Wrist monitors have gained in popularity lately for various reasons. Similar to an upper arm cuff monitor, the position of the arm is crucial for obtaining an accurate measurement. Because of the increased popularity, many people have been inquiring, what is the correct arm position for a wrist blood pressure monitor?
To obtain the correct arm position for a wrist blood pressure monitor the elbow should rest comfortably on a level surface. The elbow should then be bent and the wrist raised so the cuff is at heart level. The wrist and hand have to remain relaxed and not bent backward or forward.
If arm position is unproperly executed, there’s a decent chance your readings will be inaccurate 1. I’ll inform you about tips to help accomplish the correct position and the most common errors to avoid that most people are making right now. In addition, I’ll explain how your readings will be inaccurate and by how much.
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Arm Position For Wrist Blood Pressure Monitor
The first step for correct arm position is placing your elbow on a flat surface. There are a few steps you must perform prior to this step for your measurements to be accurate. Many of them are the same as if you were using an upper arm monitor.
- First sit down in an upright chair similar to a dining room chair. Do not use one that angles back or a soft cushiony couch.
- Your back should be supported against the upright part of the chair.
- Keep your legs uncrossed and feet flat on the floor. Crossed legs have been shown in studies to increase blood pressure by as mush as 7 mmHg 2.
- Apply the wrist cuff onto your wrist according to the proper guidelines. If you’re unsure about how to perform this step properly, you can read how in my blog post, How to Use a Wrist Blood Pressure Cuff.
After setting your body and wrist cuff into position, place your elbow on a flat surface. The surface should be level like the top of a table or desk. You’ll position your chair close enough to the flat surface or table so you don’t have to lean forward.
Next, raise your wrist by bending your elbow until the cuff has reached heart level 3. Heart level is approximately the midpoint of your sternum. This is half way from where your collar bones meet near the bottom of your neck to where the bottom of your ribcage curves up and meets together.
If it’s possible, try keeping your arm relaxed and rest your hand against your chest area 4. The more relaxed and support you can provide to your arm the better. An unsupported arm can raise blood pressure because your muscles have to tense slightly. You’d be surprised how much this can raise BP! I wrote a blog post about it which you can check out right here, Unsupported Arm Blood Pressure.
Now you can begin your measurement. Make sure you keep your wrist and hand relaxed. In addition, don’t bend them backward or forward.
Another option is to use an upright chair that has a flat comfortable side arm where you’ll rest your elbow. Bend your elbow and raise your wrist like using a table, except your arm is more to the side rather than in front of your torso. In addition, the height of the chair arm should be comfortable enough so your arm is not awkward when the wrist is raised.
Are you interested in purchasing a new wrist monitor? Check out the one I recommend in my review blog post by clicking here, Wrist Monitor.
Most Common Errors With Arm Position For A Wrist Monitor
Many people make mistakes using both an upper arm or wrist monitor. While I perform my research or observe people in general, I witness more mistakes with the wrist monitor 5. Unfortunately, these mistakes are part of what gives wrist monitors a bad reputation for being inaccurate. The following are the most common:
Using an arm position they would use with an upper arm cuff. I see many people resting their wrist down on their thighs while sitting down. While this would place an upper arm cuff close to heart level, it leaves a wrist cuff well below.
Using the correct arm position but standing up. I see this mistake performed more by people who are exercising. I’ve seen runners stop and check their pressure while still standing. I can’t count how many times I’ve seen a bicycle rider perform this mistake. They’ll stop the bike and check their pressure with a wrist cuff while still standing and balancing the bike.
Without these mistakes, you may still question the accuracy of a wrist monitor. You’d be shocked how much a wrist cuff differed from an upper arm cuff in studies. I wrote all about that in my blog post, Are Wrist Blood Pressure Monitors Accurate?
How Arm Position Affects Blood Pressure
Failure not to support your elbow on a flat surface, like noted earlier, can result in inaccurate measurements. Some people prefer keeping their elbow on no surface at all and rest their hand on their opposite shoulder. Others like holding their arm straight out horizontal. While all three arm positions maintain the wrist cuff at heart level, they result in different readings.
In a study of 50 patients, they measured blood pressure with a wrist cuff in all three of these arm positions. They then compared all three measurements to one completed with a traditional mercury sphygmomanometer, like the ones used in a physician office. The measurements with the elbow supported on a desk were closer to the traditional sphygmomanometer than the other two arm positions 6.
Similar to an upper arm cuff, not using the correct arm position with a wrist monitor will likely result in a false reading 7. A wrist cuff held down near the thighs will give a false reading higher. Every inch a BP cuff is held below heart level has been shown to increase measurements by 2 mmHg 8. Depending on the length of your torso, positioning a wrist cuff down near your thigh may equal about 8″ too low!
- National Center for Biotechnology Information: Inaccuracy of wrist-cuff Oscillometric blood pressure devices: an arm position artifact?
- National Center for Biotechnology Information: The effect of crossing legs on blood pressure
- Omron Healthcare: How to Measure Blood Pressure
- American Medical Association: Using a wrist cuff to measure blood pressure
- National Center for Biotechnology Information: Poor Reliability of Wrist Blood Pressure Self-Measurement at Home: A Population-Based Study
- National Center for Biotechnology Information: The impact of arm position and pulse pressure on the validation of a wrist-cuff blood pressure measurement device in a high risk population
- National Center for Biotechnology Information: Blood pressure monitor with a position sensor for wrist placement to eliminate hydrostatic pressure effect on blood pressure measurement
- Wiley Online Library: Arm Position During Ambulatory Blood Pressure Monitoring: A Review of the Evidence and Clinical Guidelines