Non-invasive blood pressure monitoring using wearables for cardiovascular risk assessment: a systematic review

Cardiovascular diseases are the leading causes of mortality in women worldwide, with hypertension being a major risk factor. While traditional blood pressure monitoring techniques rely on cuff-based measurements, wearable devices offer a promising alternative for continuous and non-invasive blood pressure tracking. This systematic review investigates the extent to which wearable blood pressure measurements can serve as surrogates for traditional sensors to be implemented in risk assessment tools in predicting cardiovascular risk in women.

A systematic search was conducted in databases including MEDLINE, Embase, Cochrane Library, Web of Science, Scopus and ClinicalTrials.gov. Studies published between 2010 and 2024 were included. Exclusion criteria were case reports or animal studies. Study selection was performed based on PRISMA guidelines. Data extraction focused on wearable devices, measurement approach, validation against gold-standard BP methods, and their predictive utility for cardiovascular outcomes.

The systematic literature search revealed 14'863 results after removal of duplicates, of which 245 were selected for extraction. Most included studies used photoplethysmography, with pulse transit time and pulse wave velocity as core parameters, some using machine learning. Accuracy was moderate to high for diastolic blood pressure, but systolic blood pressure showed greater variability. Cardiovascular risk stratification showed promising results, though external validation was rare.

Wearable blood pressure monitoring technologies are maturing, with growing potential in preventive cardiovascular medicine in women. However, clinical implementation is limited by varying accuracy, need for calibration, and the lack of standardization. Further validation and longitudinal studies are needed to establish their role in cardiovascular risk prediction.