Pixel Watch unleashes Health Guardian with cuff-free blood pressure and insulin trends

Pixel Watch owners can start setting up Health Guardian today, as Google's blood pressure trends, insulin resistance trends and sleep breathing quality metrics begin rolling out in the Google Health app. The features are free on the Pixel Watch 5, Pixel Watch 4 and Pixel Watch 3, while Fitbit Air owners will need a Google Health Premium subscription later this year.

Health Guardian is finally rolling out to Pixel Watch owners

Google first showed off Health Guardian back in August, and we covered what it can do when the Pixel Watch 5 launched. Now Google has confirmed the new metrics start populating in the Google Health app today, September 24, with the first trend reports arriving in early October.

Here's what's included in the Health Guardian suite:

• Blood pressure trends: estimates your longer-term blood pressure patterns from pulse and motion data, with no cuff or manual calibration needed.
• Insulin resistance trends: tracks shifts in your metabolic health over several weeks, without requiring a single drop of blood.
• Sleep breathing quality: shows how much of each night you spent breathing optimally, then rolls it into a monthly assessment.
• Breathing Emergency Detection: an opt-in feature that can call emergency services if your blood oxygen drops dangerously low and you stop responding, limited to the Pixel Watch 4 and 5 in select European countries.

How Google's no-cuff approach stacks up against Apple and Samsung

Apple got to wrist-based blood pressure alerts first, with hypertension notifications that are cleared by the FDA and available on the Apple Watch Series 9 and newer, plus the Ultra 2 and newer. Samsung's Galaxy Watch 9 has its own Blood Pressure Trend feature, but it still needs a conventional cuff to work properly, and as we pointed out when we compared the two watches, Samsung's blood pressure tools only work when paired with a Galaxy phone.

Google's version sits somewhere in between, with no cuff and no calibration, but also no FDA clearance. Insulin resistance is where Google is out on its own, though, since neither Apple nor Samsung tracks it from the wrist. So Apple Watch owners aren't missing much on blood pressure, while Galaxy Watch owners tired of the cuff routine have a real reason to take a look.

When your first Health Guardian report will show up

Trend insights land on the first of every month, and Google needs at least seven days of wear in a month for insulin resistance, plus at least five consecutive days in a week for blood pressure.



So if you tend to leave your watch on the charger for a day or two at a time, it's worth wearing it more consistently over the next week so the October report has enough to work with. If a trend does come back "High," Google suggests confirming it with a home blood pressure monitor or talking to a healthcare professional.

Making Health Guardian free on older Pixel Watches is the right call

I'm really glad Google didn't lock these features to the Pixel Watch 5, since Pixel Watch 3 owners get the exact same trends for free on a two-year-old watch. The Fitbit Air paywall stings a little more, though, especially for a tracker that landed on our list of the best budget smartwatches partly because it doesn't need a monthly bill.

Still, the real test starts in October, and I'd personally love to see Breathing Emergency Detection make its way to the US next.

More on the Pixel Watch 5 and Health Guardian:

• What Health Guardian can do on the Pixel Watch 5
• Everything we know about the Pixel Watch 5
• Google Pixel Watch 5 (45mm)

• Follow me on X and Threads

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