Build a Medical-Grade App to Monitor Blood Pressure

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Search “heart rate monitor” in Google Play Store or Apple App Store and you will find dozens of apps that can take your pulse.

Do the same on “Blood Pressure Monitor” and you’ll find a bunch of apps too. But it doesn’t take much reading of the fine print to see that none actually record your blood pressure – they’re just data trackers for systolic and diastolic numbers from a traditional blood pressure cuff. And that’s despite the fact that blood pressure measurements are generally far more important to health — and despite the fact that the standard approach of getting your arm tied hasn’t changed in 125 years.

Riva Health’s system promises to take medical-grade blood pressure readings using a cell phone and use frequent measurements to dramatically improve blood pressure management. Image courtesy of Riva Health.

Tracking blood pressure using standard smartphone tools — specifically bright flash light and a camera — is proving much, much harder than detecting the blunt emanations from a beating human heart.

There’s at least one app that seems to be able to do this, although you can’t find it online yet. Its creators at startup Riva Health are working hard with the UCHealth Care Innovation Center to develop more than just a download. The goal is to harness near-ubiquitous enabling smartphone technology to take and save frequent and highly accurate blood pressure (and, yes, heart rate) readings without the cuff. These measurements will in turn enable a consistent, daily program – involving both artificial intelligence and real human medical experts – capable of managing patients’ blood pressure much more quickly and accurately than is typical at this time.

It could be a big deal. Dr. Richard Zane, chair of the faculty of emergency medicine at CU School of Medicine and director of innovation at UCHealth, describes hypertension – high blood pressure – as having an “exponential impact” on health human due to its complicity in many other disease states: heart attacks, strokes, aneurysms, heart failure, eye damage, kidney damage, metabolic syndrome, dementia, the list goes on. And high blood pressure is extremely common. In the United States, 116 million people – nearly half of the adult population – suffer from high blood pressure; only about 20% of them have it under control.

“One billion people on this planet have hypertension,” Zane said. “Half to two-thirds are not properly managed.”

A photo of Dr. Richard Zane
Dr. Richard Zane, director of innovation at UCHealth and professor and chair of emergency medicine at the CU School of Medicine.

cell phone blood pressure detection software

Riva is among 16 partners that the UCHealth Care Innovation Center has on a list of companies specializing in areas ranging from data science and artificial intelligence, to digital patient experience, personalized medicine, tools virtual and augmented reality, wearable devices and virtual health. These partners are the precious metals mined from more than 700 proposals that Zane and his colleagues have reviewed over the past three and a half years. CU Innovations, a partner of UCHealth and the Care Innovation Center, together invested $5 million in Riva in a $15.5 million opening funding round announced in March 2021. Most local money came from UCHealth, and that put Zane on the startup’s board.

That would seem like a big gamble for a new company with fledgling technology, but there’s more to the story. Co-founder and PhD bioengineer Tuhin Sinha had been leading the development of mobile phone blood pressure detection software for nearly five years under the Vital Labs umbrella. The software analyzes the blood pressure waveform detectable via a finger on the cell phone camera for 20-30 seconds, about the same time as it takes with a cuff (they film for 10-20 seconds , says Sinha). By the time Zane downloaded the app to his phone a few months ago, the system had proven itself. His first reaction: “Wow – it really works.”

Sinha’s co-founder was another risk-mitigator. Dag Kittlaus is a serial entrepreneur best known for co-founding the company that created Siri, which would later be acquired by Apple to appease and inform billions of dollars with her AI-powered voice. Kittlaus, a rare survivor of pancreatic cancer, wanted to channel his energies into a promising piece about healthcare. He grilled Sinha on everything from technology to a business plan. His satisfaction turned to enthusiasm and he signed on as CEO of Riva.

Monitoring programs for blood pressure application

While the idea of ​​getting medical-grade blood pressure readings using a non-medical device already in billions of pockets seems like the big story, Riva and Zane executives now seem much more interested in the potential of monitoring programs that this technological leap seems to allow.

The alarming shortcomings of current blood pressure management regimens boil down to intermittency. While there are armbands and home apps to track blood pressure over time, a minority of people with high blood pressure are dedicated users. It’s a problem, and even if you have the measurements, it often takes a trip to the doctor to make adjustments. The vast majority of patients with hypertension only have their blood pressure taken at the doctor’s office anyway. The doctor then adjusts the medications and sends the patient away until the next appointment.

Tuhin Sinha, co-founder of Riva Health.  Photo courtesy of Riva Health.
Tuhin Sinha, co-founder of Riva Health. Photo courtesy of Riva Health.

“The patient disappears and this period is relatively opaque,” ​​Sinha said.

Riva’s goal is to turn this staggered process – which can take weeks or months to bring blood pressure under control – into a continuous flow of care. If checking your blood pressure becomes as easy as scrolling through Instagram (and much less time-consuming), you can do it several times a day. Rather than a single giant pixel delivered occasionally via an armband, an accumulation of data points begins to paint a picture that displays sharper and faster. Sinha believes Riva patients will get their baseline blood pressure back under control within days rather than weeks or months, and that continued monitoring will keep it under much better control.

“We want to take these clinical measurements in real time, and we will have clinical staff monitoring them in real time. It becomes intensive cardiovascular disease management between visits instead of just reacting when a patient has chest pain,” Sinha said.

“Technology-Based Care”

For Zane, Riva Health is “democratizing blood pressure management” while also fitting nicely into UCHealth’s innovation portfolio to use AI and other technologies to combine virtual health (Zane prefers the term “technology-enabled care” due to misperceptions that virtual health is anything less than “real” health care) with in-person care to allow UCHealth and others to care for people in more effective and efficient way.

“I want doctors to only make doctor-level decisions, and the same goes for nurses and technicians,” he said. “I want technology to make things easier, not harder; faster, not slower; and lead us down the path of least resistance.

Riva’s blood pressure monitoring program would handle the basic blockage and fight of blood pressure management, he says, leaving the trickier clinical calls to UCHealth physicians. UCHealth pursues similar efforts in lipid management, diabetes, and wound care, Zane adds, and initiatives in virtual health and remote patient monitoring follow a similar playbook.

The UCHealth-Riva Health partnership — which Sinha described as “a great opportunity with a world-class institution” — goes beyond financial investment. Two clinical trials aim to prove Riva and Zane’s belief that remote high-frequency blood pressure monitoring will pay dividends in terms of patient well-being and effective care. Zane is confident that it will — and that Riva and others are helping move healthcare forward in the right direction. UCHealth will begin piloting the app in two clinical practices within the next month or two, Zane said.

“I think it’s emblematic of what will happen — and should happen — in many disease states,” Zane said.

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