Wrist vs. Upper-Arm Blood Pressure Monitors: Which Is More Accurate?

What the guidelines say

• American Heart Association (patient guidance): use an automatic upper-arm cuff monitor. Wrist and finger monitors aren't recommended because they give less reliable readings.
• AHA 2019 scientific statement on measurement: strong reservations about wrist devices unless measuring at the upper arm isn't feasible, and clinicians should recommend only validated upper-arm cuff devices.
• 2024 ESC guideline: home monitoring is done with an upper-arm cuff device. If no upper-arm cuff fits because of significant obesity, the lower arm or wrist can be considered.
• STRIDE BP: wrist devices are generally not recommended, because of lower accuracy and how hard they are to use correctly.

So the sources agree: start with an upper-arm monitor, and treat a wrist monitor as the option when that doesn't work for you.

Why wrist readings are harder to get right

The AHA's 2019 statement names two problems. The sensor has to sit over the radial artery, and bending the wrist makes that harder. And the wrist has to be at heart level: blood pressure measured below the heart reads too high, and above it reads too low.

On an arm resting on a table, an upper-arm cuff sits roughly at heart level. A wrist has to be deliberately raised and held there. An older AHA statement (Pickering, 2005) put the error from position at about 2 mmHg per inch above or below heart level, and possibly 10 mmHg or more. A later study (Adiyaman, 2006) measured a smaller effect, about 0.5 mmHg per centimetre. The size varies; the direction doesn't.

Fewer wrist monitors are validated

The AHA's 2019 statement notes that wrist devices have only been able to pass validation studies in the past decade. STRIDE BP's home list, as generated on 22 October 2026, counted 55 validated wrist devices on the market, against 350 upper-arm devices.

Buying online makes the gap wider. A 2020 study of monitors sold online in Australia (Picone, Hypertension) found 18.3% of upper-arm devices and 8.0% of wrist-cuff devices were validated, and none of the wrist-band wearables.

When a wrist monitor makes sense

The main reason is arm size. If your upper arm is larger than an extra-large cuff covers, the AHA's 2019 statement says blood pressure may be measured at the wrist, and the ESC says the same where no cuff fits. Check first: our cuff size chart shows how to measure your arm, and an extra-large or cone-shaped cuff may solve it.

If you have another medical reason you can't use a cuff on either upper arm, ask your doctor which device and arm to use.

How to use a wrist monitor

• Choose a validated model. STRIDE BP's home list includes wrist devices such as the Omron RS7 Intelli IT (HEM-6232T-E) and the Microlife BP W100.
• Sit as for any reading: back supported, feet flat, after at least 5 minutes of rest.
• Rest your elbow on a table and raise your wrist to heart level. Some wrist monitors only measure when held at the right height.
• Keep your wrist straight, not bent up or down, and stay still and quiet until it finishes.

Then take your wrist monitor to an appointment and compare it with the clinic's device, as described in our guide to checking your monitor's accuracy. The rest of the routine is the same as for an upper-arm cuff, covered in our guide to accurate home readings.

Logging wrist readings

Stick to one monitor where you can, so changes in your log reflect you rather than a switch of device. The CardiLog app works with wrist and upper-arm monitors alike, since you type a reading in or photo-scan the display, and you can add a note to say which monitor you used. Our guide to validated home blood pressure monitors covers choosing an upper-arm model.