XNUMX hour blood pressure monitoring

XNUMX-hour blood pressure (BP) monitoring is a modern research method that allows you to control the daily rhythm of a person’s blood pressure in a familiar environment. The data obtained provide a complete picture of the influence of behavioral factors on blood pressure and reflect the dynamics of the effect of antihypertensive drugs in patients receiving therapy for high blood pressure.

How does the device work?

The essence of the procedure is to measure pressure indicators at certain intervals. The measurement is performed regardless of the patient’s activities after a certain time interval, which is determined only by the doctor. On average, it ranges from 12 to 30 minutes during the daytime and every hour at night.

Against the background of the entire study, the patient fills out a personal diary during the day, in which he makes any changes in his state of health and the symptoms that have arisen. Comparing the indicators of ABPM (XNUMX-hour blood pressure monitoring) and entries in the diary, the attending physician makes an accurate diagnosis. The diary reflects the state of activity, rest, medications that the patient takes. All these data allow us to estimate pressure drops during periods of rest or physical activity.

Blood pressure and activity are two dependent indicators. The basis of the method is the comparison of data that take into account the habitual activity of the patient. Under the conditions of a single measurement of blood pressure indicators, their variability is not reflected. The procedure lasts for 24-48 hours, depending on the reasons for which the ABPM was prescribed. A device is fixed on the human body that automatically measures blood pressure.

When is a diagnosis scheduled?

The most common reason for XNUMX-hour blood pressure monitoring is to assess the effectiveness of antihypertensive therapy, especially in the case of combined treatment using several groups of antihypertensive drugs. Other reasons for prescribing ABPM are the diagnosis of early arterial hypertension, symptomatic arterial hypertension, patients with heart failure, with myocardial hypertrophy, in the presence of brain diseases, suspected sleep apnea syndrome, frequent stress, depression, suspected severe late toxicosis during pregnancy.

ABPM is used to examine patients suffering from various types of hypotension: constitutional and orthostatic, and also as a preventive monitoring of the working population.

ABPM allows you to determine the presence of the so-called “office hypertension”, in the diagnosis of which it is necessary to timely regulate the mode of work and rest, a procedure is recommended when examining recruits.

Contraindications to the procedure

The procedure for daily monitoring of blood pressure is a completely safe study and has no absolute contraindications for performance. But there are relative contraindications, which include thrombophlebitis of the upper extremities, an acute infectious disease (as a temporary contraindication), impaired motor activity due to the severity of certain chronic diseases. And also: dermatological diseases that involve damage to the upper limbs: fungus, lichen, etc .; injuries of the upper extremities; blood diseases, such as: hemorrhagic purpura, severe thrombocytopenia, as well as petechial rash and other diseases, an important sign of which is the appearance of bruises even with slight skin pressure; mental illness, manifested in aggression, inability to self-care and other symptoms; vascular diseases involving lesions of the veins and arteries of the upper extremities (at the stage of exacerbation).

Preparing for the procedure

Special preparation for the study is not required, the patient does not need to change the diet or lifestyle. Measurement of blood pressure should be as close as possible to real daily conditions.

Required documents

A patient undergoing such a procedure should worry about collecting a package of necessary documents. On the appointed day, it is necessary to take a passport confirming the identity of the patient, medical reports from the doctor (indication for ABPM and the patient’s outpatient card). The patient should have comprehensive information about previous procedures and studies.

Procedure

Before the procedure, the patient should sit for a few minutes. The key to correct diagnosis is the coordination of the actions of the doctor and the patient. The study is being carried out:

• with the installation of a cuff and a tonometer;
• with the obligatory filling of the diary by the patient;
• with the removal of the device;
• with a comparison of the results obtained and the data entered by the patient.

Installation of the device takes no more than 15 minutes. A suitable position for installing the cuff is sitting. The cuff is put on the right arm of the right-hander and on the left-hander. It is important to consider which arm the patient is more active. The mark on the cuff should match the most pulsating point on the arm (blood pressure will be measured on it). The point is located on the distal part of the shoulder and is easy to find. With the help of a special device, the cuff is fixed on the shoulder. A register and a mercury tonometer depart from this device.

preliminary instruction

Blood pressure monitoring will pass without complications if the patient can comply with several mandatory conditions within two days: during pressure measurement, the patient must take a comfortable position and, if possible, extend his arm with the cuff. If these recommendations are not followed, it will not be possible to obtain accurate results.

On the day of ABPM, excessive physical activity is not recommended. If the fixation of indicators occurs during work or movement, the patient needs to stop – this rule guarantees accurate results. If possible, during the period of blood pressure monitoring it is necessary to exclude stressful situations. You should not follow the measurements – such behavior will cause nervousness, which will affect the diagnostic results.

At night, you should not worry about the operation of the device. In the daytime, as far as possible, the patient leads his usual way of life – he goes to work, does household chores. You can’t limit yourself, otherwise you won’t be able to get results in an environment close to the natural environment. If unpleasant symptoms occur, the patient makes notes in a diary indicating the time of day and the load that gave a negative reaction to the body.

Rules for the patient

Correct measurements are entirely dependent on the behavior of the patient. Keeping a diary is a prerequisite that guarantees diagnostic results. The daily routine is entered into the diary: sleep, stress, psycho-emotional experiences, walks, clinical symptoms that have arisen during the day, medication. Detailed records will allow you to assess the state of the body and the factors that worsen the patient’s well-being.

If any negative symptoms appear, the patient consults a doctor. Headaches (severe migraines), weakness or nausea are reasons to stop ABPM. It is recommended to avoid crowded places, establishments with a lot of noise for two days – it will affect the registrar and prevent correct measurements. If the edge of the cuff is displaced, it must be corrected – the correct position of the cuff is 2 cm below the elbow. If the patient is concerned about the correct conduct of ABPM, the attending physician will be able to make an accurate diagnosis and prescribe an effective treatment.

What can be learned with SMAD?

For the diagnosis of the disease, the variability of blood pressure values ​​during the day is used. The analysis of the received results is carried out on the basis of 4 indicators. Average blood pressure values ​​differ between night and daytime. In the daytime, normal blood pressure is 130/85 mm, and at night – 120/70 mm.

The second indicator is the recorded moments of the maximum increase in blood pressure – the number of deviations from the norm indicates the complexity of the disease. A daily index is calculated, consisting of systolic and diastolic blood pressure. The last indicator that allows you to assess the state of health of the patient is the value of the morning increase in pressure.

Explanation of results

The attending physician is responsible for deciphering the results. The patient is not able to evaluate and compare all the obtained indicators on his own. Patients with arterial hypertension are assigned a specific group, which is calculated on the basis of a daily index.

Increased risk of cardiovascular disease in patients with an index less than 10%. For such patients, there is a risk of complications. A daily index of zero indicates that at night, blood pressure exceeds daytime blood pressure. Such patients are assigned additional studies: patients are threatened with heart failure and kidney damage.

A daily index of more than 20% indicates a decrease in blood pressure at night. Such people are at risk of stroke and need additional treatment. If the daily index ranges from 10 to 20%, nothing threatens a person – no obvious deviations from the norm have been identified. Additional studies will help to establish the cause of the deterioration of the patient’s condition.

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