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The definition of normal blood pressure (BP) values in adults and children is based on mercury sphygmomanometry, and standard mercury readings are the main basis for BP-disease associations.1 Unfortunately, mercury has toxic effects on the environment and the mercury sphygmomanometer will have to be gradually replaced.2 However, there is a rearguard movement to retain mercury until some satisfactory substitute can be found.
We investigated the type of BP devices that are currently being used in Departments of Paediatrics in Greece. In a total of 76 departments, 30% use a mercury sphygmomanometer, 25% use automated devices, 25% use either mercury or automated devices, and 20% use an aneroid sphygmomanometer. Interestingly, 1 in 3 departments has the commonly used automated monitor “Dinamap” (several models); furthermore, half of these departments are using the model 8100. However, the accuracy of Dinamap monitors is questionable, especially the model 8100, which, when tested against the standard mercury sphygmomanometer, was found to detect mean systolic and diastolic BP values significantly above auscultatory readings.3
We feel that replacement of mercury sphygmomanometer with automated devices has become increasingly common but, also, rather questionable in some countries, considering the lack of validated automated devices for the paediatric age group. The recent “International Protocol” established by the European Society of Hypertension for validation of BP measuring devices, is designed for adults and does not make recommendations for children.4 Facing the beginning of new standard in clinical sphygmomanometry, there is little doubt that we need a consensus conference. Such a conference would help in making recommendations for endorsing the use of alternative devices as the optimal replacement for mercury devices. In addition, the development of appropriate validation standards for paediatric use of BP devices and the elimination of inaccurate monitors would improve our methods of BP measurement and interpretation.
Competing interests: none declared