Smartwatch-Derived Exercise Metrics as Predictors of Early Hypertension: A Prospective Observational Study

Background: Early detection of hypertension is crucial for cardiovascular prevention. Smartwatch-derived physiological and activity metrics may offer a practical tool for identifying individuals at risk before clinical onset. Methods: In this 12-month prospective study, 230 normotensive adults (30–60 years) were monitored using smartwatches recording heart rate variability, resting heart rate, and moderate-to-vigorous physical activity . Results: Twenty-eight participants (12.2%) developed hypertension. Those with new-onset hypertension had lower heart rate variability (42.6 ± 10.8 vs. 56.1 ± 12.9 ms, p  < 0.001) and lower moderate-to-vigorous physical activity (38.4 ± 14.2 vs. 57.9 ± 16.7 min/day, p  < 0.001). Reduced heart rate variability and moderate-to-vigorous physical activity independently predicted hypertension. Conclusions: Smartwatch-derived autonomic and exercise metrics can identify normotensive adults at risk of developing hypertension, supporting their role as digital biomarkers in preventive cardiology.