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Pressure for change: unresolved issues in blood pressure measurement
1Department of Primary Health Care, Newcastle upon Tyne. malcolm.aylett@smrl.demon.co.uk
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Mercury sphygmomanometers will soon be banned. Clinicians need guidance on alternative blood pressure devices and cuff sizes. The study explores the role of ambulatory and home monitoring for cardiovascular health assessment.
Area of Science:
- Clinical Medicine
- Cardiovascular Health
- Medical Instrumentation
Background:
- Upcoming prohibition of mercury sphygmomanometers necessitates exploring alternatives.
- Lack of authoritative guidance on alternative blood pressure monitoring devices and cuff sizes.
- Traditional consulting room blood pressure measurements may not be optimal for cardiovascular health assessment.
Purpose of the Study:
- To address the urgent need for guidance on alternative sphygmomanometers.
- To investigate the optimal cuff size for accurate blood pressure measurement.
- To evaluate the role of continuous ambulatory and home blood pressure monitoring in routine care.
Main Methods:
- Review of current literature on blood pressure monitoring devices.
- Analysis of the efficacy of different cuff sizes.
- Discussion of the integration of ambulatory and home monitoring into clinical practice.
Main Results:
- Significant uncertainty exists regarding suitable mercury-free sphygmomanometers.
- Cuff size selection remains a critical but debated issue.
- Ambulatory and home monitoring offer potential advantages over intermittent clinic readings.
Conclusions:
- Urgent clinical and research focus is required on mercury-free sphygmomanometers and cuff sizing.
- Continuous and home blood pressure monitoring should be considered for comprehensive cardiovascular assessment.
- Transitioning to new technologies requires clear guidelines and evidence-based recommendations.
Abstract:
The use of mercury is likely to be prohibited within a few years and clinicians have not yet seriously considered what sphygmomanometers they will use, nor is authoritative advice available on alternative instruments. Doubts also surround the thorny question of cuff size. Most blood pressures are taken in assessing cardiovascular health, and serial consulting room measurements may not be the best way of doing this. What is the role of continuous ambulatory monitoring in routine care? What is the place of home monitoring by patients, now that accurate and easy-to-use electronic sphygmomanometers are available?