Blood pressure monitoring device. 24-hour blood pressure (BP) monitoring is a procedure that helps make a diagnosis of blood pressure disorders. What does the doctor learn from the results of the smear test?

We measure blood pressure throughout the day. We identify hypertension.
The cardiologist gives a full analysis of the results and recommendations.

The cuff and device must be worn 24 hours to record readings every hour.

The cost of diagnostics is 1,400 rubles.
It is cheaper only in a comprehensive examination.

The most common cause of death in our time is diseases of the cardiovascular system. More than a million people die from them every year in our country! And it’s not bad medicine that’s to blame for this - modern cardiology has a wide range of opportunities to help sick people. But the problem is that many of us go to the doctor too late, often arriving at the hospital by ambulance, with a heart attack or stroke.

Along with atherosclerosis, the development of which is difficult to prevent, one of the causes of life-threatening conditions (such as impaired blood supply to the heart or brain) is the “trifling”... hypertension. Not everyone knows that this disease can develop over many years, starting at a young age, asymptomatically and gradually. In their 30s, few people pay attention to an increase in upper or lower blood pressure by several units, and not everyone has a tonometer at home. And those who accidentally find out about their hypertension often brush it off: just take pills when nothing bothers you!

Another problem associated with the diagnosis of hypertension is the “white coat syndrome”. Some of us have retained an unconscious fear of doctors and medical institutions since childhood. Therefore, at an appointment with a cardiologist, a tonometer may show unreasonably high blood pressure numbers, while there is no illness. And for some in the hospital, the pressure, on the contrary, drops, while during work or at night its values ​​can be high... How to catch insidious hypertension?

A good way to get an objective picture is to conduct 24-hour blood pressure monitoring (ABPM). During this procedure, the patient wears a special device on his body for 1-2 days that records blood pressure readings in conditions as close as possible to natural ones. Based on the results of the study, the doctor receives all the necessary information in order to confirm or refute the presence of hypertension or symptomatic arterial hypertension (increased blood pressure caused by a particular disease).

ABPM prescribed in the following cases:

• - if you suspect “white coat syndrome”;
• - with a “borderline” increase in blood pressure (when its numbers are not high enough to immediately make a diagnosis, but cause alertness to the doctor);
• - when an increase in blood pressure is detected for the first time;
• - if you suspect the symptomatic nature of hypertension (for example, when the increase in pressure is associated with stress before consulting a doctor or occurs due to a concomitant disease);
• - when examining young people with unfavorable heredity for hypertension;
• - if the patient periodically experiences fainting, to exclude hypotension (low blood pressure);
• - in patients with already established hypertension, coronary heart disease and vascular lesions of the brain to identify critical blood pressure values;
• - to evaluate and adjust drug therapy.

Detection of office hypertension (hypertension “at the workplace”) is important for timely correction of work and rest regimes. It is believed that the risk of increased blood pressure with this option is much less than with persistent hypertension and relatively small compared with people whose blood pressure is normal. However, it is possible that office hypertension is a prestage of hypertension and is not a completely harmless condition, so timely changes in working conditions can prevent the formation of persistent hypertension.

Is it possible to sign up for ABPM without a doctor’s referral?

You can pass ABPM on your own initiative if you believe that this research will be useful to you.

Even if the procedure does not reveal any abnormalities, be sure to save the results of the study

– they can be used as a sample for comparison in the future ABPM.

What can and cannot be done during ABPM?

1. Watch the position of the cuff on your shoulder. Its lower edge should be fixed 1-2 fingers above the elbow. If you feel that the cuff has slipped off your arm, be sure to correct it.
2. Before each measurement, the device ABPM beeps. If you have the opportunity, do not move while measuring pressure, so the results will be more accurate. While the device pumps air into the cuff, relax your arm. At the end of the measurement, a repeat beep will sound.
3. Make sure that the tube connecting the monitor to the cuff is not pinched by clothing or when you are sitting or lying down.
4. Do not allow water to come into contact with the device (do not shower during the study), and also try to avoid ABPM long stay near sources of electromagnetic radiation (power lines, microwave ovens, television and radio transmitters).
5. If you think that the device ABPM is broken - do not try to repair it yourself and do not disassemble it. Report the incident to your healthcare provider.

In addition to the direct increase in blood pressure in various situations, the cardiologist examines a person’s circadian rhythms - the natural decrease or increase in blood pressure during the day. Deviations from the normal rhythm may be a harbinger hypertension or other health problems. Based on the information received, the doctor may recommend that you change your diet, give up bad habits, or undergo additional examinations.

At 24-hour blood pressure monitoring evaluate indicators such as:

• Average blood pressure values ​​during the study period. The normal value of average blood pressure per day is less than 130/80 mm (less than 135/85 mm during the day, less than 120/70 mm at night).
• Episodes of maximum increase in blood pressure.
• Daily profile (daily index) of systolic and diastolic blood pressure.
• The magnitude and speed of the morning increase in blood pressure.

1. "Dipper"– daily index within 10-20% (22%).
2. "Non dipper"– daily index less than 10%.
3. “Night peaker”– daily index less than 0.
4. "Over dipper"– daily index more than 20%.

These criteria are important for the physician who is treating a hypertensive patient, since patients whose nocturnal blood pressure reduction is insufficient (“Non dipper”) have an increased risk of cardiovascular complications and target organ damage of hypertension. Patients whose average blood pressure levels at night exceed those during waking hours (“Night peaker”) are at high risk of developing heart failure and kidney damage. Detection of a daily index of less than 0 is typical for patients with secondary (symptomatic) arterial hypertension and can help in the diagnosis of diseases accompanied by high blood pressure. As a rule, with secondary hypertension.

Pressure measurements without a specific system can hide the true picture of whether the patient has it or not. Daily monitoring of blood pressure readings can provide valuable information for the attending physician.

What is 24-hour blood pressure monitoring?

For a detailed understanding of the characteristics of the patient’s increased blood pressure, with further identification of the causes of this phenomenon, daily monitoring of blood pressure is carried out. The procedure makes it possible to correctly diagnose and prescribe appropriate treatment.

Daily blood pressure monitoring is carried out according to the developed methodology; the difference may be made by the devices of the hardware system selected for the study. The procedure can be carried out in conjunction with daily monitoring of the cardiogram.

Elena Malysheva will talk about how to properly perform 24-hour blood pressure monitoring in the following video:

Who is prescribed

• If the patient's blood pressure tends to decrease. Especially if at the same time there are dizzinesses and attacks of “lightheadedness.” Daily observation will make it possible to:
  • determine the boundary indicators,
  • degree of development of hypotension,
  • What are the patterns in pressure changes?
• If the patient has high blood pressure, there are the same reasons to monitor this phenomenon throughout the day. The study will clarify:
  • what are the highest blood pressure readings a patient has?
  • what time of day does this happen?
  • what causes the reaction that causes a change in pressure;
  • effectiveness of the drugs used
  • and other factors influencing increased blood pressure.

Why is it carried out?

An excess of blood pressure above the value accepted as normal is called hypertension. This condition is fraught with consequences such as:

• contributes to the emergence
• and other problems.

Many people do not monitor changes in pressure and only realize it when dire consequences overtake them. An important task is to study the question:

• whether the patient really has hypertension,
• what factors influence changes in pressure,
• individual selection of effective hypertension,
• how the body reacts to physical and emotional stress,
• The causes of presyncope and fainting are determined.

The procedure is repeated if necessary to clarify the diagnosis as prescribed by the doctor. There are no restrictions on the number of such procedures, except in cases that have contraindications.

Read below about daily blood pressure monitoring in stroke patients and other indications for the procedure.

The following video will tell you when a doctor prescribes 24-hour blood pressure monitoring:

Indications for testing

• Elderly patients. This is due to the fact that age is one of the factors that contribute to the tendency to increase blood pressure, because:
  • the accumulation of harmful effects occurs over time,
  • aging of body tissues and other age-related features.
• The theory that an increase in blood pressure when measured by a medical professional may be “white coat” hypertension is being tested. In other words, the psychological factor of the body’s reaction to the presence of a medical worker is triggered. Many people have been afraid of doctors since childhood. Therefore, daily monitoring of changes in blood pressure in the absence of a “white coat” can provide objective information about the issue being studied.
• "Nocturnal" hypertension. Daily monitoring can detect this phenomenon.
• Hidden hypertension. Fluctuations in pressure that appear in the workplace are the so-called “workday” hypertension.
• Drug therapy where close monitoring is required.
• Determination of the rhythm of changes in pressure indicators throughout the day. If a circadian rhythm disorder is detected, this provides useful information about the patient’s condition and the further task will be to search for the causes of this phenomenon and adjust treatment measures.
• Cases when the use of drug therapy is not successful. The pressure does not decrease its indicator.
• If the patient’s blood pressure cannot be called high, but such that the doctor is somewhat wary.
• Pronounced pressure drops. Low values ​​give way to high values ​​when the possibility of complications arises.
• Clarifying the diagnosis when symptoms of nervous system deficiency appear.
• Diagnosis of conditions when low pressure is recorded.
• If the person is young, but has unfavorable heredity regarding hypertension.
• When monitoring patients with insulin-dependent diabetes.
• When examining pregnant women, if pressure deviations from the norm are observed.

Contraindications for

The procedure is not carried out in the following cases:

• If the patient’s condition worsens while monitoring blood pressure readings, this type of diagnosis is abandoned. The procedure is not performed if cardiac conduction is impaired, arrhythmia or pressure is over 200 Hg. Art.
• If monitoring has already been carried out and undesirable consequences appear after the procedure.
• The following phenomena are contraindicated:
  • thrombocytopenia,
  • injury to the arm on which the cuff is installed,
  • skin diseases at the cuff attachment site,
  • thrombocytopathy.

Is diagnostics safe?

Measuring blood pressure throughout the day does not pose a danger to the patient. He should carry on as usual.

If the patient has symptoms that coincide with contraindications for the use of devices for 24-hour blood pressure (BP) monitoring, then the procedure is not performed.

Preparing for monitoring

In order for daily monitoring of pressure indicators to be successful, it is necessary to perform preparatory steps. Preparation of technical means:

• It is necessary to ensure that the recorder is provided with power for the specified operating time. Check whether the battery is charged; if batteries are used, then it is necessary to analyze whether their charge is enough for 24 hours of uninterrupted operation.
• The recorder is connected to a computer and programmed with individual information:
  • patient information,
  • Recorder operating mode:
    • an interval is set at which pressure will be measured for daytime and nighttime;
    • programming a signal on the eve of measurement, if it is decided that it is needed;
    • a setting is entered regarding whether measurement readings will be shown on the display.
• To select a pneumatic cuff that will fit the patient, measurements of the forearm circumference are taken.

Installation of devices for the procedure:

• The cuff is placed on the forearm of the non-working arm:
  • for right-handed people on the left hand,
  • for left-handers on the right hand.
• To prevent the cuff from moving during monitoring, it is fixed. For this purpose, double-sided discs with a sticky coating are sometimes used.

The patient is explained the rules of behavior during the examination:

• During the next automatic pressure measurement, the patient must ensure that his arm is lowered along the body and his muscles are relaxed.
• It is necessary not to think about the measurement readings and not to be interested in them, so as not to influence the result.
• At night you should sleep as usual, without focusing on the measurement process.
• If a person is in motion, then when he hears a signal that the next pressure value will be removed, he must stop, relax his hand and lower it down. In this position, you should wait until the measurement is completed.
• The patient is told that during the procedure it is necessary to keep a diary. It records, indicating time periods, what type of activity the person was engaged in, what sensations accompanied the activity, and changes in well-being. Such a document is very important, because the patient’s diary contains important examples of data from daily blood pressure monitoring.

How does the procedure work?

At the outpatient clinic, the patient is equipped with devices that will remain on him for 24 hours and measure blood pressure.

• A pneumatic cuff is placed on the forearm. Its position is fixed so that it remains the same for the entire duration of the study.
• The main device is attached to the belt. It weighs about 300 g and does not cause any discomfort to the patient.

After receiving all instructions, the patient can go home and do their usual activities. Devices on the patient’s body will automatically take pressure measurements at specified intervals and keep records of them.

It is important for the patient to responsibly take notes in the diary so that the doctor can get a reliable picture of the relationship between changes in blood pressure and the possible cause of this phenomenon.

When the test time ends, the device is turned off. You should come to an appointment with a doctor to provide the device and a diary for decoding.

During the procedure, the following recommendations should be followed:

• It is necessary to ensure that the tube that connects the device and the cuff does not become pinched.
• If there are signs that the device has become faulty, you should return to the doctor; you should not try to fix it yourself.
• The cuff is secured above the bend of the elbow by two fingers. If its position has shifted, the patient needs to correct it.
• The patient should not go into places where sources of electromagnetic radiation are located.
• Postpone water procedures during the study because the equipment cannot be wet.
• While the equipment is taking measurements, you should relax your hand. The beginning and end of the measurement are indicated by a signal.

We will talk about decoding the results and examples of conclusions on the complex of daily blood pressure monitoring below.

Decoding the results

The computer program processes the monitoring results automatically. Main indicators of daily observation:

• The daily rhythm of pressure, in other words, is called the circadian rhythm. Its violation indicates that the cause of this phenomenon should be found.
• Average pressure values ​​are an important indicator for assessing the results of the study.
• Pressure variability is an assessment of how pressure readings deviate from the circadian rhythm curve.

Average diagnostic cost

The approximate cost of a 24-hour blood pressure monitoring procedure averages 700 rubles.

In the video below, responsible parents will find useful information on how to prepare their baby for the procedure of 24-hour blood pressure monitoring:

Cardiological pathologies are becoming “younger” every day. Pressure disorders in this case are no exception. The reasons for this phenomenon lie not only in poor ecology and poor quality nutrition. A large number of stressful situations also affects the situation. It can be difficult even for a specialist to recognize when the pressure is high, for example, during psychological overload, from real hypertension. This leads to the need to conduct daily blood pressure monitoring (ABPM). This procedure allows us to identify the patient’s hypertension and the time of day when the pressure increases maximum in order to adjust treatment.

This procedure is included in the mandatory examination of the condition of a patient in whom pressure deviations are suspected during the day. To carry out this monitoring correctly, you need to know some diagnostic rules.

Indications for the procedure

The method of daily blood pressure monitoring is very popular today, since the daily index allows you to study pressure fluctuations and record them. To obtain accurate results, the patient needs to wear a device that measures and records blood pressure every 15 minutes for a day or more.

The results of daily fluctuations in blood pressure monitoring are necessary for the doctor when examining people who complain of:

• for rapid fatigue, headache or dizziness;
• blurred vision or the appearance of spots before the eyes;
• the appearance of noise in the head or other signs of health problems.

Pressure control is often carried out in pregnant women, even if they do not have the above and other symptoms, but the doctor has noticed increased blood pressure.

Important! Pressure surges often lead to strokes or heart attacks, and often to death. There is a very high mortality rate among people suffering from this pathology.

Often a similar problem occurs among those who worry before the office or during an appointment. Daily blood pressure monitoring helps to understand whether this is a reaction to a hospital visit or a pathology.

The procedure is indicated for:

• primary diagnosis of hypertension;
• monitoring treatment results in patients suffering from hypertension;
• the need to obtain information at what time the patient’s blood pressure is most often elevated in order to adjust the dosage of medications;
• sleep apnea syndrome;
• signs of hypertension in pregnant women;
• suspicion of;
• assessing the professional suitability of people working where blood pressure fluctuations are unacceptable.

Contraindications to ABPM

It should be remembered that daily monitoring of blood pressure cannot always be done.

ABPM is contraindicated for:

• exacerbation of skin pathologies at the site of the applied cuff;
• blood clotting abnormalities;
• the body's tendency to bleed;
• trauma to the upper extremities, which excludes the possibility of compression;
• disorders of the functioning of the brachial arteries, which do not allow accurate pressure measurements;
• patient refusal to monitor.

ABPM is useless for heart rhythm disturbances or high blood pressure ().

Important! The use of devices for ABPM in case of contraindications can not only lead to an error in the readings, but also to an incorrect diagnosis. In this case, complications and even death are possible if pressure surges are not taken into account or their treatment is incorrect.

Equipment for ABPM

The ABPM device records the slightest changes in blood pressure, both systolic and diastolic, reflecting the measurement results on a graph. The device shows:

• “working” blood pressure of the patient;
• its changes during load;
• BP at night and during sleep.

Devices designed for ABPM are sensitive and record any pressure deviations. The data obtained during monitoring can deceive the doctor if the patient does not follow the instructions.

There are several methods for controlling blood pressure. Doctors consider ECG monitoring and Holter blood pressure to be the most effective. The principle of the method is that electrodes are installed on the patient’s chest near the heart to analyze the pulse and all deviations in the functioning of the heart. For greater accuracy of the procedure, doctors often use a special sleeve, putting it on one shoulder.

The BPro 24-hour blood pressure monitor is bulky. It limits the subject’s movements: he has to move very calmly, hung with wires. But still it gives the opportunity:

• diagnose hypertension;
• predict acute blood flow disorders;
• monitor the effectiveness of antihypertensive treatment.

To monitor blood pressure indicators, an oscillometric device is sometimes used, which carries out computer analysis of the results.

Another popular method is to use the bplab system. The method is convenient in that when the pressure is high, the system regulates the pressure force. Thanks to this, the patient does not experience discomfort during the examination. But it’s easy to deceive a doctor when deciphering monitoring data if the patient filled it out incorrectly. Such an error can lead to incorrect diagnosis and treatment, which is dangerous for the patient’s life.

Preparation for the procedure

On the day of daily blood pressure measurement, it is better to wear a T-shirt or shirt with short sleeves, and, if necessary, loose clothing on top, since the device for daily blood pressure monitoring is placed in a bag for this time and hung on the neck, and a cuff is put on the arm.

Sometimes doctors advise you to bring batteries for the device.

Before the study, patients should lead their usual lifestyle.

Before the examination, the patient is explained all the main points and given general instructions to avoid mistakes.

How is the procedure performed?

On the morning of the day when blood pressure monitoring is scheduled, the patient must see a doctor. There is no special preparation for the success of the procedure. The research procedure is carried out for 24 hours.

In order for a pressure measuring device to help make accurate measurements and make a diagnosis, you need to:

• do not disturb the location of the device “sleeve” on the arteries;
• behave calmly;
• do not take baths or showers to prevent water from getting on the device;
• try not to bend the pump tube;
• avoid heavy loads;
• strive to sleep normally;
• record all tonometer readings in a diary (a patient’s diary during daily monitoring is necessary for diagnosis).

Measurement of indicators of all types of pressure is carried out with special tonometers. They are called "monitors".

ABPM in childhood

The method of daily blood pressure monitoring is also used in pediatric practice. Moreover, it is one of the reliable ways to control arterial hypertension, helping to diagnose and treat it in childhood.

In pediatric nephrology, 24-hour monitoring, for example, is more effective than random blood pressure measurements. Using this method, polycystic disease can be diagnosed in children at an early stage.

In other words, blood pressure monitoring in children and adolescents is also used to solve problems:

• improving the efficiency of diagnosing arterial hypertension;
• examination of children suffering;
• studying the autonomic nervous system;
• identifying reactions to doctors;
• diagnostics of NCD;
• early ;
• assessing the quality of treatment provided.

In addition, doctors consider it advisable to use the pressure monitoring method in pediatrics in a comprehensive examination of children with cardiovascular pathologies.

Decoding the results

ABPM results are important for diagnosing many pressure abnormalities in patients, but they must be interpreted. They are deciphered by the doctor, allowing him to make an accurate diagnosis and select a course of therapy. After all, the results of monitoring, depending on the method and device, can be presented as a graph or a chain of blood pressure level records. Here are approximate comparative characteristics of the measurement results:

In this case, the patient is asked to keep a diary, entries in which allow an accurate interpretation of the ABPM results using the device. In the diary, the patient records all the loads and their time, the menu on the day of the study, and sleep time. If the patient experienced stress, he should record this fact in his notes, which will facilitate decoding. It is easy to decipher the readings, since there is a lot of information during this control.

Analysis of data obtained from a daily study of blood pressure with devices, the most informative are the following parameters: average blood pressure, time indices of hypertensive and hypotensive pressure, blood pressure range indicators. Moreover, the values ​​are calculated both per day and for certain periods of time. The conclusion about hypertension is given after deciphering the monitoring.

Reliability of the method

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.

The method of 24-hour blood pressure monitoring has a high percentage of accuracy, but errors are still common. This happens for the reason that the patient may keep the diary incorrectly or may not make entries immediately, but then distort the information. For example, exercise can increase blood pressure, but the patient has not recorded the reason for the increase.

The military registration and enlistment office requires ABPM when a conscript reports blood pressure abnormalities. At the same time, in order to deceive, a conscript often violates the instructions for conducting an examination for the purpose of deception. But this fact is often discovered when the doctor deciphers the testimony and notes. Because the information and the instrument readings will contradict each other.

Daily blood pressure monitoring is an examination that allows you to identify the dynamics of changes in blood pressure (BP) during the day, subject to normal human activity. The technique is used to diagnose hypotension and hypertension. The common name is the abbreviation ABPM.

In people with impaired functioning of the cardiovascular system, blood pressure is unstable. Periods of constant increase or decrease in blood pressure, during which specific clinical signs of a disorder appear, are the exception rather than the rule. Typically, blood pressure fluctuates throughout the day, depending on the load, psycho-emotional state and even the person’s diet.

It is very difficult to reliably diagnose hypotension or hypertension by taking a single blood pressure measurement by a doctor. This is due to the patient’s individual reaction to the stressful situation that arises when visiting the clinic. Moreover, there is even a special term that describes the increase in pressure in the doctor’s office - “white coat” hypertension.

Unlike a one-time blood pressure measurement, ABPM allows you to obtain more reliable data

If a person feels uncomfortable in the clinic, the doctor’s blood pressure measurements cannot be considered reliable. The pressure at home, at rest, and the readings when examined by a specialist will vary, often quite significantly. ABPM allows you to avoid mistakes and accurately determine the dynamics of changes in blood pressure at rest, during normal household activity and under the influence of other factors.

An alternative to ABPM is a blood pressure diary kept by the patient himself. But such data cannot be considered accurate, since a person may forget to measure blood pressure or deliberately distort the values ​​in an attempt to deceive the doctor.

Daily monitoring of ABPM pressure, carried out using a special device throughout the day, is the most accurate method of modern diagnosis of blood pressure disorders in patients of any age group.

What determines ABPM?

The ABPM device records the slightest fluctuations in blood pressure and presents them in the form of a graph. The ABPM results obtained are deciphered by the doctor, allowing an accurate diagnosis and selection of the optimal treatment regimen.

The method shows:

• the patient’s normal or “working” pressure;
• changes in performance under load;
• Blood pressure at night;
• pulse pressure.

In this case, the patient must keep a special diary, which will help accurately decipher the ABPM results. The diary records all moments of stress, diet, time of awakening and time of going to bed. If a person was stressed during the day, this is also recorded in the records, which must then be analyzed by a doctor.

Deciphering ABPM does not take much time, thanks to the large amount of information. The device is very sensitive and detects even the slightest pressure deviations. Data obtained during monitoring includes the following information:

• graph of blood pressure changes during the day;
• average values ​​of systolic, diastolic and pulse pressure;
• values ​​of lower and upper blood pressure during sleep;
• changes in performance under load;
• the degree of pressure reduction at night.

Having figured out what data can be obtained through ABPM monitoring and what it is, you should know when this method is used in cardiology, as well as all its advantages and disadvantages.

Example of ABPM result

When is the examination scheduled?

ABPM allows you to determine the dynamics of pressure changes in various diseases. Indications for the ABPM indicator monitor:

• determination of the degree of hypertension;
• diagnosing situational increases in blood pressure;
• hypotension;
• monitoring blood pressure in pregnant women.

Using ABPM to monitor how blood pressure changes throughout the day can be prescribed to patients who have recently suffered a myocardial infarction or stroke. This allows you to timely adjust the treatment regimen.

Indications for ABPM monitoring are diabetes mellitus, gestational disorders, vascular atherosclerosis, heart failure, and renal failure. People with these diseases and disorders constitute the main risk group for developing hypertension.

During pregnancy, ABPM is used to monitor a woman's condition. Poor 24-hour blood pressure readings in the later stages are an indication for an emergency cesarean section.

For hypertensive patients, ABPM should be carried out to determine the dynamics of disease progression and select the optimal treatment regimen. In this case, simultaneously with ABPM, electrocardiography (ECG) is necessary. ABPM also monitors changes in heartbeat and is therefore prescribed for heart disease.

In addition to ABPM, which measures blood pressure (BP), cholesterol and glucose levels may be measured in certain groups of patients to make an accurate diagnosis.

Preparing for the examination

If the patient has been prescribed ABPM, the doctor gives detailed instructions before starting these examinations. Preparing for an ABPM analysis or study:

• normalization of the daily routine;
• refusal of clothes that hinder movement;
• cancellation of physical activity;
• refusal to swim.

While wearing the device, do not take a bath or shower, as moisture will damage the device. On the eve of installation of the device, the patient is allowed to take any sedative. Sleeping with the device on your chest is not very comfortable, so it is important to get enough sleep before installing it.

If the patient is taking any medications that may distort ABPM data, the doctor should be notified about this. In this case, the specialist will give detailed instructions on preparing for ABPM; in some cases, medications are discontinued or their dosage is reduced to avoid distortion of blood pressure values.

How is monitoring carried out?

The most common and accurate research method used in cardiology, according to Holter, is ABPM and an electrocardiogram. A Holter examination involves round-the-clock monitoring of ABPM, recording the characteristics of the heart at times of changes in blood pressure.

The examination algorithm is simple:

• a wide cuff is placed on the shoulder, into which air flows;
• the cuff is attached to the device;
• the device is located on the harness on the chest;
• Blood pressure is measured every half hour;
• all data is recorded in the device’s memory.

The device does the main work. The ABPM device is a mini-computer or a very smart tonometer that not only measures pressure, but also remembers the values, analyzes them and builds a graph of changes in blood pressure. The patient only has to follow a few rules:

• live according to a normal schedule;
• do household chores without looking at the device;
• do not shower;
• refuse any medications (after agreeing with your doctor);
• Do not allow the device tube to bend with the hand with the cuff installed.

The device takes measurements every 30 minutes. The doctor gives the patient a special diary in which any load is recorded during the day. Any changes in the psycho-emotional state and other factors that can provoke a surge in pressure are also entered there.

The Holter study also includes measurements of heart parameters

How should the patient behave?

Installing the device causes virtually no discomfort. A person feels the same as when measuring blood pressure with a home tonometer. The only negative is the constant pressure on the arm with the cuff, every half hour.

To avoid distortion of data obtained during the survey, you should:

• behave as usual;
• avoid intense exercise;
• do not change your diet;
• do not take medications for hypertension;
• do not be nervous;
• refuse tight clothes;
• Make sure that the device tube is not compressed.

Stress and psycho-emotional stress can distort the results of the examination. They must be avoided. It is better to minimize contact with others on the day of wearing the device, not to get irritated over trifles and try to remain in a relaxed state.

On the day of blood pressure monitoring, overtime and night shifts should be avoided. Going to bed should be at the patient's usual time. At the same time, it is important not to forget to record this in your diary.

It is necessary to record all events that can affect blood pressure readings

Disadvantages of wearing the device

The ABPM itself is somewhat reminiscent of a small shoulder bag, however, it should be worn around the neck or chest. The device is compact, but can be noticeable to others. You can hide the device under loose clothing.

The main inconvenience when wearing the device is the periodic compression of the artery in the arm while the cuff is inflated with air. The sensations are similar to the operation of a regular tonometer, but are repeated every half hour. In this case, the sudden start of operation of the device can take a person by surprise and provoke a small stressful surge in pressure. However, this practically does not distort the meaning, since after literally 2-3 inflations of the cuff, patients get used to the operation of the device.

Another problem is the loss of sensitivity in the arm where the cuff is worn. This is due to the same compression of the artery. However, some people feel tired in the arm with the cuff.

People with particularly sensitive skin may experience irritation or diaper rash after wearing the cuff for a day. This is explained by the fact that most often it is made of artificial material, which does not allow the skin to breathe. The problem is more likely to be aesthetic and goes away quite quickly even without treatment.

A serious disadvantage of wearing the device is the need to constantly ensure that the tube connecting the cuff to the tonometer is not compressed. When going to bed, you will have to choose a body position that will not interfere with the normal flow of air into the cuff. Unfortunately, sleeping with an ABPM device is very uncomfortable.

Contraindications

There are no absolute contraindications to the examination. It may be necessary to reschedule the installation of the device to another date if a person develops a skin rash or aggravated dermatological disease in the area where the cuff was installed, for example, psoriasis.

Installation of the device is impossible in case of fractures, severe bruises, burns and other injuries of the arm on which the cuff is placed. In this case, the study is postponed until the person has fully recovered and the skin has recovered.

In case of hand injuries or skin damage, the examination is postponed

Cost of examination

Daily blood pressure monitoring should be prescribed only by a cardiologist. The average cost of this examination depends on the clinic in which the devices are installed, as well as the type of device.

A study using the Holter method will cost an average of 2,300 rubles. In fact, the price range is very wide. In different clinics, ABPM costs from 1200 to 3500 rubles. At the same time, the price does not affect the quality of the examination, since all devices for measuring pressure work on the same principle, so there is always a place where this procedure will be cheaper.

The cost of ABPM also depends on the region. In provincial clinics, the examination costs up to 1,500 rubles, in the capital – from 2,000.

Is it possible to deceive ABPM?

Hypertension, neurocirculatory dystonia of the hypertensive type and severe heart failure are diseases in which young people may not be accepted into the army. To confirm the diagnosis, 24-hour blood pressure monitoring is required, as the most optimal way to determine the dynamics of changes in blood pressure.

Young people who don't want to serve often wonder how to cheat ABPM. The recommendations listed below can be safely published in the section of bad advice, but they really help to increase blood pressure and fool the ABPM device.

1. While installing the cuff, you should hold your breath. You need to breathe only after it is filled with air.
2. When measuring pressure, you should tense your buttocks and pull your toes towards you. These manipulations are invisible to others, but the body takes them for training, so the pressure rises.
3. Tonics that will help raise blood pressure - tincture of lemongrass, ginseng, eleutherococcus. They can be taken 15 drops three times a day a few days before the ABPM installation.
4. While wearing the device, lower the arm with the cuff below heart level. If a person is lying on the bed, you need to raise your legs high at this time. This disrupts normal blood flow and increases blood pressure.
5. In order for the average ABPM value to exceed 155 per 100 mmHg. You can take energy drinks, coffee, coffee beans, very strong black tea or caffeine tablets.
6. Those who want to accurately deceive ABPM should remember one important rule - during sleep, blood pressure drops by an average of 20%. If, after all the above methods of raising blood pressure, you fall asleep soundly at night, your blood pressure will drop, and the average reading for the examination will not exceed 140 mmHg. Thus, in order to be falsely diagnosed with hypertension, you will have to remain awake during 24-hour blood pressure monitoring.

The listed methods negatively affect the functioning of blood vessels and the heart. After activities to deceive ABPM, you will have to intensively rest and recover for at least two weeks.

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24-hour blood pressure monitoring

In order to maximize objectification of blood pressure indicators, round-the-clock monitoring is recommended. That is, the value of pressure (both upper and lower) is determined not only at rest, but also when the human body is exposed to various stress factors.

Daily monitoring is a procedure that makes it possible to determine the dynamics of the general condition and the adaptive potential of the cardiovascular system, that is, an indicator of how adequately a person can adapt to intensively changing environmental conditions.

Indications for the procedure

Daily blood pressure monitoring (abbreviated as ABPM) is a rather complex cardiological study, which is recommended for absolutely all patients without exception who have experienced cardiocirculatory problems at least once. The feasibility of conducting this study is due to the fact that ABPM increases the accuracy of assessing the true blood pressure, especially if there is a suspicion of the initial degree of arterial hypertension (AH) in the subject. The procedure is extremely simple for the patient, since he is not required to do anything particularly complicated, unless, of course, you count keeping a diary. Moreover, 24-hour blood pressure monitoring is a non-invasive procedure that is completely painless and safe. 24-hour blood pressure monitoring is carried out in the following situations:

1. Elderly age. People whose age reaches 60-70 years have a tendency to manifest hypertension. This is due to the fact that over time the results of adverse effects accumulate, body tissues age and some other age-related changes appear.
2. Suspicion of the so-called. In the situation under consideration, elevated blood pressure may be a banal psychological reaction of a person to the presence of a doctor. Many people have an animal fear of people in white coats. Therefore, daily blood pressure monitoring allows you to obtain the most reliable and objective information.
3. Nocturnal hypertension. By implementing daily monitoring, you can easily identify this violation.
4. Hidden hypertension. Changes in blood pressure that occur at work are often referred to by clinicians as workday hypertension.
5. Drug therapy that requires strict monitoring and control of blood pressure. Occurs during therapy with centrally acting hypotonic drugs, as well as when using ganglion blockers.
6. Assessment of the rhythm of changes in blood pressure parameters during the day. When identifying a violation of the circadian (daily) rhythm, the procedure allows one to obtain very valuable information about the patient’s condition and determine the most likely causes of the pathology in question. Also, a diagnostic study allows you to adjust therapeutic measures.
7. Lack of effect from using synthetic ones. If the pressure does not decrease despite hypotonic therapy, this procedure must be performed.
8. Serious fluctuations in SBP and DBP. The study is definitely required if low readings are quickly replaced by high ones or there is a threat of cardiac complications.
9. Specification of the diagnosis in the presence of clinical signs of pathology of the nervous system, which is of an autonomic nature.
10. Identification of conditions in which persistent hypotension occurs.
11. The presence of a hereditary predisposition to manifesto, as well as to other cardiocirculatory pathologies.
12. The patient has a history of insulin-dependent type 1 diabetes. In such a situation, it is definitely necessary to systematically monitor indicators.

Preparation for the procedure

No special preparation is required. Admission or cancellation the day before and on the day of the study must be agreed upon with the attending physician.

Daily blood pressure monitoring should never be carried out on the day of intensive diagnostic examinations, including drawing blood for various tests, X-ray examinations, and physiotherapeutic procedures.

In order for blood pressure monitoring to show an objective picture, it is very important to properly prepare for this procedure. To do this, you should strictly adhere to the recommendations listed below:

1. Ensure that the blood pressure recorder is properly charged during the procedure. When using batteries, consider whether they will be enough for 1 day of uninterrupted operation.
2. Connect the recorder to a PC and program it with individual patient data. It is also necessary to set the functional mode of the device. For this purpose, determine the interval at which blood pressure will be measured.
3. It is necessary to measure the circumference of the forearm. This is required to make the optimal selection of the appropriate air cuff that will suit the patient.
4. Install a device designed for 24-hour blood pressure monitoring.
5. The cuff is fixed to the forearm. Accordingly, for right-handers, the left hand is used, and for left-handers, it is attached to the right. In order to avoid displacement during the procedure, it is necessary to securely fix it. Sometimes double-sided discs with a sticky surface are used for this.
6. Proper and timely training is of great importance. This will help the patient choose the right behavior during the examination.
7. When performing automatic blood pressure measurements, it is important to ensure that the arm is positioned exclusively along the body, and its muscles are as relaxed as possible.
8. You should not think about the indicators or be interested in them during the test. This will help to avoid the influence of stress factors on the examination result.
9. At night, a hypertensive patient definitely needs to sleep without focusing on the current measurement process, as this can lead to unreliable results. If a person suddenly hears a signal about the start of the next one, he needs to stop, lower his hand with the cuff attached to it down and relax. It is in this position that you must wait until the measurement is completed.

It is necessary to conduct during monitoring, in which all types of activities that a person engages in throughout the day will be noted. And not only that, you also need to note the time and sensations that accompany the workload. This document is fundamentally important because it contains valuable information about 24-hour blood pressure monitoring.

Contraindications

The procedure has no absolute contraindications at all - if only because it is non-invasive and completely safe. The only side effects that can be identified are discomfort in the arm for 1–2 days after the examination, since the cuff may press.

As a casuistry, the instructions contain information that, in theory, absolute complications are possible during previous monitoring, namely, skin diseases on the shoulder, thrombocytopenia, thrombocytopathy and other hematological pathologies during an exacerbation, trauma to the upper limb girdle, diseases accompanied by vascular damage upper limbs. But until now there has been no evidence to suggest that such incidents have occurred. Another question is that there are possible inconveniences that you are likely to encounter during the procedure:

1. Difficulty sleeping and falling asleep. Based on the considerations that the device measures blood pressure at night, a person can wake up from squeezing the arm with a cuff or from a preliminary signal. This will be especially true for those who sleep lightly.
2. It will be impossible to fully bend the arm at the elbow, based on the consideration that the cuff is attached just above the joint. Inconvenience may arise the moment you decide to wash your face or brush your teeth. You will also have to refrain from taking a shower or bath, because this device cannot be wet.
3. Of course, these are all the disadvantages of the procedure in question, but all of them are completely insignificant against the advantages of the procedure - you agree, they can be tolerated in order to establish an accurate diagnosis, which after ABPM can be considered reliable.

Manufacturers of devices intended for round-the-clock monitoring indicate in the instructions relative contraindications:

• Thrombocytopenia and thrombocytopathies, as well as other blood pathologies during clinical exacerbation.
• Skin lesions localized in the shoulder area.
• Pathologies are accompanied by damage to the blood vessels of the hands.
• Upper limb injuries.
• Poor tolerance of the procedure, noted last time.
• Significant disturbances in the conductivity and rhythm of the heart, SBP more than 200 mm Hg. Art.

How is the procedure performed?

In an outpatient setting (that is, at home), a person is equipped with special medical devices that will be fixed on him and remain there throughout the day, while recording the dynamics of blood pressure, but the doctor carries out preparatory measures in the hospital.

1. For this purpose, securely attach the pneumatic cuff to the shoulder.
2. The main device is fixed on the belt. It weighs about 300 g and does not cause any discomfort to a person.
3. After receiving all the necessary instructions, the patient can safely go home and do their usual activities.
4. The device, fixed on the human body, will automatically measure blood pressure at certain time intervals and record the obtained values.
5. The patient must be extremely careful about recording all necessary information in the diary. This will allow the doctor to obtain an objective picture of changes in blood pressure parameters and establish the most likely causes of fluctuations. After completion of clinical studies, the device should be switched off.
6. All that remains is to come to an appointment with a specialist in order to give him the device and the diary for further decoding.

During the actual session, you must adhere to the recommendations listed below:

1. Avoid squeezing any tubing that may be used to connect the device to the cuff.
2. If there are signs of malfunction of the device, you should return to the doctor.
3. You should not even try to repair the device yourself.
4. The cuff is fixed two fingers above the elbow. If the device has changed its position in a certain way, the patient should try to correct it independently.
5. During the procedure, a person should not enter areas where sources of electromagnetic radiation are localized.
6. It is important to temporarily refrain from performing water procedures, since the device should never be wetted.
7. When taking measurements, it is recommended to relax your hand. Before the start and end of the measurement, a characteristic signal appears.

Advantages and disadvantages of the method

Daily measurement of SBP and DBP has a number of clinically significant advantages:

1. The most important advantage is the ability to capture even minor fluctuations in the indicator in different categories of patients.
2. ABPM data more objectively reflect the level of blood pressure in the daily life of patients and take into account the impact of external and internal factors on their body. Average blood pressure values ​​obtained from ABPM are more closely related to the resulting target organ damage than data from clinical measurements;
3. ABPM data before the start of therapeutic measures may have a predictive value in the manifestation of cardiovascular complications;
4. Regression of target organ damage is more closely related to changes in ABPM values ​​than to clinical blood pressure levels.

Decoding results

In addition to direct changes in blood pressure values ​​in various situations, a cardiologist examines a person’s circadian rhythms - the natural fluctuations of this indicator during the day.

Some deviations from the normal rhythm may be harbingers of hypertension or other cardiac pathologies.

When carrying out ABPM, the following indicators are assessed and interpreted:

1. Average blood pressure readings for the period of the study.
2. Episodes of maximum increase in blood pressure.
3. Daily profile (daily index) of SBP and DBP indicators.
4. The magnitude and intensity of the morning increase in blood pressure.

Depending on the obtained indicators of the daily blood pressure profile, all patients with hypertension can be divided into four main groups:

• “Dipper” is a daily index fluctuating between 10-20% (22%).
• “Non dipper” – daily index less than 10%.
• “Night peaker” – daily index less than 0.
• “Over dipper” – the daily index is more than 20%.

Patients who develop a nocturnal BP fall that is insufficient (“Non dipper”) have an increased risk of cardiogenic complications and target organ damage of hypertension. Patients whose data at night exceed those during waking hours (“Night peaker”) have a high risk of heart failure and renal pathologies.

Identification of a daily index less than 0 is typical for patients with secondary (symptomatic) hypertension and can help in the further diagnosis of nosologies associated with high blood pressure.

The information obtained during ABPM will allow not only to verify the diagnosis of hypertension, but also to correct therapeutic measures.

Evaluation of the study results

ABPM data is processed automatically using a PC. When performing the procedure, the following indicators are of leading importance:

1. Circadian rhythm of blood pressure. In medicine, this parameter is called the circadian rhythm. Fluctuations in this value over a wide range indicate the need to search for the root cause of headache.
2. Average blood pressure readings.
3. Blood pressure variability. This parameter makes it possible to determine how strongly blood pressure readings deviate in correlation with the circadian rhythm.
4. The identified features or any specific pathology should be shown by graphs of blood pressure changes for the corresponding period of daily monitoring. In other words, analysis of ABPM results makes it possible to calculate average blood pressure values ​​per day, as well as during the day and at night, blood pressure variability, assess the severity of blood pressure hypotension at night relative to daytime, and identify blood pressure levels in the morning.

ECG monitoring should not be confused with Holter; these are completely different procedures, and one does not exclude the other. Moreover, it very often happens that in some cases (for example, when monitoring ABPM indicators) all values ​​are within the normal range, and the Holter cardiogram shows pronounced deviations. Accordingly, we can conclude that both procedures need to be done. They will perfectly complement each other and will allow you to get the most complete picture of the patient’s clinical condition.

It is also very important to compare heart rate indicators over time and evaluate the data obtained as a whole. Ideally, make sure that all of them are sent from the monitors to the display of the gadget, and there is no need for the patient to fill out any logs.