Korea first to recommend cuffless blood pressure monitors,

For out-of-office monitoring with Class IIb, Level B evidence… first positive recommendation worldwide

Clinical use expands following reimbursement… wider adoption in primary care for measuring ambulatory blood pressure

Society prepares study involving over 1,000 patients… to secure evidence to strengthen recommendation based on its treatment improvement effect

Cuffless blood pressure monitors, which measure blood pressure without inflating a cuff around the arm, have been included in Korea's hypertension treatment guidelines for the first time. The Korean Society of Hypertension (KSH) has become the first in the world to recommend cuffless blood pressure monitors for out-of-office blood pressure measurement, establishing a clinical framework for their use.

The move is expected to accelerate clinical adoption, which is already increasing following reimbursement coverage, by reducing patient discomfort associated with conventional ambulatory blood pressure monitors and easing equipment burdens on healthcare providers. The society also plans follow-up clinical studies to strengthen the recommendation.

At a press briefing on July 17, the KSH introduced the major updates in its sixth edition of the 2026 Korean Society of Hypertension Guidelines and their clinical implications.

(from the left) Seonghoon Choi, Director of Public Relations at KSH (Hallym University College of Medicine); Kwang-il Kim, Chairman of KSH (Seoul National University Hospital); Sang-Hyun Ihm, Chair of the KSH Guideline Committee (The Catholic University of Korea College of Medicine); Eun Mi Lee, Secretary of the KSH Guideline Committee (Dongguk University College of Medicine)

First positive recommendation…opens door to clinical use

The updated guidelines retain the existing recommendation to use validated cuff-based blood pressure monitors for office, home, and ambulatory blood pressure measurement while newly adding cuffless monitors as an option for out-of-office monitoring.

Its use received a Class IIb recommendation with Level B evidence, meaning it may be considered in practice. This differs from U.S. and European guidelines, which do not recommend cuffless devices for clinical use.

The society emphasized that this is the world's first positive recommendation for cuffless blood pressure monitors. While international discussions continue regarding their accuracy and appropriate use, the recommendation reflects growing validation data and real-world clinical experience accumulated in Korea.

Kwang-il Kim, Chairman of KSH and professor at Seoul National University College of Medicine, explained, "There were concerns from overseas academia that Korea might be moving too quickly, but others viewed it as taking the lead in a new field. This is the first positive recommendation for cuffless blood pressure monitors anywhere in the world."

In Korea, Sky Labs' CART BP, a ring-type blood pressure monitor, has already undergone validation against conventional 24-hour ambulatory blood pressure monitoring and is being used in clinical practice. Moving beyond being just a simple wearable device, its use has broadened as a clinical tool for ambulatory blood pressure monitoring.

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Sang-Hyun Ihm, Chair of the KSH Guideline Committee (Catholic University of Korea), said, "Given that the device is already being used in Korean patients and supporting evidence has accumulated, we concluded it would not be appropriate to classify it as a technology that should not be used. Although it has not reached Class I or IIa, we introduced it as a Class IIb recommendation that may be considered in clinical practice."

Adoption expands following reimbursement…use expands across primary care clinics

The inclusion of cuffless monitors in the guidelines is also expected to support the growing use of the technology following reimbursement coverage.

Eun Mi Lee, Secretary of the KSH Guideline Committee, said, "We understand that the use of cuffless blood pressure monitors has increased significantly since its reimbursement listing. The convenience for both patients and healthcare professionals serves as a clear advantage."

She noted, however, that additional validation is needed in certain patient populations, including those with thick finger joints, improperly positioned sensors, arrhythmias, or pregnancy.

The society attributed the increase in use partly to broader adoption by primary care clinics. Traditional 24-hour ambulatory blood pressure monitoring requires dedicated equipment and repeated cuff inflation, placing burdens on both providers and patients. This had limited its use in smaller clinics.

Seonghoon Choi, Director of Public Relations at KSH (Hallym University College of Medicine), said, “The rate of ambulatory blood pressure monitoring using conventional cuff-based devices has remained around 0.5% in Korea. The growing use of cuffless monitors suggests that primary care physicians, not just tertiary hospitals, are now participating in out-of-office blood pressure monitoring."

Choi added, "The society has long emphasized that treatment decisions should not rely on a single office blood pressure measurement. The expansion of ambulatory blood pressure monitoring in primary care is therefore a very encouraging development."

Cuffless monitors were newly introduced in practice

Can monitor blood pressure at night and in daily life… expands treatment data

One of the main advantages of cuffless monitors is their ability to measure blood pressure during sleep and daily activities without repeated arm compression.

Conventional ambulatory monitors inflate every 15 or 30 minutes, allowing patients to anticipate measurements and complain about sleep disturbances or discomfort during the night.

Ring-type cuffless monitors can measure blood pressure more frequently without compressing the arm, potentially enabling more comprehensive monitoring beyond nighttime to routine daily activities.

KSH President Kim said, "Conventional ambulatory monitors measure blood pressure every 15 or 30 minutes, whereas cuffless devices can collect readings at many more time points. They also offer advantages for nighttime and prolonged monitoring that exceeds one day."

The technology may also benefit patients who have difficulty wearing arm cuffs, such as those undergoing hemodialysis or those who experience discomfort from repeated cuff inflation.

For now, KSH sees the primary clinical role of cuffless monitoring in the follow-up of patients already diagnosed with hypertension, using the devices to assess treatment response, nighttime blood pressure, and diurnal variation while establishing interpretation criteria specific to cuffless measurements.

Large clinical study involving over 1000 patents planned…. To prepare data to elevate the recommendation level

The KSH is preparing an investigator-initiated clinical trial to strengthen the recommendation in future guideline updates.

Chairman Kim said, “Whereas previous studies focused mainly on whether cuffless devices produced measurements comparable to cuff-based monitors, the next phase will evaluate whether treatment guided by cuffless blood pressure readings improves blood pressure control and patient outcomes.

"The evidence showing that cuffless monitors can generate values comparable to conventional ambulatory monitors supported the current Class IIb recommendation. Going forward, we need to demonstrate whether treatment based on cuffless measurements leads to better outcomes and predicts prognosis more accurately than existing methods."

He added, "A single meaningful study could support a Class IIa recommendation, and consistent findings from both domestic and international studies could eventually lead to a Class I recommendation. Class IIb does not indicate a problem with the device -- it marks the beginning of a new clinical field."

The planned study is expected to enroll more than 1,000 patients, with the final sample size depending on participating institutions and whether primary care clinics are included. The KSH aims to launch the study later this year after completing institutional reviews and protocol evaluations.

The recommendation is not limited to any specific product. According to the KSH, any cuffless monitor that demonstrates sufficient accuracy and clinical evidence may receive the same level of recommendation.

The updated guidelines also introduce isolated diastolic hypertension as a new category, strengthen blood pressure targets for high-risk patients, classify single-pill combination therapies, establish diagnostic and treatment algorithms for resistant hypertension, and emphasize more proactive management of hypertensive disorders of pregnancy. In particular, hypertensive disorders of pregnancy were identified as an area requiring efforts to bridge the gap between the guidelines and clinical practice, as the number of patients continues to increase while treatment options available in Korea remain limited.

Chairman Kim said, "Gestational hypertension not only impacts maternal health but also the health of the child. The society will continue exploring policy solutions and providing the information needed to improve care."