Blood pressure measurement

Hanna TolonenNational Public Health Institute, Finland

HES Workshop, Luxembourg, 9-11 April 2008

Critical issues

Choice of the blood pressure measuring devicePosture of the subject and arm during the measurementSelection of correct cuff sizeStandardization of the measurement protocolTraining

HES Workshop, Luxembourg, 9-11 April 2008

Measurement device

Aneroid sphygmomanometer

Simple mercury sphygmomanometer

Automated bp device

HES Workshop, Luxembourg, 9-11 April 2008

Directive 2007/51/EC

1. May not be placed on the market:(a) in fever thermometers;(b) in other measuring devices intended for sale to the general public (e.g.manometers, barometers, sphygmomanometers, thermometers other than fever thermometers).

…3. By 3 October 2009 the Commission shall carry out a review of the availability of reliable safer alternatives that are technically and economically feasible for mercury containing sphygmomanometers and other measuring devices in healthcare and in other professional and industrial uses.

On the basis of this review or as soon as new information on reliable safer alternatives for sphygmomanometers and other measuring devices containing mercury becomes available, the Commission shall, if appropriate, present a legislative proposal to extend the restrictions in paragraph 1 to sphygmomanometers and other measuring devices in healthcare and in other professional and industrial uses, so that mercury in measuring devices is phased out whenever technically and economically feasible.

HES Workshop, Luxembourg, 9-11 April 2008

Used measurement devices

Simple mercury sphygmomanometer considered ’golden standard’In past national HES:

Mercury sphygmomanometer: 50% Automated device: 50%Aneroid sphygmomanometer: No information about the use in any of the national HES

HES Workshop, Luxembourg, 9-11 April 2008

Legal restrictions and other limitations

For the use of mercury sphygmomanometerAsked from country contact persons in June 2007

Replies from 19 countriesUse allowed in all countries (some local limitations)In some countries it is getting difficult to

Obtain service (cleaning, testint, etc.)Find new devices on the market

HES Workshop, Luxembourg, 9-11 April 2008

Conclusions

Traditionally mercury sphygmomanometers are recommended

Protocol can be standardizedRequires

Extensive trainingPassed audiogram for the measurers

Automated devices often usedProblems with the comparability between devices and in time trends