Cuffless Blood Pressure Devices Fall Short of Clinical Standards

The conversation turns to the growing number of cuffless blood pressure devices, including smartwatches, fingertip monitors, and rings, and whether primary care clinicians should trust the readings patients bring in. Pamela Kushner, MD, FAAFP, says the 2025 American Heart Association and American College of Cardiology standards are explicit: cuffless devices should not be used for diagnosis, medication titration, or clinical management of hypertension because no clinical validation tools yet exist for them.

Kushner notes that many patients believe these devices are accurate and may report their blood pressure is well controlled based on readings that have never been validated against a certified device. Her practice solution is to have patients bring their home blood pressure device into the office, where it can be checked against a calibrated office device to confirm accuracy. For patients facing social determinants of health that limit access to a home device, Kushner says clinicians should consider lending devices so patients can build buy-in and check their blood pressure at home in the morning and evening.

She sees a role for artificial intelligence emerging in this space, potentially allowing patients to transmit home readings ahead of a visit so clinicians can review trends quickly and act on them. Beyond device selection, Kushner points to lifestyle interventions that support blood pressure control, including reducing dietary salt and incorporating exercise. She notes that breathing exercises and stress reduction can lower blood pressure briefly, though these strategies alone will not sustain control.

Kushner closes the segment by connecting uncontrolled hypertension to two of its most serious downstream consequences: vascular dementia and kidney disease. She describes blood pressure control as one of the few modifiable factors clinicians have to reduce the risk of vascular dementia, a condition with no treatment once diagnosed. She also notes that unmanaged hypertension, particularly in combination with diabetes, accelerates damage to the endothelial lining of the kidney and elsewhere in the body, reinforcing why she considers blood pressure the most preventable cardiovascular risk factor available to clinicians.