22:220–2.

    Article  CAS  PubMed  Google Scholar 

  28. Komori T, Eguchi K, Hoshide S, Williams B, Kario K. Comparison of wrist-type and arm-type 24-h blood pressure monitoring devices for ambulatory use. Blood Press Monit. 2013;18:57–62.

    Article  PubMed  Google Scholar 

  29. Hornstrup BG, Rosenbæk JB, Bech JN. Comparison of ambulatory tonometric and oscillometric blood pressure monitoring in hypertensive patients. Integr Blood Press Control. 2020;13:41–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kario K. Evidence and perspectives on the 24-hour management of hypertension: hemodynamic biomarker-initiated ‘anticipation medicine’ for zero cardiovascular event. Prog Cardiovasc Dis. 2016;59:262–81.

    Article  PubMed  Google Scholar 

  31. Kokubo A, Kuwabara M, Nakajima H, Tomitani N, Yamashita S, Shiga T, et al. Automatic detection algorithm for establishing standard to identify “surge blood pressure”. Med Biol Eng Comput. 2020;58:1393–404.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Van Velzen MHN, Loeve AJ, Niehof SP, Mik EG. Increasing accuracy of pulse transit time measurements by automated elimination of distorted photoplethysmography waves. Med Biol Eng Comput. 2017;55:1989–2000.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wang R, Jia W, Mao ZH, Sclabassi RJ, Sun M. Cuff-free blood pressure estimation using pulse transit time and heart rate. Int Conf Signal Process Proc. 2014;2014:115–8.

    PubMed  PubMed Central  Google Scholar 

  34. Lazazzera R, Belhaj Y, Carrault G. A new wearable device for blood pressure estimation using photoplethysmogram. Sensors. 2019;19:2557.

    Article  CAS  PubMed Central  Google Scholar 

  35. Chan G, Cooper R, Hosanee M, Welykholowa K, Kyriacou PA, Zheng D, et al. Multi-site photoplethysmography technology for blood pressure assessment: challenges and recommendations. J Clin Med. 2019;8:1827.

    Article  PubMed Central  Google Scholar 

  36. Dey J, Gaurav A, Tiwari VN. InstaBP: cuff-less blood pressure monitoring on smartphone using single PPG sensor. Annu Int Conf IEEE Eng Med Biol Soc 2018;2018:5002–5.

    PubMed  Google Scholar 

  37. Chandrasekhar A, Kim CS, Naji M, Natarajan K, Hahn JO, Mukkamala R. Smartphone-based blood pressure monitoring via the oscillometric finger-pressing method. Sci Transl Med. 2018;10:eaap8674.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Luo H, Yang D, Barszczyk A, Vempala N, Wei J, Wu SJ, et al. Smartphone-based blood pressure measurement using transdermal optical imaging technology. CircCardiovasc Imaging. 2019;12:e008857.

    Article  Google Scholar 

  39. IEEE 1708-2014 - IEEE Standard for Wearable Cuffless Blood Pressure Measuring Devices. Available online at: https://standards.ieee.org/findstds/standard/1708-2014.html.

  40. Michalakeas C, Katsi V, Soulaidopoulos S, Dilaveris P, Vrachatis D, Lekakis I, et al. Mobile phones and applications in the management of patients with arterial hypertension. Am J CardiovascDis. 2020;10:419–31.

    Google Scholar 

  41. Omboni S, Gazzola T, Carabelli G, Parati G. Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens. 2013;31:455–67.

    Article  CAS  PubMed  Google Scholar 

  42. Pellaton C, Vybornova A, Fallet S, Marques L, Grossenbacher O, De Marco B, et al. Accuracy testing of a new optical device for noninvasive estimation of systolic and diastolic blood pressure compared to intra-arterial measurements. Blood Press Monit. 2020;25:105–9. https://doi.org/10.1097/MBP.0000000000000421.

    Article  PubMed  Google Scholar 

  43. Vybornova A, Polychronopoulou E, Wurzner-Ghajarzadeh A, Fallet S, Sola J, Wuerzner G. Blood pressure from the optical Aktiia Bracelet: a 1-month validation study using an extended ISO81060-2 protocol adapted for a cuffless wrist device. Blood Press Monit. 2021;26:305–11.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Dörr M, Weber S, Birkemeyer R, Leonardi L, Winterhalder C, Raichle CJ, et al. iPhone App compared with standard blood pressure measurement -The iPARR trial. Am Heart J. 2021;233:102–8.

    Article  PubMed  Google Scholar 

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Contributions

KT (K Tsioufis) was responsible for designing the rationale of the article. FT, KT (K Thomopoulos), KD, DT were responsible for conducting the search, screening potentially eligible studies, extracting and analysing data, interpreting results, and updating reference lists. DK and PI were responsible for collecting all above data according to the article rationale and write the main article as well as designing the table and figure of the article

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Correspondence to D. Konstantinidis.

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Konstantinidis, D., Iliakis, P., Tatakis, F. et al. Wearable blood pressure measurement devices and new approaches in hypertension management: the digital era. J Hum Hypertens 36, 945–951 (2022). https://doi.org/10.1038/s41371-022-00675-z

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