[HN Gopher] The science behind on-the-wrist blood pressure tracking
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       The science behind on-the-wrist blood pressure tracking
        
       Author : brandonb
       Score  : 74 points
       Date   : 2024-10-10 14:40 UTC (8 hours ago)
        
 (HTM) web link (www.empirical.health)
 (TXT) w3m dump (www.empirical.health)
        
       | bloopernova wrote:
       | Tangentially Related:
       | https://arstechnica.com/health/2024/10/your-doctors-office-c...
        
         | brandonb wrote:
         | Yeah -- in addition to inappropriate measurement technique,
         | "white coat hypertension" can cause elevated blood pressure
         | readings.
         | 
         | And, of course, you have the fact that the American College of
         | Cardiology (ACC) updated their blood pressure guidelines in
         | 2017 to use a lower threshold. So some people with moderately
         | high blood pressure would now be considered to have
         | hypertension and are recommended to seek treatment.
        
       | kbrisso wrote:
       | Measuring blood pressure on the wrist is tricky. I usually do
       | three measurements to get an accurate reading. I have two
       | machines I use. The older one is actually better than the new
       | one. Another thing is, pay attention to how you feel. I can feel
       | my blood pressure when it's high and usually know when the device
       | reading is off. I do this because my family has a history of high
       | blood pressure and so far because of lifestyle choices I have
       | avoided the need for meds.
        
         | wil421 wrote:
         | Why do you have to do it so often? Why do you even do it if
         | you're not on meds? Third, what would you even do if it's high?
        
           | kbrisso wrote:
           | I don't check my blood pressure every day. Maybe twice a
           | month or when I feel like crap. I also check my glucose. Why?
           | I believe if I keep myself in check I will keep myself out of
           | the hospital as I age. High blood pressure and diabetes are
           | two things I can manage. I don't want to be on meds unless I
           | absolutely have to. Exercise and these tools allow me to
           | figure out what I can eat and not. I'm not obsessed with my
           | health or a health "nut". The upside is I don't get sick that
           | much and feel good.
        
       | corry wrote:
       | Actually, there is a wrist device called "Aktiia" that's approved
       | for use for continuous BP monitoring with clinical accuracy by
       | the UK and German health authorities (I believe). It's a bit of a
       | pain to get over the pond, but with a shipment-forwarding company
       | + a UK App Store account you can get up and running.
       | 
       | I've dabbled a bit with it and it's very close to the cuff
       | measurements.
       | 
       | It works by calibrating with their custom arm cuff device. I'd
       | guess that it's correlating what the wrist sensor sees w.r.t.
       | your wrist blood vessels and what the "true" reading is from your
       | arm. You re-do the calibration every few weeks.
       | 
       | The device takes a reading every 20 or 30 minutes or so and seems
       | to try to pick periods where you're more stationary.
       | 
       | However, one thing to be aware of is that you are not used to
       | seeing your BP readings from the entire day. Did you jump in a
       | cold plunge 10 minutes before it ran? Get ready to see a really
       | high reading dot in the 'danger zone'. Went for a jog and are
       | catching your breath on a park bench? High dot.
       | 
       | This isn't a bad thing, it just takes some getting used to since
       | your "daily average" will be significantly above the readings
       | you're used to if you're doing arm cuff measurements at the
       | start/end of the day. Of course it's also getting readings at
       | those more usual times too, but they get washed out in the larger
       | number of data points from your day.
       | 
       | And goes without saying, your blood pressure SHOULD go up and
       | down based on your activity and time of day. You just aren't used
       | to seeing it other than at true rest.
       | 
       | But all in all it's been fascinating to see, and there's no doubt
       | in my mind that this technology will be mainstream quickly (and
       | Apple will likely dominate it).
        
         | Etheryte wrote:
         | This is super exciting, thanks for posting! I developed high
         | blood pressure after Covid and have done a few 24h studies to
         | better understand it. The traditional machines are super bulky,
         | essentially like carrying a regular BP monitor around with a
         | pouch that's strapped to you, maybe just a bit smaller. All in
         | all it's far from convenient and can kick in at inopportune
         | times. Having around the clock insights would hopefully give me
         | a better understanding of the condition. For context, I've
         | jumped through all sorts of specialty doctor hoops and there is
         | no known underlying cause outside of the fact that it just
         | showed up after Covid.
         | 
         | Do you or anyone you know happen to have firsthand experience
         | with the device?
        
           | misstuned wrote:
           | I've found similar. I don't know if it was post-Covid, but I
           | have completely asymptomatic high blood pressure. It's really
           | scary to go to the doctor for an extremely routine health
           | check expecting to be back at work in an hour, and then
           | suddenly be told that your blood pressure is so high that you
           | need to go to hospital immediately.
           | 
           | There's no obvious cause, I'm fit and healthy in all other
           | ways, I've had multiple blood tests and ECGs, my cholesterol
           | is normal, everything is normal, just the blood pressure. I
           | also didn't know about this machine but I might get one. I
           | have developed anxiety around having it taken (because of the
           | experience of getting sent to hospital!) so it goes up when I
           | take it, like extreme white-coat syndrome.
           | 
           | I'm definitely getting one of these gadgets so I can see what
           | it really is, without the stress and pain (those things
           | hurt!) of inflating cuffs.
        
           | corry wrote:
           | Hey I have firsthand experience with it as indicated in the
           | post. Probably a few months worth of wear at this point.
           | 
           | BP remains a great mystery to me, even with the device. My
           | cardio fitness is pretty good despite carrying a few extra
           | pounds (I'm in the low 50s for resting heart rate), and while
           | overnight I dip down in the 120's, I can see it shoot up
           | based on various things like cold plunge, caffeine, exercise
           | (during), etc. I can also see it drop temporarily (hot tub,
           | meditation, the hours FOLLOWING intense exercise, etc).
           | 
           | I had many pet theories through the years - that I had white
           | coat syndrome, that I disliked the feeling of the cuff, etc
           | etc. But the device showed me that, no, something really is
           | going on independent of these pseudo-causes.
           | 
           | BTW water retention seems to play a big role. When I did
           | keto, which causes a big drop in water retention, my BP also
           | went down. Strange. Supplements have an impact too.
           | 
           | All this to say - get the device and see for yourself, but
           | you might find yourself in the same place I am - which is
           | that you have much better understanding of what's going on in
           | terms of symptoms but are still on the search for "the
           | underlying cause" if there even is such a thing.
        
         | brandonb wrote:
         | I'll bet blood pressure readings throughout the day will be
         | analogous to the data we get from CGMs (continuous glucose
         | monitors). You get lots of spikes during the day.
         | 
         | Given enough data pairing continuous blood pressure with major
         | events like heart attacks and strokes, we may even develop more
         | accurate models to predict which types of spikes create the
         | most cardiovascular risk.
        
           | corry wrote:
           | Totally agree, although perhaps the real gift of this
           | technology will be from the fact that people can be more
           | aware of the underlying conditions (high BP) and tighter
           | feedback loops on how to reduce it / manage it vs. just
           | helping notify about an acute emergency situation.
           | 
           | As I typed the above sentence out, I thought "why not both?".
           | Use the technology to reduce your risk, but in the event that
           | the bad event still happens the notification could save your
           | life.
        
         | paulgerhardt wrote:
         | Was unaware of the Aktiia. Thank you for posting. I saw
         | firsthand how CGM changed my behavior and would love the same
         | for ketones and blood pressure.
         | 
         | I am particularly excited about the UT Austin research[1] that
         | used conductive temporary tattoos to get actual real time data
         | and not just polling at intervals. However it's not yet at the
         | stage of commercialization and the design is more the width of
         | a cuff than a watch.
         | 
         | [1] https://scitechdaily.com/electronic-tattoo-offers-highly-
         | acc...
        
         | Aurornis wrote:
         | > However, one thing to be aware of is that you are not used to
         | seeing your BP readings from the entire day. Did you jump in a
         | cold plunge 10 minutes before it ran? Get ready to see a really
         | high reading dot in the 'danger zone'. Went for a jog and are
         | catching your breath on a park bench? High dot.
         | 
         | This is a great point. Blood pressure readings are only useful
         | in the context of stationary measurements under known
         | conditions. Blood pressure is inherently volatile and depends
         | on activity and recent movements, or to extreme events like
         | cold exposure.
         | 
         | There are even finger-cuff blood pressure monitors designed for
         | continuous, constant blood pressure measurement in the context
         | of a lab or hospital setting. Their measurements would be
         | useless in the context of someone moving around all day, but it
         | can be useful in the context of someone under anesthesia or
         | undergoing a controlled lab test.
        
           | nradov wrote:
           | Anecdotally I find my blood pressure (measured with a regular
           | upper-arm cuff while sitting) to often be lowest soon after
           | completing a workout, like a hard 5K run outside. I'm not
           | sure why, maybe the vasodilation effect from increased nitric
           | oxide production?
        
         | rootusrootus wrote:
         | IIRC there's also a Samsung Galaxy Watch that does blood
         | pressure monitoring, with similar requirements. Have to work a
         | bit to get the app installed in the US, but then it takes
         | periodic measurements, is fairly accurate, and requires
         | calibration once a month.
         | 
         | I was really hoping Apple was going to bring BP to the watch
         | this year, but my guess is the regular external calibration
         | requirement is too much for their plug-and-play philosophy.
        
           | indoordin0saur wrote:
           | Are the sensors already capable of it? Maybe someone could
           | make a third party app for the watch
        
           | ljosifov wrote:
           | +1. I also use Samsung Galaxy Watch (Active2) and find it to
           | work well for me. I'm surprised more people don't know about
           | it. I know couple of people that suffer from high BP. They
           | showed little interest when I told them about the watch.
           | 
           | Regular external calibration helped me build confidence. I
           | was suspicions if the watch worked, and how well it worked.
           | Calibration is every month - it expires. I take 3
           | measurements in parallel watch-cuff, and tell the watch App
           | what the cuff measured. I didn't mind it initially. I now
           | find it annoying tbh. I see why Apple would like to get rid
           | of it. Post calibration, I measure 3 times in parallel both
           | watch and cuff to check if they match. If the difference is
           | within 5% - then fine. In 3 years it's happened twice where
           | they differed more and I had to recalibrate. From
           | recollection - both times with a reason, a TV was turned on
           | in living room.
           | 
           | I have the impression that BP measurements differ though the
           | day (lower in the morning, higher in the evening), depending
           | on activity or at rest of course, I think there maybe some
           | seasonality too (winter v.s. summer). Measuring BP when going
           | to the doctor once a year strikes me as a wholly inadequate.
           | If the BP is absurdly high out of normal range - then yeah,
           | we learn something is wrong with the patient. But in any
           | other case - don't see what can be deduced from 1 random
           | measurement.
           | 
           | To check if the calibration is important, I had my wife use
           | the watch, that is calibrated on me. She got absurd readings.
           | So yes - the calibration is important and is tied to the
           | person that did the calibration. (edited to add this)
        
         | sph wrote:
         | > And goes without saying, your blood pressure SHOULD go up and
         | down based on your activity and time of day. You just aren't
         | used to seeing it other than at true rest.
         | 
         | Yeah, people panic reading a single 150 systolic, yet routinely
         | it can reach 220+ during heavy exercise. It's perfectly fine.
         | The health metric is the BP at rest, i.e. how low it goes when
         | you're completely idle.
         | 
         | I find it takes up to 20 minutes to reach its lowest sometimes,
         | in state of absolute calm: no movement, no talking, no anxiety.
         | Hence the 'white collar hypertension', i.e. high BP when
         | measured in hospitals and GPs office, where they don't give you
         | enough time to settle down, or are not spaces that induce calm
         | mental states.
         | 
         | The way I take my BP reading is every 5 minutes, until I get a
         | similar reading after 2 consecutive measurements. It takes
         | longer than you'd expect.
        
           | AStonesThrow wrote:
           | During a recent visit, I mentioned my "White Coat Syndrome"
           | was probably affecting me right there, so they selected their
           | most attractive woman with the best perfume and a manual
           | sphygmomanometer for a hands-on measurement, before releasing
           | me.
        
           | corry wrote:
           | 100% hard agree. I'm now paying most attention to my
           | overnight rate, like in the middle of the night - but even
           | that takes a few hours to get down to the minimum value.
           | Fascinating to see the big spike prior to waking up that
           | signals your body is preparing for rising.
           | 
           | Did I eat late before bed? Higher BP overnight. Drink any
           | alcohol at all after, say, 12pm? Higher BP overnight. So it's
           | still useful and interesting to see the overnight values
           | change and shift around.
           | 
           | However, the contrarian in my mind says that it's not smart
           | to ONLY pay attention to your deep rest state BP, since that
           | only applies to a fraction of the day. And if you're running
           | around at high values for the rest of the day, you're still
           | potentially doing damage to your kidneys, retinas, etc - the
           | sensitive blood vessel stuff.
           | 
           | So it's a useful device, it's useful to have the data, but
           | it's also still a bit of black box.
           | 
           | The fact that 80% of all high blood pressure is of unknown
           | physiological cause is a real head scratcher considering that
           | cardiac misadventures are the leading cause of death in the
           | Western world.
        
         | throwup238 wrote:
         | _> However, one thing to be aware of is that you are not used
         | to seeing your BP readings from the entire day._
         | 
         | Same thing with those continuous glucose monitors that almost
         | anyone can get and put on their arm now. The vast majority of
         | the data and recommendations we have are for diabetics using
         | regular single use measurements or a proper glucose tolerance
         | test so shortly after the user eats a bowl of rice while
         | wearing it, it sends them into a hypochondriac spiral when they
         | see a peak of 200. Their doctor generally has to talk them
         | down. There's just not that much data on what the average
         | healthy person's response to blood sugar is, especially when
         | it's continuously monitored.
        
           | outworlder wrote:
           | > There's just not that much data on what the average healthy
           | person's response to blood sugar is, especially when it's
           | continuously monitored.
           | 
           | Chicken and egg situation, no?
           | 
           | People are advised not to use those devices because there
           | isn't much data about them for otherwise healthy people. But
           | if they don't use those devices, there won't be much data.
        
         | LorenPechtel wrote:
         | I found the exact reverse with the jog. One day I went into the
         | mountains with a cuff on my wrist and took a bunch of
         | measurements. I wasn't jogging but I had something like 25
         | pounds on my back and was definitely pushing myself.
         | 
         | There was a huge effect from perceived temperature--while I
         | didn't do the cold plunge I got some quite high readings when I
         | was on the chilly side. Yet I could get low-normal readings
         | with my heart rate above 130 which is the highest I could go at
         | that elevation. Obviously I couldn't actually take a reading
         | while moving but I could have it on my wrist, stop and
         | immediately press the button. The pattern I observed was
         | activity raises temperature which lowers blood pressure.
        
           | corry wrote:
           | Thanks for sharing. For me, I can see that DURING exercise,
           | my blood pressure is quite raised but then drops down lower
           | than usual in the hours that follow. However, I think that's
           | more a function of resting HR - which remains elevated.
           | 
           | My particular BP scenario is good diastolic, high systolic
           | but low rest heart rate (low 50s). My pet theory is that my
           | heart does fewer but stronger pumps, which increases the BP.
           | After exercising, when heart rate remains elevated, the BP is
           | lower since the heart is doing more frequent but less
           | powerful beats.
           | 
           | Just a pet theory, I haven't even discussed it with a medical
           | professional.
        
         | avidiax wrote:
         | I am wondering if continuous blood pressure monitoring would
         | have some knock-on effects as a measurable, correlatable
         | negative health effect of stress.
         | 
         | It would mean that you can literally show that working
         | conditions are shortening your life.
         | 
         | Your company's health insurance could look at BP during
         | commuting hours and in the office vs. at home and raise rates
         | on companies based on their policies.
        
         | m463 wrote:
         | Hmm... I remember reading that cuff blood pressure measurements
         | require your arm to be supported. (and also explains why a lot
         | of blood pressure measurements are inaccurate)
         | 
         | I wonder if you're calibrating on a supported arm, then letting
         | your arm swing free later with the wrist device.
        
       | oidar wrote:
       | I would love to have continuous BP monitoring. I ready for this
       | tech to mature. I'd wager that blood pressure varies way more
       | during the day than weight (which can vary as much as 5 lbs or
       | more) - and continuous, easy BP monitoring at would cause HT dxs
       | to drop significantly.
        
         | candiddevmike wrote:
         | Why do you think this would cause HT diagnosis to drop? If
         | anything all of these continuous monitors create more patient
         | visits and probably more diagnosis.
         | 
         | I'm interested in what the future holds when these things are
         | capable of FDA-approved diagnosing. Will Apple send a
         | prescription for BP meds to my pharmacy?
        
           | oidar wrote:
           | I think there is a lot of white coat HT that makes up many
           | cases. I think the ACS recommends a measurement 3 times in a
           | row at different office visits. So, maybe anxiety might be a
           | direct cause of HT dx.
        
         | rootusrootus wrote:
         | > HT dxs
         | 
         | I'm unfamiliar with this abbreviation but did my best with
         | Google. Does it mean 'hypertension diagnoses'?
        
           | oidar wrote:
           | yes
        
         | wil421 wrote:
         | The problem with this is exercise messes with blood pressure.
         | 
         | "Extremely high blood pressure elevations of up to 345/245 mmHg
         | were observed during the lifts."[1]
         | 
         | My doc even said it can get as high as 400 and it's important
         | to breathe correctly.
         | 
         | [1]https://pubmed.ncbi.nlm.nih.gov/2632751/
        
           | oidar wrote:
           | Yes, BP is much higher when exercising, but presumably in
           | these situations the user will indicate that they are
           | exercising in whatever app they are syncing with. 24 hour
           | ambulatory BP measurement protocol directs pts to not
           | exercise during the time to rule out this confounding factor.
        
         | lispisok wrote:
         | High blood pressure has been defined as blood pressure over a
         | certain threshold when blood pressure is taken a certain way.
         | That certain way is at rest when it's lower than moving around.
         | All the data and research has correlated health outcomes that
         | way. We already know blood pressure is higher when you are up
         | and about than after you've been sitting down for 5 minutes. If
         | you're trying to get out of your hypertension diagnosis using
         | continuous monitoring you are in for disappointment because
         | hypertension has been defined by your blood pressure when it's
         | at its lowest.
        
           | oidar wrote:
           | If you look at the BP measurement protocol for HT dx, most
           | people will never have a visit that matches that protocol
           | because it costs a lot of time and time is something medical
           | practices don't like to give for something as simple as HT
           | dx.
           | 
           | https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA..
           | ..
           | 
           | 24 hour ambulatory BP measurements are the gold standard for
           | accurate HT dxs.
        
           | hombre_fatal wrote:
           | Well, baked into your own claim, they don't have hypertension
           | if their pressure is only elevated when it's taken (e.g. the
           | doctor's office) rather than what it might drop to otherwise.
           | 
           | I have a blood pressure monitor that takes the lowest of
           | three measurements. It's really annoying to use, takes
           | forever, feels uncomfortable, and my blood pressure often
           | drops another 10 points if I do it all over again because
           | I've been laying in the bed another 5min.
           | 
           | Passive measurements address all of this. You also get to see
           | what activities have what impact on your blood pressure. How
           | does your daily blood pressure graph look like on and off
           | ADHD meds, for example?
           | 
           | I can't wait until this info is part of the wrist wearable
           | kit.
        
       | stewh_eng wrote:
       | I'm a med device engineer and have watched the hopes and dreams
       | of cuffless BP monitoring tech. I hope we get there as it will be
       | hugely important. However, remember tech is only a small part of
       | the battle. We need to figure out clinically what to do with all
       | this new continuous data.
       | 
       | I am very sceptical PPG alone will be capable for many reasons.
       | Aktiia does indeed have European regs clearance. But, they don't
       | have FDA clearance. The FDA is a very different beast (more hands
       | on - and they'll be absolutely much more heavy with such a new
       | approach) - and they must have concerns on the approach for it to
       | take this long. The FDA even has accelerated programmes for
       | breakthrough high impact tech as they really do want it to get to
       | market safely.
       | 
       | The main cuffless FDA cleared devices I know measure the pulse
       | transit time betwen a central ECG patch and a peripheral based
       | PPG (that time is then calibrated to a BP with the Moens
       | Kourteweg equation) - see Biobeats watch and a now defunct
       | wearable ICU monitor company I can't find the name of.
       | 
       | The issue with PPG is that it is wildly sensitive. The PPG
       | waveform morphology will changed dramatically based on the
       | pressure of the sensor against the skin, unconstrained changes in
       | orientation of the human and arm etc. Changes in morphology !=
       | changes in system wide BP.
       | 
       | Speak to an anaesthesiologist and they'll tell you blood pressure
       | is function many things eg cardiac output, stroke volume, heart
       | rate, blood volume, total peripheral resistance etc etc (https://
       | www.sharinginhealth.ca/multimedia/images/blood_press...). The
       | question is whether PPG alone can measure all these things. I
       | suspect it's really just measuring lots of proxies of all these
       | things. And that's fine - however in the presence of people with
       | conditions or on therapeutics that alter these in very
       | personalised and unpredictable ways then error may start to creep
       | in on free living measurement. Paradoxically, it's probably these
       | people for whom this tech would have most impact - not the
       | worried well.
        
         | utschig wrote:
         | Sotera Wireless
        
           | stewh_eng wrote:
           | That's the one! They were lightyears ahead but seemingly
           | couldn't make the commercials work. Thank you!
        
         | saltcured wrote:
         | I wonder if you've heard of the Resonance Sonomanometry method
         | claimed by Esperto Medical https://esperto.health/ and how you
         | think this compares to others.
         | 
         | It seems like it might be an ultrasonic method? They claim no
         | calibration needed, but I don't know if it is tolerant to
         | movement and posture.
         | 
         | I can also imagine this might be too power intensive to put in
         | a smartwatch form factor. Maybe more of a bedside or clinical
         | device...
         | 
         | Disclaimer: I had past contact with some of their researchers
         | in a different bioimaging domain. I don't know anything more
         | about this venture than it says on the website.
        
       | gausswho wrote:
       | I am fascinated by the concept of blood pressure as one of the
       | foremost tools of health. Can someone recommend perhaps a book
       | size read on the history of how we came to learn of its value and
       | help illuminate well... what it even is?
        
       | jcims wrote:
       | Side note, I started monitoring with a cuff-style monitor over
       | the past month, and one thing that's super important is keeping
       | the cuff at about heart level. The cuff I got actually reminds
       | you of this verbally. While it obviously makes sense, it's a bit
       | surprising how much a change in elevation affects the readings.
        
         | isoprophlex wrote:
         | Try sticking it around your ankle and measuring while standing
         | up. I get 250 mmHg systolic, easily
        
       | daemonk wrote:
       | For most instruments, it's an interplay between resolution and
       | consistency. There isn't a "true" reading in any sense of the
       | word. There is just how much resolution you are measuring and how
       | consistent the measurement is between independent readings of the
       | same event.
       | 
       | The overwhelming amount of pre-existing clinical data gathered by
       | cuff-monitors means that any novel measurement methods benefit
       | from tying/correlating their output to the existing data for
       | compatibility. It's a bit unfortunate in some sense as cuff-
       | monitor data lacks resolution and sometimes can be a bit of a
       | drag on novelty.
        
       | mysterypie wrote:
       | I'm hoping someone can answer a question that's been bugging me
       | for years: When I take blood pressure medication my blood
       | pressure goes down _but my heart rate goes up_ [1]. That can't be
       | good. Heart rate has a strong inverse correlation with lifespan,
       | and this even holds across species (animals with higher heart
       | rates have shorter lifespans). So does lowering blood pressure
       | reduce the risk of heart disease, stroke, etc, but nevertheless
       | shorten your lifespan in other ways because of a higher heart
       | rate?
       | 
       | [1] I've verified this for myself with careful record keeping
       | over long periods of starting/stopping different BP meds, but I'm
       | not entirely sure it's true for everyone.
        
         | CookieCrisp wrote:
         | My understanding of the heart rate correlation to lifespan
         | between different species is that it is "within a couple levels
         | of magnitude" and that an increase of 10% in a human's rate
         | does not correlate at all to a 10% decrease in lifespan
        
         | Aerroon wrote:
         | Have you mentioned this to your doctor? There are different
         | types of blood pressure medications. Some will lower your heart
         | rate.
         | 
         | Back when I took beta blockers they reduced my heart rate from
         | 65-70 to 45-55.
        
         | brandonb wrote:
         | This sounds like reflex tachycardia -- your body wants to
         | ensure blood is flowing to all the right places, so it raises
         | heart rate to partially compensate for blood pressure falling.
         | Reflex tachycardia can be a normal response to certain types of
         | blood pressure medications, like vasodilators or diuretics.
         | Beta blockers are a different common type of blood pressure
         | medication that attempt to lower both blood pressure and heart
         | rate simultaneously.
         | 
         | If the increase in heart rate is large (>30bpm), especially
         | when going from laying to standing, it could be a sign of
         | underlying dysautonomia or POTS. If you experience symptoms
         | (dizziness, fatigue, fainting, etc) it's worth getting
         | evaluated. We (the OP) do offer medical care for POTS here:
         | https://empirical.health/pots
         | 
         | As for the relationship between low heart rate and longer life
         | spans, it's not necessarily causal -- a lower heart rate is
         | often a sign of a stronger cardiac muscle (each beat pumps more
         | blood, so fewer beats per minute are required to pump the same
         | volume of blood). So I'd suspect much of the relationship here
         | is driven by these confounding variables!
        
         | AStonesThrow wrote:
         | It's the futility of trying to make two arbitrary numbers go
         | down and covering up a mere symptom.
         | 
         | Hypertension is correlated with a lot of issues, and it's easy
         | to measure.
         | 
         | It's also easy to keep formulating novel chemicals, so keep
         | complaining about side effects, and your physician will be
         | happy to keep spinning the Formulary Roulette Wheel.
        
         | naveen99 wrote:
         | It's complicated. You need blood pressure to live...
         | 
         | Too low heart rate can also be a problem.
         | 
         | talk to your cardiologist about your specifics.
         | 
         | At the population level, the guidelines have backed off over
         | the last 20 years. What's normal now used to be called high
         | blood pressure.
        
         | smeeth wrote:
         | I'm not a doctor, but my understanding is that lower blood
         | pressure can indeed lead to a higher heart rate under certain
         | circumstances. For instance, people taking minoxidil for hair
         | loss can experience lower blood pressure, which leads to higher
         | heart rates and increased left ventricle thickness as a side
         | effect.
         | 
         | My suspicion is that this happens because the heart is trying
         | to maintain a constant oxygen supply to the muscles. However,
         | if blood pressure is lowered by improving factors like arterial
         | flexibility, stroke volume (amount of blood per heartbeat),
         | muscle oxygen efficiency, or oxygen content in the blood, the
         | heart wouldn't need to pump faster.
        
         | eig wrote:
         | It's pretty normal for heart rate to increase with a drop in
         | blood pressure. It's part of a normal reflex called the
         | baroreceptor reflex that your body evolved to keep you alive.
         | 
         | To answer your question, there have been an abundance of
         | epidemiological studies showing that the drop in blood pressure
         | is worth the slightly increased heart rate (assuming you've
         | been diagnosed with hypertension). The main benefit is the drop
         | in stroke risk, atherosclerosis, and kidney damage, even
         | despite the fact that your heart has to beat faster.
        
       | nisegami wrote:
       | Two tidbits from me:
       | 
       | Several years ago, I got an omron wrist cuff blood pressure
       | monitor. Some doctors showed heavy skepticism at the time but
       | I've never seen any reason to think it's inaccurate when properly
       | mounted and with healthy batteries.
       | 
       | I had a sleep study done last year using a brand new machine the
       | lab got (literally unboxed while I was there) that uses a
       | combination of the ecg signals and pulse timing to calculate
       | blood pressure continuously once calibrated. Seemed pretty cool
       | to me and I got the impression this technique is fairly new?
        
       | danihh wrote:
       | Great read.
       | 
       | Side note: please fix your header. Makes the website appear so
       | much less professional than the information it provides really
       | is.
        
         | brandonb wrote:
         | Thanks! Would you be able to send me a screenshot of what
         | you're seeing? It may be formatting differently on your screen
         | than mine. bmb@empirical.health.
        
       | loughnane wrote:
       | Haven't read the article yet but there are three big things that
       | hinder the usefulness of this tech as it stands:
       | 
       | 1. Most clearances only apply to when people are motionless. 2.
       | Often need to calibrate frequently. 3. No practitioner knows what
       | to do with continuous bp data even if they had it.
       | 
       | Solve those and we've got something big. Until then progress is
       | welcome but not revolutionary.
        
       | mikesabbagh wrote:
       | I got a Xiaomi GT3 watch for less than 40$ including shipping. it
       | has blood pressure measuring. How accurate? I dont know. I have a
       | normal BP, and it always shows me normal values. Whe I try it on
       | my son or wife's wrist, it always measures a lower BP.
       | 
       | Anyways, I stopped looking at it, and I only use it for the looks
       | and to show me notifications.
        
         | Etheryte wrote:
         | Have you considered comparing it to a regular blood pressure
         | monitor in parallel? My guess is that since it isn't certified
         | as a medical device, it's essentially just a random number
         | generator. No smart watch from a big name brand offers this
         | feature yet, so I doubt a $40 device has figured it out.
        
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