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In Reply: The letter from Dr Schwartz and colleagues and their referenced publication on validation protocols adds weight to our concern about current validation protocols. We argued that "[v]alidation standards should be based, in part, on the percentage of individual readings within an accurate range." The findings of Schwartz et al clearly demonstrate the hazards of depending on group means for instrument validation.¹

We agree with Dr Karnath that the mercury sphygmomanometer should remain available until other instruments are better validated. As we noted, however, a validated, frequently calibrated, and maintained aneroid instrument is a suitable alternative for those who no longer have access to mercury manometers.

We share the concerns of Drs Fournier and Safar about the use of oscillometric instruments in elderly individuals. We also agree that the use of algorithms to calculate systolic and diastolic blood pressure in those with stiff arteries is challenging and associated with . . . [Full Text of this Article]

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