REAL-WORLD IMPLEMENTATION AND CLINICAL IMPACT OF CUFFLESS AMBULATORY BLOOD PRESSURE MONITORING

초록

Objective: Ambulatory blood pressure monitoring (ABPM) provides superior cardiovascular risk prediction compared with office measurements, yet its use remains limited because of discomfort and accessibility barriers. Cuffless BP monitoring has been proposed as an alternative, but no device had previously received regulatory approval for ambulatory use. We evaluated the first regulatoryapproved cuffless ABPM system in routine clinical practice. Design and method: We conducted a retrospective study at two tertiary hospitals in South Korea between January and October 2025 and included all patients who underwent cuffless ABPM with CART-BP Pro, the first insurance-reimbursed cuffless ABPM device. We assessed data quality, ambulatory BP patterns, hypertension phenotypes, and treatment modifications using multivariable logistic regression. Results: Among 1,564 patients prescribed cuffless ABPM, 1,489 (95 2%) completed monitoring and 1,220 (88 5%) met quality criteria. Abnormal dipping patterns were common (79 5%). Masked hypertension was identified in 27 6% overall and in 49% of office normotensive patients, with nighttime BP elevation in 98 5% of these cases. Lower nighttime SBP predicted white-coat hypertension (adjusted OR 0 20 per 10mmHg, 95% CI 0 14–0 28), whereas higher nighttime SBP predicted masked hypertension (adjusted OR 4·80 per 10mmHg, 95% CI 3·41–6·98). Among treatment-naïve patients, 39% initiated antihypertensive therapy after monitoring. Among those already treated, 41% underwent regimen changes (17% intensification; 26% de-intensification). Failure to achieve 24-hour BP <130/80mmHg was independently associated with intensification (OR 2·31, 95% CI 1·30–4·18, Figure). Conclusions: Cuffless ABPM showed high feasibility in routine care, with strong patient acceptance and high data-quality performance. The high prevalence of masked hypertension and abnormal nocturnal patterns suggests that conventional office- or home-based measurements may underdetect clinically important phenotypes. Treatment modifications following cuffless monitoring indicate that clinicians incorporated ambulatory information into therapeutic decisions. Prospective studies with cardiovascular endpoints are needed to define the long-term clinical role of cuffless ABPM.