Why Blood Pressure Tech Is Due For A Physics-Based Rethink, According To Esperto Medical's Founders

Photo: Matt Fu, Esperto Medical

Significant progress has been made in digital health over the last 10 years. It's now possible to see oxygen levels on a ring, stream real-time EKG to a phone, and monitor glucose continuously through a patch. But for blood pressure — the one vital sign most clinicians check on nearly every patient — it's mostly business as usual.

The standard cuff is still the go-to instrument at clinics and at home. Although it's a familiar tool, its deficiencies are becoming more and more difficult to overlook, especially in a health care environment that's moving toward real-time monitoring and care, and data-driven decision-making.

Alaina Rajagopal, the cofounder of Esperto Medical, shared, "Blood pressure is currently measured by a cuff that squeezes the arm occasionally or an arterial catheter, which is inserted directly into an artery. Patients dislike both options because they are inconvenient and uncomfortable. As a clinician, I dislike that I have to choose between getting good, continuous data through inserting a painful and time-consuming arterial catheter or to settle for lower-quality data in favor of saving time and risk to the patient. Until resonance sonomanometry, there really wasn't an ideal solution."

A bottleneck to hidden care?

Blood pressure is generally a beginning sign of a patient's status change. But the current tools are either static or invasive. Cuff-based monitors offer isolated snapshots. Routine monitoring can involve more invasive strategies, such as inserting arterial lines, which are feasible only in the ICU. That leaves a huge hole in the way doctors collect and respond to cardiovascular data — especially outside the hospital.

Some companies have attempted to fill this gap with cuffless wearables or predictive modeling. But many of those are based on assumptions that don't always hold true in a diverse set of patients or real-world use. Movement, skin tone, BMI or even posture can make results less reliable, problems that seldom come up in a polished demonstration but that do matter in everyday use.

This has led to a bottleneck: no fundamentally scalable method to measure blood pressure continuously, comfortably and reliably across patient populations. And as care extends more deeply into homes, that gap becomes more pressing. Aditya Rajagopal, cofounder of Esperto Medical, explained, "Historically, researchers have tried to solve this problem by miniaturizing blood pressure cuffs and putting them on the wrist or finger, or they have tried to measure proxies for blood pressure with photoplethysmography-based technologies — the same technology used in a pulse oximeter. However, these methods calculate blood pressure intermittently, in the case of cuffs, or don't calculate real blood pressure at all, in the case of PPG methods. My team and I really took a hard look at the first-principles physics of measuring true blood pressure continuously, non-invasively, and without calibration. Once we understood the problem from a fundamental level, we were able to develop a solution that addressed the challenges with existing devices."

Caption: Alaina Rajagopal demonstrating an early prototype, Esperto Medical

Reimagine the Basics

One startup that has invented a unique way of solving this problem is Esperto Medical, which is using a physics-centric approach for vital sign tracking. Thinking outside of the box with the industry's conventional methods, Esperto developed a new platform based on Resonance Sonomanometry™ which is an ultrasound-based technique, independent of calibration to a cuff or catheter, measuring arterial behavior directly.

Their device measures on live readings from any visible artery and monitors blood pressure continuously without interfering with care. Instead of calculations based on machine learning models, it reads real-time vascular changes from principles of resonance and sound—contrary to more typical algorithmic estimates.

The company is currently still pre-commercial, but it's already being developed for use cases that extend beyond adults. In July, Esperto received a grant from the Midwest Pediatric Device Consortium, an FDA PDC program, to develop the platform for children — for whom the challenge of reliable, non-invasive monitoring is, some may say, even more acute.

Beyond Vital Signs

The majority of devices on the market focus narrowly on single vital signs, while Esperto's platform is intended to do more. The system also delivers on calibration-free, continuous blood pressure measurements as well as a suite of additional advanced cardiovascular metrics, meaning clinicians get something akin to a "cardiovascular microscope."

The device in question senses pulse, respiratory rate, skin temperature, arterial stiffness, arterial radius, blood flow, and more directly via ultrasound resonance technology right from the arm. It can also evaluate multiple arteries simultaneously, including central arteries, which will allow for the study of central versus peripheral circulation, gravity effects on blood flows, as well as potentially provide an earlier diagnosis of vascular pathologies.

Clinicians haven’t had this level of precision and breadth with traditional monitors before. Yet as the healthcare system moves rapidly toward prevention at an earlier stage and treatment tailored in real-time, having a way to measure these extra things could be just as important for the field holistically as measuring what is in the blood.

A Long-Overdue Shift

The growth in remote care infrastructure and digital-first triage tools by healthcare systems demands that foundation diagnostics like blood pressure evolve. The status quo is incompatible with where medicine is heading.

Companies like Esperto are not purporting to have all the answers. But their willingness to rethink the measurement model from scratch — and design for real-world variability — puts them in a small but growing group of players quietly tackling a problem that many others have overlooked.

Alaina Rajagopal said, "At Esperto, we have been working to develop a tool that can provide blood pressure continuously and noninvasively for all patients, on any artery, in any research or clinical setting. Being able to assess not only blood pressure but a diversity of other metrics like arterial radius, arterial wall thickness, and arterial stiffness can provide a microscope into the cardiovascular system that may let us eventually predict certain types of disease like critical limb ischemia, heart attacks, or strokes. If we can predict disease, we might be able to prevent it through early treatments. We are excited about delivering on BP and new indications ourselves, but we are even more thrilled about what the tool can enable others to discover."

Were continuous, cuff-free monitoring to become broadly available and established, the impact could radiate from hospital efficiency into home-based care, chronic disease management and health equity.

Until then, the simple blood pressure reading stands out as a surprisingly modern challenge, one with more riding on its accuracy than many people suspect.

This post was authored by an external contributor and does not represent Benzinga's opinions and has not been edited for content. This content is for informational purposes only and not intended to be investing advice.
This article is for informational purposes only and does not substitute for professional medical advice. If you are seeking medical advice, diagnosis or treatment, please consult a medical professional or healthcare provider.