01.06.2017
(ABPM) is a special procedure that is used to determine changes in blood pressure during the day.
As a result, the doctor receives a fairly complete picture of the patient’s condition. And he can choose the right treatment regimen. So, if your blood pressure rises in the morning, your doctor will recommend taking medications immediately after sleep. If blood pressure rises at night, it makes sense to take medications before bed. This method is much more effective than conventional measurement with a tonometer.
For checking useheart rate monitor(or heart rate monitor ). A cuff is attached to it using a tube, similar to the one used in blood pressure monitors. To take data, the device is connected to a computer.
Who is ABPM indicated for?
Monitor blood pressurecarried out in order to identify hidden hypertension, or to monitor at what time of day a hypertensive patient experiences pressure surges, how drugs to normalize blood pressure affect blood pressure readings, to find out the reasons for the lack of results from taking hypertensive medications. The procedure is also useful for other diseases:
- hereditary hypotension;
- disorder of the autonomic nervous system;
- type 1 diabetes;
- sleep apnea – stopping breathing at night.
ABPM gives good results in the treatment of elderly patients.24-hour blood pressure monitoringallows you to correctly determine treatment for people experiencing severe nervous tension and psychological overload due to their profession.
The procedure is indicated for pregnant women if complications arise in the second and third trimesters; pregnant women with an established diagnosis of hypertension, for proper delivery.
How is daily monitoring carried out?
A cuff is placed and secured on the patient's arm at the level of the heart, which is connected by a tube to a device that automatically pumps and deflates air in the cuff. The device is located in one block with a small monitor that records the indicators. The unit can be attached to your belt with a special belt or worn on your shoulder.
Under the cuff there is a special sensor for recording impacts. pulse
Measurement blood pressureoccurs automatically after a signal is sent from the monitor’s memory unit. How is it carried out? The procedure and how often measurements will be taken are determined by the doctor individually.
This usually happens every fifteen minutes during the day, and at night the interval is half an hour. In cases where the time of pressure rise is known, the interval between measurements can be ten minutes (but not the entire day , but for a couple of hours). The procedure lasts day . The device can be configured for other times, for example: half an hour during the day and an hour at night.
When blood pressure measurementfinished, the patient comes back to the medical facility to remove device . The doctor will transfer the monitor readings to the computer. The program will allow:
- compare measurement indicators with averages. 120 (plus/minus 6) by 70 (plus/minus 5) per day. In the morning the numbers could be: 115 (plus/minus 7) by 73 (plus/minus 6). In the evening the average is 105 (plus/minus 5) over 65 (plus/minus 5);
- determine your circulatory rhythm.
Based on the results, the doctor will issue a conclusion and attach data to it.
How to behave during the procedure
When conducting24-hour blood pressure monitoringthe patient can lead a normal lifestyle, but it is better not to subject himself to excessive force loads in the gym. There are no restrictions on food intake, with the exception of alcohol.
The cuff should be worn over a thin cotton T-shirt to prevent irritation as the cuff is reusable.
During the procedure, you should keep a diary where you record the sensations at the time of measurement. arterial pressure. The monitor has a special button for unscheduled pressure measurement. It can be used if the condition suddenly worsens.
You should also record all your actions in your diary. during the day . When taking medications, food, there were attacks of palpitations, headaches, and others. Even such a small thing as moving from room to room or climbing stairs should be recorded. All entries do with exact time indication.
The day before the procedure, medications to normalize blood pressure are stopped, but only as directed by the doctor. You should not do this yourself. If the purpose of the study is to find out how the medications work, they will not be stopped.
For pregnant 24-hour blood pressure monitoringIt is carried out only in a hospital under the supervision of a doctor.
For whom ABPM is contraindicated
Like any procedure, measurementblood pressure during the dayNot shown to everyone. You shouldn't do it:
- with hand injuries or damage to arteries and veins in the hands;
- various blood diseases that manifest themselves as bluish spots when squeezed;
- if there is a fungus, lichen or other skin diseases on the skin of your hands.
Daily monitoring should be carried out with great caution when the systolic reading is above 200 millimeters of mercury.
It will not be useful to carry out24-hour blood pressure monitoringin mentally ill people. Especially if this is associated with aggressive behavior or the person’s inability to offend himself.
Is it possible to use ABPM in the treatment of children?
Daily pressure monitoringcan be performed in children starting from the age of seven.
The study is carried out in conjunction with an ECG.
The technique is used for hypertension, hypotension, heart rhythm disturbances or periodic loss of consciousness.
What is good about the method?
This the study allows us to record absolutely all pressure fluctuations, even the slightest deviations from the norm. It helps to identify hidden and temporary hypertension. For example, in patients experiencing a stressful situation when measuring blood pressure in the hospital (white coat syndrome), it may rise sharply. In a familiar environment, a person calms down and the indicators return to normal.
Daily allowance devicemeasuring blood pressure is useful in cases where an increase in blood pressure cannot be detected at a doctor’s appointment, and the patient’s condition worsens.
The indisputable advantages of the method include the ease and simplicity of using the device. Thanks to this, ABPM is widely known and used everywhere.
Since the device easy to hide under clothing, the patient does not experience any inconvenience and can lead a normal lifestyle.
The method helps:
- determine whether the development of heart and vascular diseases is predicted;
- develop treatment for heart attack, hypertensive crisis, stroke and other serious diseases;
- fluctuations in pressure during the day can confirm or refute disease of the kidneys, liver, cerebral vessels, heart more accurately than other clinical studies;
- determine the effectiveness and correctness of the selected medications.
Having received pressure monitoring data, the doctor will be able to determine the most correct treatment regimen for hypertension, prescribe medications appropriate to the patient’s condition, prescribe nutritional standards and the need for physical activity.
Disadvantages of ABPM
From the point of view of the correctness of the analysis of the patient’s condition, the reality of the results obtained, there are no complaints about the method either from doctors or from patients.
But when using the device, some difficulties arise. If the cuff is placed on a bare arm, irritation may occur. With frequent squeezing of the cuff, some subjects experience numbness in the arm.
What else do you need to know
To ensure that your daily blood pressure monitoring results are accurate and that the time spent on the study is not wasted, listen to the advice of experts:
- when measuring pressure, the hand should be along the body;
- if the device signal catches you while walking, stop, relax your arm and lower it along your body;
- It is forbidden to look at the readings during the procedure. They do this to avoid distortion of the readings. High readings may cause stress in the patient and continued monitoring will not make sense;
- You need to sleep at night, otherwise the results will be these research will be incorrect.
Recently, most cardiac pathologies have increasingly begun to be diagnosed in people at a young age. A disease such as arterial hypertension is no exception. This is explained by many provoking factors, ranging from poor environmental conditions and quality of nutrition to frequent stressful situations.
To differentiate elevated levels resulting from any psycho-emotional or physical stress from a true hypertensive crisis, specialists often use a technique such as 24-hour blood pressure monitoring (ABPM).
Every person should have an idea of what it is, in what cases it is used, how it is carried out and what it shows.
Description of the procedure
So that the specialist can understand how blood pressure (BP) increases and what provokes deviations, the patient is given ABPM. Thanks to this procedure, it becomes possible to make a correct diagnosis and select the most optimal therapeutic measure.
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Daily pressure monitoring is carried out using a special technique, and the devices intended for research may differ.
The procedure can also be carried out simultaneously with monitoring the cardiogram throughout the day.
A condition in which blood pressure exceeds acceptable normal values is called hypertension in cardiology. Against the background of this pathological process, various unpleasant consequences can develop.
The most common include:
- heart attack;
- atherosclerosis;
- arrhythmia;
- stroke and others.
Most people do not pay attention to their blood pressure, do not monitor it, and go to medical institutions only when serious consequences occur.
What does this method help to identify?
Examination using 24-hour monitoring allows you to find out:
- whether the patient suffers from hypertension;
- what can help improve performance;
- what are the causes of fainting;
- the body's reaction not only to physical, but also to emotional stress.
It also helps to make the choice of the most effective medications necessary for the treatment of high blood pressure.
The procedure can be repeated an unlimited number of times, except in situations where its implementation is contraindicated.
When is it prescribed?
Pressure monitoring is carried out at:
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- heart attacks;
- strokes;
- nocturnal angina;
- subarachnoid hemorrhage;
- hypertensive crisis;
- apnea syndrome;
- respiratory failure;
- frequent fainting conditions;
- carrying out extensive surgery;
- nephropathy or hypertension during pregnancy;
- hypotension while taking certain medications that help lower blood pressure.
ABPM is prescribed in many situations. The technique allows you to determine the exact cause that provoked disorders of the cardiovascular system. In addition, it helps to better reflect the functioning of vital organs such as the kidneys and heart.
For whom it is contraindicated
The main contraindications to the session are:
- complications that arose during the previous study;
- injury to the skin in the shoulder area;
- diseases characterized by damage to the upper extremities;
- thrombocytopenia and thrombocytopathy, other pathological processes of hematopoiesis during an exacerbation;
- hand injuries
ABPM is done with extreme caution when the patient’s systolic pressure increases to over 200 mmHg. Art.
Features of the event
To obtain the most reliable data, it is necessary to approach the examination correctly and follow the specialist’s recommendations during the examination.
How to prepare for ABPM
The procedure does not require special preparation. On this day, the patient should lead his usual lifestyle. At the same time, there is no need to limit either physical or emotional stress. But it is not recommended to work out in the gym or drink alcohol on this day.
In addition, the day before the session you must stop taking medications.
However, such actions should be carried out only after consultation with your doctor. During the examination, medications are taken without fail, and each time they are recorded in a special diary.
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This will allow the specialist to see and evaluate the effect of medications on blood pressure readings. The patient may also consume food and fluids on the day of monitoring.
When measuring blood pressure, it is important to adhere to certain rules that apply to all people:
- the tube connecting the device and the cuff should not be pinched;
- If you suspect a malfunction of the device, you should not attempt to correct it yourself (the intervention of a specialist is required);
- when changing the position of the cuff, it must be returned to its original state - 2 fingers above the elbow;
- do not visit places with elevated sources of electromagnetic fields;
- be in a relaxed position while measuring blood pressure (the patient will be notified by a sound signal about the beginning and end of the session).
In addition, you should avoid water procedures, since the device cannot be wet.
Blood pressure measuring device
The device works based on the fact that when blood passes through a compressed artery, this provokes the appearance of vibrations. When they are registered, it becomes possible to study oscillations using certain algorithms.
It is necessary to take into account that the average value of blood pressure depends on the largest wave amplitude, systolic - on a sharp increase, and diastolic - on a decrease.
Drugs for daily monitoring are produced not only by Russian, but also by foreign companies. Among the most modern models are the latest developments that allow simultaneous ABPM and ECG.
Some Japanese devices also record the position of the torso, temperature conditions and the intensity of the patient’s physical activity.
Execution technique
To carry out diagnostics, the patient visits a medical facility in the morning. Before installing the device, it is necessary to do an electrocardiogram and measure blood pressure. If the values do not exceed the norm, then a specialist mounts the device.
The cuff is fixed in the forearm area on the non-working arm in such a way that its position does not change during the entire period of the study. A mini-computer is attached to the belt, allowing you to read and write the necessary information.
The patient can also be fitted with electrodes of a Holter monitor, which allows parallel examination of the heart throughout the day.
The device operates continuously with periodic pumping of air into the cuff.
After the patient receives all the necessary recommendations, he goes home and goes about his usual activities.
What actions are needed when wearing the device?
When carrying out daily blood pressure monitoring, it is important to behave accordingly, as described by the doctor when installing the device, and to wear the device correctly.
At the time when the next automatic blood pressure measurement occurs, the person must ensure that his muscles are in a relaxed state and his arm is located along the body.
It is important not to think that the indicators are being measured, as this may distort the validity of the results. Night sleep should also be restful. There should be no thoughts about the research process.
If the measurement began while moving, you need to stop and monitor the position of your hand.
Journaling
In addition to the fact that blood pressure is automatically measured at certain intervals throughout the day, it is also important to keep a patient diary, which records all the events performed by the patient during the day.
- depth and duration of sleep;
- number of awakenings;
- state of health;
- physical and emotional stress;
- eating food;
- taking medications;
- the presence of certain clinical symptoms, such as dizziness, fainting or a state foreshadowing them, pain in the heart, loss of vision, and others.
At the end of the examination, the doctor checks the monitoring data and records of complaints. This makes it possible to identify situations that provoke an increase in blood pressure and select the most optimal scheme of therapeutic measures.
Data interpretation
The interpretation of the results is carried out exclusively by a specialist. Data collected during the day is transmitted to a computer monitor and processed using a special program.
Particular attention is paid to such indicators as:
- blood pressure rhythm;
- average values;
- variability.
For each patient, the pressure level is determined individually, on the basis of which a conclusion is made. The assessment takes place according to parameters that will differ from the normal value.
Average blood pressure readings for a healthy person are shown in the table below.
Features of the study in pregnant women
Daily blood pressure monitoring during pregnancy is prescribed in the third trimester. This examination allows us to identify existing deviations that may negatively affect labor.
While carrying a child, the female body is subjected to increased stress, which can provoke an increase in blood pressure to 140/90. ABPM for pregnant women is the best option for determining whether an excess of the indicator is the cause of the development of a pathological process or is it a concomitant factor of an interesting situation.
Advantages and disadvantages
Among the main positive aspects of the technique are:
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- monitoring changes in blood pressure over a long period of time;
- the ability to monitor indicators without interrupting your usual activities;
- establishing short-term variability;
- assistance in the treatment of patients with serious diseases.
This method also helps to identify under the influence of what factors the level of value changes and in what period of time.
But, like any procedure, ABPM also has its downsides.
The main disadvantage is the discomfort that occurs when air is pumped into the cuff. The patient has a feeling that the arm is going numb. Diaper rash and a rash under the cuff may form. Another disadvantage is that the method is paid.
Is it possible to fool the device?
There are certain situations in which many young people, especially conscripts into the army, manage to deceive ABPM. These include the following:
- holding your breath while fixing the device;
- tension in the gluteal muscles;
- taking tonic medications that help increase performance;
- raising your legs while lying on the bed during the next measurement;
- drinking coffee, strong tea or energy drinks.
It is also important to remember that blood pressure drops during night sleep. Therefore, to prevent this from happening, in order to deceive the device, you will need to stay up all night.
Daily monitoring allows you to identify many pathological processes. Also, thanks to this method, it is possible to select effective treatment regimens for diseases of the kidneys, heart and blood vessels, thyroid gland and central nervous system.
Over the past ten years, the method of 24-hour blood pressure monitoring (ABPM) has received significant development. Currently, this method has gone beyond scientific research and is increasingly being used in practical healthcare.
The purpose of this training manual is to reflect the main, most important points of practical work with ABPM systems.
- Indications for ABPM
Diagnosis of arterial hypertension (AH)
1. Borderline AG.2. Identification of the “white coat” phenomenon.
3. Suspicion of symptomatic hypertension.
4. Examination of patients with hypertension in combination with coronary artery disease, heart failure, left ventricular myocardial hypertrophy, cerebrovascular diseases, carbohydrate and lipid metabolism disorders, sleep apnea syndrome.
5. Examination of young people with unfavorable heredity for hypertension.
- Diagnosis of arterial hypotension
2. Examination of patients with disorders of postural and dynamic blood pressure control.
3. Syncope.
- Control of drug intervention
2. Assessment of the effectiveness and safety of pharmacotherapy.
3. Assessment of resistance to drug treatment and selection of the optimal treatment regimen in such patients.
4. Study of the individual daily rhythm of blood pressure during a chronotherapeutic regimen of drug treatment.
| Method | Advantages | Flaws |
| Auscultatory | 1.
Worldwide, it is recognized as the standard for non-invasive blood pressure measurement for both diagnostic purposes and and for verification of automatic blood pressure meters 2. Increased resistance to vibration and hand movements |
1.
Sensitivity to external noise, accuracy of microphone placement over the artery 2. The cuff and microphone must be in direct contact with the patient's skin. 3. Determination of blood pressure is difficult with weak Korotkoff sounds, with a pronounced “auscultatory failure” and “endless tone” |
| Oscillometric | 1.
Due to its resistance to noise loads, it can be used at high noise levels 2. Blood pressure indicators are almost independent of the rotation of the cuff on the arm and little dependent on its movements along the arm (if the cuff has not reached the elbow bend) 3. It is possible to determine blood pressure through thin clothing, which does not affect the accuracy |
1. Relatively low resistance to vibration and hand movements |
Currently, there are three known methods of measuring blood pressure: invasive (direct), auscultatory and oscillometric.
Invasive (direct) method of measuring blood pressure. A needle or cannula connected by a tube to a pressure gauge is inserted directly into the artery. The main area of application is cardiac surgery. In clinical and physiological experiments, 24-hour invasive blood pressure monitoring is used. The needle inserted into the artery is flushed with heparinized saline using a microinfuser, and the pressure transducer signal is continuously recorded on magnetic tape.
From non-invasive Currently, auscultatory and oscillometric methods of measuring blood pressure are most widely used.
Auscultatory method by N. S. Korotkov. Registration of blood pressure is carried out by determining Korotkoff sounds using one or more microphones located above the abrachialis.
Oscillometric method. The method is based on the fact that when blood passes during systole through a compressed section of the artery in the cuff, micropulsations of air pressure occur, by analyzing which it is possible to obtain the values of systolic, diastolic and average pressure. Oscillation analysis is carried out using special patented algorithms. Systolic pressure usually corresponds to the pressure in the cuff, at which the sharpest increase in the amplitude of oscillations occurs, average - the maximum level of oscillations, and diastolic - a sharp weakening of oscillations.
| Firm | DMS Advanced Technologies Company, Russia | SpaceLabs Medical, USA | Meditech, Hungary | A&D, Japan |
| Model | MDP-NS-01 | 90207/ 90217 | ABPM-02/M | TM-2421 |
| SBP, mmHg Art. | 60-260 | 70-285/ 60-260 | 0-280 | 61-280 |
| DBP, mmHg Art. | 40-200 | 40-200/ 30-200 | 40-159 | |
| Wed. Blood pressure, mmHg Art. | 50-240 | 60-240/ 40-230 | ||
| Heart rate beats/min | 40-180 | 40-180 | 35-200 | |
| Method of measurement | Oscillometric or auscultatory | Oscillometric | Oscillometric | Oscillometric and auscultatory |
| Automatic measurement interval, min | From 3 to 90 | From 6 to 120 | From 1 to 60 | From 1 to 120 |
| Number of measurement periods | 2 | Up to 12 | Up to 4 | |
| Duration of one measurement, s | 30-120 | 35-50 | 30 — 120 | — |
| Number of measurements | 150 | 240 | 300 | 300 |
| Maximum pressure in the cuff, mm Hg. Art. | 300 | 300/ 285 | ||
| Storage System | Permanent action | Permanent action | Permanent action | Permanent action |
| Operational Standards | A.A.M.I., B.H.S. | AAMI, BHS, FRG | A.A.M.I., B.H.S. | A.A.M.I., B.H.S. |
| Power supply | 4/3 batteries or 4/3 NiCd AA batteries | 4 batteries or 4 NiCd AA batteries | 4 built-in NiCd batteries | |
| Software; language | DOS, Windows; Russian | DOS, Windows;English | DOS, Windows; Russian | S, Windows; English |
| Weight, g | 360 without batteries | 347/255 including batteries | 350 including batteries | 390 including batteries |
| Standard monitoring duration, h | 24-48 | 24-48 | 24-48 | 24-48 |
| Cost for 1 set in US dollars | — | ~ 4500 | ~ 2800 | ~ 3825 |
| Note: the “/” sign separates the parameters of two different models of blood pressure recorders | ||||
- Equipment for non-invasive ABPM
The market for modern non-invasive automatic recorders for outpatient ABPM is quite extensive; it includes both foreign companies and domestic manufacturers. The most widespread developments in our country are those presented in Table. 2. In recent years, devices have appeared that allow bifunctional 24-hour monitoring (BP + ECG), for example, the Cardio Tens system from Meditech, Hungary. The latest achievement in daily monitoring is the multisensory system TM-2425/2025 (A&D Company, Japan), which during the day records not only blood pressure and ECG, but also ambient temperature, patient’s body position, acceleration (acceleration of the patient’s movement), and analyzes the intervalogram .
One of the most important parameters when choosing a device for ABPM is the accuracy of blood pressure measurement.
- Methodological aspects of ABPM
Preparation and installation of a blood pressure monitor. Before starting monitoring, you must make sure that the recorder's power source (batteries or accumulators) has sufficient charge to carry out ABPM. For example, the AVRM-02/M system (Meditex, Hungary) allows you to control the battery voltage on the display of the recorder when you insert power supplies into the device or when you press the orange button for a long time (10 s).
After this, the recorder is connected to a personal computer via a special cable, and the recorder is programmed (initialized) using a computer program. Programming includes information about the patient, setting periods and measurement intervals (for example: 1st period from 10 to 23 hours, interval between measurements 15 minutes; 2nd period from 23 to 7 hours, interval between measurements 30 minutes), presence or absence before each measurement of the sound signal, as well as the need for the values of systolic, diastolic blood pressure and pulse rate to appear on the display. Today, the generally accepted intervals between measurements are: for daytime - 10-15 minutes, for nighttime - 30 minutes.
After the recorder is initialized, it is necessary to measure the patient's upper arm circumference in order to select the correct pneumatic cuff size. According to WHO recommendations (1993), a standard cuff for adults should have an internal pneumatic chamber 13-15 cm wide, 30-35 cm long and cover at least 80% of the perimeter of the limb. For patients with an upper arm circumference greater than 32 cm, a larger cuff should be used to prevent overestimation of blood pressure values. For example, blood pressure monitoring systems from SpaceLabs Medical (USA) are equipped with cuffs of four sizes: 13-20 cm (children), 17-26 cm, 24-32 cm, 32-42 cm and 38-50 cm.
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The cuff selected according to the size is applied to the left hand of “right-handers”, and to the right hand of “left-handers”. The artery mark on the cuff should coincide with the point at which the a.brachialis pulsation is most pronounced, usually this point is in the distal third of the shoulder. Because the cuff can move during monitoring, resulting in distorted results, we typically use 60mm diameter adhesive, double-sided discs to secure the cuff.
Control (verification) measurements. A pneumatic cuff installed on the patient's shoulder is connected simultaneously with a recorder and a mercury sphygmomanometer using a special T- or Y-shaped device. At least four consecutive measurements are taken with an interval of at least two minutes. The last three measurements are taken to calculate the average “medical” and “instrumental” blood pressure values. If the differences between these average values exceed 5 mmHg. Art. for diastolic blood pressure and/or 10 mm Hg. for systolic blood pressure, it is necessary to check the correct application of the cuff. If differences persist, the cuff is moved to the other arm or a device with a different method of determining blood pressure is used.
Patient instruction. Correct behavior of the patient during monitoring is of great importance to achieve good results with a minimum number of erroneous measurements. The purpose of the study should be explained to the patient in detail and asked to comply with the rules below.
- When measuring blood pressure, the arm with the pneumatic cuff should be extended along the body and relaxed.
- Intense physical activity and exercise are excluded on the day of blood pressure monitoring.
- If blood pressure measurement begins while walking, you need to stop, lower your arm along your body and wait until the measurement is completed.
- The patient is not allowed to look at the readings of the device, as this provokes an alarming reaction in him, which can lead to distortion of the results and neutralize the main advantage of ABPM.
- At night, the patient should sleep and not think about the work of the recorder, otherwise the values of night blood pressure will be unreliable.
- During monitoring, the patient should keep a detailed diary, which reflects his actions and well-being.
- Processing and basic principles for assessing ABPM results
All existing systems for monitoring blood pressure are usually supplied complete with a special computer program. This program allows you not only to initialize the blood pressure recorder, but also to read and automatically process monitoring results and, in addition, issue them in printed form. Below we will look at the main indicators of the daily blood pressure profile (BPAP), which today are practically universally accepted.
Average values. Calculation of average values (systolic, diastolic, mean blood pressure and pulse rate) is the most common way to evaluate the results of blood pressure monitoring. Typically, average values are calculated for the day (24 hours), day (waking period, for example, from 7 to 23 hours) and night (sleep period, for example, from 23 to 7 hours). The obtained average values give the main idea of the level of blood pressure in a particular patient and have high prognostic significance, which has been proven by numerous studies. When assessing average values obtained from blood pressure monitoring, different criteria are used than when assessing traditional blood pressure measurements. In table 3 we present standards for the average values obtained by J. Staessen et al. (1998) based on an analysis of national projects and individual studies on ABPM.
The change in average values during treatment is the most important characteristic of the effectiveness of the antihypertensive drugs used.
Frequency of increase in blood pressure (FAP) (pressure load, hypertensive load, time index) - the percentage of blood pressure measurements exceeding the level taken as the upper limit of normal (for the day - 140/90, for the night - 120/80 mm Hg. Art.) total number of registrations. This indicator has several names, reflected in the title of this section, but the most successful, in our opinion, is the name “frequency of increased blood pressure during monitoring” (V. M. Gorbunov, 1997).
The NPP indicator is closely related to the average blood pressure values. However, at high blood pressure levels, this indicator, approaching 100%, loses its information content. In such cases, PPBP is calculated as the area under the curve of blood pressure versus time, limited to 140 mmHg. Art. for systolic blood pressure and 90 mm Hg. Art. for diastolic blood pressure. The NPP indicator complements the analysis of average blood pressure values and has the same high prognostic significance. It can also be successfully used in assessing the effectiveness of antihypertensive drugs.
Blood pressure variability. Determining variability involves assessing deviations of blood pressure from the circadian rhythm curve. In the algorithms of modern systems for blood pressure monitoring, a simplified indicator is most often calculated - the standard deviation from the average blood pressure (STD) for the day, day and night periods. The critical values of this indicator for patients with mild and moderate arterial hypertension (AH) are given in Table. 4.
If a patient has an excess of at least one of the four values, then he is included in the group of people with increased variability. Increased blood pressure variability is usually associated with damage to target organs (left ventricular myocardial hypertrophy, atherosclerosis of the carotid arteries, changes in the fundus vessels, etc.).
Circadian rhythm of blood pressure (circadian index). To analyze the severity of the circadian rhythm, the degree of nocturnal blood pressure decrease (NBP) is usually calculated. In table 5 shows the methodology for calculating this indicator.
Disturbances in the circadian rhythm of blood pressure are more common in patients with impaired carbohydrate tolerance, type I and II diabetes mellitus without hypertension and with hypertension, in normotensive patients with unfavorable heredity for hypertension, in persons with symptomatic hypertension (pheochromocytoma, renal hypertension, etc.) .
According to the literature, circadian rhythm disorders with insufficient reduction in blood pressure at night are associated with a higher incidence of strokes, more frequent development of left ventricular myocardial hypertrophy, and more frequent and severe microalbuminuria. Women with insufficient blood pressure reduction at night are more likely to develop coronary artery disease and have a higher mortality rate from myocardial infarction.
All of the above ABPM parameters are used both in the diagnosis of hypertension and in the assessment of antihypertensive therapy. For example, if the average daily DBP consistently exceeds 90 mm Hg, and the RR is more than 50%, then stable hypertension can be diagnosed with confidence. With the values of these indicators being 85 mm Hg. Art. and 15-20%, respectively, we can talk about normal blood pressure. When assessing antihypertensive therapy, it is necessary to take into account the specific nature of the average values of SBP and DBP, since they reflect the results of a large number of measurements and are usually not associated with the patient’s anxiety reaction. Therefore, a decrease in average DBP values by at least 3-5 mmHg. Art. during treatment may indicate a significant antihypertensive effect.
When selecting antihypertensive therapy, it is necessary to strive to normalize blood pressure both during the day and at night. In this case, it is necessary to take into account the possibility of excessive hypotension at night in some patients. However, today there are no unambiguous criteria for assessing this condition based on ABPM data.
The administration of antihypertensive drugs should not cause significant shifts in the ratio of daytime and nighttime blood pressure values in patients with normal SBP.
Effective antihypertensive therapy usually leads to a decrease in blood pressure variability. If, during treatment, there is a significant increase in blood pressure variability, the treatment result should be considered unsatisfactory.
When assessing the uniformity of the effect of long-acting antihypertensive drugs, which are prescribed once a day, you can use the trough/peak coefficient - the ratio of the final and peak effects (CE/PE). To calculate this coefficient, the amount of reduction in SBP or DBP relative to the initial schedule obtained before treatment is divided by the similarly calculated amount of reduction in blood pressure at the peak of the drug's effect. According to FDA recommendations (Food and Drug Administration, USA), this ratio should be at least 50%. A lower EC/PE ratio indicates an insufficient hypotensive effect of the drug at the end of the interdose interval or excessive hypotension at the peak of the drug's effect. This requires adjustment of the dose or timing of the drug.
The technique by which blood pressure is measured and the results recorded for 24 hours is called 24-hour monitoring. It involves recording indicators at specified time intervals using a special device or a traditional tonometer.
This method of monitoring cardiac activity makes it possible to determine the average pressure, its values at night and during the day, the amplitude of fluctuations and the threat of damage to target organs.
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Benefits of 24-hour blood pressure monitoring
24-hour pressure measurement is considered a diagnostic standard and purpose. It has more potential for obtaining reliable results than a random one-time measurement. The benefits of 24-hour blood pressure monitoring (ABPM) include:
- shows how the daily level of load affects the pressure value;
- reflects nighttime pressure changes;
- helps to diagnose sharp fluctuations - hypertensive and hypotensive crises, fainting states;
- when examining it, it is possible to make a forecast about the possibility of acute vascular disorders (,);
- gives a chance to accurately select the optimal time and dosage of antihypertensive drugs or assess the effectiveness of taking prescribed medications;
- eliminates reaction to medical personnel.
The best option is simultaneous monitoring of blood pressure and ECG ().
This complex makes it possible to establish the relationship between the main characteristics of the cardiac cycle, which cannot be identified by standard one-time methods.
Indications for use
Used to diagnose the following conditions:
- clinical hypertension (reaction to health care workers);
- increased blood pressure during stress overload during working hours;
- borderline increase in pressure;
- nocturnal form of hypertension, apnea;
- symptomatic variants of the disease - a reaction to medications that increase blood pressure, disorders of the autonomic nervous system, myocardial infarction or ischemia, circulatory failure, inadequate electrical stimulation or its poor tolerance;
- variability of indicators across multiple measurements;
- high blood pressure was detected in the absence of objective data from clinical studies;
- traditional measurement shows the norm for numerous risk factors and diseases of target organs;
- diagnosis of hypertension in pregnant women with possible preeclampsia.
ABPM can also be used in selecting patients for drug treatment, assessing the effectiveness of therapy, drawing up a regimen with individual selection of the regimen and dosage of drugs, before surgery or childbirth, to study the risk of stroke or heart attack.
The technique has no contraindications, but there are a number of pathologies when it needs to be temporarily abandoned: injuries or pathology of the blood vessels of the hands, exacerbation of blood diseases, patient refusal, pressure exceeding 195 mm Hg. Art., serious forms.
What should a patient do with ABPM?
In order to obtain reliable blood pressure readings, the patient must adhere to the following rules during the monitoring period:
- the arm does not need to be bent during the measurement period, it should be in a relaxed state, located along the body;
- the lower level of the cuff is placed 1 - 2 cm above the elbow bend;
- if the device has started taking measurements, and at this time the patient is in motion (for example, walking down the street), then you need to stop and lower your hand;
- you cannot play sports or do intense physical work, but otherwise the daily routine should be normal;
- It is not recommended to monitor the recorder's performance.
When carrying out diagnostics, it is prohibited to disconnect parts of the blood pressure measuring device, hit it or expose it to moisture.
Watch the video about daily blood pressure monitoring:
How is the complex carried out?
For automatic monitoring, a cuff is placed on the patient's non-working arm (for right-handed people, on the left). In this case, its location should be in the place of the strongest pulsation of the brachial artery. The pneumatic cuff communicates with the pressure recorder through connecting tubes. It is a compact monitor that is attached to the subject's belt.
Measurements are taken every 15 minutes during the day and every 30 minutes at night. The received data is loaded into a computer for processing by a special program.
Why keep a diary
In parallel with blood pressure measurements, the patient should record all events related to activity and health status:
- duration of sleep and its depth, number of night awakenings;
- level of psychological stress, stressful situations and your well-being during this period;
- physical activity;
- eating;
- all medications that are taken;
- presence of headache, dizziness, fainting, heart pain, visual impairment.
Then the doctor compares the data provided by the monitor with the patient’s complaints recorded in the self-monitoring diary. Based on them, we can draw conclusions about situations that contribute to increased blood pressure and draw up an optimal antihypertensive therapy regimen.
Method of measuring blood pressure and pulse rate
In the event that blood pressure monitoring is indicated, but there is no special monitoring device, patients are advised to record the results.
In this case, the same diary entries are kept as with ABPM, but the frequency of measurements per day does not exceed 6 - 8. In this case, it is imperative to diagnose blood pressure before going to bed and in the morning before taking medications.
- Correct measurements are carried out according to the following principles:
- an hour or two should pass after eating and drinking coffee or tea;
- the hand is completely freed from clothing;
- You cannot talk while taking measurements;
A cuff of appropriate size is required, it must cover at least 80% of the shoulder circumference.
The pulse is determined on the radial artery a centimeter above the wrist joint, on the side of the thumb. To count the frequency of beats per minute, use the index, middle and ring fingers of the second hand and a stopwatch.
Control device
Models of pressure monitoring devices are produced by Russian manufacturers (DMS advanced technologies), as well as foreign companies. The most interesting are recent developments that can simultaneously record blood pressure and ECG. And the Japanese multisensory system produced by the AND company can also take into account the temperature during measurements, the location of the patient’s body, and the intensity of his movements.
Pressure increases at night due to illness, stress, sometimes apnea and panic attacks are added to them if you do not sleep. The reasons for sudden jumps in blood pressure during sleep may also lie in age, in women during menopause. For prevention, long-acting drugs are chosen, which is especially important for older people. What pills are needed for nocturnal hypertension? Why does blood pressure rise at night, but normal during the day? What should be normal?
Hypertension is considered a common disorder that leads to dangerous health consequences. To avoid complications, it is worth conducting a detailed diagnosis. One of the methods for identifying accurate indicators is daily blood pressure monitoring. This procedure allows you to establish accurate indicators and select adequate therapy. So, what is ABPM?
Daily blood pressure monitoring is carried out to assess the condition of the cardiovascular system. It consists of regularly measuring blood pressure and its fluctuations throughout the day. To conduct the study, a special device is used - a sphygmomanometer.
An ordinary measurement of an indicator using a tonometer, which is carried out only a few times, does not reflect the full picture. Blood pressure readings fluctuate all the time throughout the day. This process is influenced by many factors - emotional state, physical activity, use of medications.
Blood pressure monitoring allows you to take into account all possible daily fluctuations in pressure and record them throughout the day. Based on the average parameters of fluctuations, it is possible to identify lesions of the cardiovascular system, the need for therapy and subsequent diagnostic studies.
Daily blood pressure monitoring can be carried out in a variety of situations. It allows you to solve the following problems:
- Detection of arterial hypertension - increased blood pressure. ABPM is used in borderline conditions or when there is doubt about the correctness of the diagnosis. This technique is also needed when identifying high blood pressure due to heart failure or neurological abnormalities.
- Diagnosis of hypotension – decreased blood pressure. This procedure is required for all kinds of violations that are associated with a decrease in this indicator.
- Control of drug therapy. Daily blood pressure monitoring allows you to understand how effective the prescribed treatment is. In some cases, it becomes necessary to choose another drug. With the help of ABPM it is possible to monitor the dynamics of changes in various pathologies and the effectiveness of therapy.
The procedure is often required to objectively assess the condition of the heart and blood vessels within a short period of time. Such a need may arise upon recognition of fitness for military service. Identifying many cardiac abnormalities requires a lot of time. Conducting daily monitoring can make this process faster.
Important: This diagnostic procedure can be used for people who have unfavorable heredity. It is carried out even for those people who do not suffer from damage to the cardiovascular system.
Daily blood pressure monitoring is a very informative procedure. Key indications include the following:
Contraindications
This research may not always be carried out. Key contraindications include the following:
- recurrence of skin pathology in the area of application of the cuff;
- traumatic injuries to the hands, which exclude the possibility of applying a cuff;
- exacerbation of blood clotting disorders and the presence of a tendency to bleeding;
- obstruction of the patency of the arteries of the shoulders, which is confirmed instrumentally;
- human refusal.
It is worth considering that the study may not yield results if there are significant heart rhythm disturbances. Also, it is not used at - more than 200 mm Hg. Art. 
Preparation
For the examination to be successful, it is very important to properly prepare for the diagnosis. At this stage it is necessary to check the operation of the technical device:
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- It is important to ensure that the recorder is provided with the required amount of power. Therefore, it is worth checking the battery charge level and understanding whether it is enough for a day of continuous operation.
- Connect the device to a computer and program it to suit a person’s individual parameters. Information about the patient and the operating mode of the recorder are entered into the device. In this case, it is worth setting the interval at which pressure will be measured day and night. If it is necessary to use a signal on the eve of measurement, it must be programmed. The specialist also configures the indicators that will be visible on the monitor.
- To select the correct cuff, it is worth taking measurements of the patient’s forearm.
To carry out the procedure, the cuff of the equipment is applied to the area of the non-working arm: for right-handers - on the left, for left-handers - respectively, on the right. To prevent the device from moving, it must be firmly fixed. In some cases, special discs that have a sticky coating are used for these purposes.
Simultaneous monitoring of ECG and blood pressure is possible It is imperative to inform the patient about the procedure algorithm:
Technique of the procedure
In cardiology, the patient is provided with special devices that will remain on him throughout the day:
- A cuff is placed on the forearm area and secured in such a way as to maintain the position for the period of the study.
- The main device is fixed to the belt. It weighs approximately 300 g and does not cause discomfort to the patient.
After receiving the necessary instructions, the person can go home and begin household chores. The device, which must be worn on the body, will beep at preset intervals.
During this period, it is important to fill out the diary responsibly. This will help the doctor get a complete picture of the relationship between changes in pressure and the type of human activity.
After completing the home diagnostics, the device is turned off. Then you need to go to an appointment with a doctor, provide him with the device and data for decoding. Based on the information received, the doctor makes a conclusion. 
In order for the determination of pressure to be informative, you need to adhere to the following recommendations:
- It is important to ensure that the tube that serves as the connection between the device and the cuff is not pinched.
- If signs of device malfunction appear, you should consult a doctor. Do not try to repair the device yourself.
- The cuff should be attached approximately a couple of fingers above the bend of the elbow. When changing the position of the device, the patient must correct it.
- It is important to try to avoid exposure to sources of electromagnetic radiation.
- During the diagnosis, you should avoid water procedures, since the device is prohibited from getting wet.
- When the device takes a measurement, you need to relax your limb. A signal indicates the start and end of the measurement.
Typically, pressure measurements are carried out every 15 and 30 minutes during the day and at night, respectively, but if necessary, the doctor can change the device settings.
Decoding the results
To decipher the results of the procedure, you should consult a doctor. Monitoring data is processed using a computer program. This is done automatically. Key indicators of the procedure include the following:
Advantages and disadvantages of the procedure
This method of measuring blood pressure has a high diagnostic value. This comes with a number of benefits. Thanks to daily monitoring, it is possible to:
- Perform a large number of measurements over a long period of time - more than 50.
- Get reliable results. This is due to the fact that the person remains as calm as possible during the procedure.
- Record pressure readings not only during the day, but also at night.
- Analyze the pressure time curve.
- Coping with complex pathologies.
- Predict the progression of cardiovascular diseases.
- Determine the degree of target organ damage. This is due to the connection of such violations with average daily pressure readings.
- Monitor the effectiveness of the therapy.
A single blood pressure measurement in a hospital does not provide such accurate results. This provokes problems with determining the diagnosis and choosing medications. Also, the doctor may have difficulty assessing the effectiveness of therapy.
Please note: Daily monitoring evaluates pressure readings many times. Thanks to this, it is possible to determine at what time the parameters were violated. This allows you to choose the dose and time of use of the drugs so as to maintain normal blood pressure throughout the day.
The key disadvantages of the method are the disruption of the patient's comfort. These include the following:
- daily monitoring is quite expensive;
- when compressed by the cuff, numbness of the shoulder may occur;
- there is a risk of skin irritation under the cuff;
- possible sleep disturbance due to round-the-clock operation of the device;
- There are several contraindications to the procedure.
Daily monitoring is considered an informative procedure that allows you to assess blood pressure within 24 hours. Thanks to this, it is possible to make the correct diagnosis and select adequate therapy. In addition, the procedure allows you to evaluate the effectiveness of the treatment and adjust the regimen of medications.
Still have questions? Ask them in the comments! A cardiologist will answer them.
