Background and Aim: Despite a growing number of cuffless blood pressure (BP) devices becoming available, these are not yet recommended by peak clinical bodies because of insufficient clinical validation. The aim of this study was to systematically review and critically evaluate published validation studies of commercial cuffless BP devices against methodological principles derived from current standards and consensus statements.

Methods: A systematic search of Embase, Medline, PubMed and IEEE was conducted to identify validation studies of pre-market or post-market commercial cuffless BP devices. Studies evaluating and reporting device performance against a reference BP measurement method were included for analysis. Data relating to device characteristics, validation methodology, author conclusions and bias were extracted. Validation methodology was evaluated against eight ‘validation requirements’ developed from available standards/consensus statements that can be applied to both preliminary and formal validation studies.

Results: A total of 68 studies evaluating 40 unique cuffless BP devices were included, of which 22 devices were available for purchase at the time of review. Most of the studies (81%) assessed device performance under resting conditions (static test), with 42.6% involving evaluation soon after calibration with a cuff-measured or invasively-measured BP value (a fundamentally flawed approach). Only one third of studies (34%) assessed performance during induced or naturally occurring changes in BP (change test). Few studies performed a stability test (13.2%), position test (2.9%) or motion test (13.2%), and only 4/62 (5.8%) compared to a baseline model (where relevant). 23.5% did not cover an adequate range of blood pressures, and, of the 57 studies using optical technology, 19.1% reported skin tone. Non-independent studies were more common (69%), for which positive conclusions (89%), bias (34.1%) and flawed/limited methodology (87.3%) were more common than for independent studies (48%, 4.8% and 57.2% respectively).

Conclusion: Validation of commercial cuffless blood pressure devices is currently limited by bias and flawed or limited methodology. While these issues risk creating an illusion that cuffless BP devices are accurate, data from this study indicate that there is presently insufficient evidence to justify adopting any of these devices in clinical practice.

Background: At the fourth United Nations High-Level Meeting in 2025, governments committed to controlling hypertension in an additional 150 million people by 2030. Reducing population sodium intake lowers blood pressure and switching salt consumption from regular salt to potassium-enriched, sodium-reduced salt is a practical way to achieve this at scale.

Aim: To estimate the effects of replacing regular salt with potassium-enriched salt on global hypertension control.

Methods: We modelled the effect of switching from regular salt (100% NaCl) to potassium-enriched salt (75% NaCl + 25% KCl) on systolic blood pressure (SBP) falling from >140 to <140 mmHg across 193 territories. We assessed replacement of: 1) all salt; 2) discretionary salt used at home; and 3) non-discretionary salt used in processed and restaurant foods, sauces, and condiments. Baseline SBP distributions were from the Global Burden of Disease Study 2021, and effects of sodium reduction and potassium supplementation were from systematic reviews, assuming additive effects. Using gamma distributions, we estimated the probability of SBP >140 mmHg under each scenario and the status quo. The number achieving an SBP reduction from >140 to <140 mmHg was calculated by multiplying the change in probability by the population size. Uncertainty was quantified using 1000 Monte Carlo simulations.

Results: Globally, replacing all regular salt with potassium-enriched salt was estimated to reduce SBP from >140 to <140 mmHg in 363 million people (95% uncertainty interval [UI]: 318–418), equivalent to 34% of those with high SBP. Replacing discretionary salt alone would benefit 225 million people (95% UI: 195–262; 21%), and non-discretionary salt alone 196 million (95% UI: 172–227; 18%). Each scenario exceeded the UN target of 150 million additional people with controlled hypertension. Under full replacement, more males than females would achieve control (211 million [40%] vs 151 million [28%]) with a similar pattern for the other intervention scenarios.

Conclusions: Replacing regular salt with potassium-enriched salt could substantially accelerate global hypertension control and support United Nations non-communicable disease prevention targets. All governments should consider context-specific implementation of this scalable and cost-effective strategy.

Introduction: Hypertension is the most common condition managed in primary care. This study aimed to understand general practitioners’ (GPs’) practices and perspectives on five different blood pressure (BP) measurement methods: clinic, automated office (AOBP), 24-hour ambulatory (ABPM), home, kiosk, and cuffless measurements.

Methods: We conducted semi-structured interviews with 22 GPs (55% femals) from metropolitan, regional, and rural areas across different states of Australia.

Results: Most GPs relied primarily on repeated clinic BP measurements for hypertension diagnosis, expressing a sense of trust and control over their own measurement practices. These measurements were performed by either GPs or nurses, with most GPs reporting using the lowest BP reading for decision-making. Although AOBP was perceived to be more accurate than clinic BP, many GPs raised concerns about the space and personnel required. Despite perceiving ABPM as the gold standard, GPs identified cost and anticipated patient refusal as barriers, limiting its use. GPs routinely used home BP monitoring for patients with high BP, but education on how to measure BP was not commonly provided. GPs sometimes suggested that patients have their BP measured at pharmacies if they did not have a home BP device. Kiosk BP readings were generally not used by GPs because of uncertainty regarding whether kiosk devices were validated and whether the measurement environment was appropriate. GPs would not recommend cuffless BP devices to patients.

Conclusions: GPs were confident in using clinic BP for hypertension diagnosis and management. However, gaps remain in the use of AOBP and out-of-office guideline-recommended BP measurement techniques.

Background and aim: Automated Office Blood Pressure (AOBP) supports standardised, high-quality BP measurement but there are barriers to implementation, including non-user-friendly design and operation of AOBP devices. This study aimed to consult with end-users of AOBP to identify device-specific characteristics that support the implementation of guideline-recommended AOBP across clinical and community settings.

Methods: AOBP device usability was evaluated as part of a co-designed AOBP pilot implementation study conducted across general practices, community pharmacies, and community organisations in regional Tasmania, Australia, during 2025-2026. Participating sites (n=11) were provided with one of three commercially available AOBP devices for use during the pilot (1. Omron HEM-907; 2. A&D Medical UM-212 BLE or; 3. Uscom BP+). Multi-method data attained across 788 AOBP measurements included, 38 staff surveys, 31 protocol fidelity observations, 57 patient interviews and post-pilot focus groups with 33 staff. Data were synthesised across data sources to identify device-specific characteristics influencing usability, acceptability, protocol fidelity and workflow compatibility.

Results: AOBP devices were acceptable and usable across participants. Key characteristics supporting implementation of AOBP included automation of the AOBP protocol, including programmed rest, repeated measurements at predefined intervals, and automatic calculation of average BP. Simple, intuitive controls, clear display, and easy retrieval and retention of individual and averaged readings were important for reducing operator burden and supported protocol fidelity. Electronic medical record integration and compatible data-transfer systems were identified as important for reducing manual data entry and supporting accurate documentation of AOBP results. Additional desirable functionality included standing AOBP measurements and atrial fibrillation detection to support opportunistic screening. Practical considerations included portability, appropriate cuff size availability, and suitability across different clinical and community settings.

Conclusions: This study identified several AOBP device-specific characteristics, that if addressed by device manufacturers, could help improve measurement protocol fidelity, reduce operator burden and facilitate implementation of guideline-recommended AOBP measurement into routine practice.