A Cross-Sectional Evaluation of Accuracy, Calibration Status and Certification Compliance of Blood Pressure Measuring Devices used by healthcare Providers Across India

Blood pressure (BP) measurement is a fundamental clinical procedure for the diagnosis and management of hypertension. Accurate BP readings are essential not only for individual patient care but also for population-level health management and policy decisions (Pickering et al., 2005; Parati et al., 2014). However, the reliability of these measurements depends heavily on the accuracy, maintenance, and calibration of the instruments used (O’Brien et al., 2013). In India, a wide variety of BP measuring devices are in clinical use. These include mercury sphygmomanometers, aneroid devices, and different types of automated digital monitors (Gupta et al., 2019). These instruments are employed by healthcare professionals (HCPs) across all levels of care— primary, secondary, and tertiary. However, very little is known about their current accuracy, condition, or calibration status (Sharman et al., 2020). Most BP instruments used in outpatient clinics and hospitals are never routinely calibrated after purchase (Veiga et al., 2019). Moreover, many HCPs are unaware of the need for periodic validation, and no standard national guidelines currently exist to ensure the quality control of these devices (Gupta & Xavier, 2018). While mercury sphygmomanometers have long been considered the gold standard, they pose occupational and environmental hazards and are being phased out globally (Myers et al., 2010; WHO, 2011). Aneroid devices are more portable and widely used, but they are prone to mechanical wear and drift over time (Jones et al., 2001). Digital BP monitors are now being used increasingly, particularly in primary care settings, but their accuracy varies significantly by brand, model, and maintenance conditions (Stergiou et al., 2018; Sharman et al., 2020).