How to turn on the 24-hour blood pressure measurement device. Long-term blood pressure monitoring: device, results

From this article you will learn: what ABPM is, indications for daily monitoring blood pressure, what diseases can be identified by such a study. How the procedure goes, what the patient should do, interpretation of the results.

Article publication date: 04/06/2017

Article updated date: 05/29/2019

Daily blood pressure monitoring is a diagnostic procedure. It involves repeated measurements of blood pressure throughout the day using a special device.

This allows you to analyze changes in pressure throughout the day and night: is it always increased (decreased), during what type of activity and how much does it increase (decreases), does it change in night period. Some devices measure not only blood pressure, but also heart rate.

A referral for examination is given by a cardiologist or therapist.

Indications for use

The procedure is prescribed to patients who complain of:

• fatigue;
• headaches, dizziness;
• decreased vision, spots before the eyes;
• noise or ringing in the ears, stuffy ears.

ABPM can also be prescribed to a person who has no unpleasant symptoms, but when the doctor measures the blood pressure, it is elevated. The reason for this may be the phenomenon " white coat": This individual feature, which is expressed in a specific psychological reaction to doctors. A person with the “white coat” phenomenon begins to worry excessively at any medical manipulations, so his blood pressure and heart rate increase. Measuring blood pressure and heart rate using daily monitoring allows us to exclude the influence of this phenomenon on the diagnosis.

The procedure allows you to identify arterial hypertension (hypertension), as well as preliminarily determine its cause - the underlying disease. It is confirmed during further examinations. This method can also be used to diagnose chronic hypotension ( arterial hypotension

) - low pressure.

• ABPM allows:
• predict how dangerous arterial hypertension is for a particular patient;
• determine what complications it can lead to or has already led to; understand what level physical activity
• determine whether blood pressure medications that have already been prescribed for treatment are effective.

Carrying out the procedure

Progress of the examination:

1. You come to the doctor. It attaches a portable device to your body for 24-hour blood pressure monitoring. It consists of a cuff (the same as a conventional tonometer), a connecting tube and the main part of the device, which records the received data into the built-in memory (most often the device itself is placed in a case on a harness, which is hung over the shoulder or attached to the patient’s belt) .
2. You go through the day according to your usual schedule, but keep a detailed diary. There you write down everything you did during the day, indicating the time.
3. The device measures blood pressure every 15 minutes during the day and every 30 minutes at night. Sometimes this interval can be longer (for example, every 40 minutes during the day and every hour at night), depending on the settings.
4. If you have been prescribed any medications, please notify your doctor. Their appointment may be canceled during the examination. If the doctor said that there is no need to cancel the appointment (for example, in the case when it is necessary to evaluate the effectiveness of treatment), take the medications according to the previous schedule and write down the time of administration in your diary. You can also write down at what point you felt the effect of the medications.
5. A day later you come to the doctor again. He takes off the device and says when to come for the results. Typically, data processing takes no more than one day.

With the results, you go to your treating cardiologist or general practitioner. Based on ABPM data, he can make a diagnosis and also prescribe further diagnostic procedures to clarify the cause of hypertension.

Memo for the patient

There are a few things you will need to keep in mind when going through this diagnostic procedure.

The basic rule: when the device starts measuring blood pressure (you can recognize this moment by the inflation of the cuff, and some models emit a signal before starting the measurement), stop, relax your arm and lower it down.

Otherwise, the device will not be able to measure pressure, or the result will be incorrect.

Rules for keeping a diary	Be sure to record during the day
	Time of moderate physical activity (climbing to the 4th–5th floor, walking from 1000 m)
	Driving time
	Time of stress or increased emotional tension (if any)
	Time to take medications
	Meal time The time when you felt any unpleasant symptoms, detailed description
these symptoms, what were you doing at that moment	What exactly were you doing at the time of each pressure measurement?
Be sure to record at night	Bedtime and wake-up time
	Time of night awakenings
	What did you do when you woke up at night

It happens that the device begins to re-inflate the cuff immediately after measuring the pressure. This means that the device was unable to take a measurement last time. Possible reasons for this: you have strained your arm, or the cuff has become loose. If your arm is relaxed when you first try to measure, have someone tighten the cuff so that it fits snugly against your arm (you can do this yourself, but it will be awkward to tighten it with one hand).

Intense physical activity (fitness, Gym) on the day when 24-hour blood pressure monitoring is carried out are prohibited.

Contraindications and inconveniences of the procedure

The procedure has no contraindications.

From side effects You can only notice discomfort in the arm for 1–2 days after the examination, because the cuff can press.

We will also tell you about possible inconveniences that you may encounter during the procedure:

• Difficulty sleeping. Since the device also measures blood pressure at night, you may wake up from the cuff squeezing your arm or from a preliminary signal. This is especially true for those who are light sleepers.
• It is impossible to fully bend the arm at the elbow, since the cuff is attached just above the joint. This may make it inconvenient, for example, to wash your face or brush your teeth.
• You will have to refrain from taking a shower or bath, since the device cannot be wet.

These are all the disadvantages of the procedure. They can be tolerated for the sake of an accurate diagnosis, which can be made after ABPM.

Decoding the results

24-hour blood pressure monitoring provides full information about changes in systolic and diastolic blood pressure during the day and night.

You will receive a sheet with the examination result the next day after the procedure.

It will indicate:

Determining the severity of hypertension by mean pressure

	Mean systolic blood pressure	Mean diastolic blood pressure
Low pressure	During the day – below 100 At night - below 90	During the day – below 65 At night – below 50
Normal	During the day – 100–135 At night – 90–120	During the day – 65–85 At night – 50–70
Borderline hypertension	During the day – 136–140 At night – 121–125	During the day – 86–90 At night – 76–85
Mild hypertension (grade 1)	During the day – 141–155 At night – 126–135	During the day – 91–100 At night – 76–85
Moderate hypertension (grade 2)	During the day – 156–170 At night – 136–150	During the day – 101–110 At night – 86–100
Severe hypertension (grade 3)	During the day – more than 170 At night - more than 150	During the day – more than 110 At night - more than 100

The degree of nocturnal reduction in blood pressure should normally be 10–20%. Insufficient blood pressure reduction at night is an indicator of health problems.

Insufficient blood pressure reduction during sleep

Pulse pressure (the difference between the upper and lower pressure) should not exceed 53 mmHg. Art. (ideally 30–40 mmHg). Increased pulse pressure may indicate problems with thyroid gland, as well as about vascular diseases. In patients with large values pulse pressure increases the risk of complications of hypertension.

Blood pressure variability is the degree of its change during the day. Normally, systolic blood pressure variability should be less than 15 mmHg. Art., diastolic - less than 12 mm Hg. Art. Increased variability indicates low vascular elasticity, which increases the risk of stroke and retinal hemorrhages.

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 cardiac dysfunction vascular system blood pressure is not constant. Periods of constant increase or decrease in blood pressure, during which specific symptoms appear Clinical signs violations 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 stressful situation, which occurs when visiting a 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 modern diagnostics 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 during 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, 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 later This is an indication for an emergency caesarean 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 takes any medicines which may distort ABPM data, you should warn your doctor about this. In this case, the specialist will give detailed instructions about preparation for ABPM, in some cases drugs 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 could 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.

In people with special sensitive skin Irritation or diaper rash may appear after wearing the cuff for a day. This is explained by the fact that most often it is made from artificial material, which prevents the skin from breathing. 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 the person develops skin rash or worsened dermatological disease in the area where the cuff is 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 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 the best way determining the dynamics of blood pressure changes.

Young people who don't want to serve often wonder how to cheat ABPM. The following recommendations can be safely published in the section bad advice, but they do help raise 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 thing 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 average according to 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.

One of the most important diagnostic procedures for many diseases is continuous monitoring throughout the day, otherwise - ABPM.

When monitoring the patient, a blood pressure monitoring machine is used.

This is a specially designed device that allows you to make a comprehensive analysis.

A smart device for measuring blood pressure on a daily basis allows doctors to find out:

• is the patient’s blood pressure always high (or low);
• how and how much the pressure level changes during a particular type of activity;
• whether pressure changes occur during the patient's sleep.

Some 24-hour blood pressure measuring devices have another function - in addition to measuring blood pressure, they record heart rate. A referral for such an examination, when the diagnosis has not yet been established, can be obtained from two specialists - a therapist or a cardiologist.

There are a number of known symptoms for which blood pressure monitoring is a vital procedure:

1. frequent headaches;
2. noticeable decrease in vision, flashing “spots” before the eyes;
3. frequent stuffy ears, ringing, or noise in them;
4. rapid or even rapid fatigue during any work.

The same diagnostic procedure can be prescribed for complete absence the listed symptoms.

An indicator of possible ill health here will be a constant increase in blood pressure during a medical examination. It's about about the so-called “white coat” phenomenon, when the patient has a pronounced psychological reaction to any medical action.

Obvious anxiety at the sight of a doctor leads to quite predictable consequences - increased blood pressure and heart rate. To be completely sure that the “white coat” phenomenon is taking place here, doctors prescribe an ABPM procedure, where a device for 24-hour blood pressure monitoring plays a major role.

People who have crossed the threshold of middle age should carefully monitor the state of their health, if any alarming symptoms insist on the implementation of ABPM.

What diseases can the procedure detect?

A 24-hour device for measuring blood pressure allows you to identify:

• (high blood pressure);
• (low pressure).

But these are not all the positive properties of the procedure; for doctors, it is an invaluable assistant, acting for the benefit of a particular patient.

Using a device to measure blood pressure throughout the day, the doctor without any problems and very accurately:

• predicts existing danger arterial hypertension for each individual patient;
• can determine what complications are possible for the patient in the future or already exist at the moment;
• identify the level of physical activity that is optimal for a particular person;
• can understand how effective those already prescribed were.

It is unreasonable to refuse the ABPM offered to you; with its help, the doctor will receive a complete picture of the existing errors in your body and will be able to prescribe the most effective treatment.

How is the procedure carried out?

There are few people who are happy to accept diagnostic procedures and the treatment itself; often this occurs only from a simple lack of correct information. But there is really nothing scary about ABPM. The patient simply comes to see the doctor, who will attach a portable device to his body to measure daily pressure.

Device for measuring daily pressure

The device itself looks like this: a cuff (painfully familiar to us from a standard tonometer), a connecting tube and the main part that writes the read data into the built-in memory).

These devices have minor differences; the most common are devices in a case on a harness, which is attached to a belt or thrown over the shoulder.

After this, the patient goes home (to work, service), where he will spend a very ordinary day, but will have to keep a so-called diary. You will need to record on paper absolutely all your actions for the day, not forgetting to indicate the exact time. What events should be recorded in the diary? Be sure to record the time you take medications, record the time you eat, the specifics of any physical activity: went to the store, to the kitchen, went up to the fourth floor, etc. Unpleasant symptoms must be noted - headache

, dizziness, heart pain, shortness of breath, etc.

If you have been prescribed ABPM, take this procedure very seriously, as it provides unique chances for correcting your health.

How the ABPM device functions, some nuances of the examination

How does the device for continuous blood pressure monitoring work? Extremely clearly, the device will measure the blood pressure of the person being examined every 15 minutes. daytime

, once every 30 minutes at night.

There are no small details during the examination period, especially when it comes to taking medications. If you are already undergoing treatment or taking medications, please inform your doctor. The course may have to be interrupted, but this should only be decided by a doctor. If there is a need to assess the quality of treatment, drugs are taken according to the prescribed schedule, recording the time of administration on paper. It is definitely worth noting the moment when the patient feels the effect of taking the pills.

A day later, the doctor will remove the device, informing the patient at what time the diagnostic results will be ready. At the appointed time, the subject comes to see a therapist or cardiologist. Using ABPM data, the specialist will give you a diagnosis. If hypertension is diagnosed, additional diagnostic procedures are prescribed to clarify the causes of the disease.

ABPM for the patient is an opportunity to learn about the most important features your body, you need to undergo examination in strict accordance with the doctor’s instructions.

What the patient needs to know when undergoing the procedure

There is a special rule - when the device for daily blood pressure monitoring starts working (the cuff is inflated, in other models a signal sounds), you need to stop, relax your arm, lowering it down.

This is extremely important for measuring pressure and obtaining an accurate result.

We methodically keep a diary, noting every moderate physical activity(climb to the 4th floor and above, walking a distance of over 1 km). Do not forget to note the time you spent behind the wheel, periods of high energy, if any.

Taking medications, food, the occurrence of unpleasant symptoms, a detailed description of the latter - all this should be reflected in the diary.

All this applies to ordinary daily life. The time of going to bed and the time of waking up should also be noted in the diary. If your sleep was interrupted, do not forget to make a note about it in your diary.

Sometimes the blood pressure monitor does not work correctly, inflating the cuff a second time without any delay. There is only one explanation - the device failed to take measurements the first time due to a loose cuff, or excessive stress

hands.

The cuff should fit snugly to the arm; if not, it should be tightened. If you are diagnosed with blood pressure, you cannot engage in fitness or visit gyms. There may be some discomfort in the arm due to cuff pressure, sleep disturbance in light sleepers. The arm does not bend completely at the elbow, so– washing and brushing teeth are somewhat difficult. Taking a shower or bath will also have to be postponed until better times - moisture is harmful to the device.

Despite some inconveniences, the patient must endure them, since the staging correct diagnosis– the basis of high-quality and effective treatment.

Contraindications for ABPM

You should not think that ABPM is indicated for absolutely everyone.

There are a number of diseases in which daily blood pressure measurement with a device is contraindicated:

• some skin diseases that affect the upper extremities (fungi, lichen and others);
• injuries upper limbs;
• vascular diseases affecting the arteries and veins of the upper extremities (in the acute stage);
• blood diseases in which the slightest compression of the skin is accompanied by the appearance of bruises (petechial rash, hemorrhagic purpura, severe thrombocytopenia, etc.);
• various mental illness patient, leading to inability to self-care, aggressiveness, and other serious consequences.

Video on the topic

How is 24-hour blood pressure monitoring performed:

So it's enough a large number of Patients are currently deprived of the opportunity to carefully examine the characteristics of their blood pressure. It is possible that in a few years such a problem will simply cease to be relevant, since specialists will have a different, more advanced device for monitoring pressure.

Today, a blood pressure monitoring device is the best way to set errors in the area of ​​​​blood pressure, allowing you to prescribe correct treatment patient.

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:

• 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:
  • which ones are the best high performance the patient has pressure,
  • 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, it works psychological factor body reactions to the presence medical worker. 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 gives 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 where use drug therapy does not bring success. The pressure does not decrease.
• 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 deficiency appear nervous system.
• Diagnosis of conditions when low pressure is recorded.
• If the person 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 possible reason 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 the study for the duration of the study water procedures, 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:

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 of fear of the white coat syndrome;
• 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 disadvantages are mainly based on unpleasant sensations during examination, especially if 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.

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Indications for use

Blood pressure monitoring is carried out under the following circumstances:

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When not to do it?

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

• dermatological lesion skin, mainly upper extremities;
• pathology 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.

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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.

Before undergoing a blood pressure diagnosis, you need to stop taking medications.

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.

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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.

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Holter monitoring

The medical community prefers to simultaneously test daily pressure and record your heart rate. 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 the human sternum to record data. heart rate and display them on 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 chest skin (due to the inability to attach the device). People with the following complaints are advised to conduct monitoring focusing on Holter:

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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 settings.

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Features of a child

Unlike adults, determining normal blood pressure limits in children is challenging. After all, fluctuations occur against the background of hormonal changes, physical activity, and heredity. Doctors have developed special thresholds for possible normal pressure for children depending on age and somatotype. The implementation of the technique is not fundamentally different from the ABPM of an adult. The only difference will be the threshold of accepted readings. For example, a value of 120/80 is considered normal for tall child, and for a low one it will be a high figure.

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ABPM during pregnancy

ABPM in pregnant women is carried out in the 3rd trimester, the result of which will show the presence or absence of pathologies that can affect labor activity. During pregnancy, the body undergoes increased load, during which the pressure often increases to 140/90. ABPM for pregnant women is a way to determine whether high blood pressure is the cause of pathology or a concomitant factor of pregnancy.

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Interpretation of ABPM results

The results are deciphered on a computer, after which the doctor makes a conclusion.

The results of daily monitoring of arterial levels are transferred to a PC, where they are decrypted. Most often, decoding is carried out using the method of measuring average values, which are taken over 24 hours (8 night and 11 day). The result shows the blood pressure level of a particular patient, on the basis of which the doctor makes a conclusion. The assessment is done according to criteria different from ordinary blood pressure. The average accepted values ​​for a healthy patient are summarized in the table:

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Final word

ABPM is an indispensable method for diagnosing hidden pathologies. Doctors resort to the technique when the usual measurement method is suspicious. Often carried out among pregnant women (in the last period of gestation), since the pressure increases due to the additional load, which diverts attention from possible problems. The procedure has a preparation algorithm, rules for conducting and calculating results.

24-hour blood pressure monitoring (ABPM)

Arterial pressure - important indicator human health. The well-being and, consequently, the quality of a person’s life often depends on it. But there are situations when a single measurement of this indicator is not enough for a doctor. In these cases, 24-hour blood pressure monitoring (ABPM) is prescribed.

What is it and how is it done?

24-hour blood pressure monitoring – instrumental study, in which this indicator is monitored throughout the day. It is carried out like this: a cuff is placed on the patient’s shoulder to measure blood pressure. Using a special tube, the cuff is attached to the recorder. This small device pumps air into the cuff at regular intervals and then releases it. During the day, measurements are usually taken every 15 minutes, at night - after 30 minutes. Sensitive sensor detects onset and decay time pulse waves(as with conventional Korotkoff pressure measurement). The results are recorded in the device's memory. After reading them using a computer program, the doctor functional diagnostics analyzes the results and gives a conclusion.

What will this study show?

The study shows a number of important implications for human health.

1. Maximum and minimum blood pressure (systolic and diastolic) during observation in the patient's natural environment, and not in the hospital.
2. Average blood pressure during daytime and nighttime hours, which will determine whether the patient has hypertension. This is the main indicator for which the study is conducted.
3. Circadian rhythm of blood pressure. Failure to lower blood pressure at night is associated with an increased risk of heart attack and stroke.

All this data will help to diagnose hypertension and select the right treatment, and then evaluate its effectiveness.

About self-measurement of blood pressure

Constant self-measurement of blood pressure will provide significantly less valuable information. It cannot be carried out at night. If a person wakes up on purpose, this leads to an inevitable increase in pressure and distortion of the results.

You need to know that the most accurate results are obtained by measuring traditional method Korotkov (determination of tones using a phonendoscope). It is best to use semi-automatic devices with automatic air injection, since manual injection can cause a short-term rise in pressure. Devices that measure pressure on the wrist or finger are much less accurate. We recommend devices that operate on mains power rather than on batteries.

It should be taken into account that in approximately 5% of patients, pressure monitoring indicators differ significantly from self-monitoring data. Therefore, it is very important to carry out control measurements in the diagnostic room immediately after the start of the study.

How to prepare for research

On the recommendation of the attending physician, certain medications for the treatment of hypertension may be discontinued before monitoring. Unless specifically instructed to do so, you should take all medications as usual.
It is advisable to wear a light T-shirt with sleeves up to the elbow, and some loose clothing on top, since the recorder will be placed in a bag and hung around your neck, and there will be a cuff on your arm.

Before the study, you can eat, drink, and lead a normal lifestyle.

How to behave during research

Detailed instructions are given by the functional diagnostic nurse. She should give the patient a diary in which he will note his actions and sensations during each blood pressure measurement (except for sleep time), as well as taking medications and sleep time.

At the beginning of each measurement, the patient should stop and extend his arm down along the body, relaxing it. After completing the measurement, the subject must make an entry in the diary and continue the interrupted lesson. If the cuff slips, you need to carefully adjust it. The tube through which air is pumped must not be allowed to bend.

The increase in pressure in the cuff is often quite severe, resulting in pain when squeezing the arm. These feelings must be tolerated.

Indications for research

1. “Borderline” blood pressure figures identified during repeated measurements using the Korotkoff method.
2. Monitoring of selected antihypertensive therapy, including to exclude episodes of severe hypotension after taking medications.
3. Suspicion of “white coat hypertension”, when high blood pressure is recorded only when measured by medical staff. Suspicion of “workplace hypertension,” when increased blood pressure occurs at work.
4. Severe hypertension resistant to treatment.

In the presence of the listed indications, especially valuable information can be obtained from the following groups of patients:

1. Pregnant women.
2. Sick diabetes mellitus 1 type.
3. “White coat hypertension” and “workplace hypertension.”
4. Episodes of hypotension.
5. Young people with disorders of the autonomic nervous system.
6. Older patients.
7. Patients suffering from hypertension without treatment effect.

Contraindications for the study

1. Exacerbation skin disease at the site where the cuff is applied.
2. Disturbances in the blood coagulation system with a tendency to bleeding during exacerbation.
3. Injuries to both upper extremities, excluding the possibility of compression by a cuff.
4. Impaired patency of the brachial arteries, confirmed instrumentally.
5. Patient refusal.
6. The study may be useless if there are significant disturbances in heart rhythm, as well as very high blood pressure values ​​(more than 200 mm Hg).

“Health Expert” program on the topic “24-hour blood pressure monitoring - ABPM”

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