Cuffless blood pressure in 2025: from promise to practice: a narrative review

Cuffless blood pressure (BP) technologies have moved from concept to everyday wearables, spurred by consumer adoption and recent regulatory milestones. Yet clinicians face mixed signals on accuracy, calibration stability, and clinical use. This review synthesizes current evidence and emerging standards to clarify where cuffless data can add value.

Most devices estimate BP from surrogate signals and require periodic calibration, making outputs reliable for trends around the last calibration but less so for absolute values. New cuffless-specific validation frameworks mandate dynamic testing (position/hydrostatics, activity/exercise, awake-sleep, pharmacologic response, and prerecalibration drift). Professional bodies currently advise against diagnosis or drug titration using cuffless readings unless a device passes such protocols. Real-world studies show feasibility and patient preference but only moderate agreement with cuffs and limited outcomes data. Special populations (chronic kidney disease/dialysis, pregnancy, pediatrics/frail, diverse skin tones) introduce additional accuracy and equity concerns.

Cuffless wearables may be used as adjuncts to surface patterns and support engagement; diagnosis and treatment decisions must be confirmed with validated upper-arm measurements. A pragmatic "good-enough" checklist includes stable calibration over weeks, accuracy across dynamic states and subgroups, and transparent multisite validation. Priorities include harmonized standards, inclusive datasets, and trials linking cuffless monitoring to clinical outcomes.