Wrist Blood Pressure Cuffs Are Not Recommended for Clinical Use
Your provider should be using an upper arm cuff, not a wrist cuff, for blood pressure measurement in clinical practice. The American Heart Association explicitly states that wrist monitors are not recommended for routine clinical use 1, 2.
Why Upper Arm Cuffs Are the Standard
Upper arm oscillometric monitors are the most reliable and preferred type of device for blood pressure monitoring, providing the most accurate measurements compared to wrist or finger monitors 2.
The brachial artery pressure (measured at the upper arm) is the measurement used in all epidemiological studies of hypertension and its consequences, making it the evidence-based reference method 1, 2.
The 2017 ACC/AHA Hypertension Guidelines specify that the cuff should be positioned on the upper arm at the level of the right atrium (midpoint of the sternum), with proper cuff sizing 1.
The Problem with Wrist Monitors
Wrist monitors have a critical disadvantage: the wrist must be held precisely at heart level during measurement, significantly increasing the possibility of erroneous readings 2.
Research comparing wrist devices to conventional upper arm measurement found mean differences of 16 mmHg systolic and 6 mmHg diastolic, with 40% of patients having clinically important differences exceeding ±20/±10 mmHg 3.
The study concluded that wrist blood pressure measurement has low reliability and cannot compete with the upper arm standard procedure 3.
Limited Exception for Wrist Monitors
Wrist monitors may only be acceptable in patients with morbid obesity when very large arm circumferences with short upper arm length cannot be correctly cuffed, even with a thigh cuff 1.
In such cases, a validated wrist blood pressure monitor held at the level of the heart may be used as an alternative 1.
If a correctly fitting upper arm cuff cannot be applied in obesity, wrist measurement should be considered over using an incorrectly fitting standard cuff (which has sensitivity of only 0.73 and specificity of 0.76) 4.
What You Should Do
Request that your provider use an upper arm cuff for blood pressure measurement, as this is the guideline-recommended standard of care 1.
If your provider continues using a wrist cuff without a valid clinical reason (such as inability to fit an upper arm cuff), this represents a deviation from established clinical guidelines 2.
Ensure any device used has been validated according to standard international protocols (AAMI or British Hypertension Society) 1, 2.