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Reliability of sphygmomanometers used in hospitals and primary care centers. Survey in the Esmeraldas region (Ecuador)

Abstract:

Objective. Cardiovascular diseases represent an emerging health problem in Ecuador as well as in other developing countries. High blood pressure is the main modifiable cardiovascular risk factor. The aim of our study was to assess the accuracy and condition of the sphygmomanometers used in diagnosing and treating hypertension i the region of Esmeraldas (Ecuador). Methods. In the summer of 1999 we examined all available sphygmomanometers in 37 health services (2 urban and 2 rural hospitals, 12 urban and 11 rural health centers, and 10 private surgeries). We assessed the functioning of each sphygmomanometer and the condition of its components, and measured the bladder in each cuff. Gauge accuracy was tested against a properly calibrated mercury manometer at 150 and 90 mm Hg. Results. Of the 92 sphygmomanometers, 76 (82.6%) were aneroid models and 16 (17.4%) were mercury models. Forty (43.5%) had been used for less than one year and 23 (25.0%) for more than 5 years. Half of the sphygmomanometers (46) presented some kind of functional or component fault, 71 bladders (77.2%) did not meet the recommended dimensions and 34 (37.4%) had gauge errors greater than ± 4 mm Hg. Combining the evaluation criteria of working condition, bladder size and gauge accuracy for each manometer, 82 of the 92 (89.1%) presented at least one problem. Conclusions. Because of the current state of the sphygmomanometers, blood pressure measurements in Esmeraldas' health services are unreliable. A policy for acquisition, maintenance and calibration of the sphygmomanometers is urgently needed.