It takes a special skill set to make something as repetitive, boring, stressful, and annoying as blood pressure (BP) monitoring look and feel good. While I'm lucky enough to still be too young and healthy to worry about my own BP, I do manage a small town pharmacy in Lebanon, which requires me to perform routine measurements on many patients.
Unroll the cuff, slide it around the arm, correctly position the diaphragm, close the cuff, adjust the stethoscope, inflate the cuff, let it slowly deflate while listening in, and finally remove everything after the readout is done. Rinse and repeat. It always feels like there are way too many steps involved than necessary. And the process never leaves a digital footprint to compare, properly track, or keep a history of the measurements. If only there was a better way.
QardioArm isn't the only bluetooth-connected cuff that aims to bring BP monitoring into the digital "smart everything" age, but it certainly is the most eye-catching. I had been following Qardio's ventures for a few months before CES 2015, but once I spotted them on the show floor and saw the device and app live, I knew the company had done its due diligence in both design and functionality, but most importantly in accuracy.
|Accuracy and certifications||QardioArm is FDA cleared, European and Canadian CE marked, and as accurate as my manual sphygmomanometer.|
|Design||It looks minimal, the cuff doubles as a cover, and the magnet system that holds it closed and turns it on and off is fuss-free.|
|Qardio App||There's almost nothing that I wanted the Qardio app to do that it doesn't already.|
|Simplicity and convenience||Unroll the cuff, wear it, open the app, tap start. Using QardioArm couldn't be any easier. And it's very convenient to have your entire history charted across days, locations, and situations.|
|Multiple measurements||You can set Qardio's app to take up to 3 measurements successively and show you the average for more accuracy.|
|Visitor mode||Because you may need to take someone else's BP.|
|Useless without a connected device||There's no physical button to inflate the cuff and no screen to read the results. QardioArm is practically a paperweight when it isn't connected to a phone or tablet.|
|Too reliant on the magnet||I'm not sure what would happen if you open the cuff and QardioArm doesn't turn on. There's no other way to use the unit.|
|Limited multiple user support||Only one user can be logged in at a time from the app. For 2 people to use QardioArm, you have to log out and sign in with the other profile, or install Qardio's app on another device.|
|No Android Wear app||Qardio is heavily promoting Apple Watch integration on its website, but Android Wear isn't supported despite having been available on the market much longer.|
Design: A Sci-Fi BP Monitor
Health instruments seldom look good. They're functional, and they are almost invariably built for their function, not their appeal factor. That's not the case with QardioArm. I have rarely taken the unit out without a patient asking if it's new, wondering what magical sauce it uses, or commenting about how unconventional the design is.
The main unit is a shiny plastic — white on mine, but other colors are available albeit more expensive — with no buttons, no screens, and nothing disturbing its clean lines aside from a hidden latch that opens the battery compartment and a small pinhole for resetting the device. It's enrolled in a black cuff that's attached to it and doubles as a cover for the unit. If you completely fold it, a magnet holds the end of the cuff tightly closed.
The cuff can wrap around arms sized between 22cm and 35cm. Its fabric and stitching are excellent, with strong velcro patches on the inside. And while there's no power button, simply pulling the magnet away to open the cuff turns the device on. It goes off after being closed and idle for a while.
That's it. No gauge, no hoses, no inflation bulb, and no stethoscope needed. It's minimal and it slightly looks like what BP monitors would be in a 1990's sci-fi movie that was set in 2020.
The downside of course is that there's no way to use QardioArm without a smart device. The lack of a screen is telling - you can't see any values unless you are connected to a phone/tablet. Plus, the command to inflate the cuff generates from the app, so it is impossible to make a blind measurement and wait until later to sync it with the device. That could be a major problem if you only have one phone for example and its Bluetooth connection is acting up. It could even be more of a problem if you pull the cuff and QardioArm doesn't turn on or isn't detected by your device. Although there are less components, there seem to be more potential failure points.
Usage: No Degrees Required
I couldn't tell you how many people think that BP measurements are an alien thing that must be difficult to learn and impossible to master. That's why it's important for modern BP monitors not to overwhelm or stress people out. You want the experience to be as frictionless as possible, especially for relatively older patients, and QardioArm delivers that. The only thing you need to do is unroll the cuff, slide it on your arm, and close it. Open the app and you should see a big green Start button. Tap that and the cuff inflates by itself, measures your BP, then deflates and displays the value on your device. It couldn't be any easier.
Even pairing QardioArm with a phone for the first time is a matter of tapping the two together. There are no pin codes, no need to know how to make your device discoverable via Bluetooth, and no stumbling blocks for the average user who wouldn't know how to walk around them. You only need to make sure that your device runs Android 4.4 or above and has Bluetooth 4.0 before you try using them together, but at this point, any phone or tablet released in the past year (and more) ticks these boxes.
Qardio App: Treasure Trove Of Options
Qardio's app pleasantly surprised me. After seeing the Applesque hardware design, I confess I was dead sure that the Android app would be an afterthought that barely works. I couldn't have been more wrong.
Sure, the design remains slightly iOS-inspired and there aren't any Material elements, but it doesn't stick out like a sore thumb on my Lollipop-running phone. I'd say it feels like a refined iteration of Holo that does the job of not looking very outdated.
Functionally, however, the Qardio app shines. After creating an account and inputting your profile details (name, age, height, weight, sex, and doctor's contact details), you land straight in the measurement section. There you'll see 4 drawings explaining how to use QardioArm and how to position the device correctly while seated or lying down.
Taking a BP measurement
Once you unroll the cuff, a big green Start button appears instead of the drawings and you're good to go. After the measurement is done, the results show up on the screen for the systolic pressure, diastolic pressure (both in mmHg), and the heart rate (pulse).
The app instantly lets you know if the heartbeat was irregular and visually color-codes the result: blue for hypotension, green for normal, yellow for prehypertension, light red for Stage 1 hypertension, and red for Stage 2 hypertension.
Regarding irregular heartbeats, Qardio explains:
If irregular heartbeat is detected during the measurement procedure, a message will be displayed. Repeat the measurement after one hour. If irregular heart beat is detected several times in a day or week, we recommend you discuss this with your doctor.
Under this condition, the wireless blood pressure monitor can keep functioning, but the results may be inaccurate. There are 2 conditions under which the signal of irregular heart beat will be displayed:
- The coeffcient of variation (CV) of pulse period >25%.
- The difference between adjacent pulse periods ≥0.14s and the number of such pulses constitutes more than 53 percent of the total number of pulses.
Swipe left to reveal the World Health Organization's (WHO) BP classification graph with yours pinned on it for a better understanding of how good, mild, or severe your current condition is. Finally, you can save the result, dismiss it, and add a note (handy for tracking how your mood or medications affect your health).
If enabled in the settings, the app will also append a location to your BP measurement. You can save these locations as home, work, gym, vacation, or doctor, and while they aren't important for an individual reading, they do provide some additional information over time. If your blood pressure is always high when you're at the in-laws, you have an unshakable proof to avoid or lessen those compulsory visits. You can also see if work stresses you more than home or vice versa, whether going to a higher altitude affects your health, and more.
Where the real benefit of using QardioArm shows up is in the History section of its app. 5 tabs let you browse your previous measurements in different fashions. I've already discussed the fourth tab that handles places and locations, so I'll talk about the remaining four here.
The first charts up the systolic and diastolic values using the same color coding options explained above. It can display them daily, weekly, or monthly, with a little slide-out box that shows the average, lowest, and highest value.
The second tab does the same thing but in list form, with the benefit of being able to tap on each one individually for the WHO classification graph and personal notes.
The third tab is a calendar view of your measurement days. It can provide a bird's-eye view of a patient's compliance, but I'd argue that the daily display in the chart tab can do the same thing, albeit with more scrolling. Clicking on a checked day doesn't show you the values for it, making this screen even less useful.
And the fifth tab
is basically the same as the first one, but only for diastolic pressure. I don't know why Qardio felt compelled to dedicate a separate tab for this, but it's there if you need it. is actually a chart of your heart rate, in similar fashion to the BP chart in the first tab.
And finally a sharing option on the top of the History section lets you send all your readouts to your doctor with a personal note.
One thing I know from anecdotal evidence is that BP measurement is contagious. If I'm checking patient A's BP and patient B comes into the pharmacy, they will invariably see the cuff and want to check theirs, even if they didn't have BP on their mind before stepping inside. If patient C follows them, they will want that too. And it's a domino effect that can't be stopped, especially when the monitor is as strange and enticing as QardioArm. I mean people need to experience it once.
So it's a good thing that Qardio includes a guest option — if others see you using it, they'll want to try it out. Flip the Visitor mode switch in the measurement tab and the app will take a reading but instead of offering to save it, it'll give you the option to email the result. Handy.
Unfortunately, there's no regular multiple users option inside the app. If you plan on using the Qardio unit with several persons, you will need to log out/in for each one. Otherwise, you can install the app on another device, pair it with Qardio, and log in with another profile.
Guides, Reminders, Slideshow, Social
Qardio's app is full of more nice little touches. There is an option to set up reminders for measurements, guides for taking a BP, replacing the batteries, and more, a social element to follow friends and family members' BP, and a cool slideshow setting that plays images from your device while taking the measurement. That's thoughtful. If enabled, it will resort to stock Qardio images when in visitor mode, to protect your privacy. Double thoughtful.
Accuracy And Trustworthiness
Qardio claims that QardioArm "measures blood pressure with a resolution of 1 mmHg and pulse with 1 beat/min. The accuracy is +/- 3 mmHg or 2% of readout value for blood pressure, and +/- 5% of readout value for pulse." Based on my personal consecutive comparisons between QardioArm and a sphygmomanometer, these claims are largely right. I never found any surprising discrepancy between both readouts, always ending up with the same value within 5 mmHg. Given that a person's position and shifting state might influence their blood pressure over a few minutes, that can explain why the difference was sometimes slightly larger than 3mm on my consecutive measures with both devices.
But don't take my word. QardioArm has been clinically validated and is approved by most major health commissions. The company's website explains that QardioArm "has undergone independent, formal clinical validation according to ANSI/AAMI/ISO 81060-1:2007, ANSI/AAMI/ISO 81060-2:2009, ANSI/AAMI/IEC 80601-2-30:2009, as well as British Standard EN 1060-4:2004. QardioArm is a regulated medical device: FDA cleared, European CE marked and Canadian CE marked."
What improves QardioArm's accuracy is an option to take multiple, successive measurements for a better average readout. It can be set to measure twice or thrice, with pauses from 15 to 60 seconds in between. The average value is then calculated and presented as the final result.
At $99 for the white version (currently $94 on Amazon), QardioArm is in the same price range as similar offerings from iHealth and Withings, but it's significantly more expensive than good ol' digital blood pressure monitors. Is there a real benefit to using an app instead of a small black and white screen on a device with memory for previous readouts? Yes, and Qardio tries its damned best to prove it. The app is chockfull of options to justify this price hike, from charts to reminders, slideshows, doctor emailing, places tracking, personal notes, there's a lot of added value in using QardioArm instead of a regular digital blood pressure monitor.
While there are some downsides to an all-digital solution, mainly in the impossibility to do anything without a connected device, QardioArm proved to be nice, simple, useful, and reliable enough to become my go-to blood pressure monitor. The latter point is the most important one, but I have to admit that the fact it isn't bad on the eyes wasn't a poor argument either.