Checking the dynamics of blood pressure smat. 24-hour blood pressure (BP) monitoring is a procedure that helps make a diagnosis of blood pressure disorders
What is hypertension or hypotension? Most older people are familiar with these two terms, as time takes its toll. Age, environment, lifestyle, bad habits - all this leaves a mark on health. For example: these diseases began to manifest themselves at a young age. People suffer from hypertension as early as 35-40 years of age. Diseases are getting younger, and this forces people to seek treatment medical assistance. For a doctor to diagnose a disease associated with a change blood pressure, he will resort to examining the patient using ABPM (24-hour blood pressure monitoring). This study carried out using a special apparatus, fully automated.
History of the method
Daily monitoring blood pressure is a procedure that has been popular since the 1970s. Until this time, for daily monitoring, devices were used in which the patient must pump air into the cuff himself. Air pumping took place in certain time, which the device reminded with a characteristic timer sound signal. There were attempts to produce a device that measured blood pressure by invasively inserting a catheter into the brachial artery, but the technique did not become popular.
Blood pressure monitoring deviceOnly in the 1970s was an automated device developed that, using a mini-computer, read data on a patient’s blood pressure throughout the day. It works both day and night, allowing doctors to see a picture of high or low blood pressure.
How is pressure measured?
ABPM in cardiology is considered an indispensable diagnostic method, as it helps doctors see changes in blood pressure under different patient loads. To start with middle third A cuff is installed on the patient’s shoulder, which corresponds to the usual cuff of a device for measuring blood pressure. Next, it is connected to the register, the part that is responsible for the air supply. On the other side, the cuff is connected to a sensor that records blood pressure. The collected data is recorded in the device's memory. When daily blood pressure monitoring has been completed, the doctor can only transfer the collected results to a computer. After analyzing the results, he makes a conclusion.
Indications for diagnosis using this technique
ABPM records the slightest changes in blood pressure, so doctors often recommend that patients keep a diary for the day of diagnosis. In a diary, a person should record the loads during the day - from waking up to going to bed. The doctor must understand: under what stress or stress the patient feels a decrease or increase in blood pressure. There is a whole list of indications for daily blood pressure monitoring:
- blood pressure control in hypertensive patients,
- primary analysis of the condition,
- reception antihypertensive drugs,
- diabetes mellitus,
- vegetative pathology nervous system,
- sleep apnea syndrome,
- diagnostics for those individuals whose blood pressure rises during a certain daily period,
- Diagnosis of ABPM should be mandatory for people who experience frequent stress,
- suspicion of preeclampsia in pregnant women,
- examination of a pregnant woman with severe hypertension before labor(to select the optimal method of delivery),
- blood pressure monitoring for conscripts and preventive examinations working segments of the population.
Are there any contraindications?
No matter how effective blood pressure monitoring is using automated equipment, there are several contraindications to the procedure:
- illnesses skin (fungal diseases, lichen, eczema, etc.),
- petechial rash (appears with minimal pressure on the skin),
- blood diseases (thrombocytopenia),
- bruises, hand injuries,
- vascular lesions of the arteries and venous vessels of the hands,
- mental illness.
Wearing the device for a long time may worsen the course of the disease. You need to increase or decrease your blood pressure only after checking your blood pressure using a classic tonometer.
How to properly prepare for the procedure?
Blood pressure monitoring and analysis of the results obtained are two interrelated concepts that directly depend on the patient’s lifestyle during the diagnostic period. The person undergoing monitoring should behave as naturally as possible, as in normal life. Definitely not worth visiting on this day. gym or drink alcohol. These two factors can trigger pressure surges.
Installation of the device You can only take medications prescribed by a doctor as long as they are indicated in the patient’s diary. ABPM is a reusable device, so for hygienic reasons it is better to wear a thin long-sleeved jacket. The fabric of clothing should be simple.
If a person undergoes ABPM in private clinic or a simple hospital, then he needs to have with him:
- passport,
- outpatient card,
- doctors' opinions,
- various extracts from the medical history,
- results of parallel diagnostics,
- voluntary health insurance policy (VHI if you have insurance from the company),
- documentation or certificates of entitlement to benefits.
What is the price? Carrying out the procedure in Moscow clinics can vary between 3000-4000 rubles. If we talk about remote areas, the cost can be significantly lower.
How is the procedure done?
To monitor blood pressure, the patient needs to come to the doctor in the morning to install the device. Before fastening, blood pressure is measured using a tonometer, and an electrocardiogram can be performed. If the indicators are within normal limits, then specialists install a cuff and hang a reading mechanism in the form of a mini-computer on the belt. To make the patient comfortable, the mini-computer can be kept in a purse. It can be hung on your belt or over your shoulder.
Important! For right-handed people, the cuff is hung on left hand, and for left-handed people - vice versa.
If necessary, electrodes of a Holter monitor can be attached to the patient’s body, which simultaneously counts the work of the heart for that day. The monitor for measuring blood pressure works continuously, periodically pumping air into the cuff.
When the monitor is installed, it is important for the patient to choose the most convenient location for the mini-computer. It should not interfere or be compressed, for example: due to the specific nature of the patient's work. Often people who drive cars travel on highways or long time carried out in a sitting position, it is better for them to place a bag with a mini-computer over their shoulder. It shouldn't shrink because it has buttons.
If a person feels sharp deterioration well-being, he can press the button for unscheduled pressure measurement.
Important! Every 20-30 minutes a new portion of air will enter the cuff, so during this period it is better to lower the arm down. At night, air pumping occurs once per hour.
After installation, the patient must not forget about the rules:
- record all activities during the day (breakfast, lunch, going to the park, climbing stairs, sleeping, watching a movie, etc.),
- note changes in well-being during periods of minimal stress (the appearance of headache, nausea, dizziness, weakness, numbness of the limbs, tinnitus),
- record medication intake.
The results of ABPM should be dealt with by a doctor. He must remove the device and transfer the collected results to a computer. The patient should not have the device removed at home. During the period between air pumping intervals, a person should behave as naturally as possible for his lifestyle. The interpretation of the results should be carried out comprehensively, taking into account all types physical activity and taking medications throughout the day.
Decoding
The interpretation of the results is based not only on the blood pressure level; pulse rate is added to the analysis. Blood pressure often increases in the morning and during the day, but decreases at night.
Example results Daily blood pressure monitoring is carried out for both children and adults. Decryption features:
- In adults ideal parameters Blood pressure can be considered the interval between 110/70 and 140/90 mm Hg. during the day. For child's body pressure may be lower.
- The doctor must compare the results of the night and day regimen. If we talk about the norm, then the daily index of fluctuations in systolic and diastolic blood pressure should be within 10-25%.
- ABPM can detect deviations from the norm even when at least 1 indicator is above or below the norm.
Blood pressure monitoring is done to complex diagnostics patient, so sometimes this device can be supplemented with a Holter monitor.
Advice! It is worth remembering that the difference between the upper and lower pressure should not exceed 53 mmHg. Art. If we talk about healthy body, then this indicator should not be higher than 30-40 mHg. Art.
During the decoding period, the doctor may notice an increase in pulse pressure. This condition indicates the presence of diseases thyroid glands and vessels. In people who have an elevated pulse pressure, the risk of complications sharply increases hypertension.
If blood pressure does not decrease well at night, then this condition may signal the development of:
- diseases of the urinary system,
- adrenal tumors,
- coronary heart disease,
- diabetes mellitus,
- neurosis,
- stroke or heart attack.
Are there any inconveniences during the diagnostic period?
To measure blood pressure at home, ordinary tonometers are often used, but they are put on the arm only during the period of measuring the indicators. Often this time does not take more than 1-2 minutes.
ABPM for the elderly This is unacceptable for daily monitoring, since the cuff is in one position on the arm the whole day. During this time, the patient may encounter a lot of inconveniences, but they are minor:
- the lower arm may swell during sleep,
- During the diagnostic period, you cannot take a bath or shower (the Prior cannot be wet),
- at night a person can wake up due to signals from a mini-computer,
- inconvenience in bending the arm at the elbow, for example: when driving a car or brushing your teeth.
Modern medicine using this method is able to see the results of the patient's condition. Increase blood pressure or decrease it? Now this question is not relevant for many, since ABPM allows you to accurately determine the type of change in blood pressure for both hypotensive and hypertensive patients.
What's the use?
In addition to the fact that the device shows a picture of the patient’s health, it allows doctors to see the patient’s condition during periods of various stresses. For many, blood pressure monitoring is part additional examination. People are sometimes simply afraid of doctors in white coats, so they get nervous, which leads to increased blood pressure. This condition was given the name "white coat syndrome."
When a person with this syndrome sees a doctor, he automatically panics and worries. The feeling of fear can be so great that it is difficult to see the picture of the disease. This portable diagnostic method allows the patient to relax and lead a normal lifestyle. It will not cause long-term inconvenience, so the method is considered one of the most popular.
Daily monitoring blood pressure - a diagnostic method that is used in the treatment of diseases of the cardiovascular and central nervous system, thyroid gland, kidney.
We measure blood pressure throughout the day. We identify hypertension.
Cardiologist gives full analysis results and recommendations.
The cuff and device must be worn 24 hours to record readings every hour.
The cost of diagnostics is 1,400 rubles.
It is cheaper only in a comprehensive examination.
Daily blood pressure monitoring: identify hidden threats.
The most common cause of death today is disease cardiovascular system. More than a million people die from them every year in our country! And it’s not bad medicine that’s to blame for this – modern cardiology has wide range opportunities to help sick people. But the problem is that many of us go to the doctor too late, often arriving at the hospital by ambulance, with a heart attack or stroke.
Along with atherosclerosis, the development of which is difficult to prevent, one of the causes of life-threatening conditions (such as impaired blood supply to the heart or brain) is the “trifling”... hypertension. Not everyone knows that this disease can develop over many years, starting with young, asymptomatic and gradual. In their 30s, few people pay attention to an increase in upper or lower blood pressure by several units, and not everyone has a tonometer at home. And those who accidentally find out about their hypertension often brush it off: just take pills when nothing bothers you!
Another problem associated with the diagnosis of hypertension is the “white coat syndrome”. Some of us have retained an unconscious fear of doctors and medical institutions. Therefore, at an appointment with a cardiologist, a tonometer may show unreasonably high blood pressure numbers, while there is no illness. And for some in the hospital, the pressure, on the contrary, drops, while during work or at night its values can be high... How to catch insidious hypertension?
In a good way to see an objective picture is to carry out 24-hour blood pressure monitoring (ABPM). During this procedure, the patient wears a special device on his body for 1-2 days that records blood pressure readings in conditions as close as possible to natural ones. Based on the results of the study, the doctor receives all the necessary information in order to confirm or refute the presence of hypertension or symptomatic arterial hypertension (increased blood pressure caused by a particular disease).
Who is indicated for 24-hour blood pressure monitoring?
ABPM prescribed in the following cases:
- - if you suspect “white coat syndrome”;
- - with a “borderline” increase in blood pressure (when its numbers are not high enough to immediately make a diagnosis, but cause alertness to the doctor);
- - when an increase in blood pressure is detected for the first time;
- - if you suspect the symptomatic nature of hypertension (for example, when the increase in pressure is associated with stress before consulting a doctor or occurs due to concomitant disease);
- - when examining young people with unfavorable heredity for hypertension;
- - if the patient periodically experiences fainting, to exclude hypotension (low blood pressure);
- - in patients with already established hypertension, coronary disease hearts and vascular lesions brain to identify critical blood pressure values;
- - to evaluate and adjust drug therapy.
Detection of office hypertension (hypertension “at the workplace”) is important for timely correction of work and rest regimes. It is believed that the risk of increased blood pressure with this option is much less than with persistent hypertension and relatively small compared with people whose blood pressure is normal. However, it is possible that office hypertension is a prestage of hypertension and is not a completely harmless condition, so timely changes in working conditions can prevent the formation of persistent hypertension.
Is it possible to sign up for ABPM without a doctor’s referral?
You can pass ABPM on your own initiative if you believe that this research will be useful to you.
Even if the procedure does not reveal any abnormalities, be sure to save the results of the study
– they can be used as a sample for comparison in the future ABPM.
What can and cannot be done during ABPM?
- Watch the position of the cuff on your shoulder. Its lower edge should be fixed 1-2 fingers above the elbow. If you feel that the cuff has slipped off your arm, be sure to correct it.
- Before each measurement, the device ABPM serves beep. If you have the opportunity, do not move while measuring pressure, so the results will be more accurate. While the device pumps air into the cuff, relax your hand. At the end of the measurement, a repeat beep will sound.
- Make sure that the tube connecting the monitor to the cuff is not pinched by clothing or when you are sitting or lying down.
- Do not allow water to come into contact with the device (do not shower during the study), and also try to avoid ABPM long stay near sources electromagnetic radiation(power lines, microwave ovens, television and radio transmitters).
- If you think that the device ABPM is broken - do not try to repair it yourself and do not disassemble it. Report the incident to your healthcare provider.
In addition to the direct increase in blood pressure in different situations, a cardiologist examines a person’s circadian rhythms—the natural decrease or increase in blood pressure throughout the day. Deviations from the normal rhythm may be a harbinger hypertension or other health problems. Based on the information received, the doctor may recommend that you change your diet, give up bad habits or undergo additional examinations.
At 24-hour blood pressure monitoring evaluate indicators such as:
- Average blood pressure values during the study period. Normal value average blood pressure per day is less than 130/80 mm (less than 135/85 mm during the day, less than 120/70 mm at night).
- Episodes maximum increase HELL.
- Daily profile (daily index) of systolic and diastolic blood pressure.
- The magnitude and speed of the morning increase in blood pressure.
- "Dipper"– daily index within 10-20% (22%).
- "Non dipper"– daily index less than 10%.
- “Night peaker”– daily index less than 0.
- "Over dipper"– daily index more than 20%.
These criteria are important for the physician who is treating a hypertensive patient, since patients in whom the nocturnal blood pressure reduction is insufficient (“Non dipper”) have increased risk cardiovascular complications and target organ damage of hypertension. Patients whose average blood pressure readings at night exceed those during waking hours (“Night peaker”) have high risk development of heart failure and kidney damage. Detection of a daily index of less than 0 is typical for patients with secondary (symptomatic) arterial hypertension and can help in the diagnosis of diseases accompanied by high blood pressure. As a rule, with secondary hypertension.
24-hour blood pressure monitoring (ABPM) is a diagnostic procedure. It consists of repeated measurements of indicators throughout the day. A special device is used for this purpose. Thanks to this manipulation, it is possible to analyze the dynamics of pressure changes during the day. Some devices also measure heart rate.
The essence of the procedure
To study in detail the features of increased pressure and determine the reasons this state, daily blood pressure monitoring is prescribed. This research helps to put accurate diagnosis and select the optimal therapy.
The procedure is carried out in accordance with a specific technique. The difference lies only in the use of hardware system devices that are planned to be used for research. Often the manipulation is combined with daily monitoring of the cardiogram.
Advantages and disadvantages of the technique
24-hour blood pressure measurement has a whole series benefits. The key advantage of the procedure is the ability to capture even small fluctuations in the indicator different categories patients.
Many people experience white coat syndrome. In this case, during a routine examination of a healthy patient without arterial hypertension pressure increases. Sometimes it can reach very high levels.
After receiving daily monitoring data, when a person is at rest, a specialist can draw a conclusion about the true picture. Typically, in such patients, the blood pressure remains normal throughout the day.
Some people, on the contrary, complain of hypertension, but the doctor is unable to detect it at the appointment. In such a situation, this procedure will also come to the rescue. We can conclude that ABPM plays key role in the diagnosis of arterial hypertension.
Other advantages of the technique include its accessibility and widespread use. The undoubted advantages are the lack of invasive intervention, low labor intensity and ease of use.
The disadvantages include slight discomfort for the patient, because he has to wear a cuff on his arm all day, which periodically pumps air. This may create some inconvenience during sleep. However, the high diagnostic value makes this method very common.
Indications
A 24-hour blood pressure monitor is performed in the following situations:
Preparation for the procedure
In order for blood pressure monitoring to show an objective picture, it is very important to properly prepare for this procedure.
To do this, you must adhere to the following recommendations:
Training is of great importance. This will help the patient behave correctly during the examination:
- During each automatic pressure measurement, it is important to ensure that the arm is positioned along the body and the muscles are relaxed.
- Don't think about or worry about metrics. This will help avoid influencing the result.
- You should sleep at night without focusing on the measurement process, as this may lead to inaccurate results.
- If a person hears a signal about the next pressure measurement, he needs to stop, lower his hand down and relax. It is in this position that you should wait until the measurement is completed.
- Keep a special diary during monitoring. It needs to record all the activities that a person does during the day. It is important to note the time and sensations that accompany certain loads. This document is very important because it includes valuable information about 24-hour blood pressure monitoring.
How to perform the procedure
IN outpatient setting a person is equipped with special devices that will be fixed on him throughout the day and record changes in pressure.
To do this, a pneumatic cuff is attached to the forearm. This element is securely fixed so that it maintains its position throughout the procedure. The main device is attached to the belt. It weighs approximately 300 g and does not cause any discomfort to a person.
After receiving the necessary instructions, the patient can go home and carry out normal activities. The device, attached to the human body, will automatically measure pressure at certain intervals and record the resulting readings.
The patient must be very careful about fixation necessary information in the diary. This will allow the specialist to obtain an objective picture of changes in pressure parameters and establish probable reasons hesitation.
After completing the study, the device must be turned off. After which you need to come to an appointment with a specialist to give him the device and diary for decoding.
During the session, you must adhere to the following recommendations:
- It is important to avoid squeezing the tube that is used to connect the device to the cuff.
- If signs of device malfunction appear, you should return to your doctor. You should not try to repair the device yourself.
- The cuff is attached two fingers above the elbow. If the device has changed its position, the patient should try to correct it.
- A person should not get into areas where sources of electromagnetic radiation are located.
- It is important to give up for a while water procedures, since the device is prohibited from getting wet.
- When taking measurements, it is important to relax your hand. A characteristic signal sounds before the start and end of the measurement.
The procedure is often prescribed 
children over 7 years old. It is usually combined with monitoring changes in the electrocardiogram. Indications include high or low blood pressure, disorders heart rate. The procedure is also carried out for syncope, which is a loss of consciousness.
The procedure is practically no different from examining adult patients. The only difference is that the child needs to be explained in detail or even shown how the 24-hour blood pressure monitoring device functions and what it is needed for.
Interpretation of results
Data diagnostic study are being processed in an automatic way using a computer. When performing the procedure, pay attention to the following indicators:
- Daily rhythm of pressure. In medicine, this parameter is called the circadian rhythm. Deviation this indicator from the norm indicates the need to search for the cause.
- Average pressure readings. These criteria are also very important for evaluating the data of the procedure.
- Pressure variability. This parameter allows you to assess how much pressure readings deviate from the circadian rhythm.
Circadian rhythm of pressure
Contraindications
In some situations, carry out this procedure forbidden. Key contraindications to the session include the following:
- Complications during previous monitoring;
- Thrombocytopenia, which implies a decrease in the number of platelets, thrombocytopathy, which is a violation of the qualitative composition of platelets, and other blood pathologies during an exacerbation;
- Pathologies that are accompanied by damage to the blood vessels of the hands;
- Traumatic injuries of the upper extremities.
Thrombocytopenia Pathologies with damage to blood vessels of the hands
Scope of research
- filling out a receipt for receiving the monitor
- receiving the patient's diary
- cuff application
- checking system functionality (at least 2 measurements)
- recording of blood pressure measurements for 24 hours
- processing of the record, its analysis, preparation and execution of the report and conclusion based on the results of the study by the doctor
Price full examination(24-hour blood pressure monitoring) - 5000 rubles
Understanding long-term blood pressure monitoring
(AG) is one of the most common conditions, occurring currently, can be detected in approximately 20% of representatives of the modern population. This makes it possible to call it the largest non-infectious pandemic of our time. Monitoring blood pressure levels and correcting (lowering) them higher level are justifiably considered one of the most important components in the system for preventing the development of major vascular events - acute heart attack myocardium and cerebral stroke.
Blood pressure can be determined directly (not used in widespread practice), auscultation (listening to sounds using the Korotkoff method) or oscillometrically. The most precise method is invasive, i.e. with introduction into the lumen of the artery, pressure measurement. All the others, in comparison with the above, have a number of disadvantages, introducing some inaccuracies in measurements.
ABPM – 24-hour blood pressure monitoring (BP)
– method functional diagnostics, allowing discrete recording of the level of systemic blood pressure in brachial artery within 24 hours. It is more correct to call this method of blood pressure analysis long-term monitoring
, since the registration time is not fixed and depends on the specific tasks that need to be solved.
For long-term monitoring of blood pressure, the oscillometric method of determining it is used. The latter is based on the determination of pressure (and volume) fluctuations due to the passage of different volumes of blood through the lumen of the brachial artery, compressed by a pneumatic cuff, into systole and diastole. For obvious reasons direct measurement in this case, cannot be carried out, so a special (and different) sequence of measurements and transformations is used - an algorithm.
Blood pressure measurements during long-term blood pressure monitoring oscillometric method without violating the established procedure, it is considered to be quite accurate, comparable to the Korotkoff method of listening to tones, and gives reliable results. Natural limitations in this case are the various movements of the arm (and cuff) at the time of analysis, as well as the discreteness of determinations with a given periodicity in time: the longer the established intervals, the greater the likelihood of missing episodes of increased or decreased pressure. 
Why is blood pressure monitoring required?
Despite the relatively low cost of this diagnostic procedure, before carrying out it, you need to understand for what purpose it is required. It is obvious that the level of blood pressure is characterized by a fairly wide variability in normal conditions - depending on the time of day, the presence and severity of physical activity, etc. In conditions of deviation from the average level, an increase (hypertension) and a decrease (hypotension) in blood pressure, if present, can be constant, but often have a periodic character. The latter makes it much more difficult to detect such fluctuations. For example, blood pressure may increase mainly at night or mainly in the early morning hours, at the time of psycho-emotional and (or) physical stress, in the form of a reaction to a doctor’s appointment (“ white robe"), etc. In these cases, long-term blood pressure monitoring is the optimal diagnostic method. In addition, for persons with previously diagnosed arterial hypertension, taking medications, lowering blood pressure, it is extremely important how evenly this process is carried out by time of day. The latter is important for the correction of treatment by a doctor. There are also a number of diagnostically important situations (syncope, breathing disorders - sleep apnea, etc.).
Procedure for long-term blood pressure monitoring
The procedure is carried out in the following sequence. First, the patient fills out a receipt to receive a blood pressure recorder (monitor), after which the wearable device initialized in the workstation is secured to the body. The patient is given a diary. which must be filled out, entering information about your actions, taking medications, etc. during the entire registration process. As a rule, to obtain an objective picture, blood pressure monitoring for 24 hours is sufficient; sometimes a longer period is required.
After registration is completed, the patient can independently remove the monitor according to the instructions provided to him by the staff upon receipt of the recorder or, preferably, do this in the clinic. The BP recording from the removed monitor is transferred to a workstation equipped with the appropriate software, the device's memory is reset, after which it can be used for the next procedure. The analysis of the study results is carried out by a certified functional diagnostics doctor or a clinical doctor with appropriate training. Based on the results of the study, a protocol and conclusion are formed and given to the patient. Preparation of the protocol and conclusion, depending on the current workload of specialists, can take from several hours to 3 working days. At the Multidisciplinary Professorial Medical Center "Vascular Clinic on Patriarch's", the procedure for long-term blood pressure monitoring is unified and includes all the indicated components, including a protocol with a doctor's conclusion as an integral part of it. 
If necessary (if available significant changes Blood pressure in the process of its determination) the analyzing doctor has the right to give recommendations on further tactics.
What to consider when planning long-term blood pressure monitoring
no preparation for the study is required
- registration is preferable on a working day, the registration period must be included night sleep; It is not impossible to carry out monitoring on weekends, however, the data obtained may be less valuable, because during this period of time you are deprived of your normal workloads, which undoubtedly affect your blood pressure levels
- when monitoring blood pressure, compression (compression) of the brachial artery is required at the level of the shoulder, where the cuff is applied; pressure is created by pumping air by a compressor, the operation of which is accompanied by a low noise
- depending on the expected blood pressure figures, an individual threshold for air injection into the cuff is set and the higher the pressure, the higher it is, this creates discomfort severe compression of the shoulder, including at night
- The time for installing the monitor should be calculated based on the fact that in a day it must be taken to the clinic (personal presence is not required)
- before starting the study, you will need to issue a receipt for the temporary use of a registrar that is of a certain value; Passport details are entered into the receipt, and its registration requires 10-15 minutes
- The recording device is an expensive electronic device; it cannot be wet or subjected to mechanical stress etc.
- During the study, interrupting the recording, removing the monitor, or pressing buttons is prohibited
- transcript of the recording by the doctor and the formation of the conclusion takes from several hours to days after the delivery of the monitor, depending on the workload of the doctors
What to do next after receiving the results?
If the results of the study were necessary for your attending physician, the progress of your further actions defined If you yourself “prescribed” the procedure, what happens next depends on its results. As a rule, the analyzing doctor gives his recommendations for further examination (treatment is the exclusive prerogative of the clinician). In any case, we believe that it is optimal to contact your attending physician, and we will help you decide on whose profile.
In our clinic, if necessary, you can consult with, carry out, and, if necessary, undergo metabolic disorders.
Multidisciplinary professorial medical center « Vascular clinic on the Patriarchal" invites you for examination and treatment. Contacting our clinic is a guarantee of receiving specialized medical care according to the best international standards.
Indications for the study
- episodes of increased blood pressure in young people
- variable blood pressure levels during repeated measurements, visits to the doctor, or self-monitoring data
- high blood pressure values in patients with a large number risk factors and the absence of changes in target organs and (or) blood vessels characteristic of arterial hypertension (AH)
- normal blood pressure values in patients with a large number of risk factors and (or) the presence of changes in target organs characteristic of hypertension
- significant differences in blood pressure at the appointment and according to self-monitoring data
- inability (resistance) to antihypertensive therapy
- episodes of hypotension, especially in the elderly and diabetics
- arterial hypertension in pregnant women and suspected preeclampsia
- nephropathy and other pathologies associated with arterial hypertension in pregnant women
- left ventricular myocardial hypertrophy
- obstructive sleep apnea syndrome
- episodes of hypotension during treatment (to optimize therapy)
- monitoring the effectiveness of arterial hypertension therapy without hypotensive episodes
- other special indications(determined by the attending physician)
The technique by which blood pressure is measured and the results recorded for 24 hours is called 24-hour monitoring. It involves recording indicators at specified time intervals using a special device or a traditional tonometer.
This method of monitoring cardiac activity makes it possible to determine the average pressure, its values at night and during the day, the amplitude of fluctuations and the threat of damage to target organs.
📌 Read in this article
Benefits of 24-hour blood pressure monitoring
Measuring pressure around the clock is referred to as a diagnostic standard and purpose. It has more potential for obtaining reliable results than a random one-time measurement. The benefits of 24-hour blood pressure monitoring (ABPM) include:
- shows how the daily level of load affects the pressure value;
- reflects nighttime pressure changes;
- helps to diagnose sharp fluctuations - hypertensive and hypotensive crises, fainting conditions;
- when examining it, it is possible to make a forecast about the possibility of acute vascular disorders (,);
- gives a chance to accurately select the optimal time and dosage of antihypertensive drugs or assess the effectiveness of taking prescribed medications;
- eliminates reaction to medical personnel.
Most best option– this is simultaneous monitoring of blood pressure and ECG ().
This complex allows you to establish the relationship between the main characteristics cardiac cycle, which cannot be detected by standard one-time methods.
Indications for use
Used to diagnose the following conditions:
- clinical hypertension (reaction to health care workers);
- increased blood pressure during stress overload during working hours;
- borderline increase in pressure;
- nocturnal form of hypertension, apnea;
- symptomatic variants of the disease - a reaction to medications that increase blood pressure, disorders of the autonomic nervous system, myocardial infarction or ischemia, circulatory failure, inadequate electrical stimulation or its poor tolerance;
- variability of indicators across multiple measurements;
- revealed high blood pressure in the absence of objective data from clinical studies;
- traditional measurement shows the norm for numerous risk factors and diseases of target organs;
- diagnosis of hypertension in pregnant women with possible preeclampsia.
ABPM can also be used when selecting patients for drug treatment, assessing the effectiveness of therapy, drawing up a scheme with individual selection regimen and dosage of medications, before surgery or childbirth, to study the risk of stroke or heart attack.
The technique has no contraindications, but there are a number of pathologies when it needs to be temporarily abandoned: injuries or pathology of the blood vessels of the hands, exacerbation of blood diseases, patient refusal, pressure exceeding 195 mm Hg. Art., serious forms.
What should a patient do with ABPM?
In order to receive reliable indicators Blood pressure, the patient must adhere to the following rules during the monitoring period:
- the arm does not need to be bent during the measurement period, it should be in a relaxed state, located along the body;
- the lower level of the cuff is placed 1 - 2 cm above the elbow bend;
- if the device has started taking measurements, and at this time the patient is in motion (for example, walking down the street), then you need to stop and lower your hand;
- You can't play sports or perform intense activities physical work, and the rest of the daily routine should be normal;
- It is not recommended to monitor the recorder's performance.
When carrying out diagnostics, it is prohibited to disconnect parts of the blood pressure measuring device, hit it or expose it to moisture.
Watch the video about daily blood pressure monitoring:
How is the complex carried out?
For automatic monitoring, a cuff is placed on the patient's non-working arm (for right-handed people, on the left). Moreover, its location should be in the place of the strong pulsation brachial artery. The pneumatic cuff communicates with the pressure recorder through connecting tubes. It is a compact monitor that is attached to the subject's belt.
Measurements are taken every 15 minutes daytime and 30 minutes later at night. The received data is loaded into a computer for processing by a special program.
Why keep a diary
In parallel with blood pressure measurements, the patient should record all events related to activity and health status:
- duration of sleep and its depth, number of night awakenings;
- level psychological stress, stressful situations and your well-being during this period;
- physical activity;
- eating;
- all medications that are taken;
- presence of headache, dizziness, fainting, heart pain, visual impairment.
Then the doctor compares the data provided by the monitor with the patient’s complaints recorded in the self-monitoring diary. Based on them, we can draw conclusions about situations that contribute to increased blood pressure and draw up an optimal antihypertensive therapy regimen.
Method of measuring blood pressure and pulse rate
In the event that pressure control is indicated, but not special device For monitoring purposes, patients are advised to record the results. In this case, the same diary entries are kept as with ABPM, but the frequency of measurements per day does not exceed 6 - 8. In this case, it is imperative to diagnose blood pressure before going to bed and in the morning before taking medications.
Correct measurements are carried out according to the following principles:
- an hour or two should pass after eating and drinking coffee or tea;
- the hand is completely freed from clothing;
- You cannot talk while taking measurements;
- A cuff of appropriate size is required, it must cover at least 80% of the shoulder circumference.
The pulse is determined on the radial artery one centimeter above wrist joint, from the side thumb. To calculate the frequency of beats per minute, use the index index and ring finger second hand and stopwatch.
Control device
The mechanism of action of the device is based on the fact that when the blood flow moves through the place where the artery is compressed, air vibrations occur. If you register them, you can study the resulting oscillations using special algorithms. It is generally accepted that the average level of blood pressure corresponds to the largest amplitude of waves, a sharp increase corresponds to systolic blood pressure, and a decrease corresponds to diastolic blood pressure.
Models of pressure monitoring devices are produced Russian manufacturers(VHI advanced technologies), as well as foreign companies. The most interesting are recent developments that can simultaneously record blood pressure and ECG. And the Japanese multisensory system produced by the ANDA company can also take into account temperature regime during measurements, the location of the patient’s body, the intensity of his movements.
There is an increase in pressure at night due to illness, stress, sometimes apnea and panic attacks if you don't sleep. The reasons for sudden jumps in blood pressure during sleep may also lie in age, in women during menopause. For prevention, long-acting drugs are chosen, which is especially important for older people. What pills are needed for nocturnal hypertension? Why does blood pressure rise at night, but normal during the day? What should be normal?
