A perfect replacement for the mercury sphygmomanometer: the case of the hybrid blood pressure monitor

Abstract

This study validated a hybrid mercury-free device as a replacement of the mercury sphygmomanometer for professional use, and also as a standard for future validations. A validation study was performed according to the European Society of Hypertension International Protocol 2010 (ESH-IP) in 33 subjects using simultaneous blood pressure (BP) measurements. A total of six BP measurements were taken per participant simultaneously by a supervisor (S; hybrid auscultatory device Nissei DM3000) and two observers (A and B; mercury sphygmomanometers). ESH-IP analysis (99 BP readings): mean device-observer systolic/diastolic BP difference 0.2±2.0/0.1±2.0 mm Hg; systolic BP differences p5/10/15 mm Hg in 97/99/99 readings, respectively (diastolic 98/99/99). All 33 subjects had 2 of 3 BP differences p5 mm Hg and none without a difference p5 mm Hg. Further analysis (198 BP readings): mean differences S-A 0.1 ± 2.4/0.2 ± 2.4 mm Hg (systolic/diastolic), S-B 0.3 ± 2.1/0.2 ± 2.2, A-B 0.2 ± 2.4/0.0 ± 2.3; differences p2 mm Hg S-A in 88/84% (systolic/diastolic), S-B 87/85%, A-B 87/86% and p4 mm Hg S-A 95/ 96%, S-B 95/96%, A-B 95/98%. In conclusion, a hybrid mercury-free auscultatory BP monitor comfortably passed the ESH-IP 2010 requirements and has the same level of accuracy as the mercury sphygmomanometer. This device appears to be a reliable alternative to the mercury sphygmomanometer for professional use and also as a standard for future validations.

Comparisons of auscultatory hybrid and automated sphygmomanometers with mercury sphygmomanometry in hypertensive and normotensive pregnant women

“…With the automated device, when measuring DBP in particular, only 61% of BP differences were within 5 mmHg (!60% required to achieve A rating), and there was a mean BP difference of 5 mmHg in hypertensive women and 6.3 mmHg in preeclamptic women ( Table 3). The accuracy of the auscultatory device in our population of hypertensive and normotensive pregnant women is consistent with the results with this device in an adult population [14] and with the other mercury-free hybrid sphygmomanometers validated in adults [19][20][21]. It may be that these hybrid sphygmomanometers will be equally accurate as the A&D UM-101 in pregnancy.…”

Blood Pressure Measurement: Clinic, Home, Ambulatory, and Beyond

“…15 Hybrid BP measurement devices avoid the problem of mercury toxicity and give the choice of auscultatory or automated measurement. 16-19 …”

Blood Pressure Measurement Methodologies

“…[2] Newer hybrid sphygmomanometers combining oscillatory and manual auscultatory methods have now replaced mercury devices and have also been validated by studies to be reliable alternatives. [9] Regardless, the mercury sphygmomanometer still remains as a reference and standard against any new developments or validations in BP measurement. [9] The oscillatory method detects air volume variations or oscillatory amplitudes in the BP cuff during deflation and the maximal oscillation point corresponds to mean arterial pressure.…”

“…[9] Regardless, the mercury sphygmomanometer still remains as a reference and standard against any new developments or validations in BP measurement. [9] The oscillatory method detects air volume variations or oscillatory amplitudes in the BP cuff during deflation and the maximal oscillation point corresponds to mean arterial pressure. [2,5] As the oscillations begin around systolic pressure and continue below diastolic pressure, BP is estimated through an algorithmic interpretation of the oscillatory amplitudes and the heart rate.…”