Continual cuffless blood pressure monitoring in children: agreement and feasibility compared with ambulatory blood pressure monitoring

BACKGROUND: Cuffless wearable technologies enable continual blood pressure (BP) monitoring and may improve tolerability compared with conventional cuff-based methods. Pediatric data comparing cuffless devices with ambulatory blood pressure monitoring (ABPM) remain limited. METHODS: In this prospective observational study, children with well controlled type 1 diabetes mellitus and normal office BP underwent simultaneous 24-h monitoring using a wrist-worn cuffless optical device and conventional ABPM. Between-method differences were assessed for averaged 24-h, daytime, and nighttime systolic and diastolic BP. Equivalence was evaluated using the two one-sided tests procedure with a prespecified exploratory ± 10 mmHg margin, whereas individual-level agreement was assessed using Bland-Altman analysis. RESULTS: Twenty-one participants were included (mean age 14.7 ± 2.6 years). Mean differences (Aktiia - ABPM) were -4.5 mmHg for 24-h systolic BP and -0.8 mmHg for 24-h diastolic BP. The 90% confidence intervals were fully contained within the ±10 mmHg margin for 24-h and nighttime systolic BP and for diastolic BP across all periods, but not for daytime systolic BP. Bland-Altman analysis showed modest mean bias but wide limits of agreement, particularly for systolic BP. Nocturnal systolic and diastolic BP dipping was attenuated with cuffless monitoring. CONCLUSIONS: In this selected pediatric cohort, continual cuffless BP monitoring was feasible and showed group-level comparability with ABPM for averaged 24-h BP values. However, it should not be considered interchangeable with ABPM for individual clinical decisions or assessment of nocturnal dipping. Larger studies in more diverse pediatric populations are required before broader clinical implementation.