Cuffless 24-hour ambulatory blood pressure monitoring-guided antihypertensive titration in real-world clinical practice: a prospective non-randomized study.

Background: Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is the reference standard for diagnosing hypertension and assessing treatment response, but routine use remains limited by conventional cuff-based devices. We compared 6-month ambulatory blood pressure (BP) between cuffless 24-hour ABPM-guided titration and usual care in outpatient hypertension management. Methods: We conducted a single-center, open-label, non-randomized prospective study of adults with uncontrolled hypertension between March and November 2025. Participants were assigned by the treating physician, without randomization, to CART BP pro-guided titration (CART BP arm, Results: Among 162 participants with a valid 6-month ABPM recording, the adjusted between-group difference in 24-hour systolic BP was -7.35 mmHg (95% confidence interval [CI], -12.03 to -2.67 mmHg; Conclusions: In this non-randomized study, a care pathway incorporating cuffless 24-hour ABPM was associated with lower 24-hour ambulatory systolic BP at 6 months compared with usual care, whereas office systolic BP did not differ significantly between arms. Given the non-randomized design, these findings are hypothesis-generating and require confirmation in a randomized trial. Trial Registration: ClinicalTrials.gov Identifier: NCT07454148.