The optimal groove design of a MEMS piezoresistive pressure sensor for ultra-low pressure measurement is proposed in this work. Two designs of the local groove and one design of the annular groove are investigated. The sensitivity and linearity of the sensor are investigated due to the variations of two dimensionless geometric parameters of these grooves. The finite element method is used to determine the stress and deflection of the diaphragm in order to find the sensor performances. The sensor performances can be enhanced by creating the annular or local groove on the diaphragm with the optimal dimensionless groove depth and length. In contrast, the performances are diminished when the local groove is created on the beam at the piezoresistor. The sensitivity can be increased by increasing the dimensionless groove length and depth. However, to maintain low nonlinearity error, the annular and local grooves should be created on the top of the diaphragm. With the optimal designs of annular and local grooves, the net volume of the annular groove is four times greater than that of the local groove. Finally, the functional forms of the stress and deflection of the diaphragm are constructed for both annular and local groove cases.