Feeling the Pressure: Smartwatches and Wearables Expanding Into Hypertension Monitoring
They're closing the gap with dedicated medical devices. But they're not there... yet.
For years, smartwatches were seen primarily as tools for fitness tracking and convenience. But with each new product cycle, they're edging closer to territory once reserved for specialized medical devices. Apple's latest announcements highlighting heart-focused features for the Apple Watch Series 11 and watchOS 26 show that the line between lifestyle gadgets and health-monitoring tech is more blurred than ever.
From their humble beginnings of text notifications and step counters, smartwatches and wearables have evolved into tech-packed powerhouses, with sensors and software that spot irregular heart rhythms, estimate blood oxygen saturation, measure heart rate, track sleep patterns, and even take an electrocardiogram (also called an ECG or EKG) using an app.
Today’s latest hardware and software now adds the ability to flag potential hypertension risks. Available on the new Apple Watch Series 11 and Ultra 3 on release and the Series 9, Series 10, and Ultra 2 with the watchOS 26 update, this long-awaited feature has the potential to help millions take a more active part in maintaining their heart health. And with devices from companies like Samsung, Huawei, and others poised to add similar functionality, the push towards true wearable medical devices for the masses is accelerating.
A Growing Problem
Hypertension, or high blood pressure, occurs when the force of blood pushing against your arteries is consistently too high. Over time, hypertension raises your risk of serious health problems like heart attacks, heart failure, and strokes. Because hypertension doesn't usually cause symptoms, spotting it early can help control it before it impacts your long-term health.
“It is remarkable how many patients don’t realize that their blood pressure is uncontrolled,” says Ajay Kirtane, MD, SM, interventional cardiologist and Director of Columbia’s Interventional Cardiovascular Care program. “Wearables that allow patients to be empowered in their own healthcare offer a great potential opportunity, if the implementation is right.”
Apple's hypertension notification feature uses an optical sensor to look for patterns in how your blood vessels respond to your heartbeat over about 30 days. If it sees a pattern that suggests high blood pressure, you get a notification along with a recommendation that you:
- Confirm the reading with a home blood pressure cuff.
- Meet with your doctor for a more complete diagnosis and, potentially, a treatment plan.
Not there… Yet
The Series 11 isn't the first smart watch to have this capability; in addition to recent Apple Watch models, Samsung, Huawei, and other device makers have also listed hypertension notifications as an upcoming feature on existing and future models, or already offer some version of it in other parts of the world.
The problem has been getting US approval to market the feature: Apple only received clearance as of Sept 12th, just days before the launch of the Apple Watch 11 series. (Samsung is still awaiting US approval for its version of the feature.)
So far, only FDA-approved blood pressure cuffs can give exact numbers that doctors use to diagnose and treat hypertension. The smartwatch’s role remains screening — helping you know when you might need to check more carefully.
To help with regulatory approval, Apple is careful to call this feature a notification, not a monitor, allowing them to clear a lower bar. And the feature isn’t for everyone: Apple’s intended use guidelines focus on adults 22 years or older who don’t already have a hypertension diagnosis; it also excludes people who are pregnant. Expect other manufacturers to follow this strategy.
Navigating the line between fitness and health devices and a dedicated medical device is challenging. By offering this feature on the Apple Watch, which is by far the best-selling device of its kind, millions of users now have useful information to inform their next steps. But with that many users, the potential for misfires and wrong conclusions is significant. Users may treat a notification as a diagnosis or a reason to panic. Some may disregard alerts if they feel the device isn't accurate. Promoting any new health-related feature while setting realistic expectations is a moving target; for heart health, especially, it requires careful consideration.
Dr. Kirtane stresses that even with their continued improvements, today’s wearables can be helpful screening companions but can't take the place of a professional diagnosis, validated monitoring equipment, or regular appointments with a healthcare provider. “I think that the "holy grail” for hypertension management would be an unobtrusive wearable that gives easy and accurate measurements of continuous blood pressure,” says Dr. Kirtane. “But that’s not where the technology is yet.” Using both together — consumer devices for awareness, clinical tools for confirmation — offers the safest and most effective approach.
The Takeaway
While the gap between smartwatches and medical devices is closing, it is still very much intact. Consumer wearables aren't a replacement; instead, think of them as more of a bridge: they can empower people with early awareness and more data, and encourage them to take the next steps with validated monitoring and discussing results with your doctor.
The best plan for working on your heart health is still analog: working with your cardiologist and making lifestyle choices that reduce your risk for heart disease. But for screening and getting a more complete picture, these devices offer a great starting point at your fingertips… or wrists.
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