--- title: "Do Calibrated Cuffless Blood Pressure Readings Track Real Changes? | KnowYourPrime Evidence Registry" description: "Finding KYP-ER-0022, rated Uncertain. Mostly not. Calibrated cuffless devices tend to stay close to the cuff reading they were calibrated with: in 166 people the cuffless 24-hour average sat 1.8 mmHg from the calibration value while the cuff average moved 7.4 mmHg, and the error grew the further..." url: https://knowyourprime.com/evidence-calibrated-cuffless-blood-pressure-tracking --- KnowYourPrime Evidence Registry · Finding KYP-ER-0022 # Do Calibrated Cuffless Blood Pressure Readings Track Real Changes? Question assessedAfter calibration with a cuff, does a smartwatch or bracelet blood pressure reading follow real changes in blood pressure? KnowYourPrime evidence rating Uncertain Evidence is conflicting, inconsistent, or difficult to interpret. Mostly not. Calibrated cuffless devices tend to stay close to the cuff reading they were calibrated with: in 166 people the cuffless 24-hour average sat 1.8 mmHg from the calibration value while the cuff average moved 7.4 mmHg, and the error grew the further real pressure moved. One finger device passed a full set of tracking tests. Finding KYP-ER-0022 Version 1.0 Reviewed October 24, 2026 Rating rule 1.6 [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/) ## Why this is rated Uncertain A cuffless device calibrated against your cuff can look accurate simply by repeating numbers near the calibration value. The real test is whether it follows a change, after medication or over the day. A finger photoplethysmography monitor met the European Society of Hypertension scenarios, including a fall in pressure, which is the clean anchor. A month-long Samsung Galaxy Watch 5 study found accuracy declined as values moved from the calibration point, and several studies and two Hypertension reviews found calibrated devices pulled toward their calibration. With a clean anchor and core-hitting conflicts, the rule rates the claim Uncertain. How the rating rule reads this evidence - Anchor-grade evidence affirms the core relationship. - An anchor study is present but its own reported finding does not cleanly affirm this claim, so it does not count toward the Established threshold. - The claim rests on a single anchor whose finding affirms it; a second independent affirming anchor is needed to reach Established. - A clean anchor supports this claim, but an unresolved conflicting study contradicts it on the core relationship, so the evidence is treated as in genuine dispute. - Some evidence conflicts on secondary points that do not change the core direction. ## Key results - In 166 participants wearing a pulse-transit-time cuffless device and a cuff monitor simultaneously, the mean difference between the calibration reading and the 24-hour average was 7.4 mmHg systolic for the cuff and 1.8 mmHg for the cuffless device, and the cuffless error grew almost linearly with how far pressure had moved. (Derendinger et al., Journal of Hypertension, 2024) - In 40 patients, a Samsung Galaxy Watch Active 2 showed proportional bias against 24-hour monitoring, overestimating low systolic pressures and underestimating high ones. (Falter et al., Frontiers in Cardiovascular Medicine, 2022) - In 37 participants measured daily for 28 days after calibration, a Samsung Galaxy Watch 5 was assessed against a validated Omron cuff across its full recalibration interval; the authors report accuracy declined as values diverged from the calibration point. (Walzel et al., Digital Health, 2026) - In three people followed through a blood pressure medication increase, a home cuff recorded a large fall that the Aktiia bracelet barely registered. (Tan et al., Journal of Hypertension, 2023) ## What this finding covers **Applies to:** Cuffless wrist, finger and bracelet devices calibrated against a cuff, and whether their readings follow blood pressure changes after calibration. **Does not cover:** Watches with a built-in cuff; whether the first reading after calibration is accurate; diagnosis or medication decisions. ## Limitations - The one fully passing device is a finger monitor, not a consumer smartwatch. - The medication-tracking test followed three people. ## Evidence base 10 studies scored · 2 anchor · 6 conflicting · 2 supporting · Evidence last evaluated Oct 19, 2026 ### Anchor studies The studies the rating rests on. 1. Clinical Validation of Photoplethysmography-Based Finger Cuffless Blood Pressure Monitoring Following European Society of Hypertension Recommendations.Qiu et al., Journal of the American Heart Association, 2026. [doi.org/10.1161/JAHA.126.050501](https://doi.org/10.1161/JAHA.126.050501) 2. Long-term accuracy and stability of blood pressure measurements from a smartwatch: Prospective validation studyWalzel et al., Digital Health, 2026. [doi.org/10.1177/20552076261415923](https://doi.org/10.1177/20552076261415923) ### Conflicting studies Studies whose findings run against the claim. 1. Cuffless Blood Pressure Measurement: Where Do We Actually Stand?Mukkamala et al., Hypertension (Dallas, Tex, 2025. [doi.org/10.1161/HYPERTENSIONAHA.125.24822](https://doi.org/10.1161/HYPERTENSIONAHA.125.24822) 2. Ability of a 24-h ambulatory cuffless blood pressure monitoring device to track blood pressure changes in clinical practice.Derendinger et al., Journal of Hypertension, 2024. [doi.org/10.1097/HJH.0000000000003667](https://doi.org/10.1097/HJH.0000000000003667) 3. Evaluation of the ability of a commercially available cuffless wearable device to track blood pressure changesTan et al., Journal of Hypertension, 2023. [doi.org/10.1097/hjh.0000000000003428](https://doi.org/10.1097/hjh.0000000000003428) \[conflict statement: Aktiia supplied the devices tested, and two authors have been paid by Aktiia\] 4. Feasibility and measurement stability of smartwatch-based cuffless blood pressure monitoring: A real-world prospective observational study.Han et al., Hypertension Research, 2023. [doi.org/10.1038/s41440-023-01215-z](https://doi.org/10.1038/s41440-023-01215-z) 5. The Microsoft Research Aurora Project: Important Findings on Cuffless Blood Pressure Measurement.Mukkamala et al., Hypertension (Dallas, Tex, 2023. [doi.org/10.1161/HYPERTENSIONAHA.122.20410](https://doi.org/10.1161/HYPERTENSIONAHA.122.20410) 6. Smartwatch-Based Blood Pressure Measurement Demonstrates Insufficient AccuracyFalter et al., Frontiers in Cardiovascular Medicine, 2022. [doi.org/10.3389/fcvm.2022.958212](https://doi.org/10.3389/fcvm.2022.958212) ### Supporting studies Studies consistent with the claim that do not carry the rating on their own. 1. Long-term stability and blood pressure change tracking with a cuffless wearable device in hypertensive patients.Proença et al., Blood Pressure, 2026. [doi.org/10.1080/08037051.2026.2707794](https://doi.org/10.1080/08037051.2026.2707794) 2. Continual Versus Occasional Blood Pressure (COOL-BP) in Remote Hypertension Management.Unlu et al., American Journal of Hypertension, 2025. [doi.org/10.1093/ajh/hpaf003](https://doi.org/10.1093/ajh/hpaf003) \[author affiliations include Aktiia; funding listed from Aktiia\] ## Version history | Version | Date | Rating | Change | | --- | --- | --- | --- | | 1.0 | October 24, 2026 | Uncertain | First published. | Rating history on the research desk: Uncertain (October 19, 2026). ## Cite this finding KnowYourPrime Evidence Registry, Finding KYP-ER-0022, version 1.0, reviewed 2026-10-24. https://knowyourprime.com/evidence-calibrated-cuffless-blood-pressure-tracking Machine-readable: [JSON](https://knowyourprime.com/evidence-calibrated-cuffless-blood-pressure-tracking.json) · [Markdown](https://knowyourprime.com/evidence-calibrated-cuffless-blood-pressure-tracking.md) · [All findings](https://knowyourprime.com/evidence) ## Related - Research desk: [the blood pressure research desk entry for this question](https://knowyourprime.com/research-desk-blood-pressure#calibrated_change_tracking), with every scored study and its role - Related finding: [Cuffless Blood Pressure Accuracy at Night](https://knowyourprime.com/evidence-cuffless-blood-pressure-at-night) (KYP-ER-0021) - Related finding: [Accuracy of Smartwatches With a Built-In Blood Pressure Cuff](https://knowyourprime.com/evidence-smartwatch-cuff-blood-pressure-accuracy) (KYP-ER-0020) - On this site: [Can a Smartwatch or Ring Really Measure Blood Pressure?](https://knowyourprime.com/can-a-smartwatch-measure-blood-pressure) - On this site: [How Accurate Is Samsung Galaxy Watch and Whoop Blood Pressure? What Calibration Does to the Numbers](https://knowyourprime.com/how-accurate-is-samsung-watch-and-whoop-blood-pressure) This is KnowYourPrime's own assessment of the published evidence, rated under the [KnowYourPrime evidence methodology](https://knowyourprime.com/methodology). The rating is set by a fixed rule from the roles of the studies above and moves only when the evidence or the rule changes. Every change to the rating or the text is published as a new dated version. 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