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Why 24-Hour Blood Pressure Monitoring Matters

  • Deblina Chattopadhyay
  • 5 hours ago
  • 6 min read

Continuous blood pressure monitoring is essential for accurately diagnosing and managing hypertension because clinic-based readings often miss critical fluctuations like nocturnal hypertension, masked hypertension, and morning surges. Traditional methods such as home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) provide better insights than clinic measurements, but still fall short in comfort, duration, and accessibility. This blog explains why 24/7 blood pressure tracking is necessary, what current methods miss, and how continuous monitoring improves cardiovascular risk detection.


Hypertension or high blood pressure is one of the most common chronic conditions worldwide as it affects 1.28 billion adults globally.¹ Out of the ones who are diagnosed and treated, it is seen that only around 1 out of 4 people have their Blood Pressure under adequate control level. BP is often referred to as the ‘silent killer’ as it is difficult to manage effectively and progresses without noticeable symptoms to serious complications development. 


Insufficient monitoring between clinic visits and ‘white coat’ readings often distorts the blood pressure patterns in the patient. Clinic only measurements capture mere snapshots and misses daily fluctuation data like nocturnal spikes, morning surges and masked episodes that drive 50% of cardiovascular risks.²


In recent years, wearable devices have developed into being promising tools for continuous monitoring of one’s health. From chest patches to smart rings, medical wearables have come a long way in discrete design for non-invasive and non-interfering ways to collect physiological data in daily life. 


Continuous out-of-clinic monitoring data reveals true burdens like masked hypertension affecting 15-30% and doubling stroke risk or nocturnal hypertension in 10-20% untreated cases.³


Why Hypertension Management Needs Better Out-of-Clinic Tools


Hypertension is estimated to be responsible for about 7.5 million deaths annually which amounts to 13% of all deaths worldwide. Yet it causes no pain nor does it have any obvious symptoms nor any warning signs visible to the untreated patient.⁴


Traditionally, hypertension has been diagnosed after brief monitoring of patients using clinic based blood pressure measurement medical devices. However, these measurements provide only a glimpse into one’s cardiovascular state.⁵ For an individual, blood pressure fluctuates significantly throughout the day due to factors such as stress, physical activity, diet, sleep, circadian rhythm, etc. And it is because of this variability that clinicians might miss important patterns. 


Hidden Patterns in Blood Pressure That Clinics Miss


Masked Hypertension


It is observed that some individuals show normotensive levels in clinics but elevated blood pressure when observed elsewhere. This condition is known as ‘masked hypertension’ and affects about 10-30% of the general population.  It causes similar cardiovascular risks as sustained hypertension and is specifically prevalent in younger patients, people with high stress work, more in men, people with obesity and those with sleep disorder. 


There is a range of subtypes like masked morning hypertension or masked nocturnal hypertension, etc. classified by the time of day in which elevation in blood pressure occurs.⁶


White Coat Hypertension


The other end of the spectrum are people who show elevated blood pressure levels only in clinical environments due to a conditioned neurophysiological stress response. This is called ‘white coat hypertension’ that artificially inflates systolic readings by 20-30 mmHg, whereas in their daily life their blood pressure measurements will be quite adequate.⁷


Nocturnal Hypertension


Blood pressure normally drops during sleep by 10-20% compared to daytime levels, but for some people however, it might remain elevated at night. This condition is called ‘nocturnal hypertension’ and it is strongly associated with cardiovascular risks. 


According to 2023 ESH Guidelines, nocturnal hypertension is defined as “night-time systolic BP is higher than 120 mmHg and/or diastolic BP is higher than 70 mmHg”. A trend for nocturnal hypertension is observed in people with sleep apnoea, autonomic neuropathy, kidney disease and metabolic disorders. Since this condition persists beyond daytime hours and often does not appear in clinic readings, it remains undetected by standard blood pressure monitoring methods.⁸


Blood Pressure Variability (BPV)


Another metric that is quite important to monitor is ‘blood pressure variability’, which refers to the short term swings in blood pressure level on measurements across several minutes, hours or days due to stress or activity. High variability is frequently associated with increased cardiovascular events in a person.⁹


Multiple studies have reported that excessive blood pressure level surge in the morning is associated with high risk of stroke, cerebral hemorrhage or other hypertension-mediated organ damage.  Capturing such cardiovascular patterns requires recurring or continuous monitoring outside the clinical setting. 


Traditionally this style of blood pressure monitoring has been done using either Home Blood Pressure Monitoring (HBPM) or 24-hours Ambulatory Blood Pressure Monitoring (ABPM). 


These methods were effective but had their own limitations like the following:

  • Cuff inflation that often disrupts sleep.

  • Monitoring periods being limited.

  • Devices were quite uncomfortable for long periods of wear.


Why Continuous and 24/7 BP Data Changes the Clinical Picture


The 2024 European Society of Cardiology (ESC) Guidelines¹⁰ and the 2025 AHA/ACC Guidelines¹¹ have both recommended out of clinic blood pressure measurement to be essential for accurate diagnosis and management of hypertension in an individual.


Out of medical settings blood pressure monitoring provides substantially better prognostic information that clinical readings alone cannot provide. 


The gold standard for out of clinic measurements has been the 24-hour ABPM which is basically a medical device that is worn by the patient throughout the day, and the cuff of it inflates every 15-30 minutes.¹² However invaluable ABPM might be, there are real-world limitations of it. To top that, it is expensive and requires visiting the clinic to fit and retrieve the device. Also the patient only gets a one-day window worth of data.


The Gap Between Measurement and Reality


The core issue is clear: blood pressure is continuous, but our measurement systems are not.


We are trying to understand a dynamic physiological signal using fragmented data points. This mismatch leads to missed diagnoses, incomplete risk assessment, and suboptimal treatment strategies. 


What clinicians and patients truly need is a way to monitor blood pressure continuously, comfortably, and over extended periods, without disrupting daily life.


Bridging the Gap: The Need for Continuous Monitoring


The need for continuous, real-world blood pressure data is now well established. Detecting conditions like masked hypertension, nocturnal hypertension, and abnormal variability requires monitoring that extends beyond the clinic and beyond short-term measurement windows.


This naturally leads to the next question:

If continuous monitoring is so critical, can wearable devices actually deliver it reliably? Not as a replacement for clinical tools, but as a way to extend monitoring into the 23 hours of the day that traditional methods cannot capture.


In the next blog, we break down how wearable devices measure blood pressure, what current research says about their accuracy, and where they fit in real-world hypertension care.



References:

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