Blood pressure measurements are important, so avoiding errors are crucial. Using a wrist blood pressure cuff can complicate matters. The differences in technique between a wrist cuff and upper arm cuff can produce false readings if not performed properly. Because of this, a question I get asked from many is, how to use a wrist blood pressure cuff?
How to use a wrist blood pressure cuff:
- Sit upright in a chair with feet flat on the floor and back supported.
- Place the wrist cuff around the bare wrist.
- Position the monitor on the inside of the wrist.
- Adjust the wrist cuff, so it’s snug with no space between the cuff and wrist.
- The end of the cuff should be approximately 1/2 to 1 inch from the wrist crease at the bottom of the palm.
- The wrist cuff should not cover the wrist bone protrusion on the outside of the wrist.
- Comfortably rest the elbow on a flat surface and raise the wrist to heart level.
- Keep the wrist and hand relaxed.
- Do not bend the wrist backward or forward.
- Begin the measurement.
Failure to follow any of the steps may result in false blood pressure readings. This can give you or the doctor a misdiagnosis and have an adverse affect on your blood pressure goals and treatments. What good is checking your pressure if you’re not obtaining an accurate reading?
This blog post will further explain each step and explain why they are necessary. In addition, I’ll cover other habits which must be followed when using a wrist cuff. If you’re looking to purchase a new wrist monitor, you can check out the one I recommend in my blog post, right here.
How To Use a Wrist Blood Pressure Cuff
Prior to applying the monitor to your wrist, the following guidelines should be followed:
- Avoid all caffeine, smoking, exercise and eating 30 minutes prior to measuring. All of these activities are known to increase your BP in the short-term. Coffee may raise it up to 12.6 systolic higher 1.
- Empty your bladder before starting your relaxation and quiet time.
- Have 5 minutes of relaxation and quiet time while sitting in the same chair you’ll be using for your measurement.
BP Tip: You can lower BP naturally by changing how you breathe. There’s a device approved by the FDA and The American Heart Association. It guides your breathing a few minutes a day which has been proven to lower BP. You can check it out in the manufacturer’s website by clicking here.
Every part of your measurement is important including the proper body positioning. You should be seated in an upright chair with your back supported. An upright dining room chair with a tall back is ideal. Your feet should be flat on the floor and your legs uncrossed. Crossed legs were shown to increase BP by as much as 7 mmHg systolic and 2 mmHg diastolic 2.
Applying The Wrist Cuff
The first thing is to make sure your wrist doesn’t have any clothing over it. It’s ideal to wear short sleeves or a pushed up long sleeve shirt. If you’re rolling up a long sleeve, make sure its loose, if not it can create a tourniquet effect. Applying a cuff over clothing can increase systolic between 10 and 50 mmHg higher 3. I wrote a whole blog post on this which included a study of over 2,000,000 BP measurements, How Tight Clothing and Long Sleeves Can Affect Blood Pressure.
The monitor should be on the inside of your wrist and forearm and tightened snug. There shouldn’t be any loose space between the cuff and your skin but not too tight either. Take a look on the outside of your wrist where the bone protrudes on the little finger side. The cuff should not be covering the protrusion.
The edge of the cuff should be approximately 1/2 to 1″ away from the crease of your wrist or where the bottom of your palm is.
How do you know which wrist to use? It’s typical to have a slight difference in blood pressure between each arm. The arm that consistently has the higher readings should be the wrist to use 4. I tell a story of a 69-year-old woman who was given unnecessary treatments and a longer hospital stay because the nurses used different arms. You can read about it in my blog post, Why Blood Pressure Can be Different in Each Arm.
Arm and Cuff Position
Now that you have your body in the proper position and the cuff on your wrist, start your 5 minutes of quiet time. Once you’re relaxed, the wrist and arm position are the next step. Just like with an upper arm cuff, it’s extremely important to have the wrist cuff at the height of your heart 5.
There are two ways to accomplish this. The first is to rest your elbow on the table surface in front of you. Then bend your elbow raising the cuff up to the same height as your heart. Most decent monitors have a heart height sensor which will let you know when the cuff is at the correct height. Please read your monitor manual for the specific instructions on this for your particular monitor.
The Omron wrist monitor I recommend, requires the distance from the top of your seat to the top of the table to be between 10 to 14″ apart. If the distance doesn’t fall into the range, they say to turn off the sensor and determine the height yourself. In addition, the size of persons torso may make the sensor inaccurate. If either one of these are the situation for you, follow the second technique.
The second technique involves stopping the cuff at the height you determine where your heart is. You can keep your elbow in the same position as the first technique above. Or you can slide it out to the side and position the cuff close to your chest to help determine the correct height. Once the cuff is at the correct height, keep it there for the measurement.
The next step is to activate your device and start the measurement. During the measurement, remain relaxed and don’t move your body or arm. Take three measurements with about 1 to 2 minutes of rest in between. Your monitor may automatically store your readings, either way record your results in a log.
If you don’t necessarily require a wrist monitor, you should use an upper arm monitor which has been shown to be more accurate.
- American Heart Association Journal Circulation: Coffee Acutely Increases Sympathetic Nerve Activity and Blood Pressure Independently of Caffeine Content
- National Center for Biotechnology Information: The effect of crossing legs on blood pressure
- American Heart Association: Are blood pressure measurement mistakes making you chronically ill?
- National Center for Biotechnology Information: Accurate Blood Pressure Measurements and the Other Arm
- Wiley Online Library: Arm Position During Ambulatory Blood Pressure Monitoring: A Review of the Evidence and Clinical Guidelines