Advances in Ambulatory Blood Pressure Monitoring: Integrating Novel Technologies and Variability Indices for Optimized Hypertension Management and Cardiovascular Risk Prediction

Hypertension remains a leading cause of cardiovascular morbidity worldwide, necessitating precise blood pressure (BP) monitoring for effective diagnosis and management. Traditional office BP measurements have limitations, prompting widespread adoption of ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). This review synthesizes recent technological advancements including validated cuffless devices, wearable sensors, and smartphone-based applications, which offer continuous and context-aware BP assessment. Additionally, the integration of blood pressure variability (BPV) indices and phenotypic classifications such as nocturnal dipping and morning surge into clinical practice enhances cardiovascular risk stratification. Clinical applications of these innovations facilitate improved diagnosis of white-coat, masked, and nocturnal hypertension, enable phenotype-guided therapy adjustments including chronotherapy, and promote medication adherence monitoring. Emerging trends emphasize machine learning, big data analytics, multimodal data integration, and telemedicine, proposing a future of personalized hypertension care. Despite promising developments, challenges remain in device validation, data interpretation, and clinical implementation. This comprehensive review highlights the evolving landscape of hypertension monitoring and its potential to transform cardiovascular risk prediction and management.