By Yair Lurie, Founder and CEO, Cardiowell. Published October 30, 2026.
The International Society of Hypertension published new global guidelines on October 26. They lower the treatment target for more people and make standardized home monitoring the main way to diagnose and manage high blood pressure. That's this week's deep dive.
Also this week: Huawei brought its wrist-cuff Watch D3 to the ISH meeting in Dubai and set up a research fund with the society, Google started sending blood pressure and insulin resistance trends to Fitbit Air and Edge subscribers, a Swiss study tested whether a cuffless arm sensor drifts over six weeks, and CMS still hasn't released its final 2027 rule on remote monitoring.
Deep dive: The 2026 ISH guidelines put standardized home monitoring at the center of hypertension care
What happened
The International Society of Hypertension (ISH) published its 2026 Global Hypertension Practice Guidelines in the Journal of Hypertension. They were presented on October 24 at the ISH scientific meeting in Dubai. Thirteen authors and 24 reviewers from 23 countries worked on them, led by George Stergiou, who was ISH President for 2024-2026.
ISH writes its guidelines for global use, so they come in two levels of care (below). Several device makers were in Dubai the same week.
What changed
ISH summarizes the main changes this way:
A new "elevated blood pressure" category. It replaces "high-normal" and covers 130-139 systolic and/or 80-89 diastolic. Diastolic readings of 80-84 now fall in this group.
The diagnosis threshold stays at 140/90 in the office.
Earlier treatment. Medication is recommended for most people with confirmed elevated blood pressure. Low-risk people first get three months of lifestyle changes.
A lower target for more people. The guidelines recommend "a target below 130/80 more broadly under optimal care," adjusted for frailty and tolerance. The 2020 version set targets below 130/80 for people under 65 and below 140/90 for those 65 and older.
Two levels of care. "Essential care" should be available to everyone. Where resources allow, clinicians add "optimal care" elements.
Newer treatments. The guidelines add recommendations on aldosterone synthase inhibitors and other newer drug classes, and "consideration of renal denervation for selected patients at expert centers."
In the US, the National Kidney Foundation's commentary on the 2025 AHA/ACC guideline, covered last week, also supports a target below 130/80.
Home monitoring becomes the main tool
This is the change I care about most. Under optimal care, ISH makes standardized home monitoring the main method for both diagnosis and ongoing management. The guidelines warn against relying on "casual readings at home or in clinics for hypertension evaluation." Ambulatory monitoring, the 24-hour cuff test, "remains important for specific indications where available."
The guidelines also give detailed recommendations for "trained and authorized nurses, pharmacists and other health workers" to share care, based on their prescribing rights and access to physicians. ISH also launched an AI app, ISH OnTheGo, and will start a global implementation program in November.
This is the change I care about most. With optimal care, ISH makes standardized home monitoring the primary method for diagnosis and ongoing management. The guidelines warn against relying on "casual readings at home or in clinics for hypertension evaluation." Ambulatory monitoring, the 24-hour cuff test, "remains important for specific indications where available."
The guidelines also give detailed recommendations for "trained and authorized nurses, pharmacists and other health workers" to share care, based on their prescribing rights and access to physicians. ISH launched an AI app, ISH OnTheGo, alongside them, and a global implementation program starts in November.
What the guidelines say about the home protocol
The full guideline, published in the Journal of Hypertension, spells out what "standardized" means at home:
Device: a validated automated upper-arm cuff, from lists such as STRIDE BP, in a cuff size that fits the arm. Devices that store and average readings are preferred.
Diagnosis: measure for 3 to 7 days, morning and evening, before medication if treated. Take two readings each time, after 5 minutes of seated rest and 1 minute apart. Collect at least 3 days of readings (12 total).
Interpretation: average all readings after dropping the first day. An average of 130-134/80-84 is elevated blood pressure, and 135/85 or higher is hypertension.
Long-term follow-up: at least one or two duplicate measurements per week or per month. The guidelines say that too-frequent monitoring, such as daily, "must be avoided."
When to use it: initial diagnosis; before and after any treatment change; before each follow-up visit; to confirm resistant hypertension; and for long-term monitoring, where ISH says it "may improve adherence to treatment."
Users also need training in how and when to measure and how to read the results.
What they say about wearables and cuffless devices
ISH takes a clear position. Cuffless devices "still have issues with accuracy, and they are not currently recommended for the diagnosis and management of hypertension." If adequately validated, ISH says, they could have a clinical impact comparable to home and ambulatory monitoring.
Smartwatch AI features that aim to detect hypertension "may be useful for hypertension screening in apparently healthy individuals" but need conventional cuff measurements to confirm the diagnosis. Wrist-watch cuff monitors, which inflate a small cuff, are a separate category: several are on the market, "a few have been properly validated for accuracy," and more research is needed on their clinical use.
The guidelines also name digital health platforms that "enable automated transmission and interpretation of BP readings" as a way to support treatment adjustment and follow-up by care teams.
What "standardized" asks of a home program
The word "standardized" is doing the work in that recommendation. A home reading is useful only when the device is validated, the cuff fits, the patient follows a protocol, and someone reviews the numbers and acts on them.
Cardiowell's 'always-connected' blood pressure monitor is FDA 510(k) cleared. In general, a 510(k) requires a manufacturer to show the FDA that its device is substantially equivalent to one already legally on the market. For a blood pressure monitor, that typically means clinical validation against a reference method under a recognized standard, with the label limited to what the data supports. That covers the device. The program sets the protocol and review.
I assume many home programs slip up in the protocol. Patients measure at different times, skip days, or log readings by hand. Cellular devices remove pairing and logging steps, so readings arrive with a timestamp and no app. Then a nurse, pharmacist, or physician reviews them and decides whether to titrate. The ISH team-care language fits that workflow well.
What it means for clinics
US clinics follow the AHA/ACC guidelines. The ISH guidelines add a global voice for home readings, and, when used correctly, they drive diagnosis and treatment.
The practical question is who pays for the review. CMS will soon decide who can bill for remote monitoring (see Policy below). I hope the final rule keeps it workable for small practices, because the guidelines are moving more of hypertension care into exactly that work.
My view: this is good news for patients. A lower target and better home measurement mean more people get treated earlier, with real numbers instead of a single office reading. The tools to do it at scale exist now. The next step is making the protocol easy enough that patients actually follow it.
Devices & Wearables
Huawei brings the Watch D3 to ISH and sets up a research fund with the society
Huawei showed its Watch D3 at the ISH-ECS 2026 meeting in Dubai, October 22-25, per Huawei's press release. The D3 is a wrist-cuff oscillometric monitor. Huawei describes its method as "ultra-narrow airbag oscillometric measurement technology": a slim cuff in the strap inflates, using the same principle as an arm cuff. We covered the mechanism on September 25.
Three things are new:
An exercise mode. A before-and-after-exercise mode tracks how blood pressure changes with activity and flags potentially abnormal responses. Huawei says this mode is "the first of its kind in the industry" to receive EU CE certification under the Medical Device Regulation, and that it has Class II medical device registration in China. Huawei makes those "first" claims.
A research fund with ISH. Huawei and ISH set up a Wearable Blood Pressure Technology Innovation Fund. The fund selected the first three projects from more than 80 applications, involving the University of Colombo (Sri Lanka), the University of Edinburgh, Peking University People's Hospital, and the University of Cambridge. The release doesn't state the funding amount or which institution leads each project.
A hybrid ambulatory study. Ruijin Hospital (Shanghai Jiao Tong University) is testing "Minimally Disruptive ABPM": all-day optical (PPG) sensing calibrated by the watch's cuff readings, aiming to cut the cuff measurements in a 24-hour session from 27 to 7. It will expand to Saudi Arabia and Malaysia. No results are reported yet.
According to the release, George Stergiou, then ISH President, described the D3 as a novel, reliable wearable device, and said ESH and ISH encourage clinical use of validated wrist-cuff monitors while calling for more research on how to use them in practice. Wang Jiguang, President of the Chinese Hypertension Association, said the Ruijin approach and other D3 features point to blood pressure management that is "automated and seamlessly embedded into daily life." Paul Sonnier shared the news in his LinkedIn Digital Health group.
What the release doesn't say: I found no FDA clearance for the Watch D3 in the FDA's database or in news coverage, and the release doesn't mention the FDA. One independent review says the D3 isn't FDA-cleared or sold in the US. I also found no published validation study of the D3. Its predecessor, the Watch D2, passed two ISO 81060-2 validation studies, per the Medaval device listing.
The Ruijin design is the most interesting part to me. It pairs optical tracking with periodic cuff calibration, which is the same recalibration question the Swiss study below tests. A consumer brand funding research through a hypertension society is a sensible way to build clinical credibility. The funded projects will tell clinicians more than the launch does.
Google sends blood pressure and insulin resistance trends to Fitbit Air and Edge
Google's Health Guardian features, monthly blood pressure trends and a new insulin resistance trend, are rolling out to Fitbit Air and Fitbit Edge for Google Health Premium subscribers, per Google. Version 5.11 of the Google Health app began rolling out the week of October 23, according to 9to5Google. Users can now set up trends, with the first reports due in early November. Blood pressure trends require wearing the Fitbit Air for at least five consecutive days in the month; insulin resistance requires at least seven days and nights.
Premium costs $9.99 a month, per Droid Life. The Fitbit Air launched in May at $99.99, per 9to5Google.
Google is careful about what these are. Its footnote for insulin resistance says the feature "is not intended to diagnose, mitigate, treat, or cure any disease" and "is not a prescreener for diabetes nor is it intended to monitor glucose levels in real time." The blood pressure trends stay a wellness feature, "not a prescreener for hypertension," per Google's August announcement. We covered them on October 16.
The insulin resistance feature is based on Google's WEAR-ME study. Google's research summary describes 1,165 remote US participants with Fitbit or Pixel Watch devices. A model using wearable data plus demographics reached an auROC of 0.70; adding fasting glucose raised it to 0.78, and adding routine blood panels raised it to 0.80, with 76% sensitivity and 84% specificity for that full model. An auROC measures how well a model ranks people by risk, and it shouldn't be read as a detection rate. That summary describes the earlier preprint, and I couldn't confirm the final figures in the published Nature paper or whether the app runs the same model. Google's August post says the app's model was pretrained on data from 5 million opted-in users.
Insulin resistance and high blood pressure often show up in the same patients. A monthly nudge to get a blood test or check blood pressure with a cuff can bring people into care earlier. The flip side matters too. A wellness feature that stays quiet isn't a clean bill of health, and clinicians should tell patients that.
Sky Labs is working on a calibration-free version of its ring
At the Korean Society of Cardiology meeting on October 17, Sky Labs CEO Lee Byung-hwan said the company is using real-world clinical data to develop blood pressure measurement "without separate calibration" for its CART ring and is "now pursuing commercialization," The Bio reports. No timeline or accuracy data were given.
Sky Labs is also running a four-year "CUFFLESS Study" with the Korean Society of Hypertension. It will compare cardiovascular and stroke outcomes between treatment guided by office blood pressure and treatment guided by 24-hour CART readings. The sample size wasn't stated.
CART BP pro today is a finger ring with an optical sensor, calibrated with a cuff, per Korea Biomedical Review. It's approved and reimbursed in Korea, holds CE marking and UK MHRA registration, and isn't FDA-authorized. This category most needs an outcomes trial. Disclosure: Cardiowell has an integration relationship with Sky Labs.
Sutter Health adds heart failure to its remote monitoring program
Sutter Sync, Sutter Health's digital chronic care program, now includes heart failure patients at high risk of hospitalization, MedCity News reports. Patients use Bodyport's FDA-cleared Cardiac Scale to track fluid status daily, with data flowing into Epic and pharmacists adjusting medications.
The program started with hypertension in March 2025 and now has more than 13,000 patients. Sutter says over 90% of hypertension participants with previously uncontrolled blood pressure improved control within six months. That's Sutter's own figure, and it hasn't been peer-reviewed. Pharmacists adjusting medication from home data is the same team-care model ISH just endorsed.
Policy & Regulation
CMS's final 2027 rule on remote monitoring is still pending
As of October 30, CMS hadn't published the CY 2027 Physician Fee Schedule final rule. It's expected by November 1. The proposal would pay for remote physiologic monitoring only when the billing practice's own employed staff do the work, require an initiating visit, and revalue the device supply codes by tying them to the self-measured blood pressure codes, per Prevounce. More than 44,000 comments were filed. Current rules apply through December 31. Next week's edition should have the answer.
Chronic care management audits are increasing
Medicare contractors are running more Targeted Probe and Educate reviews of chronic care management (CCM) claims, and OIG is conducting a national review of the Part B CCM codes, per HCCA's Report on Medicare Compliance via JD Supra. Wabash General Hospital in Illinois settled for $166,761 over CCM billing after self-disclosing, without admitting liability. The risks flagged include copy-paste care plans, missed 20-minute thresholds, and consent gaps. Attorneys quoted in the piece expect CCM scrutiny to follow the proposed RPM staffing rule.
Programs that document the actual review and the decisions made from it will be best positioned.
Rural health funds go to remote monitoring and telemedicine
CMS announced $193.7 million for Florida from the $50 billion Rural Health Transformation Program, spread across 45 organizations, per CMS. The money funds telemedicine, remote patient monitoring, pharmacy services, and community paramedicine. CMS announced similar awards for Georgia and Idaho this week. I found no hypertension-specific line items.
CVS tests pharmacists in chronic care
CVS is piloting pharmacists who take blood pressure, cholesterol, and blood sugar measurements in five Michigan stores, Reuters reports via KSL. Its chief medical officer said CVS is in talks with CMS about expanding pharmacists' role in chronic care. It's an early pilot with few details.
Clinical & Research
A six-week study tests whether a cuffless arm sensor drifts without recalibration
Researchers at CSEM (the Swiss Center for Electronics and Microtechnology) and Lausanne University Hospital (CHUV) tested CSEM's wearable PPG-based cuffless monitor in 30 adults with hypertension over six weeks, published in Blood Pressure. The European Society of Hypertension highlighted the study on LinkedIn this week.
The device is a research prototype with no product name. In this study, the sensor sat on the upper arm. It estimated blood pressure from 50-second optical recordings, processed offline and blinded to the cuff results. It needs one initial calibration (an offset) to provide absolute values. The paper doesn't state any regulatory status, and the authors describe it as a method-comparison and feasibility study.
Patients came in four times over six weeks and were compared with an oscillometric arm cuff (Microlife WatchBP Home A). The analysis looks at changes between visits, so the calibration offset cancels out. The results:
No drift. The systolic error showed no trend over time (−0.45 mmHg per week, p = 0.43).
Change agreement. Systolic changes agreed with the cuff at 0.2 ± 12.8 mmHg, with limits of agreement of about ±25 mmHg. Diastolic: −0.1 ± 7.4 mmHg.
Large changes. For changes above 15/10 mmHg, the ISO 81060-3 thresholds, the device moved in the same direction as the cuff 83% of the time for systolic (35 of 42) and 86% for diastolic (31 of 36).
Two findings stood out to me. First, a "no change" model that carries the first cuff reading forward scored nearly the same average agreement as the device but caught 0% of the real changes. A headline mean error can look good while missing every change that matters. Second, the reference cuff was noisy too. Standard validation rules would have discarded 69% of readings, so the authors tripled the exclusion thresholds.
The limits are real. Thirty people at one site, seated in-clinic spot readings rather than 24-hour or daily-life wear, few large blood pressure changes, and a reference that isn't the gold standard. The authors excluded people with known arrhythmia, and the algorithm flagged unrecognized arrhythmia in 21 measurements. Four authors are with CSEM, which holds a patent application on this approach and has unnamed financial relationships with interested companies, none involved in the study. CSEM funded it internally.
This is the recalibration question in the ESH 2023 cuffless validation recommendations, and it connects to last week's Signal Ring deep dive on calibration-free claims. I'd like to see the same test run over months, in daily life, with protocolized medication changes.
Missed blood pressure pills erase much of the benefit, even in trials
An individual-patient analysis of nine randomized trials with 91,339 participants, presented by Qianqian Yang of the University of Oxford at ESC Congress 2026, looked at adherence, per ScienceDaily. Even inside trials, the share taking at least 80% of doses fell from 88% in year one to 79% by year five. Participants who took their medication had systolic pressure 5.2 mmHg lower than comparators and 11% fewer major cardiovascular events. Those with lower adherence had systolic pressure 3.0 mmHg lower and no significant reduction in events.
This is a conference presentation, not a journal publication. Trial participants usually take their pills more reliably than everyone else, so real-world adherence is likely worse. Adherence support belongs in every hypertension program.
An ear-clip nerve stimulator didn't beat a sham device
SCRATCH-HTN, a UK pilot trial led by Queen Mary University of London and published in Hypertension, randomized 63 adults with uncontrolled blood pressure to an at-home ear-clip stimulator or a sham device, per ScienceDaily. Daytime ambulatory systolic pressure fell 3.15 mmHg with the active device and 5.50 mmHg with the sham, a non-significant difference, Medical Daily reports. Heart rate variability also showed no difference. A subgroup with baseline systolic blood pressure of 160 or higher did better with the active device, which is exploratory. The sham arm's drop reminds us how much blood pressure shifts in trials without active treatment.
ACC publishes a decision pathway for resistant hypertension
The American College of Cardiology published a 2026 Expert Consensus Decision Pathway on resistant hypertension in JACC, per JAMA. It covers standardizing blood pressure measurement across settings; diagnosis; drug, lifestyle, and device treatment; comorbidities; and putting new technologies into practice. It calls for prompt treatment intensification and for tackling nonadherence with simpler regimens, single-pill combinations, and team-based care. I haven't read the full pathway yet.
Lorundrostat lowered blood pressure in patients with kidney disease
In a substudy of the phase 3 Launch-HTN trial presented at ASN Kidney Week, the aldosterone synthase inhibitor lorundrostat lowered office systolic pressure by 9.6 mmHg in patients with chronic kidney disease and 12.2 mmHg in those without, placebo-adjusted at 12 weeks, per TCTMD. Urine albumin fell 52.2% versus placebo in CKD patients with albuminuria. It's a sponsor-funded subgroup analysis, with no safety data reported. This is the drug class ISH just added to its guidelines.
Also worth a glance
Time in target range after brain bleeds. A pooled analysis of four trials with 2,810 patients after intracerebral hemorrhage linked more time with systolic below 130 to fewer recurrent strokes (HR 0.94), per NeurologyLive. Time in range requires frequent home readings.
Wall squats. A 100-person trial in BMJ Open Sport & Exercise Medicine found systolic pressure fell about 14 mmHg in adults with systolic 120-140 who kept up three wall-squat sessions a week, and the benefit faded when they stopped, per ScienceDaily. The groups were small and excluded hypertensive patients.
Heat and autonomic function. A small PLOS ONE study found that men with type 2 diabetes and hypertension had blunted heart rate, heart rate variability, and baroreflex responses during 90 minutes at 40°C compared with controls. Only 16 men were analyzed.
Oura in a GLP-1 trial. UC San Diego Health uses Oura Ring sleep, heart rate, and activity data in GLP-1 and bariatric surgery patients, per Oura. No blood pressure measure is listed.
Brownsville hypertension project. A three-year, CDC-funded New York City project distributed more than 300 home blood pressure monitors and supported providers serving more than 64,000 patients, per the NYC Health Department. It reports activity and no blood pressure outcomes.
CLIA and FDA, explained through Theranos. In The Device Files, Blythe Karow lays out which lab tests fall under CLIA, run by CMS, and which need FDA review. She also notes that software interpreting test results can be a device on its own. That line will matter more as companies combine wearable data with blood biomarkers, as Google's WEAR-ME research did.
The thread this week
Most of this week was about where blood pressure gets measured, and how well.
ISH moved the main measurement into the home and asked to standardize it. Huawei and Sky Labs are both working on ways to need fewer cuff readings. The Swiss study shows how to test that honestly, and why a good average error isn't enough. The adherence data reminds us that the reading only helps when someone acts on it and takes the pill.
I'm optimistic. Home measurement keeps getting easier, and the evidence on what works keeps getting more specific. I hope CMS's final rule lets clinics do the review work the guidelines now ask for.
The full version of this column, with the same sources, lives on the Cardiowell blog: [ARTICLE URL — cardiowell.com, not yet published]
If this was useful, subscribe to The Week in Blood Pressure & Wearables to get a new edition every Friday.
References
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