Can aneroid sphygmomanometers be used at altitude?

Mercury-independent devices are increasingly being used in clinical practice as mercury will soon be removed from clinical use as a result of environmental, health and safety concerns. The aim of this study was to evaluate the accuracy of a portable aneroid device in an adult population at high altitude by following the part of the protocol of the British Hypertension Society regarding comparison between device and observer. We examined 10 subjects in Cerro de Pasco, Peru, which is situated 4370 m above sea level. The aneroid device was initially calibrated at both high altitude and at sea level to ensure optimal function. Validation of the device was undertaken at high altitude by connecting it in parallel to two mercury sphygmomanometers. Eleven sequential same-arm measurements were taken from each subject by two trained observers, alternating between mercury sphygmomanometry and the aneroid device. Simultaneous mercury readings were also recorded for additional analysis. During calibration, all 60 comparisons between the aneroid and mercury sphygmomanometers were within 3 mm Hg both at sea level and at high altitude. At validation, the device achieved an A grade for both systolic and diastolic pressures and also fulfilled the requirements of the Association for the Advancement of Medical Instrumentation. The mean and standard deviation for systolic and diastolic pressures, respectively, were -1.32 (4.3) mm Hg and 3.7 (4.7) mm Hg in sequential analysis and -0.7 (2.6) mm Hg and -3.3 (2.7) mm Hg in simultaneous analysis. We conclude that the Riester-Exacta portable aneroid device can be recommended for use in an adult population at high altitude.