Making wearables matter: Blood pressure monitoring could be the tipping point

Today’s wearables are still designed for the healthy and wealthy, not those who could benefit the most. Medical wearables offer the potential to collect health data and improve health via a combination of real-time AI and expert human intervention. Apple’s announcement of FDA clearance of its Watch for screening for irregular heart rhythms was meant to be groundbreaking. But its medical value right now remains limited and controversial. What will make the promise into reality?

I believe the application that will make wearables medically matter is automated blood pressure monitoring. Blood pressure may not be sexy, but it’s a universally understood measurement and a clinically central one. Your doctor measures your blood pressure every single time you visit. Even those who don’t pay close attention to their health know that high blood pressure increases risk of heart attack and stroke, and lower blood pressure saves lives.

High blood pressure, or hypertension, affects between 30-50% of adult Americans, or 75-120 million people. It’s the No. 1 risk factor in deaths worldwide, and the No. 1 modifiable risk in heart disease and stroke, the top two worldwide causes of death. Despite this, only half of people with high blood pressure are lowering it enough, even with medications. Why? A big reason is lack of information.

Doctors advise everyone at risk to monitor their blood pressure, but few do it often enough, in large part because inflatable blood pressure cuffs, while universal, are uncomfortable and inconvenient. In fact, current medical guidelines recommend automated blood pressure monitoring to more accurately measure your blood pressure, but hardly anyone is willing to use a motorized cuff that squeezes your arm every 30 minutes while you try to sleep! Cuffless automated monitoring would provide more accurate information, enable timely intervention, lower blood pressure and save lives.

Numerous companies have tried to create a cuffless automated blood pressure monitor, including Apple, Samsung, Google, Microsoft, Amazon, Fitbit and Jawbone, as well as a very long list of startups. No one has yet been successful. As a healthcare investor excited about this area, I have met with many of the startups working on this problem, and I see some common issues.

What’s missing?

Companies in this area should first focus on generating medical-quality data. Teams need experts in FDA regulation and clinical studies and need to listen to them when planning timelines and budgets. Unlike some other areas where VCs invest, this is not a market for moving fast and breaking things. Instead, companies need to collect training data from hundreds of people, especially those with hypertension, to ensure their product meets the FDA’s performance standards.

We can make wearables matter.

But accurate data is just the tip of the iceberg. More complete blood pressure data should enable healthier decisions and lower blood pressures. This could mean a warning that average blood pressure has increased recently, or a proactive text or call from your doctor or a family member. It could include suggested adjustments to medications or healthier behaviors based on patterns through the day and night. User experience plays a critical role in real-world use. Automated monitoring should be no more intrusive than wearing a wristwatch and getting a notification.

On the cusp

The good news is a breakthrough in this space doesn’t seem that far away. Better sensors, algorithms, computing power and battery life are helping companies produce results closer to FDA standards. I expect multiple groups will meet the challenge in the next 18 months. Room exists for multiple winners in this market, given the huge market opportunity and wide range of use cases. Every major wearable platform is under pressure to consider adding FDA-cleared applications, and blood pressure is at or near the top of their “most wanted” lists.

Companies that can connect better data to better blood pressure will be able to create value and win payment from insurers, consumers or both. For example, Medicare has recently significantly improved coverage of remote patient monitoring.

Measure what matters

Cuffless automated blood pressure monitoring will improve how we treat high blood pressure, both through medication and healthy behaviors. Automated monitoring will better support people at highest risk, such as patients recovering from heart failure or stroke, by providing early warnings of potential recurrence. Ultimately, we could even get early warnings of heart attacks, strokes or other events, giving us time to act.

Current wearables measure what comes easily, like steps and heart rate. By instead measuring what matters medically, we can use that data to extend lives. We can make wearables matter.