Omron HeartGuide: My life with a blood pressure smartwatch

In the middle of a conversation at dinner, I slowly lift my arm to my chest. I feel the slight compression. I wait, and it stops. My blood pressure isn't bad. I drink my iced tea.

I've been wearing the Omron HeartGuide on my wrist for several weeks, now. It's the first FDA-cleared fitness watch that's a real, serious blood pressure monitor. It gave me a glimpse at what could be the next big frontier for wearable tech . It's fascinating and essential to me, but in its current form it won't be for everyone yet.

More: The 2 most important things to look for in a blood pressure monitor | The best blood pressure monitors for at-home use 

Watch this: Omron HeartGuide puts blood pressure on a watch

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When it comes to monitoring anything in my life, health-wise, blood pressure is the one I need to keep tabs on the most. I've had hypertension, high blood pressure, for years. I see a cardiologist regularly. I take medication. I use a home cuff (or am supposed to) for monitoring. None of this is fun. Apple's introduction of ECG on Apple Watch Series 4 last year enables many people to spot possible atrial fibrillation, but it does nothing for my awareness of my blood pressure.

Blood pressure isn't an easy technology to crack for easy, portable use. I've tried smaller versions of the inflatable arm cuffs, but they're still the sort of things you'd need to stick in a backpack.

Real blood pressure

The HeartGuide doesn't have any new types of optical sensors onboard. The blood pressure tech involves an inflating bladder on the inside that you can actually feel pressurizing over your wrist. Starting a reading is really simple: press the top button and then lift the watch to heart level. It buzzes when the elevation is correct, and starts to take a measurement, which takes about 30 seconds. You have to stay still during the reading.

Omron's CEO, Ranndy Kellogg, says the HeartGuide's inflatable wrist-cuff is rated for 30,000 uses. If I used it five times a day, that would be over 16 years (although by that time, the battery may not last). If any problems occur with the tech, which I haven't had, Omron will replace the watch for free.

Readings pop on the watch, which stores up to 100 readings at a time. Systolic, diastolic and heart rate from the spot measurement show up. My readings seemed low at first, but I checked against my home arm cuff (also by Omron) and got similar readings. So far, so good.

Checking everywhere

Suddenly, I started checking on my blood pressure in places I never used to: at the movies, watching How To Train Your Dragon with the kids. At the mall. During breakfast. In the middle of Cheesecake Factory, long lines and screaming kids, deep in suburban New Jersey. I'm folding my arm to my chest, holding still while my wrist slowly gets gripped by the cuff of my watch. There's a buzz: I check my blood pressure. No surprise, not great. But the process becomes addictive.

It also means that I'm finally checking my blood pressure, something I've avoided doing at home for literally months. If nothing else, that's the biggest success of the idea of a blood pressure watch: it helps me stay aware.

The readings, right now, are all manual. A future update that awaits FDA clearance will take nocturnal readings while sleeping, for results that no current blood pressure device can even do, and might help raise awareness of unknown conditions while sleeping, or effects of medication at night.

It's big

Know this: the Omron HeartGuide isn't designed to be your everyday smartwatch replacement. It's big, topping even the bulkier GPS watches I've tried, and it dwarfs everyday smartwatches like the Apple Watch and Fitbit Versa . The metal case and transflective always-on display feel like a super-sized Garmin running watch. And there's no touchscreen, instead just three side buttons that handle blood pressure readings, cycling through fitness stats and Bluetooth pairing. The wrist strap is the bulkiest component of all.

A large rubber strap lays on top of an underlayer that's actually an inflatable microcuff, using the same underlying tech as a blood pressure arm cuff. Off my wrist, it looks utterly bizarre. An included pair of soft fabric covers line the inner cuff for breathability and to help keep the equipment more dirt and sweat free. It's a thick-feeling watch, and doesn't always easily slide under my shirt sleeves. Sometimes I accidentally trigger a blood-pressure reading when the watch's top button presses on my jacket cuff, and I feel my wrist start to constrict.

It's a big watch to sleep with: that thick cuff isn't very comfy. I also had to make sure to take it off before showering.

I'm wearing the medium-sized watch, which is the only version FDA-cleared at the moment. Omron also has a smaller-cuff and larger-cuff model planned, but they need separate FDA clearances because of different blood pressure algorithms. The larger-cuffed model is expected next, and the smallest-cuff version will arrive by the end of the year.

Syncing with my phone

Omron's Heart Advisor app syncs readings, plus step count and a log of hours slept, to a HIPAA-compliant cloud service. The app syncs to Apple Health, too. Omron's app is unusual because it's aiming to serve up blood pressure-based heart insights, an ambitious move for a medical device. My first insights, so far, started by telling me I had heart rhythm irregularity, something my Apple Watch with ECG and my cardiologist haven't noticed. Recently, those insights have changed to saying "no irregular heartbeat has been detected," which makes me feel a lot better.

The HeartAdvisor app isn't as easy to use as a regular fitness app like Fitbit , but it's really intended to be more of a app-based conduit to blood pressure analysis, not a full dashboard for everything else. Still, I'd like to see future smartwatches that can get blood pressure readings and also loop that data in to every other stat more organically.

Not exactly a smartwatch

The HeartGuide runs its own basic software, and only shows time, steps, a log of hours slept (no deeper analysis) and the most recent blood pressure measurement. It can get notifications of incoming calls and text alerts, but can't actually read the text. Battery life lasts about two to three days, when taking blood pressure measurements about 10 times a day. Taking more, which was hard to resist for me, takes a toll on battery life. To charge, you clip it onto a dongle that snaps to the cuff's edge.

If the HeartGuide passes for a smartwatch from a distance, a closer look will reveal its limitations. But that's besides the point. This is for anyone who might be looking for a watch to check blood pressure, needs convenient readings and is willing to pay a lot more for this convenience. While a standard blood pressure cuff from the drug store can cost you around $30, the HeartGuide costs $500.

A visit to my cardiologist

I brought the HeartGuide to my check-up with my doctor in Manhattan, and asked her thoughts. While she took my blood pressure manually, checking and counting using a stethoscope, I used the HeartGuide to get my own reading. The results lined up (within 10 points) of the doctor's reading. I told her it's upped the number of measurements I've taken. Her question, when she found out how much it costs, was, "Who's going to use this thing?" And, "Aren't there wrist cuff blood pressure monitors that cost far less?" The answers to both those questions are: unclear, and yes. Sometimes wrist cuffs don't provide very accurate measurements for people like me with thick arms, which is why I appreciated the HeartGuide working well so far. But, yeah, there are other ways you can monitor blood pressure. And since blood pressure is a single spot measurement, not a continuous process like heart rate monitoring , there's no need to have it on your wrist all the time.

A sign of where Samsung, and others, are aiming next

The Samsung Galaxy Watch Active hints at the possibility of measuring blood pressure, via the "My BP Lab" app that watch owners can be a part of. But, to be clear, Samsung's watch doesn't do actual medical grade blood pressure measurements yet: this is a research app made in collaboration with UCSF, much like the one Samsung made available on the Galaxy S9 last year, and results are not guaranteed (I haven't tried it out yet).

But smartwatches may not be the only wearable devices looking at blood pressure. I also recently met with Valencell, a company that develops optical heart rate components for other wearable devices, and tried an earbud-based blood pressure sensor. That earbud sensor (or finger sensor) could lead to an FDA-cleared wearable down the road, according to Valencell.

Omron's not intending for the HeartGuide to be an everyday device for everyone: in fact, it seems targeted to older men who have enough disposable income to afford it. But, hopefully, it's a sign of where more affordable, wearable blood pressure tech could be headed.

Even if it is bulky, has a weird inflating cuff and is expensive... it works, and it's fascinating. I wouldn't want to wear it all the time. But no watch exists that does FDA-cleared blood pressure like the Omron HeartGuide. And it hints at what the next big breakthrough in wearable health needs to be. I want and need better portable blood pressure, and it's slowly starting to arrive.

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