Has the Time Come to Replace Mercury Sphygmomanometers by Automated Devices for Measuring Blood Pressure in Children?

Blood pressure assessment in children has acquired special relevance to prevent cardiovascular diseases later in life, therefore, there is a need to implement appropriate measurement techniques and suitable and accurate support instruments. Traditionally, blood pressure has been measured with mercury sphygmomanometers using the auscultatory technique and, at present, it is even considered to be the gold standard. Nevertheless, this device has a number of measurement pitfalls that, combined with its potential ecological risk owing to accidental mercury pollution, has stimulated the development and design of automated devices, which mainly use the oscillometric method for blood pressure measurement. Automated devices are mercury free and they have abolished some measurement procedures errors, mainly those related to the observer. However, these instruments are not better than mercury sphygmomanometers when accuracy parameters regarding blood pressure measurement are taken into consideration; on the other hand, at present, there are scarce validated automated devices for children. It is expected that mercury sphygmomanometers will be superseded in the near future, but only if automated devices are validated by international protocols and, of course, also considering the fact that they will be affordable.