1. Blood pressure
measurement
Hanna Tolonen
National Public Health Institute, Finland

2. Critical issues
Choice of the blood pressure
measuring device
Posture of the subject and arm
during the measurement
Selection of correct cuff size
Standardization of the measurement
protocol
Training
HES Workshop, Luxembourg, 9-11 April 2008

3. Measurement device
Aneroid Simple mercury
sphygmomanometer sphygmomanometer
Automated bp device
HES Workshop, Luxembourg, 9-11 April 2008

4. 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

5. 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

6. Legal restrictions and
other limitations
For the use of mercury
sphygmomanometer
Asked from country contact persons in
June 2007
Replies from 19 countries
Use 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

7. Conclusions
Traditionally mercury
sphygmomanometers are recommended
Protocol can be standardized
Requires
Extensive training
Passed audiogram for the measurers
Automated devices often used
Problems with the comparability between
devices and in time trends
HES Workshop, Luxembourg, 9-11 April 2008