Artificial intelligence (AI) analyzing patterns from a portable cuff-based blood pressure monitor and a wrist-worn fitness tracker may identify adults with stage 2 high blood pressure who are at increased risk of a hypertensive crisis up to three days before it occurs, according to preliminary research presented at the American Heart Association's Scientific Sessions 2026.
A hypertensive crisis is a medical emergency characterized by blood pressure above 180/120 mm Hg with acute end-organ damage, which can lead to stroke, heart attack, kidney damage, aortic dissection or pulmonary edema. The findings matter because they suggest that continuous monitoring and AI could provide a critical early warning window, allowing patients and clinicians to act before a dangerous spike becomes an emergency.
The study included 4,190 adults ages 40 to 85 with stage 2 hypertension, average age 62.4 years, receiving care at one hospital in Sindh, Pakistan, and followed from January 2025 to January 2026. Over 12 months, 312 participants experienced 418 hypertensive crises, about 7% of all participants. The AI tool distinguished higher versus lower risk up to 72 hours in advance. Among participants with a positive alert, about 32% experienced a hypertensive crisis, while 97.4% of those without an alert remained crisis-free. Abnormal blood pressure patterns during sleep and a sharp post-waking rise of more than 35 mm Hg compared to nighttime levels were among the strongest predictors. Participants whose blood pressure did not decrease during sleep had nearly five times the odds of an upcoming crisis, and those with the post-waking surge had nearly four times the odds. When physicians received an alert and adjusted medications within 24 hours, hypertensive crises were about 61% lower and emergency department visits about 45% lower compared to people who did not receive timely alert-triggered intervention.
"These findings suggest that continuous blood pressure monitoring can help detect these blood pressure changes earlier, which may give patients and healthcare professionals more time to act before it turns into an emergency," said lead author Waleed Razzaq Chaudhry, M.D., an internal medicine resident at the University of Maryland Capital Region Medical Center.
The implications extend to clinical practice and digital health. Maria Delgado-Lelievre, M.D., a hypertension specialist at the University of Miami Leonard M. Miller School of Medicine, noted that tools providing greater insight into blood pressure patterns between office visits may support more personalized care and earlier discussions about treatment, lifestyle changes and medication adherence. However, she emphasized that such technologies should complement, not replace, clinical decision-making. A 2025 American Heart Association scientific statement on cuffless devices highlighted that more research and standardized testing are needed before these devices and analyses are used to guide patient care. The Association recommends an automatic, cuff-style, upper arm monitor, and a list of validated blood pressure devices is available at validatebp.org.
The study has important limitations: all participants were adults living in Pakistan who received care at one hospital, so the design needs to be tested among more diverse groups and in various healthcare settings before widespread use. More research is also needed to guide clinical responses to high-risk alerts, including confirming blood pressure, reviewing symptoms and medication adherence, contacting the patient, considering medication adjustment, and determining when urgent or emergency evaluation is needed. The findings are considered preliminary until published as a full manuscript in a peer-reviewed journal, and the abstract and Online Program Planner are available. Additional resources include the 2025 High Blood Pressure Guideline, Top 10 Things to Know About the 2025 AHA/ACC High Blood Pressure Guideline, Health Threats from High Blood Pressure, and Home Blood Pressure Monitoring.
