What is the best wearable device for blood pressure (BP) monitoring?

Best Wearable Device for Blood Pressure Monitoring

Upper arm oscillometric monitors are the most reliable and preferred type of wearable device for monitoring blood pressure, providing the most accurate measurements compared to wrist or finger monitors. 1

Types of BP Monitoring Devices and Their Accuracy

• Upper arm oscillometric monitors are recommended by the American Heart Association as they provide measurements consistent with those used in epidemiological studies of hypertension and its consequences 1
• Wrist monitors have significant limitations as they require precise positioning at heart level during measurement, increasing the risk of erroneous readings 1
• Finger monitors are considered very inaccurate and should not be avoided for blood pressure monitoring according to the American College of Cardiology 1
• Devices should be validated according to standards set by the Association for the Advancement of Medical Instrumentation (AAMI) and the European Society of Hypertension International Protocol 1

Evidence for Specific Devices

• Among wrist devices, the Omron HeartGuide has been studied extensively but shows mixed results:

  • One study found it systematically underestimated systolic BP by 8.46 mmHg and diastolic BP by 2.53 mmHg compared to standard measurements 2
  • Another study comparing it with a conventional ambulatory BP monitor found acceptable differences both in-office (0.8 ± 12.8 mm Hg) and out-of-office (3.2 ± 17.0 mm Hg) 3
  • A 2024 study showed the Omron HeartGuide significantly underestimated BP compared to the validated Welch Allyn ProBP 3400, with differences of 10.4 mmHg for systolic and 3.2 mmHg for diastolic readings 4
  • Despite limitations, the Omron HeartGuide had fewer measurement failures compared to other wearable technologies (BPro and Heartisans devices) 2

• The Omron HEM-650 wrist device achieved a grade B for both systolic and diastolic BP according to British Hypertension Society protocol testing in emergency settings 5

Technology Considerations

• EKG-based devices are more accurate than photoplethysmography (PPG) based systems for heart rhythm detection 6
• PPG technology uses optical sensors but is more susceptible to motion artifacts and can be affected by factors such as tattoos and darker skin tones 6
• Infrared-based BP monitors (like Smart Wear) have shown poor correlation with conventional methods and are not recommended 7

Proper Measurement Technique

• Take readings while sitting quietly after 5 minutes of rest, with the arm supported on a flat surface at heart level 1
• Take at least 2-3 readings at one time with 1-minute intervals between readings 1
• Avoid smoking, caffeine, or exercise within 30 minutes before measurement 1
• Use a monitor with a properly fitted cuff to ensure accurate readings 1

Common Pitfalls to Avoid

• Using non-validated devices that may provide inaccurate readings 1
• Improper positioning of the arm during measurement 1
• Incorrect cuff size, particularly for patients with larger arm circumference 1
• Taking single readings instead of multiple readings at each session 1
• Not bringing the home monitor to clinic visits to verify accuracy against office equipment 1

Conclusion

Based on the most recent and highest quality evidence, traditional upper arm oscillometric monitors remain the gold standard for accurate BP monitoring 1. While wearable watch-type devices like the Omron HeartGuide show promise for convenience, they still demonstrate clinically significant measurement differences compared to validated devices 4, 2. For patients prioritizing accuracy over convenience, an upper arm monitor validated by recognized standards should be recommended.