Mercury Sphygmomanometers Should Not be Abandoned: An Advisory Statement From the Council for High Blood Pressure Research, American Heart Association
2001; Lippincott Williams & Wilkins; Volume: 37; Issue: 2 Linguagem: Inglês
10.1161/01.hyp.37.2.185
ISSN1524-4563
AutoresDaniel W. Jones, Edward D. Fröhlich, Carlene M. Grim, Clarence E. Grim, Kathryn A. Taubert,
Tópico(s)Heart Rate Variability and Autonomic Control
ResumoHomeHypertensionVol. 37, No. 2Mercury Sphygmomanometers Should Not be Abandoned: An Advisory Statement From the Council for High Blood Pressure Research, American Heart Association Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBMercury Sphygmomanometers Should Not be Abandoned: An Advisory Statement From the Council for High Blood Pressure Research, American Heart Association Daniel W. Jones, Edward D. Frohlich, Carlene M. Grim, Clarence E. Grim, Kathryn A. Taubert and Daniel W. JonesDaniel W. Jones , Edward D. FrohlichEdward D. Frohlich , Carlene M. GrimCarlene M. Grim , Clarence E. GrimClarence E. Grim , Kathryn A. TaubertKathryn A. Taubert and and for the Professional Education Committee, Council for High Blood Pressure Research Originally published1 Feb 2001https://doi.org/10.1161/01.HYP.37.2.185Hypertension. 2001;37:185–186In healthcare institutions around this country and around the world, mercury sphygmomanometers are being removed.1 In many situations, the decision to replace the instruments is being made without significant input from involved clinicians or consideration of the health risks that will follow if they are replaced by less accurate devices.Blood pressure measurement is an important indicator of the current clinical condition of patients and a powerful predictor of future cardiovascular and overall health.2 Blood pressure measurement is often considered "routine" and is often performed by those with the least training. In many institutions, blood pressure measurement is a low priority, with less than ideal quality control related to equipment selection, equipment calibration and repair, and personnel training and performance.For more than a century, the mercury gravity sphygmomanometer has been the gold standard for indirect measurement of blood pressure. Indeed, the world primary standard for pressure measurement is a mercury manometer. It is a simple, gravity-based unit with easy calibration, infrequent need for repair, and it has been validated in many clinical circumstances against direct intra-arterial blood pressure measurement.3In recent years, these mercury units have been replaced with aneroid instruments in many institutions and more recently with electronic manometers. Justifications for the replacement of mercury manometers have included concerns about the safety of mercury, concerns about regulations regarding the use of mercury in the workplace, and attempts to eliminate human error involved in the reading of measurements.4 An examination of the evidence around these concerns is necessary before clinicians contribute actively or passively to the replacement of these instruments.Are mercury manometers dangerous to use in hospital and other clinical settings? Accidental exposure to mercury from sphygmomanometers used in healthcare settings is extremely rare. It is true that there have been a few isolated instances of illness in children from mercury toxicity related to broken elemental mercury-containing instruments used in homes. Most of these occurrences have been related to broken glass thermometers.5 One detailed report has provided data suggesting that volatilized mercury, after spillage of mercury, produced reversible neurological symptoms.6 Nevertheless, modern mercury sphygmomanometers are available in models that prevent accidental spillage of mercury, which essentially eliminates the concern for this rare occurrence.Is the use of mercury manometers forbidden by regulation in the United States? No. Most regulations related to mercury deal with mercury compounds, such as those used in the manufacture of some automobile batteries. The use of mercury manometers is presently restricted in only a handful of countries.1 None of the healthcare regulatory agencies in the United States, governmental or voluntary, forbid the use of mercury manometers. However, reports of loss of hospital accreditation in the United States (for whatever reasons) have prompted widespread concern. Notwithstanding, mercury instruments are approved and are legal devices in this country, and we believe they should remain so.Are aneroid or electronic instruments a reliable substitute for mercury manometers? There are 2 crucial issues to consider here: validation and calibration. Although both aneroid and electronic instruments have some advantages of portability and ease of use, few of these instruments have had adequate validation. Still fewer of these instruments are calibrated regularly. To be sure, these instruments have a place in patient management, particularly with respect to their use as home monitoring devices. However, most of these instruments have not been adequately validated over a wide range of blood pressures, ages, and clinical conditions to warrant routine use in hospitals and outpatient settings.7 What is of critical importance is that most manufacturers of aneroid and electronic instruments recommend calibration against a mercury manometer every 6 months. However, few hospitals and clinics have a regular program of evaluation and calibration. Most of these instruments cannot be calibrated without return to the manufacturer.8Can the use of electronic instruments eliminate human error in blood pressure determination? Certainly, a challenging aspect of human blood pressure determination with a mercury sphygmomanometer is the human error introduced with the hearing and recording of the Korotkoff sounds. Hearing impairment and digit preference are 2 major concerns. Electronic instruments do offer an advantage in this area but still leave ample room for other causes of human error in cuff size determination, placement of the cuff, etc. It is apparent that all human error cannot be eliminated with electronic devices.Is accurate blood pressure measurement really important? Obviously the answer is yes. Consistent overestimation of blood pressure in the population can be associated with costly overtreatment of hypertension. Consistent underestimation of blood pressure can cost many lives in failing to prevent cardiovascular disease through effective and safe therapy of hypertension.2There is a constant need for caution in the selection of blood pressure measuring devices. New is not always better. Just as in the selection of medication for elevated blood pressure, evidence should guide our decisions. Sometimes, evidence presents us with unexpected outcomes. We encourage consideration of the same level of evidence in the selection of blood pressure measuring devices as in the selection of drugs and other medical instruments. Clinicians involved in the management of patients with blood pressure problems must accept the responsibility for ensuring adequate instruments are available. If we are passive much longer, the time to act effectively will be past.Specifically, we recommend that clinicians educate themselves on the instruments available for use in their clinics and hospitals; engage in the process of selection of instruments through dialogue with administrators and through hospital committees; encourage the general use of mercury manometers as the instrument of choice until other instruments are better validated; where aneroid or electronic instruments are used, ensure that instruments are validated through the Association for the Advancement of Medical Instrumentation or a similar organization; ensure a program of regular maintenance and calibration of all instruments. In sites where aneroid or electronic instruments are used exclusively, if mercury instruments cannot be reintroduced for regular use, insist on the use of mercury instruments for calibration of aneroid and electronic instruments; ensure a regular training program for those who measure blood pressure; join the American Heart Association in encouraging studies to validate the safety and reliability of all instruments used for blood pressure determination; and use evidence in determining both safety and reliability of any instrument.To these ends, the American Heart Association stands ready to relate with any and all organizations wishing to further explore this issue. Throughout 6 published editions on human sphygmomanometry for patients, the American Heart Association has presented updated information on this vital subject. We stand ready to consider any new views and data that are germane to the publication of our next report.The opinions expressed in this editorial are not necessarily those of the editor or of the American Heart Association.FootnotesCorrespondence to Daniel Jones, MD, Professor of Medicine, University of Mississippi Medical Center, Division of Hypertension, 2500 North State St, Jackson, MS 39216-4505. E-mail [email protected] References 1 Markandu ND, Whitcher F, Arnold A, Carney C. The mercury sphygmomanometer should be abandoned before it is proscribed. J Hum Hypertens.2000; 14:31–36.CrossrefMedlineGoogle Scholar2 The sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med.1997; 157:2413–2446.CrossrefMedlineGoogle Scholar3 Perloff D, Grim C, Flack J, et al, for the Writing Group. Human blood pressure determination by sphygmomanometry. Circulation.1993; 88:2460–2467.CrossrefMedlineGoogle Scholar4 Obrien E. Will mercury manometers soon be obsolete? J Hum Hypertens.1995; 9:933–934.MedlineGoogle Scholar5 Langford N, Ferner R. Toxicity of mercury. J Hum Hypertens.1999; 13:651–656.CrossrefMedlineGoogle Scholar6 Rennie AC, McGregor-Schuerman M, Dale IM, Robinson C, McWilliam R. Mercury poisoning after spillage at home from a sphygmomanometer on loan from hospital. BMJ.1999; 319:366–367.CrossrefMedlineGoogle Scholar7 Yarrows SA, Brook RD. Measurement variation among twelve electronic home blood pressure monitors. Am J Hypertens.2000; 13:276–282.CrossrefMedlineGoogle Scholar8 Carney SL, Gillie AH, Green SL, Patterson O, Taylor MS, Smith AJ. Hospital blood pressure measurement: staff and device assessment. J Qual Clin Pract.1999; 19:95–98. CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Lim S and Kim S (2022) Blood pressure measurements and hypertension in infants, children, and adolescents: from the postmercury to mobile devices, Clinical and Experimental Pediatrics, 10.3345/cep.2021.00143, 65:2, (73-80), Online publication date: 15-Feb-2022. Kumar R, Sahani A and Wander G (2021) A survey to gauge confidence of Indian clinicians on three primary devices for blood pressure measurement, Blood Pressure Monitoring, 10.1097/MBP.0000000000000512, 26:3, (196-199), Online publication date: 1-Jun-2021. Al-Riyami H and Nadar S (2020) The mercury sphygmomanometer: soon a museum piece!, Journal of Human Hypertension, 10.1038/s41371-020-00462-8, 35:6, (490-491), Online publication date: 1-Jun-2021. Traicu A, Grizenko N, Fortier M, Fageera W, Sengupta S and Joober R (2020) Acute blood pressure change with methylphenidate is associated with improvement in attention performance in children with ADHD, Progress in Neuro-Psychopharmacology and Biological Psychiatry, 10.1016/j.pnpbp.2019.109732, 96, (109732), Online publication date: 1-Jan-2020. Jones D (2019) Implementing Automated Office Blood Pressure Measurement, Hypertension, 74:3, (436-440), Online publication date: 1-Sep-2019. Grim C and Grim C (2018) Office Blood Pressure Measurement Hypertension: A Companion to Braunwald's Heart Disease, 10.1016/B978-0-323-42973-3.00009-3, (76-88), . Zhang M, Zhang X, Chen F, Dong B, Chen A and Zheng D (2017) Effects of room environment and nursing experience on clinical blood pressure measurement, Blood Pressure Monitoring, 10.1097/MBP.0000000000000240, 22:2, (79-85), Online publication date: 1-Apr-2017. Arena S, Simon L and Peterson E (2016) Aneroid Blood Pressure Manometer Calibration Rates in Physical Therapy Curricula, Cardiopulmonary Physical Therapy Journal, 10.1097/CPT.0000000000000023, 27:2, (56-61), Online publication date: 1-Apr-2016. Karapetyan A, Ouyang P, Tang L and Gemilyan M (2016) CHOROIDAL THICKNESS IN RELATION TO ETHNICITY MEASURED USING ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY, Retina, 10.1097/IAE.0000000000000654, 36:1, (82-90), Online publication date: 1-Jan-2016. Cao X, Song C, Guo L, Yang J, Deng S, Xu Y, Chen X, Sapa W and Wang K (2015) Quality Control and Validation of Oscillometric Blood Pressure Measurements Taken During an Epidemiological Investigation, Medicine, 10.1097/MD.0000000000001475, 94:37, (e1475), Online publication date: 1-Sep-2015. Al-Jumaily A, Lan H and Stergiopulos N (2013) Brachial artery waveforms for automatic blood pressure measurement, Journal of Biomechanics, 10.1016/j.jbiomech.2012.10.021, 46:3, (506-510), Online publication date: 1-Feb-2013. Ayodele O, Akinyemi S, Adeniji A, Akinboro A, Popoola A and Alao C (2014) Prevalence of end-digit preference in recorded blood pressure by nurses: a comparison of measurements taken by mercury and electronic blood pressure-measuring devices, South African Family Practice, 10.1080/20786204.2013.10874306, 55:1, (73-77), Online publication date: 1-Jan-2013. Grim C and Grim C (2013) Office Blood Pressure Measurement Hypertension: A Companion to Braunwald's Heart Disease, 10.1016/B978-1-4377-2766-1.00004-1, (34-44), . Serafim T, Toma G, Gusmão J, Colósimo F, Silva S and Pierin A (2012) Avaliação das condições de uso de esfigmomanômetros em serviços hospitalares, Acta Paulista de Enfermagem, 10.1590/S0103-21002012000600018, 25:6, (940-946), . Babbs C (2012) Oscillometric measurement of systolic and diastolic blood pressures validated in a physiologic mathematical model, BioMedical Engineering OnLine, 10.1186/1475-925X-11-56, 11:1, (56), . Lan H, Al-Jumaily A, Lowe A and Hing W (2011) Effect of tissue mechanical properties on cuff-based blood pressure measurements, Medical Engineering & Physics, 10.1016/j.medengphy.2011.06.006, 33:10, (1287-1292), Online publication date: 1-Dec-2011. Buchanan S, Orris P and Karliner J (2010) Alternatives to the mercury sphygmomanometer, Journal of Public Health Policy, 10.1057/jphp.2010.38, 32:1, (107-120), Online publication date: 1-Feb-2011. Butani L and Morgenstern B (2011) Casual Blood Pressure Methodology Pediatric Hypertension, 10.1007/978-1-60327-824-9_7, (113-134), . Lawton W, Luft F and DiBona G (2010) Normal Blood Pressure Control and the Evaluation of Hypertension Comprehensive Clinical Nephrology, 10.1016/B978-0-323-05876-6.00032-0, (395-410), . Huerta S, Klünder M and Bravo P (2009) Has the time come to replace mercury sphygmomanometers by automated devices for measuring blood pressure in children?, Pediatric Health, 10.2217/17455111.3.1.25, 3:1, (25-31), Online publication date: 1-Feb-2009. Kim E, Samuels T, Yeh H, Abuid M, Marinopoulos S, McCauley J and Brancati F (2007) End-Digit Preference and the Quality of Blood Pressure Monitoring in Diabetic Adults, Diabetes Care, 10.2337/dc07-0020, 30:8, (1959-1963), Online publication date: 1-Aug-2007. Schell K, Richards J and Farquhar W (2007) The effects of anatomical structures on adult forearm and upper arm noninvasive blood pressures, Blood Pressure Monitoring, 10.1097/MBP.0b013e3280858cd0, 12:1, (17-22), Online publication date: 1-Feb-2007. Grim C and Grim C (2007) Office Blood Pressure Measurement Hypertension, 10.1016/B978-1-4160-3053-9.50011-1, (58-68), . Pickering T (2007) Blood Pressure Measurement Comprehensive Hypertension, 10.1016/B978-0-323-03961-1.50047-7, (521-533), . Michael Prisant L and Fall P Ambulatory Blood Pressure in Older Patients Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics, 10.1007/978-1-59259-978-3_13, (311-338) Graves J and Althaf M (2006) Utility of ambulatory blood pressure monitoring in children and adolescents, Pediatric Nephrology, 10.1007/s00467-006-0175-6, 21:11, (1640-1652), Online publication date: 1-Nov-2006. Parati G, Faini A and Castiglioni P (2006) Accuracy of blood pressure measurement: sphygmomanometer calibration and beyond, Journal of Hypertension, 10.1097/01.hjh.0000244935.19299.f5, 24:10, (1915-1918), Online publication date: 1-Oct-2006. Faerstein E, Chor D, Griep R, Alves M, Werneck G and Lopes C (2006) Aferição da pressão arterial: experiência de treinamento de pessoal e controle de qualidade no Estudo Pró-Saúde, Cadernos de Saúde Pública, 10.1590/S0102-311X2006000900031, 22:9, (1997-2002), Online publication date: 1-Sep-2006. Graves J, Grossardt B, Gullerud R, Bailey K and Feldstein J (2006) The trained observer better predicts daytime ABPM diastolic blood pressure in hypertensive patients than does an automated (Omron) device, Blood Pressure Monitoring, 10.1097/01.mbp.0000200480.26669.72, 11:2, (53-58), Online publication date: 1-Apr-2006. Decker W, Godwin S, Hess E, Lenamond C and Jagoda A (2006) Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients With Asymptomatic Hypertension in the Emergency Department, Annals of Emergency Medicine, 10.1016/j.annemergmed.2005.10.003, 47:3, (237-249), Online publication date: 1-Mar-2006. Houtman P (2006) Management of Hypertensive Emergencies in Children Paediatric Clinical Pharmacology, 10.1201/b14101-79, (719-725), Online publication date: 13-Jan-2006. Pater C (2005) Beyond the Evidence of the New Hypertension Guidelines. Blood pressure measurement – is it good enough for accurate diagnosis of hypertension? Time might be in, for a paradigm shift (I), Current Controlled Trials in Cardiovascular Medicine, 10.1186/1468-6708-6-6, 6:1, Online publication date: 1-Dec-2005. Graves J (2005) A survey of validated automated home blood pressure monitors available for the Internet shopper, Blood Pressure Monitoring, 10.1097/00126097-200504000-00009, 10:2, (103-107), Online publication date: 1-Apr-2005. Prisant L and Jackson T Clinical Evaluation of the Elderly Hypertensive Hypertension in the Elderly, 10.1007/978-1-59259-911-0_9, (135-144) HERMAN W, KONZELMAN J and PRISANT L (2004) New national guidelines on hypertension, The Journal of the American Dental Association, 10.14219/jada.archive.2004.0244, 135:5, (576-584), Online publication date: 1-May-2004. Graves J, Tibor M, Murtagh B, Klein L and Sheps S (2004) The Accoson Greenlight 300???, the first non-automated mercury-free blood pressure measurement device to pass the International Protocol for blood pressure measuring devices in adults, Blood Pressure Monitoring, 10.1097/00126097-200402000-00004, 9:1, (13-17), Online publication date: 1-Feb-2004. Morgenstern B and Butani L (2004) Casual Blood Pressure Measurement Methodology Pediatric Hypertension, 10.1007/978-1-59259-797-0_4, (77-96), . Reinders A, Jones C, Cuckson A and Shennan A (2003) The Maxi Stabil 3: validation of an aneroid device according to a modified British Hypertension Society protocol, Blood Pressure Monitoring, 10.1097/00126097-200304000-00005, 8:2, (83-89), Online publication date: 1-Apr-2003. Pickering T (2003) What will replace the mercury sphygmomanometer?, Blood Pressure Monitoring, 10.1097/00126097-200302000-00005, 8:1, (23-25), Online publication date: 1-Feb-2003. Vinyoles E, Armengol F, Bayó J, Mengual L, Salvadó A and M. Pepió J (2003) La normativa europea y el futuro de los esfigmomanómetros de mercurio en las consultas, Medicina Clínica, 10.1016/S0025-7753(03)73739-7, 120:12, (460-463), Online publication date: 1-Jan-2003. Gerin W, Schwartz A, Schwartz J, Pickering T, Davidson K, Bress J, O'Brien E and Atkins N (2002) Limitations of current validation protocols for home blood pressure monitors for individual patients, Blood Pressure Monitoring, 10.1097/00126097-200212000-00004, 7:6, (313-318), Online publication date: 1-Dec-2002. Banegas J, Rodríguez-Artalejo F, Ruilope L, Graciani A, Luque M, de la Cruz-Troca J, García-Robles R, Tamargo J and Rey-Calero J (2002) Hypertension magnitude and management in the elderly population of Spain, Journal of Hypertension, 10.1097/00004872-200211000-00014, 20:11, (2157-2164), Online publication date: 1-Nov-2002. (2002) Don't Eliminate Mercury Sphygmomanometers, Heart Association Warns, Biomedical Safety & Standards, 10.1097/00149078-200207150-00001, 32:13, (97-99), Online publication date: 1-Jul-2002. Pickering T (2002) Principles and techniques of blood pressure measurement, Cardiology Clinics, 10.1016/S0733-8651(01)00009-1, 20:2, (207-223), Online publication date: 1-May-2002. O'Brien E (2002) Has conventional sphygmomanometry ended with the banning of mercury?, Blood Pressure Monitoring, 10.1097/00126097-200202000-00007, 7:1, (37-40), Online publication date: 1-Feb-2002. Daniels S (2001) Cardiovascular disease risk factors and atherosclerosis in children and adolescents, Current Atherosclerosis Reports, 10.1007/s11883-001-0038-3, 3:6, (479-485), Online publication date: 1-Nov-2001. February 2001Vol 37, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/01.HYP.37.2.185 Originally publishedFebruary 1, 2001 PDF download Advertisement
Referência(s)