What is smad in cardiology. 24-hour blood pressure monitoring (SMA) Monitoring SMA how to attach the device correctly

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

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

Indications for the procedure

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

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

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

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

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

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

The procedure is indicated for:

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

Contraindications to ABPM

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

It is contraindicated to carry out SMAD with:

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

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

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

Equipment for ABPM

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

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

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

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

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

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

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

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

Preparation for the procedure

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

Sometimes doctors advise bringing batteries for the device.

Before the study, patients should lead their usual lifestyle.

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

How is the procedure performed?

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

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

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

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

ABPM in childhood

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

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

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

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

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

Decoding the results

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

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

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

Reliability of the method

From the point of view of the correctness of the analysis of the patient’s condition, the reality of the results obtained, there are no complaints about the method either from doctors or from patients.

But when using the device, some difficulties arise. If the cuff is placed on a bare arm, irritation may occur. With frequent squeezing of the cuff, some subjects experience numbness in the arm.

The method of 24-hour blood pressure monitoring has a high percentage of accuracy, but errors are still common. This is due to the fact that the patient may keep a diary incorrectly or make notes not immediately, but later, distorting the information. For example, the load can increase the pressure, but the patient did not fix the cause of the increase.

The military registration and enlistment office requires ABPM when a conscript reports blood pressure abnormalities. At the same time, in order to deceive, the conscript often violates the instructions for conducting the survey with the aim of deception. But this fact is often found when deciphering the testimony and records by the doctor. Because the information and the instrument readings will contradict each other.

Recently, people of all ages are increasingly faced with the problem of high blood pressure. The appearance of this symptom can be provoked both by the development of hypertension and by the influence of external negative factors.

To determine whether a patient is suffering from a serious cardiovascular disease or whether his condition has temporarily worsened, in most cases it is suggested to undergo an examination such as ABPM.

People who come across this name for the first time usually have a logical question - what kind of procedure is this in cardiology?

ABPM, which stands for 24-hour blood pressure monitoring, is a medical examination that helps track how blood pressure changes over a 24-hour period.

The procedure is carried out using an automated device. It consists of a mini-computer and a cuff connected by a special tube.

The device reads the indicators and stores them in the recorder’s memory. Measurements take place day and night, so monitoring allows you to get the most complete picture of blood pressure fluctuations. At the end of the examination, the doctor transfers the data recorded by the registrar to the computer.

Currently, the use of a device for daily monitoring of fluctuations in blood pressure is the only reliable examination method. It helps to diagnose it at an early stage and take a timely step in the fight against it.

ABPM and Holter diagnostics are the same thing?

Holter is an American scientist who developed a smart device for daily heart rate measurement. This procedure complements long-term blood pressure monitoring for those experiencing chest pain and palpitations.

Another argument in favor of Holter diagnostics is the presence of chronic cardiovascular diseases. 24-hour examination is considered more effective than the standard ECG procedure, as it can detect paroxysmal changes in the beating rhythm and ischemia.

Like ABPM, the holter is installed for a day. Several electrodes are fixed on the patient's chest. With their help, the pulse is measured and the data is transferred to a recording device, which processes it into electrocardiograms.

The main difference between Holter diagnostics and ABPM is the monitoring of heart rate on a graph using special suction cups on the body.

24-hour monitoring of blood pressure and pulse cannot be effectively done at home using conventional devices. This is due to the fact that measurements must be taken while sleeping. If a person wakes up, the indicators will rise.

Who is the ABPM procedure indicated for?

Daily blood pressure monitoring is prescribed if:

symptoms of hypertension are caused by stress or high stress on the body;
blood pressure is slightly increased for a long time;
the patient has close relatives suffering from arterial hypertension;
the patient’s condition requires regular medical monitoring to avoid complications;
you need to find out how the chosen therapy affects the human body;
the patient suffers from white coat syndrome: blood pressure levels rise due to anxiety from a visit to the doctor;
the first signs of hypertension appeared: frequent headaches, decreased clarity of vision, shortness of breath, swelling, ringing in the ears;
the patient is bothered by frequent dizziness;
The choice of treatment methods depends on the characteristics of arterial hypertension.

Other reasons for carrying out daily blood pressure measurements include: addiction to alcohol or tobacco products, being overweight, old age and pregnancy.

Preparatory stage

Wearing the ABPM device does not require special preparation before starting the examination. Some experts recommend:

normalize your daily routine in advance;
refuse serious physical activity;
Choose loose clothing on the day of the procedure.

Sometimes, before conducting a diagnosis, the doctor asks the patient to stop taking medications for a day. On the day of the examination, medications are resumed. Refusal helps the doctor draw conclusions about the effect of drugs on the patient’s body.

The procedure for installing a device for daily blood pressure measurement takes very little time. The patient is first told about how the ABPM examination is carried out. Inform about the rules for operating the recording device. Blood pressure and pulse are measured.

If the indicators are normal, a cuff is put on the patient’s non-working arm and secured in the forearm. In case of parallel Holter diagnostics, electrodes are additionally fixed on the chest. A mini-computer packed in a special case is hung on the belt.

The 24-hour monitor checks the blood pressure index every half hour during the day and once per hour at night. The interval between measurements can vary up or down. Indicators depend on the doctor’s decision and the device model.

After a sound signal indicating the start of air supply to the cuff, the patient should lower the relaxed arm down and, if possible, stop. This position will allow you to obtain the most accurate results. After the second beep, you can continue to do your business.

During the examination period, it is advisable to lead a normal lifestyle. It is mandatory to keep a diary, in which information about your daily routine, medications taken and general well-being should be written down with a time stamp.

take a bath or shower, as water can damage the daily pressure meter;
subject the body to serious physical and emotional stress;
consume foods that provoke an increase or decrease in blood pressure (excessive or fatty foods, smoked foods, strong);
drink and smoke.

The smart device should not be exposed to too high or low temperatures, wet, or attempted to be disassembled. It is necessary to monitor the position of the cuff and connecting tube. They must be in their places.

If during measurement the cuff begins to squeeze the arm too much, the operation of the device can be stopped by pressing a special button. In this case, it is recommended to take readings again after a few minutes, and make a note about the failure in the diary.

The main disadvantage of ABPM is its inconvenience. Patients note that:

the cuff does not allow you to fully bend your arm, as it is attached slightly above the elbow joint;
a smart device interferes with sleep at night;
due to prolonged wearing of the cuff, diaper rash or allergic rashes appear on the arm;
You cannot take a bath or shower during the day;
sometimes the device stops working normally;
they experience emotional discomfort because they are forced to constantly monitor the position of the device or are afraid of damaging it.

In addition, unscrupulous patients can influence the results of daily monitoring by using drugs to increase or decrease blood pressure. However, an experienced specialist, in the process of deciphering the results, will immediately recognize abnormal surges and prescribe a repeat procedure, but in a hospital setting.

The indicators that were obtained using instruments in one day are not always characteristic of the patient. Therefore, sometimes repeated monitoring is required.

The inconvenience of the survey is compensated by accessibility and accuracy. The advantages also include:

non-invasiveness of the method;
simplicity of the procedure;
undergoing diagnostics at home;
the ability to obtain a complete picture of pressure fluctuations over a long period of time, which is important for effective diagnosis.

ABPM allows you to detect hypertension at an early stage. For this reason, for most patients this method of examination is considered the most effective.

The doctor begins to decipher the readings of daily blood pressure monitoring on the day the diagnosis is completed. The survey results indicate:

average systolic blood pressure (SBP);
average diastolic blood pressure (DBP);
difference between daytime and nighttime SBP and DBP results;
degree of pressure reduction at night;
variability of indicators.

Cost of the procedure

State clinics offer long-term blood pressure monitoring free of charge. However, in small towns there is often not enough equipment for everyone who wants to attend the examination, so the wait drags on for several months.

If you need to undergo the procedure urgently, you should consider visiting a private medical facility. The cost of the service varies depending on the size of the city and the popularity of the clinic.

City	Minimum cost (in rubles)
Moscow	2300
Saint Petersburg	1500
Kursk	1000
Ekaterinburg	900
Nizhny Novgorod	750

When choosing a private clinic, you need to carefully read the price list for services, since some institutions charge a separate fee for deciphering the examination results.

Contraindications for ABPM include:

period of exacerbation of vascular diseases affecting the condition of the arteries and veins of the upper extremities;
mental disorders;
injury to the non-working hand;
dermatological diseases, the aggravation of which can be provoked by wearing a cuff;
tendency to form bruises with any pressure on the skin;
age up to 3 years;
complications that appeared after the previous procedure;
diseases that affect the accuracy of diagnosis, for example, vascular obstruction.

A referral for examination is issued by a therapist or cardiologist. After completing the diagnosis and interpreting the results, the doctor develops a treatment program or offers the patient a set of preventive measures.

Everyone knows that many cardiological diseases have been “getting younger” in recent years, that is, they occur in young people. Is no exception. This is due not only to the poor environment and poor quality of nutrition in modern times, but also to the increased level of stressful situations, especially among the working population. But, unfortunately, it is sometimes difficult even for a doctor to recognize and distinguish a situational increase in pressure, for example, during psycho-emotional overload, from true hypertension. Therefore, more and more often in the arsenal of therapists and cardiologists there is such a method of additional examination as daily monitoring of blood pressure (ABPM), primarily allowing to detect high blood pressure in a patient - more than 140/90 mm. rt. st. (criterion for diagnosis of “hypertension”).

The history of the creation of the method goes back to the 60s of the last century, when various attempts were made to record blood pressure throughout the day. At first, devices were used in which the patient independently pumped air into the tonometer cuff according to a timer signal. Then attempts were made to measure blood pressure invasively using a catheter in the brachial artery, but the technique was not widely used. In the 70s, a fully automated device was created that independently supplies air to the cuff, and a mini-computer in the device reads data from successive blood pressure measurements, including at night when the patient is sleeping.

The essence of the method is as follows. A cuff resembling a conventional device for measuring blood pressure (tonometer) is placed on the patient's middle and lower third of the shoulder. The cuff is connected to a register that provides air supply and inflation, as well as to a sensor that records blood pressure measurements and stores them in memory. After the examination, the doctor, when removing the device, transfers the results to the computer, after which he can issue a certain conclusion to the patient.

Advantages and disadvantages of the method

The undoubted advantage of the ABPM technique is that monitoring blood pressure throughout the day allows you to detect the slightest fluctuations in different categories of patients.
For example, some people experience “white coat” syndrome, when during a routine medical examination, for example, in a healthy patient without hypertension, the pressure suddenly increases, sometimes to high numbers. After receiving the results of daily monitoring, when the patient is in a calm state, the doctor can get an idea of the true state of affairs. As a rule, in such persons the pressure becomes normal throughout the day under normal conditions.

Some patients, on the contrary, have all the complaints associated with hypertension, but it is not possible to record high numbers at a doctor’s appointment. Then ABPM comes to the doctor’s aid again, making it possible to record pressure drops characteristic of hypertension.

Thus, ABPM is often critical in diagnosing arterial hypertension.

Other advantages include the wide distribution and accessibility of the method to the population, non-invasiveness, ease of use and low labor intensity.

Among the disadvantages, mention should be made of minor inconvenience for the patient, since during the day you have to stay with a cuff on your arm, periodically pumping air, which can interfere with proper sleep. However, in light of the fact that the diagnostic value of the method is great, these inconveniences can be safely tolerated.

Indications for the procedure

modern device for ABPM

Daily blood pressure monitoring is indicated in the following cases:

Primary diagnosis.
Monitoring treatment in people with hypertension.
Obtaining information about the time of day at which the patient’s blood pressure most often increases in order to adjust the doses of drugs received at different times of the day. For example, in patients with high blood pressure at night, it is better to prescribe additional medications at night, and in the morning and daytime, the emphasis is on taking medications in the morning, immediately after waking up,
Diagnosis of hypertension in individuals with a high level of stressful situations during working hours, when hypertension has a psychogenic cause. Treatment tactics in this case should begin with sedative therapy.
Sleep apnea syndrome.
Hypertension in pregnant women, especially with suspected preeclampsia (the study is carried out in a hospital).
Examination of pregnant women before childbirth if they have hypertension in order to resolve the issue of delivery tactics.
Examination to confirm professional suitability (train drivers, etc.), as well as for conscripts whose suitability for military service is in doubt.

Contraindications for ABPM

The examination may be contraindicated in the following diseases and conditions of the patient:

Dermatological diseases associated with damage to the skin of the upper limb - lichen, fungus, etc.
Blood diseases, for example, severe thrombocytopenia, hemorrhagic purpura, petechial rash, etc., characterized by the appearance of bruises with the slightest pressure on the skin,
Upper limb injury
Vascular diseases with damage to the arteries and veins of the upper extremities in exacerbation,
Mental illness of the patient associated with inability to self-care, aggression and other symptoms.

Preparation for the procedure

Daily blood pressure monitoring does not require any special preparation. The patient is not only allowed, but even required to live at his usual pace, without limiting physical or psycho-emotional stress on the day of the study. Of course, you shouldn’t go to the gym or drink a lot of alcohol - it’s better to eliminate it completely. Also, before the study day, the patient’s medications should be discontinued, but this should only be done in consultation with the doctor who prescribed the monitoring. But during an examination carried out to monitor treatment, drugs, on the contrary, should be taken, but the time of taking certain drugs should be recorded in a special diary so that the doctor can see how they affect blood pressure levels during the day. Again, you need to agree on taking the pills with your doctor.

On the day of the study, food and liquid intake are allowed, since there is no need to “hang up” the monitor on an empty stomach. As for clothing, preference should be given to a thin long-sleeved T-shirt for hygienic reasons, because usually the cuff is reusable for all patients.

How is the procedure performed?

In the morning, at the appointed time, the patient must arrive at the functional diagnostics department. The examination can be carried out both in a clinic and in a hospital. After preliminary measurement of pressure using the Korotkoff method using a conventional tonometer, a cuff is placed on the patient’s shoulder (usually the left for right-handed people, and vice versa), connected through thin tubes to a device that pumps air and also contains a device for storing the received information. . This device is fixed to the patient’s clothing belt or placed in a special handbag that the patient wears over his shoulder. In some cases, electrodes are placed on the patient's chest to record a cardiogram - in cases of parallel.

The monitor is already configured in such a way that the device pumps air into the cuff after a certain amount of time. As a rule, this is once every 20-30 minutes during the daytime, and once every hour at night. At these moments, the patient should pause, freely lower his arm down and wait until the measurement takes place. In addition, the monitor has a button that can be pressed when unpleasant symptoms appear, and an unscheduled blood pressure measurement will occur.

During the daytime, the patient should record in the diary the time of taking medications, the time of eating, the time and nature of physical activity down to the smallest details - for example, went to the kitchen, went up to the third floor, etc. It is especially important to note the type of activity at the time of measuring blood pressure . You should also note unpleasant symptoms - heart pain, headaches, shortness of breath, etc.

A day later, the patient returns to the functional diagnostics room to have the monitor removed, the information transferred to the computer, and the conclusion of the study protocol issued.

ABPM in childhood

In children over seven years of age, 24-hour blood pressure monitoring is often used, but usually in conjunction with ECG monitoring. Indications include not only hypertension, but also (low blood pressure), rhythm disturbances, and also (loss of consciousness).

Conducting a study is not much different from examining adults, the only difference being that the child needs to be explained in more detail, or even better, shown how the monitor works and what it is needed for.

Decoding the results

The level of blood pressure, as well as some other indicators (body temperature, pulse, breathing rate) is a value subject to circadian rhythms. The highest blood pressure levels are observed in the morning and daytime hours, and low blood pressure numbers are observed at night.

Ideally, blood pressure numbers range from 110/70 to 140/90 mm Hg. In children, blood pressure may be slightly lower than these figures. When monitoring, in addition to the average blood pressure figures (systolic blood pressure - SBP and diastolic blood pressure - DBP), the variability of the circadian rhythm is indicated, that is, fluctuations in SBP and DBP up and down from the obtained average daily curve, as well as the daily index, that is, the difference between daytime and nighttime results BP as a percentage. Normally, the daily index (DI) is 10-25%. This means that the average “nighttime” blood pressure numbers should be less than the “daytime” ones by at least 10%. Rhythm variability is considered abnormal if at least one of the measurements produces numbers above or below normal blood pressure values.

example of ABPM results

Depending on the data obtained as a result of measurements, the doctor issues a conclusion indicating the above-described indicators.

Reliability of the method

Is it possible to “deceive” ABPM so as not to serve in the army? Due to the fact that in recent years many young men, for one reason or another, do not want to serve in the army, they use many tricks to obtain a medical exemption from service. For example, many, while still in high school, begin to turn to therapists with complaints about “high blood pressure” and poor self-esteem, although this is not true. It is not difficult to increase blood pressure before seeing a doctor - physical activity (running, squats, etc.) is enough, but high blood pressure numbers in a conscript at an appointment will prompt the doctor to think about the need for further examination. In particular, about the use of ABPM.

Again, it is not difficult to achieve elevated blood pressure levels with ABPM, but it is almost impossible to deceive the doctor who performed or received the results. Firstly, this is due to the fact that many conscripts try to increase their blood pressure at night, and, as a rule, in young people, even those with hypertension, their blood pressure normalizes at night. Secondly, during exercise, the heart rate increases in proportion to the pressure, which in most cases is recorded on ECG monitoring. Therefore, the doctor, seeing sinus tachycardia coupled with increased blood pressure, will most likely think about the reliability of the technique and prescribe other research methods, perhaps even in a hospital.

Some people of military age use nicotine and caffeine-containing drinks in large quantities, and sometimes even alcohol on the day of the test. Such cocktails of caffeine and continuous exercise throughout the day will certainly affect the heart and blood vessels of a young person, and can lead to cardiovascular pathology in the future. Therefore, it is better not to take risks and carry out this examination as usual. In the end, military service is not as harmful as possible complications associated with increased blood pressure under the influence of caffeine, alcohol and excessive physical exertion, which young people unknowingly resort to in order to “dodge” the army.

There are cases when, on the contrary, the patient wants to “deceive” ABPM in order to hide hypertension and continue responsible work by passing an aptitude test. In this case, it is worth recommending that the subject, at least in general terms, reconsider his lifestyle and eliminate bad habits, such as poor nutrition and excessive consumption of salt, simple carbohydrates, animal fats and excess calories (not to mention alcohol, caffeine and nicotine). And at the same time normalize the level of physical activity, get rid of stress, lack of sleep and uneven loads. Moreover, for a good result, it is worth starting “perestroika” in advance, at least several months before the examination. And after it, “fix” a new lifestyle and improve your own health, at the same time slowing down the progression of hypertension.

Video: how to pass ABPM correctly - the program “Live Healthy!”

Video: report on ABPM

01.06.2017

(ABPM) is a special procedure that is used to determine changes in blood pressure during the day.

As a result, the doctor gets a fairly complete picture of the patient's condition. And he can choose the right treatment regimen. So, if your blood pressure rises in the morning, your doctor will recommend taking medications immediately after sleep. If blood pressure rises at night, it makes sense to take medications before bed. This method is much more efficient than the usual tonometer measurement.

For checking useheart rate monitor(or heart rate monitor ). A cuff is attached to it using a tube, similar to the one used in blood pressure monitors. To collect data, the device is connected to a computer.

Who is ABPM indicated for?

Monitor blood pressurecarried out in order to identify hidden hypertension, or to monitor at what time of day a hypertensive patient experiences pressure surges, how drugs to normalize blood pressure affect blood pressure readings, to find out the reasons for the lack of results from taking hypertensive medications. The procedure is also useful for other diseases:

hereditary hypotension;
disorder of the autonomic nervous system;
type 1 diabetes;
sleep apnea - stop breathing at night.

ABPM gives good results in the treatment of elderly patients.24 hour blood pressure monitoringallows you to correctly determine treatment for people experiencing severe nervous tension and psychological overload due to their profession.

The procedure is indicated for pregnant women if complications arise in the second and third trimesters; pregnant women with an established diagnosis of hypertension, for proper delivery.

How is daily monitoring carried out?

A cuff is placed and secured on the patient's arm at the level of the heart, which is connected by a tube to a device that automatically pumps and deflates air in the cuff. The device is located in one block with a small monitor that records the indicators. The unit can be attached to your belt with a special belt or worn on your shoulder.

Under the cuff there is a special sensor for recording impacts. pulse

Measurement blood pressureoccurs automatically after a signal is sent from the monitor’s memory unit. How is it carried out? The procedure and how often measurements will be taken are determined by the doctor individually.

This usually happens every fifteen minutes during the day, and at night the interval is half an hour. In cases where the time of pressure rise is known, the interval between measurements can be ten minutes (but not the entire day , but for a couple of hours). The procedure lasts day . The device can be configured for other times, for example: half an hour during the day and an hour at night.

When blood pressure measurementfinished, the patient comes back to the medical facility to remove device . The doctor will transfer the monitor readings to the computer. The program will allow:

compare the measurement indicators with the average. 120 (plus/minus 6) by 70 (plus/minus 5) per day. In the morning the numbers could be: 115 (plus/minus 7) by 73 (plus/minus 6). In the evening the average is 105 (plus/minus 5) over 65 (plus/minus 5);
determine your circus rhythm.

Based on the results, the doctor will issue a conclusion and attach data to it.

How to behave during the procedure

When conductingambulatory blood pressure monitoringthe patient can lead a normal lifestyle, but it is better not to subject himself to excessive force loads in the gym. There are no restrictions on food intake, except for alcohol.

The cuff should be worn over a thin cotton T-shirt to prevent irritation as the cuff is reusable.

During the procedure, you should keep a diary where you record the sensations at the time of measurement. arterial pressure. There is a special button on the monitor for unscheduled pressure measurement. It can be used if the condition suddenly worsened.

You should also record all your activities in the diary. during the day . When taking medications, food, there were attacks of palpitations, headaches, and others. Even such a small thing as moving from room to room or climbing stairs should be recorded. All entries do with exact time.

The day before the procedure, medications to normalize blood pressure are stopped, but only as directed by the doctor. You should not do this on your own. If the purpose of the study is to find out how the medications work, they will not be stopped.

For pregnant ambulatory blood pressure monitoringcarried out only in a hospital under the supervision of a doctor.

For whom ABPM is contraindicated

Like any procedure, measurementblood pressure during the dayNot shown to everyone. You shouldn't do it:

with injuries of the hands or damage to the arteries and veins in the hands;
various blood diseases that manifest themselves as bluish spots when squeezed;
if there is a fungus, lichen or other skin diseases on the skin of the hands.

Daily monitoring should be carried out with great caution when the systolic reading is above 200 millimeters of mercury.

It will not be useful to carry out24-hour blood pressure monitoringin mentally ill people. Especially if this is associated with aggressive behavior or the person’s inability to offend himself.

Is it possible to use ABPM in the treatment of children?

Daily pressure monitoringcan be performed in children starting from the age of seven.

The study is carried out in conjunction with an ECG.

The technique is used for hypertension, hypotension, heart rhythm disturbances or periodic loss of consciousness.

What is good about the method?

This the study allows us to record absolutely all pressure fluctuations, even the slightest deviations from the norm. It helps to identify hidden and temporary hypertension. For example, in patients experiencing a stressful situation when measuring blood pressure in the hospital (white coat syndrome), it may rise sharply. In a familiar environment, a person calms down and indicators return to normal.

Daily allowance devicemeasuring pressure is useful in cases where a doctor's appointment fails to detect an increase in blood pressure, and the patient's condition worsens.

The indisputable advantages of the method include the ease and ease of use of the device. Thanks to this, ABPM is widely known and used everywhere.

Since the device easy to hide under clothing, the patient does not experience discomfort and can lead a normal life.

The method helps:

determine whether the development of heart and vascular diseases is predicted;
develop treatment for heart attack, hypertensive crisis, stroke and other serious diseases;
fluctuations in pressure during the day, can confirm or refute the disease of the kidneys, liver, cerebral vessels, heart more accurately than other clinical studies;
determine the effectiveness and correctness of the selected medications.

Having received pressure monitoring data, the doctor will be able to determine the most correct treatment regimen for hypertension, prescribe medications appropriate to the patient’s condition, prescribe nutritional standards and the need for physical activity.

Disadvantages of ABPM

But when using the device, some difficulties arise. If the cuff is placed on a bare arm, irritation may occur. With frequent squeezing of the cuff, some subjects experience numbness in the arm.

What else do you need to know

To ensure that your daily blood pressure monitoring results are accurate and that the time spent on the study is not wasted, listen to the advice of experts:

when measuring pressure, the hand should be along the body;
if the device signal catches you while walking, stop, relax your arm and lower it along your body;
It is forbidden to look at the readings during the procedure. They do this to avoid distortion of the readings. High readings may cause stress in the patient and continued monitoring will not make sense;
You need to sleep at night, otherwise the results will be these research will be incorrect.

An important characterizing factor of human health is blood pressure. It is what determines well-being and quality of life. Today, everyone can purchase an electric automatic device for measuring blood pressure at home and obtain information about it at any time, but there are situations when it is necessary to measure this indicator more than once. In this case, 24-hour blood pressure monitoring (ABPM) is used.

Today, three methods of measuring blood pressure are used in medicine: auscultatory, oscillometric and invasive. Most often, monitoring devices are used that incorporate oscillometric and auscultatory methods, which, in combination with each other, allow one to obtain a more complete picture of the disease.

Indications for the procedure

Persons who are suspected of having symptomatic hypertension.
Persons with “white coat” syndrome. We are talking about those who experience increased pressure within the walls of a medical institution when measured by a nurse.
Persons with “borderline” blood pressure readings, which were detected after repeated changes by the Korotkoff method.
Persons with increased blood pressure at work.
Persons suffering from concomitant diseases, which include heart failure, metabolic disorders, syncope, etc.
Persons with high blood pressure lability. We are talking about those whose blood pressure fluctuates too much from minimum to maximum values.
Elderly people over 60 years of age.
Persons with nocturnal hypertension.
Persons with bad heredity.
Persons with severe arterial hypertension that is difficult to treat.
Persons who need to obtain a prognosis for the further development of the disease.
Women who are pregnant.
Persons with disorders of the autonomic system.
Persons with type 1 diabetes mellitus.

It must be said that it will not be possible to obtain accurate data by independently measuring blood pressure, because diagnostics cannot be carried out at night, because for this a person needs to wake up, and this will inevitably increase blood pressure and distort the results. In addition, the performance of different devices can differ significantly from each other.

It is believed that the most accurate data can be obtained by measuring the Korotkoff method. At the same time, experts recommend using semi-automatic devices with automatic air injection. The manual pumping process may increase the pressure for a short time.

Devices that measure pressure on the wrist or finger are less accurate. In addition, it is better if they run on mains power rather than on batteries.

ECG and blood pressure Holter monitoring

Daily monitoring of blood pressure and ECG allows you to get a more complete picture of the disease, especially when there are hidden forms of heart disease that do not manifest themselves clinically, but are diagnosed on the ECG in a state of motion.

The American scientist Holter developed an instrumental diagnostic method, which is based on recording the electrical activity of the heart muscle, which occurs during life and changes depending on the presence of certain heart diseases. In this case, electrodes are installed on the patient’s chest, which read information about the operation of the main “motor” of the body and send it to a connected portable device.

In it, the data is processed programmatically and recorded in the form of electrocardiograms, which are stored in the device’s memory. With this method, they can simultaneously apply a cuff to the upper arm and thus carry out 24-hour blood pressure monitoring using the oscillometric method. In case of any ambiguities, the diagnosis can be extended up to 7 days.

This method has a lot of advantages and disadvantages over a standard ECG, which does not always allow recording myocardial ischemia and paroxysmal rhythm changes. This method of measuring blood pressure is almost the only one for those patients whose heart function worsens with minimal movement.

This research technique is indicated for those patients who complain of pressing or burning pain behind the chest and in the heart area, which may or may not radiate under the shoulder blade and arm from the side of the main “motor”. Pain in the left side of the chest, especially at night, is also a reason for the procedure.

This also applies to those who suffer from shortness of breath with a suffocating cough, suffer from lack of air, a feeling of sinking heart, frequent dizziness, fainting and periodic failures in the work of the main “motor” of the body. There are no contraindications for the procedure, except in cases where it is technically impossible to perform, for example, with severe obesity, body burns, etc.

24-hour blood pressure monitoring with the BiPiLAB system

This device records the patient's systolic, diastolic, mean BP and pulse rate in an automated, non-invasive way. The oscillometric method will provide accurate data on the patient's state of health with weak Korotkoff sounds, hypotension, and in the case when the auscultatory method did not give a result. At the same time, a cuff is placed on the patient's arm, which does not impair the patient's quality of life and does not make noise, which is very important for comfortable sleep.

The device is connected to the computer programmatically, that is, through special software and a communication cable. It is often combined with Holter monitoring of ECG and blood pressure. In the future, the data from both devices are processed in one program and the results are combined in a common report.

Patient Instruction

To achieve good results and achieve a minimum number of erroneous measurements, the patient is instructed. He is introduced to the rules of behavior during monitoring, here they are:

While the device is operating, the arm with the cuff must be extended along the body and relaxed.
During the entire diagnostic period, it is not recommended to engage in physical labor and sports.
If the device starts measuring while moving, you need to stop, relax and only after finishing its work continue further actions.
It is not recommended to monitor the readings of the device during measurement, since anxious anticipation can distort further results.
At night, try to fall asleep without thinking about the operation of the device.
Keep a diary and, during monitoring, reflect in it your well-being and all your actions.
Do not shower or swim during the entire diagnostic period.
Do not allow the pump tube to be kinked.

The ABPM results are assessed after 24 hours from the start of the study. A special computer program analyzes them, and the doctor, based on this, gives a conclusion about the variability of pressure, the dynamics of morning readings, the hypotension index, and then compares the obtained values with the average normative indices. Based on these data, a set of measures is prescribed that will improve the patient’s health.