Are wrist cuff blood pressure monitors accurate

Date Updated: 02/27/2021

Answer Section

Some wrist blood pressure monitors may be accurate if used exactly as directed. However, the American Heart Association recommends using a home blood pressure monitor that measures blood pressure in your upper arm and not using wrist or finger blood pressure monitors.

Wrist blood pressure monitors are extremely sensitive to body position. To get an accurate reading when taking your blood pressure with a wrist monitor, your arm and wrist must be at heart level. Even then, blood pressure measurements taken at the wrist are usually higher and less accurate than those taken at your upper arm. That's because the wrist arteries are narrower and not as deep under your skin as those of the upper arm.

Some people can't have their blood pressure measured at the upper arm because they have a very large arm or find blood pressure measurements painful. In these cases, measuring blood pressure at the wrist is acceptable.

It's common for blood pressure readings taken at home on any type of monitor to be different from those taken at your doctor's office. If you have a wrist blood pressure monitor, it's a good idea to take your monitor to a doctor's appointment. Your doctor can then check your blood pressure with both a standard upper arm monitor and a wrist monitor in the correct position in the same arm to check your wrist blood pressure monitor's accuracy. Also make sure to use a validated device.

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Not all blood pressure monitors are created equal, it seems. New research from Italy suggests that at-home, wrist blood pressure cuffs can be inaccurate if not done exactly right

The problem, it seems, may be in patient’s ability to get just the right positioning of the wrist, the researchers described in an article recently published in Hypertension Journal. The researchers trained 720 patients to use wrist devices, and then measured blood pressure at their home and in the doctor’s office with both a wrist monitor and upper arm device. The patients were then instructed to take measurements with both devices at home every morning and evening for a week.

A large percentage of the patients – 620 of them – took inaccurate measurements at home, with 433 of them off by 10 mm/hg.

Lead author Dr. Edoardo Casiglia, a clinical hypertension specialist at the University of Padua, Italy, told Reuters the only way to monitor blood pressure consistently is to trust patients to measure at home. But they found many patients are resting the wrist device below heart level, which gives falsely high numbers and could encourage a doctor to unnecessarily increase medication.

“Many devices are available, reliable and good,” Casiglia told Reuters. “Recently, many wrist devices have appeared on the market, but they require the wrist to be placed exactly at heart level.”

The researchers concluded that the use of wrist devices for home self-measurement leads to “frequent detection of falsely elevated blood pressure values,” and attributed this to patients' poor memory and rendition of instructions.

“Even after a training course, we found that choosing correct wrist position largely depends on cognitive pattern, which can be influenced by age and education,” Casiglia said to Reuters. “This is why the wrist devices are not good for everybody.”

Blood pressure monitors allow patients to keep track of their blood pressure measurements while at home, rather than relying only on doctor visits. But not all blood pressure monitors are created equal. Read on to discover how they work and whether patients should use an arm or wrist blood pressure monitor.

What Is a Blood Pressure Monitor?

We’re all familiar with getting our blood pressure taken during an annual physical or doctor visit. But patients with chronic blood pressure issues need to have it measured more than once or twice a year, and that’s where blood pressure monitors come in. Blood pressure monitors allow patients to take their blood pressure at home, without the assistance of a nurse or other medical professional. They feature a digital screen that gives a readout of your systolic and diastolic blood pressure, as well as your pulse per minute. The screen either attaches to the armband via a tube or can be strapped directly to the wrist.

How Do You Use a Blood Pressure Monitor?

Patients should avoid smoking, exercising and drinking caffeine for at least 30 minutes before they take their measurements, as these activities can all increase heart rate and effect blood pressure. They should sit quietly for at least five minutes before using the blood pressure monitor. Patients should sit straight up on a chair with good back support, with their upper arm at heart level and their hand supported (not lifted in the air). They should sit with their legs uncrossed and their feet flat on the floor.

Patients should take their blood pressure measurements at the same time of day each time. They should also take a few readings one minute apart and look at the results to get an average. If their blood pressure suddenly spikes during one reading, they should wait five minutes and try again. At-home machines aren’t as accurate as the ones that doctors and nurses use, so one high reading is not necessarily an indication of an emergency.

While patients do not need a prescription in order to buy a blood pressure monitor, encourage them to bring it into the office on their next visit so you can test the model they choose against your clinical-quality sphygmomanometer. This will give you and the patient a good idea of how accurate the at-home model readings are.

Should You Use an Arm or Wrist Blood Pressure Monitor?

Patients may have questions for you about which model of blood pressure monitor they should buy. (You can also encourage them to reach out to a doctor or pharmacist for additional advice.) Many patients are drawn to wrist blood pressure monitors because of their convenient size and portability. However, wrist blood pressure monitors deliver less reliable readings, which is why the American Heart Association recommends an automatic, cuff-style, bicep (upper-arm) monitor.

Wrist monitors are less accurate than arm monitors because the arteries in your wrist are narrower and closer to your skin as compared your upper arm, which tends to result in higher and more volatile blood pressure readings. Wrist monitors are also very responsive to body positions, and your hands tend to move around more than your upper arms. Plus, it’s more difficult to raise and maintain your hands at the level of your heart vs. your upper arm.

That being said, some people find it uncomfortable and even painful to get their blood pressure measured at their bicep, especially if they have large arms. In these cases, a wrist monitor might be a better choice.

No matter what style of blood pressure monitor the patient chooses, strongly recommend that they bring it into the office so that you can measure its reliability. This will also give you a chance to ensure that the patient is using the device correctly and to discuss any questions that they have. If the patient is a senior or a child–or pregnant–make sure that the model they choose has been validated in these conditions.

Now you know how to help patients choose the right blood pressure monitor and validate their reliability. And if you’re shopping for yourself, allheart offers a wide range of blood pressure devices, from digital at-home models to traditional manual sphygmomanometers. Don’t forget to check out our selection before you buy!

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