1. Blood pressure Mercury sphygmomanometer quality control

2. Based on EHES Manual, Part B. Fieldwork procedures, 2nd edition, 2016
Available at:
These slides can be used freely, translated and adapted to national use (e.g. concerning the equipment and fieldwork organization).

3. Quality assurance of blood pressure measurements
Each person measuring blood pressure has to pass a hearing test
Adequate training: theory and practice
Understanding the difference between clinical practice and survey fieldwork
Competence and commitment to follow protocols carefully
Checking the equipment
Auditing
Adherence to the protocol
Evaluation of data during the fieldwork

4. Theoretical and practical training
Theory providing information about
Why it is important to measure blood pressure
Why blood pressure measurements need to be standardized
What implications differences in the protocol have to the blood pressure levels
Practice with several different persons with a wide range of blood pressure levels
Supervision and feedback
At the end, testing the levels: agreement with an experienced measurer

5. Checking the equipment and regular calibration
Protocols for daily and weekly equipment checks recorded in a log book
Calibration of used devices before starting of the fieldwork
If fieldwork lasts longer than a year or the number of daily measurements is high, re-calibration may be needed in between

6. Audit visits
Regular audit visits and observations to ensure that protocol is followed correctly
Adherence to the standard protocol evaluated

7. Data evaluation during the fieldwork
Data on blood pressure measurements should be checked regularly for
Missing data and recorded reasons for that
Mean and standard deviation of systolic and diastolic measurements
Identical measurements and difference between first, second and third measurements
Terminal digit preference
Separately for each measurer (nurse)

8. Missing data and reasons for that
If blood pressure cannot be measured, a reason for that should be recorded
Frequency by measurer
E.g. if some measurer has a lot of missing information and refusals for the measurement, this may reveal that she/he is not properly introducing the measurement for the participants

9. Mean and standard deviation
Calculated by measurer, separately for systolic and diastolic measurements
Identifies if some measurers are producing readings systematically lower or higher than the team average , e.g. due to their actions

10. Difference between subsequent measurements
Calculated by measurer, separately for two subsequent systolic and diastolic measurements
Identifies possible problems with measurements and recording errors

11. Terminal digit preference
Distribution of terminal digits for systolic and diastolic measurements separately by measurer
Reveals if some measurers
have a preference for some digit (for example zero)
use odd digits which should not be used according to the protocol

12. Identical measurements
Proportion of identical subsequent measurements for the same participant, separately for systolic and diastolic measurements, by measurer Helps to determine that all 3 measurements are correctly done for all participants

13. Acknowledgement
Slides prepared by: Hanna Tolonen, Päivikki Koponen Experiences and feedback from the EHES network have been utilized in the preparation of these slides Funding: Preparation of the slides is part of the activities of the EHES Coordinating Centre which has received funding from the EC/DG SANTÉ in through SANCO/2008/C2/02-SI EHES and Grand Agreement number , and in through Grand Agreement number /BRIDGE Health

14. Disclaimer
The views expressed here are those of the authors and they do not represent the Commission’s official position.