ABSTRACT “Digital Hypertension” is a new research field proposed by the Japanese Society of Hypertension that integrates digital technology into hypertension management and proactively

promotes research activities. This novel approach includes the development of new technologies for better BP management, such as sensors for detecting environmental factors that affect BP,

information processing, and machine learning. To facilitate “Digital Hypertension,” a more sophisticated BP monitoring system capable of measuring an individual’s BP more frequently in

various situations would be required. With the use of these technologies, hypertension management could shift from the current “dots” management based on office BP readings during clinic

year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated

during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS HOME BLOOD

PRESSURE-CENTERED APPROACH – FROM DIGITAL HEALTH TO MEDICAL PRACTICE: HOPE ASIA NETWORK CONSENSUS STATEMENT 2023 Article 21 August 2023 WEARABLE BLOOD PRESSURE MEASUREMENT DEVICES AND NEW

APPROACHES IN HYPERTENSION MANAGEMENT: THE DIGITAL ERA Article 23 March 2022 THE DAWNING OF THE DIGITAL ERA IN THE MANAGEMENT OF HYPERTENSION Article 13 July 2020 REFERENCES * Kario K

Essential Manual on Perfect 24-hour Blood Pressure Management from Morning to Nocturnal Hypertension.: Wiley Blackwell; 2022, p. 1–374. * Kario K, Harada N, Okura A. Digital therapeutics in

hypertension: evidence and perspectives. Hypertension. 2022;79:2148–58. Article  CAS  PubMed  Google Scholar  * Kario K, Harada N, Okura A. State-of-the-art rapid review of the current

landscape of digital hypentension. Conn Health. 2022;1:46–58. * Omboni S, McManus RJ, Bosworth HB, Chappell LC, Green BB, Kario K, et al. Evidence and Recommendations on the Use of

Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension 2020;76:1368–83. Article  CAS  PubMed  Google Scholar  * Kario K, Hoshide S,

Mogi M. Digital hypertension 2023: concept, hypothesis, and new technology. Hypertens Res. 2022;45:1529–30. Article  PubMed  PubMed Central  Google Scholar  * Kario K. Management of

hypertension in the digital era: small wearable monitoring devices for remote blood pressure monitoring. Hypertension 2020;76:640–50. Article  CAS  PubMed  Google Scholar  * Kario K, Mogi M,

Hoshide S. Latest hypertension research to inform clinical practice in Asia. Hypertens Res. 2022;45:555–72. Article  PubMed  Google Scholar  * Pellegrini D, Torlasco C, Ochoa JE, Parati G.

Contribution of telemedicine and information technology to hypertension control. Hypertens Res. 2020;43:621–8. Article  PubMed  Google Scholar  * Yatabe J, Yatabe MS, Ichihara A. The current

state and future of internet technology-based hypertension management in Japan. Hypertens Res. 2021;44:276–85. Article  PubMed  Google Scholar  * Node K, Kishi T, Tanaka A, Itoh H, Rakugi

H, Ohya Y, et al. The Japanese Society of Hypertension-Digest of plan for the future. Hypertens Res. 2018;41:989–90. Article  PubMed  Google Scholar  * Matsuoka R, Akazawa H, Kodera S,

Komuro I. The dawning of the digital era in the management of hypertension. Hypertens Res. 2020;43:1135–40. Article  PubMed  Google Scholar  * Nakagami H. New wave of digital hypertension

management for clinical applications. Hypertens Res. 2022;45:1549–51. Article  PubMed  Google Scholar  * Rakugi H. Further promotion of “the JSH plan for the future” conscious of new normal

after/with COVID-19: message from the new president of the Japanese Society of Hypertension. Hypertens Res. 2021;44:4–6. Article  CAS  PubMed  Google Scholar  * Waki T, Miura K,

Tanaka-Mizuno S, Ohya Y, Node K, Itoh H, et al. Prevalence of hypertensive diseases and treated hypertensive patients in Japan: A nationwide administrative claims database study. Hypertens

Res. 2022;45:1123–33. Article  PubMed  Google Scholar  * Kario K, Harada N, Okura A. The first software as medical device of evidence-based hypertension digital therapeutics for clinical

practice. Hypertens Res. 2022;45:1899–905. Article  PubMed  PubMed Central  Google Scholar  * Kario K. Evidence and perspectives on the 24-hour management of hypertension: hemodynamic

biomarker-initiated ‘anticipation medicine’ for zero cardiovascular event. Prog Cardiovasc Dis. 2016;59:262–81. Article  PubMed  Google Scholar  * Kario K, Tomitani N, Kanegae H, Yasui N,

Nishizawa M, Fujiwara T, et al. Development of a new ICT-based multisensor blood pressure monitoring system for use in hemodynamic biomarker-initiated anticipation medicine for

cardiovascular disease: The National IMPACT Program Project. Prog Cardiovasc Dis. 2017;60:435–49. Article  PubMed  Google Scholar  * Kario K. New insight of morning blood pressure surge into

the triggers of cardiovascular disease-synergistic resonance of blood pressure variability. Am J Hypertens. 2016;29:14–6. Article  PubMed  Google Scholar  * Kario K, Chirinos JA, Townsend

RR, Weber MA, Scuteri A, Avolio A, et al. Systemic hemodynamic atherothrombotic syndrome (SHATS) - Coupling vascular disease and blood pressure variability: proposed concept from pulse of

Asia. Prog Cardiovasc Dis. 2020;63:22–32. Article  PubMed  Google Scholar  * Kario K, Thijs L, Staessen JA. Blood pressure measurement and treatment decisions. Circ Res. 2019;124:990–1008.

Article  CAS  PubMed  Google Scholar  * Kario K, Williams B. Nocturnal hypertension and heart failure: mechanisms, evidence, and new treatments. Hypertension 2021;78:564–77. Article  CAS 

PubMed  Google Scholar  * Kario K, Hoshide S, Mizuno H, Kabutoya T, Nishizawa M, Yoshida T, et al. Nighttime blood pressure phenotype and cardiovascular prognosis: practitioner-based

nationwide JAMP study. Circulation 2020;142:1810–20. Article  CAS  PubMed  PubMed Central  Google Scholar  * Li Y, Wang JG. Isolated nocturnal hypertension: a disease masked in the dark.

Hypertension. 2013;61:278–83. Article  CAS  PubMed  Google Scholar  * Kario K, Kanegae H, Tomitani N, Okawara Y, Fujiwara T, Yano Y, et al. Nighttime blood pressure measured by home blood

pressure monitoring as an independent predictor of cardiovascular events in general practice. Hypertension. 2019;73:1240–8. Article  CAS  PubMed  Google Scholar  * Fujiwara T, Hoshide S,

Kanegae H, Kario K. Cardiovascular event risks associated with masked nocturnal hypertension defined by home blood pressure monitoring in the J-HOP nocturnal blood pressure study.

Hypertension. 2020;76:259–66. Article  CAS  PubMed  Google Scholar  * Hoshide S, Kanegae H, Kario K. Nighttime home blood pressure as a mediator of N-terminal pro-brain natriuretic peptide

in cardiovascular events. Hypertens Res. 2021;44:1138–46. Article  CAS  PubMed  Google Scholar  * Kario K, Hoshide S, Nagai M, Okawara Y, Kanegae H. Sleep and cardiovascular outcomes in

relation to nocturnal hypertension: the J-HOP Nocturnal Blood Pressure Study. Hypertens Res. 2021;44:1589–96. Article  CAS  PubMed  Google Scholar  * Narita K, Hoshide S, Kario K. Nighttime

home blood pressure is associated with the cardiovascular disease events risk in treatment-resistant hypertension. Hypertension. 2022;79:e18–e20. Article  CAS  PubMed  Google Scholar  *

Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly

hypertensives: a prospective study. Circulation. 2003;107:1401–6. Article  PubMed  Google Scholar  * Hoshide S, Kario K. Morning surge in blood pressure and stroke events in a large modern

ambulatory blood pressure monitoring cohort: results of the JAMP study. Hypertension. 2021;78:894–6. Article  CAS  PubMed  Google Scholar  * Hoshide S, Yano Y, Haimoto H, Yamagiwa K, Uchiba

K, Nagasaka S, et al. Morning and evening home blood pressure and risks of incident stroke and coronary artery disease in the Japanese general practice population: The Japan Morning

Surge-Home Blood Pressure Study. Hypertension 2016;68:54–61. Article  CAS  PubMed  Google Scholar  * Narita K, Hoshide S, Kario K. Difference between morning and evening home blood pressure

and cardiovascular events: the J-HOP Study (Japan Morning Surge-Home Blood Pressure). Hypertens Res. 2021;44:1597–605. Article  PubMed  Google Scholar  * Hoshide S, Yano Y, Mizuno H, Kanegae

H, Kario K. Day-by-day variability of home blood pressure and incident cardiovascular disease in clinical practice: The J-HOP Study (Japan Morning Surge-Home Blood Pressure). Hypertension.

2018;71:177–84. Article  CAS  PubMed  Google Scholar  * Fujiwara T, Hoshide S, Kanegae H, Kario K. Clinical impact of the maximum mean value of home blood pressure on cardiovascular

outcomes: a novel indicator of home blood pressure variability. Hypertension 2021;78:840–50. Article  CAS  PubMed  Google Scholar  * Ishiyama Y, Hoshide S, Kanegae H, Kario K. Increased

arterial stiffness amplifies the association between home blood pressure variability and cardiac overload: the J-HOP study. Hypertension. 2020;75:1600–6. Article  CAS  PubMed  Google Scholar

  * Ishiyama Y, Hoshide S, Kanegae H, Kario K. Impact of home blood pressure variability on cardiovascular outcome in patients with arterial stiffness: Results of the J-HOP study. J Clin

Hypertens (Greenwich). 2021;23:1529–37. Article  CAS  PubMed  Google Scholar  * Schutte AE, Kollias A, Stergiou GS. Blood pressure and its variability: classic and novel measurement

techniques. Nat Rev Cardiol. 2022;19:643–54. Article  PubMed  PubMed Central  Google Scholar  * Stergiou GS, Mukkamala R, Avolio A, Kyriakoulis KG, Mieke S, Murray A, et al. Cuffless blood

pressure measuring devices: review and statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens.

2022;40:1449–60. Article  CAS  PubMed  Google Scholar  * Stergiou GS, Avolio AP, Palatini P, Kyriakoulis KG, Schutte AE, Mieke S, et al. European Society of Hypertension recommendations for

the validation of cuffless blood pressure measuring devices: European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens. 2023. in

press. * Mancia G (Chairperson), Kreutz R (Co-Chair), Brunstrom M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force

for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J

Hypertens. 2023. in press. * Kuwabara M, Harada K, Hishiki Y, Kario K. Validation of two watch-type wearable blood pressure monitors according to the ANSI/AAMI/ISO81060-2:2013 guidelines:

Omron HEM-6410T-ZM and HEM-6410T-ZL. J Clin Hypertens (Greenwich). 2019;21:853–8. Article  PubMed  Google Scholar  * Kario K, Shimbo D, Tomitani N, Kanegae H, Schwartz JE, Williams B. The

first study comparing a wearable watch-type blood pressure monitor with a conventional ambulatory blood pressure monitor on in-office and out-of-office settings. J Clin Hypertens

(Greenwich). 2020;22:135–41. Article  PubMed  Google Scholar  * Tomitani N, Kanegae H, Suzuki Y, Kuwabara M, Kario K. Stress-induced blood pressure elevation self-measured by a wearable

watch-type device. Am J Hypertens. 2021;34:377–82. Article  PubMed  Google Scholar  * Kario K, Tomitani N, Morimoto T, Kanegae H, Lacy P, Williams B. Relationship between blood pressure

repeatedly measured by a wrist-cuff oscillometric wearable blood pressure monitoring device and left ventricular mass index in working hypertensive patients. Hypertens Res. 2022;45:87–96.

Article  PubMed  Google Scholar  * Tomitani N, Kanegae H, Kario K. Self-monitoring of psychological stress-induced blood pressure in daily life using a wearable watch-type oscillometric

device in working individuals with hypertension. Hypertens Res. 2022;45:1531–7. Article  PubMed  Google Scholar  * Kario K. Nocturnal hypertension: new technology and evidence. Hypertension.

2018;71:997–1009. Article  CAS  PubMed  Google Scholar  * Asayama K, Fujiwara T, Hoshide S, Ohkubo T, Kario K, Stergiou GS, et al. Nocturnal blood pressure measured by home devices:

evidence and perspective for clinical application. J Hypertens. 2019;37:905–16. Article  CAS  PubMed  Google Scholar  * Kario K, Tomitani N, Iwashita C, Shiga T, Kanegae H. Simultaneous

self-monitoring comparison of a supine algorithm-equipped wrist nocturnal home blood pressure monitoring device with an upper arm device. J Clin Hypertens (Greenwich). 2021;23:793–801.

Article  CAS  PubMed  Google Scholar  * Tomitani N, Hoshide S, Kario K. Accurate nighttime blood pressure monitoring with less sleep disturbance. Hypertens Res. 2021;44:1671–3. Article 

PubMed  Google Scholar  * Tomitani N, Kanegae H, Kario K. Reproducibility of nighttime home blood pressure measured by a wrist-type nocturnal home blood pressure monitoring device. J Clin

Hypertens (Greenwich). 2021;23:1872–8. Article  PubMed  Google Scholar  * Tomitani N, Kanegae H, Kario K. Comparison of nighttime measurement schedules using a wrist-type nocturnal home

blood pressure monitoring device. J Clin Hypertens (Greenwich). 2021;23:1144–9. Article  PubMed  Google Scholar  * Ota Y, Kokubo A, Yamashita S, Kario K. Development of small and lightweight

beat-by-beat blood pressure monitoring device based on tonometry. Annu Int Conf IEEE Eng Med Biol Soc. 2021;2021:5455–8. PubMed  Google Scholar  * Kokubo A, Kuwabara M, Nakajima H, Tomitani

N, Yamashita S, Shiga T, et al. Automatic detection algorithm for establishing standard to identify “surge blood pressure”. Med Biol Eng Comput. 2020;58:1393–404. Article  PubMed  PubMed

Central  Google Scholar  * Kokubo A, Kuwabara M, Ota Y, Tomitani N, Yamashita S, Shiga T, et al. Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass

index. J Clin Hypertens (Greenwich). 2022;24:271–82. Article  CAS  PubMed  Google Scholar  * Kario K, Hoshide S, Tomitani N, Nishizawa M, Yoshida T, Kabutoya T, et al. Inconsistent control

status of office, home, and ambulatory blood pressure all taken using the same device: the HI-JAMP study baseline data. Am J Hypertens. 2023;36:90–101. Article  PubMed  Google Scholar  *

Tomitani N, Hoshide S, Kario K, investigators H-Js. Diagnostic agreement of masked uncontrolled hypertension detected by ambulatory blood pressure and home blood pressure measured by an

all-in-one BP monitoring device: The HI-JAMP study. Hypertens Res. 2023;46:157–64. Article  PubMed  Google Scholar  * Watanabe T, Tomitani N, Yasui N, Kario K. Validation of an ambulatory

blood pressure monitoring device employing a novel method to detect atrial fibrillation. Hypertens Res. 2022;45:1345–52. Article  PubMed  Google Scholar  * Watanabe T, Hoshide S, Kario K.

New concept of pulse irregularity for the detection of atrial fibrillation during blood pressure measurement. Hypertens Res. 2022;45:1520–2. Article  PubMed  Google Scholar  * Watanabe T,

Tomitani N, Yasui N, Kabutoya T, Hoshide S, Kario K. Assessment of a new algorithm to detect atrial fibrillation in home blood pressure monitoring device among healthy adults and patients

with atrial fibrillation. J Clin Hypertens (Greenwich). 2021;23:1085–8. Article  PubMed  Google Scholar  * Kabutoya T, Takahashi S, Watanabe T, Imai Y, Uemoto K, Yasui N, et al. Diagnostic

accuracy of an algorithm for detecting atrial fibrillation in a wrist-type pulse wave monitor. J Clin Hypertens (Greenwich). 2019;21:1393–8. Article  PubMed  Google Scholar  * Kario K,

Nishizawa M, Hoshide S, Shimpo M, Ishibashi Y, Kunii O, et al. Development of a disaster cardiovascular prevention network. Lancet 2011;378:1125–7. Article  PubMed  Google Scholar  *

Nishizawa M, Hoshide S, Okawara Y, Matsuo T, Kario K. Strict blood pressure control achieved using an ICT-based home blood pressure monitoring system in a catastrophically damaged area after

a disaster. J Clin Hypertens (Greenwich). 2017;19:26–9. Article  PubMed  Google Scholar  * Nishizawa M, Fujiwara T, Hoshide S, Sato K, Okawara Y, Tomitani N, et al. Winter morning surge in

blood pressure after the Great East Japan Earthquake. J Clin Hypertens (Greenwich). 2019;21:208–16. Article  PubMed  Google Scholar  * Kario K, Tomitani N, Kanegae H, Yasui N, Nagai R,

Harada H. The further development of out-of-office BP monitoring: Japan’s ImPACT Program Project’s achievements, impact, and direction. J Clin Hypertens (Greenwich). 2019;21:344–9. Article 

PubMed  Google Scholar  * Umishio W, Ikaga T, Kario K, Fujino Y, Hoshi T, Ando S, et al. Cross-sectional analysis of the relationship between home blood pressure and indoor temperature in

winter: a nationwide smart wellness housing survey in Japan. Hypertension 2019;74:756–66. Article  CAS  PubMed  Google Scholar  * Umishio W, Ikaga T, Kario K, Fujino Y, Suzuki M, Ando S, et

al. Impact of indoor temperature instability on diurnal and day-by-day variability of home blood pressure in winter: a nationwide Smart Wellness Housing survey in Japan. Hypertens Res.

2021;44:1406–16. Article  PubMed  PubMed Central  Google Scholar  * Yano Y. Blood pressure management in an ecosystem context. Hypertens Res. 2020;43:989–94. Article  PubMed  Google Scholar

  * Umishio W, Ikaga T, Kario K, Fujino Y, Suzuki M, Ando S, et al. Role of housing in blood pressure control: a review of evidence from the Smart Wellness Housing survey in Japan. Hypertens

Res. 2023;46:9–18. Article  PubMed  Google Scholar  * Kanegae H, Suzuki K, Fukatani K, Ito T, Harada N, Kario K. Highly precise risk prediction model for new-onset hypertension using

artificial intelligence techniques. J Clin Hypertens (Greenwich). 2020;22:445–50. Article  PubMed  Google Scholar  * Koshimizu H, Kojima R, Kario K, Okuno Y. Prediction of blood pressure

variability using deep neural networks. Int J Med Inf. 2020;136:104067. Article  Google Scholar  * Krittanawong C, Bomback AS, Baber U, Bangalore S, Messerli FH, Wilson, et al. Future

Direction for Using Artificial Intelligence to Predict and Manage Hypertension. Curr Hypertens Rep. 2018;20:75. Article  PubMed  Google Scholar  * Kario K, Nomura A, Harada N, Okura A,

Nakagawa K, Tanigawa T, et al. Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial. Eur Heart J. 2021;42:4111–22. Article 

PubMed  PubMed Central  Google Scholar  * Kario K, Nomura A, Harada N, Tanigawa T, So R, Nakagawa K, et al. A multicenter clinical trial to assess the efficacy of the digital therapeutics

for essential hypertension: Rationale and design of the HERB-DH1 trial. J Clin Hypertens (Greenwich). 2020;22:1713–22. Article  PubMed  Google Scholar  * Nomura A, Tanigawa T, Kario K,

Igarashi A. Cost-effectiveness of digital therapeutics for essential hypertension. Hypertens Res. 2022;45:1538–48. Article  PubMed  PubMed Central  Google Scholar  * Kario K, Nomura A, Kato

A, Harada N, Tanigawa T, So R, et al. Digital therapeutics for essential hypertension using a smartphone application: A randomized, open-label, multicenter pilot study. J Clin Hypertens

(Greenwich). 2021;23:923–34. Article  PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS This review manuscript refers the part of the findings of researches supported by Omron

Healthcare Co., A&D Co. and CureApp. Inc. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan

Kazuomi Kario Authors * Kazuomi Kario View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Kazuomi Kario. ETHICS

DECLARATIONS CONFLICT OF INTEREST The author declares no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in

published maps and institutional affiliations. RIGHTS AND PERMISSIONS Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a

publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing

agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kario, K. Digital hypertension towards to the anticipation medicine. _Hypertens Res_ 46, 2503–2512

(2023). https://doi.org/10.1038/s41440-023-01409-5 Download citation * Received: 28 April 2023 * Revised: 19 July 2023 * Accepted: 23 July 2023 * Published: 23 August 2023 * Issue Date:

November 2023 * DOI: https://doi.org/10.1038/s41440-023-01409-5 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a

shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * Digital hypertension *

Anticipation medicine * Blood pressure variability * Hypertension management * Wearable blood pressure monitoring * Digital therapeutics