Passive Toilet Seat-Based Monitoring Versus Traditional Blood Pressure Telemonitoring in Older Adults: A Crossover Study

Background: Home blood pressure (BP) monitoring can support hypertension care, but only when readings are collected consistently. Traditional telemonitoring (TT) with a BP cuff and scale requires active daily use, which may be difficult to sustain for some older adults. Aims: To compare adherence to The Heart Seat(R) (THS), a passive toilet seat-based cardiovascular monitoring platform, with adherence to TT using a BP cuff and scale in older adults with cardiovascular disease. Methods: In a 12-week, 2-period, 2-sequence crossover study, 49 community-dwelling adults aged 55 to 85 years at enrollment used THS and TT for 6 weeks each. Adherence, participant experience, self-reported health measures, hypertension history, and intake cuff-based BP were analyzed. THS-derived BP values were not evaluated. Results: Hypertension history was common: 34 participants (69.4%) self-reported high BP/hypertension, and mean intake BP was 119.7/74.2 mm Hg. THS adherence was higher than TT adherence (93% vs 73%; p < .001). The same pattern was observed among participants with self-reported high BP (94.6% vs 77.6%) and among those with elevated or hypertensive-range intake BP (94.5% vs 78.0%). THS adherence remained stable across the device phase, while TT adherence declined by the final study week. Conclusion: In an older adult cardiovascular sample with hypertension history, participants used the passive monitoring approach more consistently than the traditional BP cuff and scale. Future studies should evaluate whether higher adherence to passive monitoring can support validated BP capture, clinical action, and hypertension-related outcomes.