Preference, Awareness, and Use of Sphygmomanometers in the Mercury-Free Era: A Cross-Sectional Survey of Physicians in Korea

BACKGROUND: In response to global mercury reduction initiated by the Minamata Convention, the use of mercury sphygmomanometers (MSs) as mercury-containing medical devices is being phased out from clinical practice. However, little is currently known about Korean physicians' preferences and their awareness of alternative blood pressure (BP) devices post-ban. METHODS: An online survey using a convenience sample was conducted with 1,728 physicians (98.9% response rate) from the following five specialties: cardiology (9.3%), internal medicine excluding cardiology (27.5%), family medicine (16.1%), general practice (21.6%), and other specialties (34.5%). The survey included 31 items assessing preferences, awareness of alternative BP devices, and compliance with standardized BP measurement protocols (Korean Society of Hypertension Guidelines). BP devices were categorized as either mercury-based (MS) or mercury-free (aneroid, hybrid, and automated devices). RESULTS: Following the mercury ban, preferences for BP devices shifted as follows: MS (28.2%→12.8%), aneroid (13%→17.4%), hybrid (12.6%→14.5%), and automated devices (46.2%→55.3%). Even after the ban, 12.8% of physicians continued to use MS. Only 50.3% had above-average awareness of mercury-free devices. Compliance with BP measurement standards was high for cuff placement (84.8%), pulse rate measurement (81%), and 5 minutes of rest (80.3%) whereas lower compliance was noted for duplicate BP measurements (59.5%), both-arm measurements (59.5%), and positional BP measurements (52.6%). CONCLUSION: Despite regulatory restrictions, a notable proportion of physicians continue to use MS, and awareness of mercury-free BP devices remains suboptimal. Comprehensive education is needed to enhance BP measurement practices and replace mercury-based devices.