How is 24-hour blood pressure and heart rate monitoring done?

24-hour blood pressure monitoring (ABPM) is a measurement of pressure in a patient in the conditions of his usual life activity, during wakefulness, sleep, eating, walking, professional activities, physical activity. To do this, a device is attached to it, which measures the pressure at regular intervals during the day. Such diagnostics allows the doctor to determine under what circumstances a pathological change in pressure occurs and the limits of this change, after which they are assigned an individual, effective treatment for a particular patient.

ABPM technique and devices for monitoring

The first attempts to measure pressure in the conditions familiar to the patient, and not within the walls of the clinic, arose in the 60s of the twentieth century. To do this, a person had to independently measure the pressure at a certain time. But this method was very inconvenient and inaccurate. A decade later, a device was invented that takes readings automatically. To this day it is very popular.

• cuff, which is tightly fixed on the forearm along the line of the heart;
• a thin tube like a hose for supplying air to the cuff;
• heart rate and blood pressure monitor showing and recording measurement results; this device is enclosed in a thin case, like a smartphone;
• a sensor that responds to pulsations and is located under the cuff.

The 24-hour blood pressure monitor is most often located on the belt and is attached to clothing. Sometimes it is hung over the shoulder like a bag, or attached directly to the cuff. Pressure indicators are recorded at certain time intervals (the desired interval is set in the device settings), and even at night, during the day. To eliminate discomfort during sleep, the doctor prescribes sleeping pills. Other medications are prescribed or discontinued at the discretion of the doctor.

During the diagnosis, the patient makes entries in a special diary about the main points of his studies and the conditions that accompany them. All moments of poor health and the appearance of specific symptoms should also be taken into account.

At the end of the day, the device is removed and handed over to the doctor for data taking. The result is usually ready the next day.

1. Oscillographic.
2. Auscultatory.

The doctor will help determine the type of device, but when choosing a model, you should pay attention to the accuracy of the device. Moreover, not the manufacturer's data should be taken into account, but the results clinically confirmed and published by independent experts.

The oscilloscope is more accurate and works regardless of noise pollution, but it may fail or not show the result with increased physical exertion. In this case, the auscultatory device performs better.

To date, quite a lot of devices of various accuracy are known, presented by both domestic and foreign manufacturers.

Indications and contraindications for ABPM diagnostics

This method of diagnosing pressure is used for both hypertension and low blood pressure.

• to study the nature, parameters and frequency of the resulting attacks of pathological changes in pressure;
• to determine the effectiveness of the prescribed treatment for previously diagnosed hypertension or hypotension.

1. Suspicion of hypertension. If there are symptoms such as weakness, tinnitus, the appearance of "flies" in the eyes, headaches.
2. Checking for the “white coat” syndrome, when the pressure rises during a stressful condition that occurs when visiting a doctor, the rest of the time it is a normal parameter.
3. Check for the occurrence of hypertension in the performance of professional activities.
4. Significant pressure surges from very low to very high.
5. Hypertension, accompanied by heart failure, pathologies of cerebral vessels, fainting, metabolic disorders.
6. Age over 60 years.
7. Hypertension that occurs during the night hours of rest and causes symptoms of angina pectoris or sleep apnea.
8. Heredity.
9. Hypertension in pregnancy.
10. Unreasonable increase in blood pressure.
11. Normal values ​​in the presence of obvious symptoms of the disease.
12. As one of the diagnostic measures during a medical examination of recruits and a test for professional suitability in some specialties.
13. Hereditary hypotension.
14. Diabetes mellitus of the first type.
15. Diseases of the autonomic nervous system.

If a pregnant woman suffers from hypertension, which is dangerous for her and the baby, then it is possible to prescribe an examination using the SMAD method. The examination is scheduled three times: at registration, in the second trimester and immediately before childbirth. The information obtained from monitoring is used to take precautionary measures during the birth process.

If the diagnosis of hypertension has already been made and treatment is prescribed, but it does not give the desired effect, then ABPM helps to understand why. For example, the increase occurs mainly at night. Then the doctor concludes that the tablets must be taken in the evening. That is, monitoring allows you to prescribe a deeply individual treatment.

• skin and vascular diseases of the hands;
• trauma;
• blood diseases;
• serious arrhythmias;
• blood pressure indicator more than 200 mm Hg. Art.
• poor tissue conductivity;
• mental illness that does not allow the patient to entrust the device for independent use.

Advantages, disadvantages and features of 24-hour blood pressure monitoring

How is 24-hour blood pressure monitoring performed? In conducting ABPM, the patient's awareness of the need for monitoring and the correct behavior during the use of the device plays an important role. The doctor should tell about all the nuances. Before the procedure, there are no serious restrictions, you just need to take a shower. Clothing should be chosen from natural light material, preferably cotton, because it will have to be in it for the whole day.

• the patient's pressure is measured in the usual way;
• fix the cuff on the arm and the device in any convenient place;
• the nurse gives a diary to fill out and instructs what entries to make.

If ECG monitoring is performed along with blood pressure testing, then electrodes are fixed on the patient's chest.

1. The device makes noise during operation. This is due to the injection of air into the cuff.
2. The plan for taking medications will be changed, and some of them will be completely canceled (sometimes in advance).
3. When measuring pressure, the arm should be relaxed and located along the body. If the cuff begins to fill with air during movement or other physical activity, then you need to stand up and not move. Each measurement should be recorded in a diary entry.
4. It is necessary to monitor the correct location of all parts of the device: the cuff should be located in the place where it was applied in the hospital; the tube should not have bends, clamps; the recorder cannot be dropped. During sleep, you need to put it next to the pillow. You need to sleep at night.
5. Physical activity should be of a domestic nature, training on this day is excluded.
6. You can't take a shower.
7. The patient should not check the results of measurements, so as not to provoke stressful conditions caused by worries about their health. Conclusions can only be drawn by a specialist.

For the diagnosis to be effective, you need to carefully record the data in the diary. It includes all types of physical and mental activity, time of rest, sleep and awakenings, as well as medications.

There are situations when, after measuring the pressure, the device starts this process again. So, something prevented him from making a measurement the first time. In this case, you need to check the fit of the cuff to the arm and the condition of the hose.

Although the procedure is safe, it causes some inconvenience in the form of intermittent night sleep, incomplete performance of the arm on which the cuff is worn, and prohibitions on water procedures.

ABPM has advantages over a one-time pressure measurement, because readings are taken during the day and affect all aspects of human life. Moreover, the readings are accurate: the device captures even slight pressure fluctuations.

But they are insignificant compared to the result that can be achieved with the help of SMAD.

• make a prediction on the development of hypertension for a particular patient;
• identify complications caused by the disease;
• determine the level of physical activity acceptable for the patient;
• supplement or change the previously prescribed treatment;
• detect transient changes in pressure.

The reasons for the diagnosis are hypertension, hypotension, arrhythmia, a series of cases of loss of consciousness. The procedure for children is the same as for adults. But the doctor may need more time to explain the rules of conduct while wearing the device.

Deciphering the results of ABPM and patient reviews

The pressure of any person changes during the day depending on the state (sleep, wakefulness).

Therefore, the norms are drawn up taking into account daily rhythms:

• daily blood pressure is 110.7±6.7 / 69.4±5.7;
• daily blood pressure is 114.4±7.4/72.8±6.2;
• nighttime blood pressure is 103.1±6.1 / 62.5±5.4.

The doctor analyzes the monitoring data on a computer using a special program.

1. Short-term pressure surges.
2. Dynamics of pressure in the morning hours.
3. hypotension index.

Sometimes there are situations in which patients make efforts to mislead the doctor with the help of ABPM. For example, a young man does not want to serve in the army and complains of high blood pressure. In order for the device to fix the increase, it starts exhausting physical exercises, but does not take into account that the pulse increases along with the pressure, which immediately reveals the deception. That is, it is not worth trying to deceive the device.

Reviews about this method of examination are very good. Everyone complains about the inconvenience of wearing the device and cuff, but they admit that monitoring allows you to make the right diagnosis and choose the treatment that really helps. Some give advice on how to get through these days easier. It turns out that with this device you can change clothes. To do this, you can simply disconnect the tube from the registrar, and then gently return it to its place. In order not to miss the time for measuring pressure, it is advisable not to be in noisy places, especially if the season is cold and the device is covered with thick outerwear.

The biggest inconvenience for all patients is delivered by the device at night. Sleep that night is disturbing for the majority, for some, the monitor fails at this stage. It is noted that it is more comfortable to sleep by attaching it to the side - this way you can even find several comfortable positions.

There are cases of special sensitivity when the patient cannot stand it and removes the device ahead of time. There are still complaints about overestimated figures, but it must be remembered that the doctor must do the decoding using a special computer program.