Abstract Body: Introduction: Nocturnal hypertension, defined as elevated blood pressure (BP) during sleep, is a stronger predictor of cardiovascular morbidity and mortality than daytime hypertension. Although ambulatory blood pressure monitoring (ABPM) is considered the diagnostic gold standard, frequent cuff inflations can disrupt sleep, reduce comfort, and hinder adherence in clinical settings. Recent advances in wearable, cuffless BP monitors offer a promising alternative by enabling continuous, less intrusive measurements, potentially enhancing patient comfort and adherence.

Hypothesis: We hypothesized that wearable, cuffless BP monitors accurately detect nocturnal hypertension and improve patient adherence compared to ABPM.

Methods: Following PRISMA guidelines, we systematically searched PubMed and Google Scholar for studies published through January 2025 using keywords such as “blood pressure Monitoring, Ambulatory,” “Nocturnal Hypertension,” and “Wearable Electronic Devices.” Eligible studies compared wearable or cuffless BP devices with ABPM or other validated methods and reported diagnostic accuracy metrics or usability outcomes. Extracted data included study design, sample size, device type, measurement duration, BP differences, AUC values, and patient-reported outcomes.

Results: Eight studies examined wearable, cuff-free BP monitors and found that their readings closely matched those from standard ABPM. Mean systolic BP differences ranged from −1.8 to 3.9 mmHg, and diastolic BP from −2.3 to 1.16 mmHg. Nighttime biases remained within clinical limits, with AUC values up to 1.0, indicating excellent accuracy. Technologies used included photoplethysmography, piezoelectric sensors, and ballistocardiography, which estimates BP through parameters like pulse transit time and pulse wave velocity. A pooled analysis of 16 studies (n=974) revealed small mean differences between wearable and reference devices, with average systolic and diastolic differences of 3.42 mmHg and 1.16 mmHg, respectively, supporting their clinical reliability. Usability studies reported improved comfort, fewer sleep disturbances, and higher adherence.

Conclusion: Wearable, cuffless BP monitors offer high diagnostic accuracy and improved usability for detecting nocturnal hypertension. These devices show strong potential as alternatives to ABPM for routine clinical use and home monitoring. Further longitudinal studies are needed to evaluate their long-term impact on cardiovascular outcomes.