I’ve been evaluating a wearable wrist watch blood pressure monitor for the last week.
After a Twitter interaction with Omron stimulated by Dr. Wen Dombrowski, the Omron people loaned me one of their HeartGuide devices.
Omron’s website describes the device as follows:
Engineered to keep you informed, HeartGuide is a wearable blood pressure monitor in the innovative form of a wristwatch. In tandem with its companion app HeartAdvisor, HeartGuide delivers powerful new technology making tracking and managing your blood pressure easier than ever before. Proactively monitor your heart health by turning real-time heart data into heart knowledge and knowledge into action. With HeartGuide wherever you go, you’re in the know.
I and the AHA have not recommended wrist BP devices. My decision was based on my personal research in the 1990s on arterial waveforms and the influence of wave reflection. Studies have clearly shown a change in the arterial wave form as it proceeds from the ascending aorta to the periphery.
Therefore, the skeptical cardiologist was skeptical of the value of the HeartGuide
After wearing the HeartGuide for a week and using it in a variety of situations to measure my blood pressure I am rethinking my recommendation against wrist blood pressure cuffs.
I’ll give my full analysis of the device after more evaluation but what I’ve discovered is that it can serve as an accurate and unobtrusive daytime ambulatory blood pressure monitor.
Ambulatory blood pressure monitoring (ABPM) utilizes a portable BP monitor which includes a brachial BP cuff and a device that inflates the cuff every 20-30 minutes, makes a measurement and stores all the recordings for off-line review. Studies have shown ABPM is a better predictor of CV mortality than either clinic BP or home BP monitoring.
It has not been widely utilized in the US because it is poorly reimbursed.
The HeartGuide sits on my wrist and whenever I feel like it, 
wherever I am, I can quickly and simply make a recording of my BP.
With the HeartGuide I have made BP recordings in a variety of situations which I would never previously have considered.
For example, earlier this week I wore the HeartGuide to work. I measured my BP at home and it was 125/76. After dropping my gear off at my office I walked to the 6th floor of the hospital to see inpatients. This involved going down several flights of stairs, crossing to the hospital via a pedway and climbing several flights of stairs.
When I emerged on the 6th floor I stopped (because the Heart Guide does not like it if you are moving), triggered the Heart Guide and put my right hand over my heart (the Heart Guide likes you to put your hand on your heart). Within 90 seconds I knew my BP (it had increased to 143/81).
In order to do this unobtrusively I wandered into the patient waiting area and pretended to be watching NFL highlights on the TV. Nobody seemed to notice I was taking my BP!
Subsequently, I was paged to do a transesophageal echo/electrical cardioversion and went downstairs to our “heart station” where a room full of RNs, a sonographer, an anesthetist and a patient awaited me. While talking to the patient about the procedure I triggered the Heart Guide and made another BP recording. Nobody noticed!
The Heart Guide BPs are displayed on the watch face for a few seconds and can be sent via BlueTooth to the OmronAdvisor smartphone app.
The graph above shows my BP was high at 807 AM while I was talking to the patient and still up after the procedure.
One day I wore the HeartGuide to the gym and made BP measurements under a variety of conditions.
The HeartGuide will not activate while walking on the treadmill no matter how hard I try to keep my arm still. It does not like motion of any kind.
But the first reading on the left was immediately after running on the treadmill. I then performed an isometric leg press hold on a weight machine and was able to obtain a recording during this maneuver of 140/88. Shortly after the leg press I repeated the recording and it had dropped down to 104/69.
I have to say this is an abundance of BP information that is quite interesting and heretofore I had never been aware of. It opens up intriguing clinical possibilities.
I will have to spend more time analyzing the Heart Guide before writing my overall impression and recommendations but thus far I see it expanding our toolkit for understanding hypertension and personalizing cardiovacular medicine.
Try to imagine yourself standing like me outside a restaurant unobtrusively taking your blood pressure and ponder the possibilities!
Soon you may find that wherever you go, you’re in the know. But be aware of the possibility of being arrested for loitering while checking your BP.
Omnimanometrically Yours,
-ACP
If you’d like to read a detailed description of the HeartGuide check out this review while eagerly awaiting my more serious and more complete analysis.
11 thoughts on “Omron’s HeartGuide Wristwatch Blood Pressure Monitor Allows BP Monitoring During Daily Activities Unobtrusively: Can It Replace Ambulatory BP Monitors?”
This is so well written, and so wonderful. Thank you so much for this! Look forward to more of your articles.
$500 US ????? That’s a substantial premium for “wrist-wearable” form-factor, when compared to other Omron “wearable BP monitors”. It would have to be _really_ good — or the price would have to drop — for me to consider it.
Regarding the BPro (I mentioned in my reply above) It is really good Charles. The data is completely eye opening and you can’t get a CASP anywhere else noninvasively. I have ridiculously labile BPs ranging from the 90s to >150 sys and 60s to 100s diastolic. However, my 24 hr ABPM with 90 readings was very reassuring and I choose not to treat my occ high BP’s because I fear bottoming out if my BP drops due to exercise or other variables. Additionally, my CASP values tell me my aorta is doing pretty good for a 63 yo man.
I have checked the Omron 7 wrist cuff against the EVOLV taking 52 reading 1.5 minutes apart and using a statistical student t-test found no significant difference. They were both within 2% of each other over 52 readings. As I am a sample of one no inference can be drawn beyond me but for my own needs the wrist cuff is more than accurate enough and easier to use than the EVOLV. Since my blood pressure readings average out to 117/68 during the day I see no need to go further. I have found that my blood pressure readings tend to decline toward the evening as my resting heart rate usually comes down to 30 bpm by 6:00 PM.
Great write up about the watch BP monitor.
Simultaneously measuring BP with a standard Omron monitor to check the accuracy of the wrist device would be of interest.
I did this comparison with the Quardio device and the Omron, and found there was a significant divergence in the results – same arm taken one after the other, alternating the sequence. Use left arm only as Omron technical help advised that using the left arm only was advised.
Dear TSC,
I spent > a year experimenting with a wrist ABPM (https://www.medtach.com/bpro.html) using tonometric recordings of the radial artery corrected by algorithms for wave reflection. This device has no cuff and measures blood pressure, pulse, nighttime dipping and perhaps more importantly, a reading of the central aortic systolic pressure (CASP). Measurements are made q15 minutes delivering 96 readings in 24 hours without requiring any triggering. Utility was limited by the need to hold still during the readings during the day (we naturally hold still enough at night while sleeping). I tried this on approximately 50 people with successful readings obtained on 48. I myself have done approximately 30 readings on myself over the course of a couple of years. The information is absolutely remarkable. I would be happy to send you 1 of my personal readings just to look at the data produced. I think it is way more than what you are seeing from Omron. By the way, how did they convince you of the validity of the wrist readings versus the gold standard bicep position? Did you self validate? final question while I have you, I bought a competing device (EMAY) to the Alivecor to test and cannot get a clean baseline. How does the Alivecor reading look to you?
Dan
I would be interested in looking at the data using tonometry.
Omron did not convince me of the accuracy of the device and I’ve been evaluating its accuracy compared to simultaneously obtained brachial cuff recordings in a variety of settings. They have provided me with a published study showing good accuracy but I haven’t had time to review it in detail.
I think the EMAY device is similar to the SonoHealth device I reviewed on this site. Very poor baseline and a horrible diagnostic algorithm. AliveCor is far superior.
Those inclined to protest will probably object to having to put their hand over their heart but I myself think this a clever (but patriotic!) irony that perhaps even Omron has overlooked. 😉
On a more serious note the face of the Heart Guide appears rather large for those of use with more diminutive wrists. I’m assuming that it only comes in one size or as they say one size fits all. Does that constant affect its ability to give accurate readings for all individuals?
Klinn,
Indeed, I felt very patriotic every time I checked my BP!
It is large. Definitely a drawback but understandable. Only one size FDA approved I believe-the one for average wrist.
I’ve tried to use it on two petite ladies in my practice and it would not work-their wrists too small.
My bottom line on accuracy is likely going involve making sure it is working accurately for each individual by testing and confirming.
Just another device I’ll have to buy and add to my growing arsenal of data points. I assume that the BP transfers along with the normal AliveCor Kardia readings as well?
Tom,
It works with a different app than the Omron/AliveCor app.I’m not sure they talk to each other