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As we move into the new millennium, the century old Riva-Rocci/Korotkoff technique of measuring blood pressure is changing. There are a number of reasons for this. First, mercury is a toxic substance, the use of which can no longer be countenanced in clinical medicine, and the traditional technique, despite a history of reputable service, is likely to disappear from clinical practice.1 ,2 Second, it is now recognised that though the old technique has given good service, it is fraught with inaccuracies,3 and accurate automated devices are becoming available to replace the mercury sphygmomanometer. Third, 24 hour ambulatory blood pressure measurement (ABPM) has highlighted the phenomenon of white coat hypertension, and more reliance is being placed on blood pressure behaviour than on casual measurement of blood pressure levels.4
Mercury is a toxic, persistent, and bioaccumable substance, many tons of which are distributed throughout the world to hospitals and countless individual doctors and little of which is returned for disposal. Admittedly the contribution of mercury from sphygmomanometers to environmental pollution is small, but none the less, mercury from whatever source finds its way back into the environment through evaporation, in sewage or in solid waste, most seriously damaging the marine environment, and it accumulates in soil and in sediments thereby entering the food chain.1 The mercury thermometer has been replaced in many countries, and in Sweden and the Netherlands the use of mercury is no longer permitted in hospitals. In other European countries, however, including the UK and Ireland, the move to ban mercury from hospital use has not been received with enthusiasm because we do not have an accurate alternative to the mercury sphygmomanometer.1 ,2 This ambivalence often results in hospitals and doctors replacing mercury sphygmomanometers with unreliable and inaccurate devices, such as aneroid …