Response to the Advisory Statement From the Council for High Blood Pressure Research of the American Heart Association Advocating Retention of Mercury Sphygmomanometers

To the Editor:The editorial entitled “Mercury Sphygmomanometers Should Not be Abandoned: An Advisory Statement From the Council for High Blood Pressure Research, American Heart Association”1 highlights an important issue, which was also the subject of a recent editorial from the Working Party on Blood Pressure Measurement of the British Hypertension Society in the British Medical Journal .2 Though there are differences between the European and American stances on this issue, there is no doubting the common goal on both sides of the Atlantic, namely, to improve the accuracy of blood pressure measurement. It may be helpful to this common cause to examine the considerations that have influenced expert opinion in the European Union and the USA.First, there is the issue of mercury. The American view is that because there have been few reported cases of mercury toxicity in clinical practice, “mercury instruments are approved and are legal devices in this country, and we believe they should remain so.”1 In Europe, concern with mercury toxicity is focused not on healthcare workers, in whom instances of mercury toxicity are indeed rare, but rather on the disposal of mercury, which is a major threat to the environment.2–4 Mercury is a toxic substance, and there is mounting pressure from environmentalists to have it banned from use in hospitals. In Scandinavian countries and The Netherlands, the use of mercury is no longer permitted. In the rest of Europe, the move to ban mercury from clinical use has been resisted on the grounds that the once common alternative, the aneroid sphygmomanometer, becomes inaccurate with use and should not, therefore, be substituted for the mercury instrument.2 However, the reluctance of servicing personnel to handle mercury because of the danger of toxicity is forcing the pace of change with the unsatisfactory …