What is the daily blood pressure measurement called? 24-hour blood pressure monitoring - features of the procedure. Contraindications for the study

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)

• Diagnosis of arterial hypotension

• Control of drug intervention

Table 1. Comparative characteristics of the two most common non-invasive methods of measuring blood pressure

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.

Table 2. Main characteristics of 24-hour blood pressure monitors

• 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.

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 pulsation of the a.brachialis 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 prescription 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.

24-hour blood pressure monitoring, or ABPM, is a diagnostic method whose operating principle is to record blood pressure values ​​over a 24-hour period (one day).

The procedure makes it possible to accurately identify pressure surges and determine hypertension or hypotension.

A single blood pressure measurement at a doctor’s appointment is quick, but does not provide complete information. Moreover, some people experience anxiety and excitement while in a medical institution, which causes pressure surges (the so-called “white coat syndrome”) and prevents the identification of existing pathologies.

The patient is referred for this diagnostic test by a general practitioner or cardiologist.

This is what the patient looks like with the device in the photo:

The category of people who require daily blood pressure monitoring includes patients with VSD, hypertension, symptomatic arterial hypertension, diabetes mellitus, heart and kidney failure, vascular atherosclerosis, and those who have recently suffered a heart attack or stroke.

Certain patient complaints also serve as the basis for daily monitoring of blood pressure:

• frequent headache;
• dizziness;
• fainting;
• chronic fatigue;
• drop in visual acuity;

This type of diagnosis is also used in the later months of pregnancy to determine the method of delivery. Significantly abnormal blood pressure values ​​in a pregnant woman are an indication for an emergency cesarean section.

Also, 24-hour blood pressure monitoring is indicated for patients with diagnosed arterial hypertension or hypotension in order to determine the moments during the day when the pressure increases or decreases significantly. This will allow the attending physician to adjust the dosage of medications for different times of the day.

Blood pressure assessment is also carried out in healthy people to confirm their professional suitability for a certain type of activity (engine drivers, pilots, astronauts), and in conscripts of the military registration and enlistment office - to confirm their suitability for military service.

Advantages and disadvantages of the method

The main advantage of the examination is that the ABPM device (monitor) allows you to record all changes in blood pressure within 24 hours, down to the smallest fluctuations, which is of enormous diagnostic value.

Long-term monitoring helps distinguish latent hypertension from temporary hypertension. For example, a visit to the doctor causes stress in the patient, as a result of which the blood pressure rises sharply. In a comfortable environment for a person, blood pressure is kept within normal limits.

The opposite situation often arises, when the patient reports a deterioration in health, but during a consultation with a doctor it is not possible to record critical blood pressure readings. In such a situation, the ABPM system is indispensable.

The advantages of this diagnosis also include:

• Ease of use. The compact device is practically invisible under clothing, so the patient lives as usual.
• Atraumatic. The device is fixed on the patient’s body without any intervention inside the body; it is an absolutely safe diagnostic method, and therefore is suitable for a wide audience, including children over 7 years old, teenagers, adults and the elderly.

According to doctors, the data obtained using the device is beyond doubt, and in general the technique has no shortcomings, its effectiveness has been confirmed many times, and its significance cannot be overestimated.

This study also makes it possible to timely detect an increase in the rate of morning rise in blood pressure, an extremely dangerous phenomenon that can be a trigger for the onset of stroke, myocardial infarction and even sudden death.

Feedback from the subjects themselves shows that the procedure causes minor discomfort: unusual sensations from constantly wearing a cuff on the arm, periodic squeezing of the arm when pumping air.

We bring to your attention an educational video:

What is the difference from Holter?

It is worth noting that patients often confuse ABPM with another type of hardware examination - which also involves wearing the device all day long.

These are different methods: Holter monitoring differs from ABPM in that it only monitors heart rate (pulse), but not changes in blood pressure. In some cases, when a patient complains of discomfort in the heart, the doctor prescribes two simultaneous procedures - ABPM and ECG (electrocardiography) according to Holter, this is called bifunctional monitoring.

Patient photos:

The results of ABPM will be useful to the patient for further examination in cardiology - conducting and.

Is advance preparation required?

The attending physician who issued the referral for ABPM will instruct the patient on how to prepare for the study. If necessary, the doctor stops taking medications to lower blood pressure on the eve of the test so that the results are not distorted.

General preparations on the day of the procedure include:

• refusal to drink alcohol;
• limiting heavy physical activity and stress;
• proper rest the day before;
• selection of loose-fitting clothes.

Consumption of food and liquid is not prohibited. There are no contraindications to the examination, except for possible individual characteristics of the body, which should first be discussed with the attending physician.

How is the examination carried out?

This examination can be either outpatient (at home) or inpatient. Monitoring begins at 8-9 am. The technique itself is very simple.

The algorithm of actions is as follows: First, the patient comes to the hospital so that the doctor installs the recording device. Then he will need to put a cuff on his arm, like a standard tonometer, if a child is being examined - there are special smaller ones for him. The cuff is connected by thin tubes to a device that is both an air pump and a data storage device. The device is attached to a clothing belt or placed in a small handbag that can be worn on the shoulder. The device runs on batteries.

The device is programmed to inflate the cuff automatically at a certain time interval, which is set in the settings. Usually it is 15-30 minutes during the day and 30-60 minutes at night, but if the device does not like something, for example, it considers that the measurement was inaccurate, then a repeat measurement will be made and the next ones will be taken a little more often. The person being tested can take a manual pressure measurement out of turn by pressing the desired button on the device. The results after each measurement are displayed on the device screen.

The subject must record all his activities during the day in an observation diary, where he indicates the exact time of his actions. All episodes of deterioration in health also fit in there.

After 24 hours, the patient returns to the doctor, where the device is removed from him for subsequent analysis of the obtained values ​​and interpretation of the results.

Where can I get it and what are the average prices?

This examination can be completed without any problems at your local clinic; if prescribed by a doctor, it is free and is included in the compulsory medical insurance policy. The only problem is that you may have to wait in line, depending on the workload of a particular medical institution and the number of such devices in stock.

You can also take it in a private clinic, for a fee. In this case, the price of the examination depends on the medical institution, as well as on the type of equipment used and the manufacturer’s brand. The cost is also affected by the region in which the clinic is located.

The average price for monitoring in Moscow and the Moscow region ranges from one and a half to two and a half thousand rubles; in regional medical centers the price ranges from 800 to 1,500 rubles.

A number of medical clinics provide the service of installing the device directly at home. In this case, the cost of the study will increase depending on the doctor’s travel expenses.

Rules of patient behavior

The patient with the device should behave as naturally as if it were not there. For greater reliability of the data, it is necessary to avoid excessive physical activity, eliminate stress factors, follow the usual diet, and move around as usual.

It is important not to let your hand bend the tubes of the device. At the moment of squeezing the cuff, the upper limb must be relaxed, lowered down and wait until the measurement is completed. Some types of devices are equipped with a sound signal notifying the start of measurement.

The patient may experience some discomfort during the monitoring period:

1. Difficulty sleeping at night. The device measures pressure at night too, so people who sleep lightly sometimes wake up when an artery is compressed or from a sound signal. You also need to choose a position so that the hoses of the device do not bend; for this it is best to sleep on your back.
2. Inability to perform water procedures (use the shower). Since moisture should not be allowed into the device, you will not be able to wash yourself and clean yourself up.
3. Limitation of arm flexion at the elbow joint because the cuff is fixed slightly above the elbow.
4. Due to skin sensitivity, irritation may occur at the cuff attachment site.
5. Operating the device makes it difficult to change clothes.

But all this is temporary discomfort from wearing the device, which will allow you to establish an accurate diagnosis. The patient cannot remove the device on his own.

Example of filling out a diary

The subject reflects all his actions in a diary, indicating the exact time of the action. During the day, you need to record the time of consumption of food, medications, the time period of driving a vehicle, moments of light physical activity (climbing stairs, walking along the street) and the time when malaise appeared. It is imperative to indicate the time you fell asleep, and in the case of night awakenings, write down what exactly happened at that moment.

As a rule, the doctor gives the patient a special form, which he will need to fill out independently, but if the form is not available, then you can simply write everything down in a notebook. In this case, the content is important, not the design.

We present to you an example of filling out such a diary:

Does the device write something, give errors, or make beeps?

As a rule, most models of such devices emit a warning sound before starting measurement. This is absolutely normal, after this sound the patient will just need to stop, stand up calmly, and try to relax. After taking the measurement, you should continue what you were doing before.

If the ABPM device stops working, a malfunction occurs, it does not take measurements for at least an hour, then it is better not to do anything yourself, because it is unknown whether the batteries in it simply ran out, or it really broke down. In any case, if the study is interrupted even for a short period of time, the data obtained lose their reliability. Therefore, in such a situation, the only correct decision would be to carry it out again after a scheduled visit to the doctor.

If the device displays an error, for example, E001, E095, E0097, or something similar, then perhaps the patient’s cuff has slipped, the connecting tube has been pinched, in which case you just need to correct this situation. If this does not help, then the only thing that can be done, if there is no discomfort, is to take no action and just wait for a visit to the doctor tomorrow; if there is discomfort, remove the device and also wait until tomorrow. Like any equipment, this device is also prone to malfunctions.

If the message “pause” is displayed, then there is no reason to worry, this is normal operation of the device.

Decoding the results

During the study, the device is able to track the following information: average values ​​of the upper and lower limits of pressure, pulse rate, pressure dynamics over the day, indicators during exercise, systolic and diastolic pressure figures during sleep, the level of pressure decrease at night.

There is no point in trying to decipher the received data on your own and understand what they mean, because in any case, the patient will have to visit the doctor’s office at least once in order to simply give the device back.

The interpretation of the results of the electrocardiogram and blood pressure measurements is carried out by the diagnostician conducting the study, and the treatment is prescribed directly by the cardiologist. Normally, the lower pressure values ​​are 110/70 mmHg, and the upper ones are 140/90. For children, these figures are slightly lower than the indicated values.

When deciphering the data, fluctuations in systolic and diastolic blood pressure are calculated, up or down from the daily average, as well as the difference between blood pressure readings day and night, expressed as a percentage (daily index).

The daily index is considered normal if the result is within 10-25%, that is, the average blood pressure values ​​at night are ideally 10% less than the average blood pressure values ​​during the day. The standard level of pressure reduction during sleep is 10-20%.

After analyzing all the data, the doctor draws up a conclusion where a diagnosis is made indicating all the parameters.

The inability of pressure to decrease to normal levels at night indicates the possible presence of chronic kidney pathologies and diabetes mellitus. Increases the risk of developing chronic ischemic heart disease, myocardial infarction and cerebral hemorrhage.

High (normal values ​​are from 30 to 40 mm Hg) - indicates that there are vascular diseases and pathologies in the thyroid gland.

An increased degree of change in blood pressure over a daily period indicates low elasticity of the walls of blood vessels, and this provokes the risk of hemorrhage in the retina and the development of strokes.

Can this examination be erroneous and how can this be avoided?

Despite the fact that ABPM is the most reliable method in medicine for determining daily fluctuations in blood pressure, there are still a number of situations where the device may be wrong. Inaccuracies occur when the patient unwittingly or intentionally neglects the instructions and recommendations received from the doctor.

Military conscripts often do this when they undergo a medical examination in order to obtain a false diagnosis - they try to deceive ABPM in order to avoid being drafted into the army and further service.

The data will be incorrect if:

• during monitoring, use tonics - the device may overestimate the results;
• in a supine position, raise your lower limbs high - this will disrupt the natural blood flow and the pressure will increase;
• stay awake all night during monitoring;
• at the moment of squeezing your arm with the cuff, tense your buttocks and pull your feet towards you - this will cause an increase in pressure.

ABPM– a research method based on measuring and recording blood pressure indicators for 24-72 hours at certain time intervals (from 15 to 120 minutes). Daily blood pressure monitoring is prescribed to diagnose arterial hypertension and hypotension, identify the causes of fainting and dizziness, and select drug therapy to normalize blood pressure. The duration of the study is determined individually, on average it ranges from 1 to 3 days (rarely up to 7). The cost of the procedure depends on the duration of blood pressure monitoring.

Preparation

ABPM does not require preparatory measures. Before starting the study, it is worth warning the doctor about the medications you are taking, as some of them may affect the results of the procedure.

What does it show

During ABPM, blood pressure is measured and recorded at set intervals over 1-3 days. Many indicators are subjected to statistical processing, as a result of which the doctor receives information about average diastolic and systolic blood pressure, average nighttime and daytime blood pressure readings, the percentage of readings above normal, and blood pressure variability. ABPM data are used in the diagnosis of a number of pathologies:

• True arterial hypertension. In patients with true arterial hypertension, the average daily blood pressure is increased. Peak values ​​are often determined in the morning; at night, pressure decreases more slowly than in healthy people. During clinical measurement, an increase in blood pressure is also recorded.
• White coat hypertension. With "doctor's coat" hypertension, patients experience stress from the medical examination situation. They have high blood pressure values ​​during a single measurement in the presence of a doctor or nurse, but the average daily, day and night values ​​correspond to the norm.
• Hidden arterial hypertension. The key sign of latent arterial hypertension is an increase in average daytime blood pressure of more than 135/80 with a normal blood pressure value obtained from traditional measurement. Another criterion is an average daily blood pressure above 130/80 and a normal clinical value.
• Symptomatic hypertension. Cases in which mean blood pressure is higher at night than during the day are considered in favor of the diagnosis of secondary hypertension. This result indicates the need for additional diagnostic procedures and explains the low effectiveness of drug treatment with antihypertensive drugs.
• Risk of cardiovascular pathologies. A high risk of heart and vascular diseases is evidenced by the high variability of daily values. In such patients, the likelihood of changes in the fundus vessels, atherosclerotic vascular lesions, and left ventricular myocardial hypertrophy increases. If the blood pressure decreases insufficiently at night, the risk of stroke and coronary heart disease is diagnosed.

ABPM is an additional diagnostic method and cannot replace the traditional procedure of measuring blood pressure at a doctor's appointment. Monitoring results are considered in conjunction with examination data, clinical interviews and blood pressure tonometry.

Advantages

ABPM provides a greater number of blood pressure registrations than the traditional method. Thanks to this, the diagnostic value of the procedure in relation to vascular hypertension and predicting the risks of pathologies of the heart and blood vessels increases. Clinical single measurement of blood pressure is cheaper than ABPM, but less informative in differential diagnosis and detection of latent forms of hypertension. The disadvantages of ABPM are physical discomfort and motor restrictions due to wearing a pneumatic cuff, decreased accuracy of readings for supraventricular and ventricular arrhythmias.

High blood pressure (BP) is a serious problem that requires treatment. Daily blood pressure monitoring is used when the readings of the conventional measuring method are questionable. Since a person in a hospital is exposed to many stimuli, blood pressure readings may become distorted. Therefore, ABPM helps doctors obtain accurate data, which reveals hidden pathologies of the patient.

Accuracy of the method

ABPM is considered the most accurate method in determining blood pressure pathologies. It is impossible to deceive him, because the device records the slightest fluctuations in parameters. In addition, the study is not carried out alone; Holter diagnostics are often used, which records the pulse value. Using the technique, even a hidden threat is identified that conventional blood pressure measurements are unable to detect.

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Advantages and disadvantages

Daily blood pressure monitoring, like any method, has good and bad sides. ABPM indicates the possibility of developing cardiovascular pathologies. The test is carried out in the treatment of heart and blood pressure ailments. The positive ones include:

• recording indicators over a long period of time;
• absence ;
• possibility of fixation both day and night;
• determination of fluctuations in indicators of a temporary nature;
• precision due to the naturalness of the setting.

Examples of deficiencies are mainly based on unpleasant sensations during the examination, especially when the patient is excessively nervous. These often include numbness of the limb when wearing the cuff, skin irritation or diaper rash caused by the cuff, as well as the financial side of the service. A daily survey, unlike a one-time measurement, will require an investment.

A one-time blood pressure measurement does not always provide accurate data, which affects the development of treatment methods.

Indications for use

Blood pressure monitoring is carried out under the following circumstances:

When not to do it?

A person’s examination is not carried out in the following situations:

• dermatological damage to the skin, mainly of the upper extremities;
• pathologies of the circulatory system, causing bruises at the slightest impact on the skin;
• injured upper limbs;
• disease of the vessels and arteries of the upper extremities;
• psychoemotional disorders.

Preparation for the procedure

The procedure is prescribed by the attending physician, who is obliged to explain to the patient how to properly prepare. Preparing for ABPM requires following certain rules so that the measurement shows reliable information. These include:

• withdrawal of medications;
• exclusion of physical activity;
• cancellation of water procedures;
• complete sleep at night;
• refusal of compressive clothing, there should be no foreign influence on the cuff;
• taking sedatives at night for severe nervousness on the eve of a blood pressure test.

Immediately before the test:

• the patient should lower his arm down and stop moving when the device begins to automatically inflate the cuff;
• It is important to ensure that the monitoring tube and cuff are positioned correctly.

Progress of the study

The study is carried out using the auscultatory or oscillographic method, however, the use of each of them separately provides inaccurate data. In medicine, it is customary to combine 2 methods so that ABPM indicators are as accurate as possible. For examination, a cuff with a tube attached to it is applied to the middle of the upper limb, connected to a register that supplies and deflates air. The device is equipped with an ultra-sensitive sensor that detects the slightest pressure fluctuations.

The meters are adjusted individually for each patient, taking into account his regime, the period allotted for rest and work. Instructions on the number of measurements and their frequency are carried out by the attending physician, who suggests keeping a diary where the results should be recorded. The device takes measurements at least 50 times a day; monitoring is done every 15 minutes during the daytime, and every 30 minutes at night. When jumping at certain hours, you need to measure your blood pressure every 10 minutes.

Holter monitoring

The medical community prefers to simultaneously check daily blood pressure and record heart rate readings. Together, these techniques help to track indicators of the dynamics of development of diseases of the cardiovascular system and identify hidden ailments. The method was developed by a scientist from America - Holter. Special electrodes are attached to a person’s sternum to record heart rate data and output them to a special device. The automatic device system works on the principle of electrocardiography, storing the results in the device’s memory. At the same time, a cuff is hung on the shoulder to monitor blood pressure. In case of controversial issues regarding the patient’s cardiology, Holter monitoring is extended for several days.

Contraindications apply exclusively to people with mechanical damage to the chest skin (due to the inability to attach the device). People with the following complaints are advised to conduct monitoring focusing on Holter:

Measuring apparatus

Devices that help to carry out monitoring are tonometers, which record and store a large amount of information in memory. After completion of the procedure, the device for 24-hour blood pressure monitoring outputs data to a PC (personal computer), which processes the data array. The pressure measuring device is sold in pharmacies at different price categories, with different levels of settings.

Deviations in blood pressure may indicate various diseases. Sometimes a single measurement is not enough for diagnosis. In such cases, 24-hour blood pressure monitoring is used for greater clarity. This is a study in which, using a special device, indicators are monitored continuously throughout the day. That is, this is an automatic measurement that is needed in order to see what kind of fluctuation occurs over a certain time.

Using this method, various types of hypertension are diagnosed. Monitoring is quite effective in establishing therapeutic treatment with antihypertensive drugs, as well as monitoring the effect of these drugs.

Doctors note that when a person goes to the hospital, his blood pressure is always slightly elevated, due to anxiety, etc. Daily blood pressure monitoring allows you to see true readings under normal human conditions. Such diagnostics are much more effective. The study can be carried out when the patient is treated on an outpatient basis, and sometimes in a hospital.

There is a concept of false negative cases. This is when a person’s blood pressure may rise once during the day, and when measured by a doctor, the indicators may be normal. Although in fact this person is classified as hypertensive. Such people simply need this research, since the device will record when the deviation occurred, what its amplitude was and why it happened.

To do this, they use instruments that regularly measure and record indicators on a special medium. After this, the information is transferred to a computer, and a graph is created using a special program.

How is ABPM performed?

As with a conventional tonometer, a cuff is placed on the patient’s arm (on the middle third of the shoulder). From the cuff there is a tube that connects to the register. It is the register that supplies air and vents it. The device also has a sensor that is very sensitive to the manifestation of pulse waves.

The number of measurements per day is programmed individually; this is done taking into account the patient’s mode, that is, sleep and wakefulness.

For those whose blood pressure often rises in the morning, the frequency of measurements during this period is programmed once every 10 minutes. As a rule, this is required for 2 hours.

If a patient's systolic blood pressure increases to 190 mmHg. Art., it is recommended to set the frequency of measurements less, since there is a deterioration in well-being when the device is operating. Therefore, the intervals are set to about 30 minutes during the day and 60 minutes at night.

Preparation

As a rule, antihypertensive medications are stopped before this study, but it should be noted that this decision is made only by the doctor. If the doctor did not say this, then you should not do it yourself.

It is recommended to wear the cuff over a thin shirt or jacket to prevent skin irritation, discomfort, and generally for hygienic reasons. Over this should be loose clothing. Sometimes you need to purchase special batteries for this device.

There are no restrictions on the amount of food and drink you consume, and you should not cancel your usual activities. Since the study is carried out in order to record fluctuations in blood pressure in a person’s daily life.

The doctor also explains to the patient how the device works, how to behave when wearing it, and how to keep a special diary. In the diary, the patient should note how he feels, how he feels during the measurement, and if he is taking any medications, this should also be noted. Records are kept only during the daytime.

When a person feels that the device is starting to measure, he should stop and relax his hand, lowering it along the body. After this, everything must be recorded in the diary. Afterwards you can continue to go about your business.

But at the same time, you need to constantly ensure that the tube that connects the resistor and the cuff does not bend or become deformed. If the cuff slips, the patient can correct it himself, but this should be done carefully.

When air is pumped into the cuff, the pressure on the arm increases and the person may even feel pain. This is normal and you just have to be patient.

Indications for the study

Daily monitoring of indicators is most often used for such diseases and situations as:

According to statistics, 24-hour blood pressure monitoring is most often used to assess how effective antihypertensive therapy is.

Contraindications

Contraindications to such a study are also noted:

Blood pressure monitoring should be used with caution if the patient's systolic level exceeds 200 mmHg. Art., and also if there are pronounced disorders of the conduction system of the heart.

Advantages and disadvantages

The main advantage of daily monitoring over a one-time measurement is that true indicators are displayed. Monitoring provides information about changes in blood pressure over a certain amount of time. As a result, the doctor can make the correct prescription of drugs.

Since this method makes it possible to evaluate the fluctuation of the indicator throughout the day, diagnosing the underlying disease is greatly simplified.

This method allows the diagnosis of false-negative cases. With a one-time measurement, the indicator is normal, but if monitoring is carried out, it may turn out that the person is hypertensive.

We can conclude that the main advantages are:

Disadvantages of this study include factors noted by patients in their practice, such as discomfort during measurement.