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 causes of this condition, daily blood pressure monitoring is prescribed. This study helps to make an 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 number of advantages. The key advantage of the procedure is the ability to capture even small fluctuations in the indicator in different categories of 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 fails to detect it at the appointment. In such a situation, this procedure will also come to the rescue. It can be concluded that ABPM plays a 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:

1. During each automatic pressure measurement, it is important to ensure that the arm is positioned along the body and the muscles are relaxed.
2. Don't think about or worry about metrics. This will help avoid influencing the result.
3. You should sleep at night without focusing on the measurement process, as this may lead to inaccurate results.
4. 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.
5. 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 entire 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 necessary instructions the patient can go home and do 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. Do 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 avoid water procedures for a while, 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

Diagnostic test data is processed automatically using a computer. When performing the procedure, pay attention to the following indicators:

1. Daily rhythm of pressure. In medicine, this parameter is called the circadian rhythm. Deviation of this indicator from the norm indicates the need to search for the cause.
2. Average pressure readings. These criteria are also very important for evaluating the data of the procedure.
3. 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, this procedure is prohibited. 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 upper limbs.

Thrombocytopenia Pathologies with damage to blood vessels of the hands

Today it is difficult to surprise anyone with high blood pressure. A dangerous trend is that people treat this condition as a given, guided by the principle: I’ll rest, and everything will work out. But high blood pressure, even situational, can be a harbinger of a dangerous disease - hypertension. But how can you find out whether an increase in blood pressure is caused by certain provoking factors (stress, weather conditions, meteosensitivity) or is it a result pathological condition heart and blood vessels? A one-time pressure measurement does not answer this question. But monitoring blood pressure for a day or more may well clarify the situation.

The procedure for non-invasive blood pressure measurement, which lasts a day or more, is abbreviated as ABPM. Daily blood pressure monitoring is considered the most reliable way to determine true blood pressure readings, which simply cannot be done in a couple of minutes. At the same time, the procedure is not burdensome, because the patient does not have to stay in the clinic all this time. And those small requirements that he, at the insistence of the doctor, will need to fulfill during monitoring will seem trifle compared to the diagnostic value of the procedure.

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Indications

Let's start with the fact that in order to monitor blood pressure, it is not at all necessary to have documented heart and vascular diseases. For preventive purposes, any person who is jealous of their health can undergo this procedure.

Preparation

Blood pressure monitoring is one of those diagnostic and treatment procedures that do not require special preparation on the part of the patient. However, an important task for the physician remains to convey to the patient information about the goals of blood pressure monitoring and behavior during the procedure. It is from the awareness of the importance of this diagnostic method and the correct fulfillment of all medical requirements depends on the accuracy of the research results and the effectiveness of further treatment.

Another particularly important point in preparing for the procedure of long-term blood pressure monitoring is the preparation of a 24-hour blood pressure monitoring device and the selection of a cuff of the appropriate size based on the patient’s constitution.

24-hour blood pressure monitoring can be performed invasively and non-invasively. As part of the non-invasive method of monitoring blood pressure, two methods are considered: auscultatory and oscillometric, which Lately is becoming increasingly widespread because it eliminates the disadvantages of the previous method.

Invasive method: blood pressure measurements are carried out in a hospital setting. In this case, a needle connected to a sensor is inserted into the patient’s artery, which continuously records the information coming from it onto a magnetic tape.

The auscultatory method is still used in some clinics and involves listening to Korotkoff sounds using a special microphone, which is applied to the site of vascular pulsation in the cuff area. The oscillographic method of measuring blood pressure is a diagnostic measurement of average systolic and diastolic pressure based on small pulsations of air pressure in the cuff.

Both of these methods can be used both in a hospital setting and on an outpatient basis. Fortunately, today there is no shortage of equipment for non-invasive measurement of daily blood pressure on the medical equipment market. Both domestic developments and foreign technologies are presented there. Therefore, it is not at all difficult to choose equipment in accordance with your wishes and needs.

These can be ordinary tonometers that measure blood pressure (for example, the Hungarian-made model ABRM-02/M with battery charge monitoring). But many clinics prefer to use multifunctional devices (Cardio Tens, produced in Hungary, simultaneously records blood pressure and ECG indicators, and the Japanese system TM-2425/2025, in addition to everything, regularly measures air temperature, the position of the human body, increasing physical activity to accelerate movement, etc. .). I call devices for long-term blood pressure monitoring Holters, hence another name for ABPM - Holter blood pressure monitoring.

Daily blood pressure monitoring involves a continuous cycle of operation of specialized equipment. And since all such devices in outpatient settings are powered by batteries (or regular batteries), before starting the procedure, the doctor must check whether the battery charge is sufficient to carry out ABPM for the required time. In this case, on-site recharging is not possible.

A blood pressure monitoring device consists of a recorder, a display and a cuff, which are interconnected and work as a single unit. First, the recorder is initialized, for which it is connected to the PC. A special program allows you to enter individual information about the patient into the recorder’s memory, set data recording periods and intervals at which blood pressure measurements should be taken, enable or disable the sound signal function before each measurement, and note the need to display blood pressure and pulse data on the display.

The device does not record blood pressure data continuously, but at certain intervals. The following standards have been adopted: in daytime The device measures blood pressure and pulse every 15 minutes, and every half hour at night. If necessary, you can program the device for other time intervals.

After the recorder has been initialized, the cuff is selected for the device. Typically, devices of this type are equipped with several cuffs that differ in length and width. A children's cuff has a length of 13-20 cm. For adults, these figures can be very different. When selecting the optimal length and width of the cuff, it must be taken into account that it must cover at least 80% of the limb around the perimeter.

The cuff is applied to the upper limb in the shoulder area in accordance with the leading side of the body. For most people, the cuff is attached to the left arm, and for left-handed people - to the right.

There is a special mark on the cuff that indicates that the device is attached correctly if it coincides with the point of greatest pulsation.

Since pressure measurement is carried out over a long period of time, while the patient lives a normal life, i.e. is in motion, the cuff may move little by little. This cannot be allowed, because the measurement results in this case will be distorted. To prevent the device from moving relative to your hand, it is recommended to use special disks with a double-sided adhesive coating (such as double-sided tape).

Next, control measurements are carried out (about 4-6 measurements with an interval of 2 minutes). To do this, first a pneumatic cuff is attached to the patient’s shoulder, then, using special fasteners, a recorder with a display and a sphygmomanometer are attached to it, from which the average doctor and instrument values ​​are calculated. Acceptable differences between these indicators are 10 mm Hg (for systolic or upper pressure) and 5 mm Hg (for lower pressure indicators).

If the difference in readings exceeds the permissible limits, it is necessary to check the correct placement of the cuff, change the arm on which blood pressure will be measured, or change the type of device for 24-hour blood pressure monitoring.

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Technique for monitoring blood pressure

As already mentioned, the device for 24-hour blood pressure monitoring takes measurements during the time set by the program, recording the measurements in the device’s memory. Those. the person does not remove the tonometer during the entire procedure (sometimes a day, sometimes more), and even at night.

The patient is warned in advance that the blood pressure measuring device should not be wetted. Like any electrical appliance, it must be kept away from sources of moisture and electromagnetic radiation. It is forbidden to independently adjust the height of its attachment (there is a possibility of incorrectly fastening the device on your arm, which will distort the results of the study), disconnect the cuff from the recorder, remove or change batteries, or repair an allegedly broken device. It is important to ensure that the parts attaching the cuff to the recorder are not pinched by clothing or squeezed during sleep.

If the device has slipped down significantly, you can correct it by leaving a distance of about 2 cm between its lower edge and your elbow.

During blood pressure monitoring, it is not recommended to change your daily routine or habits; the only thing that needs to be limited is physical activity on the day of monitoring. It is clear that sports, fitness, etc. classes must be postponed until another day.

You should try to forget about the device during the procedure (especially since it is quite lightweight and is not attached to your dominant hand, which means it does not create any particular inconvenience), think less about possible bad results research, try to see the readings on the display. Such thoughts and actions cause a state of anxiety and restlessness, which can affect the results of studies in the form of increased blood pressure.

Night sleep should also be restful, unburdened by thoughts about the instrument readings and possible pathologies. Any nervousness distorts the night measurements and, of course, the final indicators. But the results of measuring the nighttime drop in blood pressure are very important from the point of view of diagnosing hypertension. Patients are even classified into 4 groups based on their SNBP (degree of nocturnal blood pressure reduction).

An important responsibility of the patient during the procedure is to keep special entries in the ABPM diary. But in his records, a person should display not the blood pressure values ​​and time intervals between measurements (this information is stored in the device’s memory), but his detailed actions during blood pressure monitoring and changes in well-being. All emerging symptoms should be noted in a diary, indicating the time of appearance and disappearance of the symptom.

During the day, the device measures blood pressure every 10-15 minutes. Before taking a measurement, it beeps. This function can be disabled, but for the convenience of the patients themselves, doctors advise using it. The thing is that it is advisable not to move while measuring pressure (if the signal sounds while walking, you need to stop and wait until the second signal sounds, indicating the end of the measurement). The hand on which the device is attached must be lowered down and the muscles relaxed as much as possible. These requirements are not imposed by chance, because violation of them can adversely affect the accuracy of measurements.

At night, the patient moves little and is quite relaxed, so there is no need to monitor the time of measurements.

ECG and blood pressure monitoring

If a patient, when visiting a doctor, complains of interruptions in heart function and increased blood pressure, but a one-time electrocardiogram and blood pressure measurement do not show anything suspicious, the doctor is left with many questions. These questions can be answered using a fairly simple procedure - ECG and BP for a longer period of time. Wherein ECG monitoring and blood pressure can be carried out within 1 day, and sometimes the device is left on the patient’s body for a longer time.

Daily Holter ECG monitoring is prescribed for the following patient complaints:

• pressing pain in the heart area, which appears sporadically mainly during physical exertion,
• palpitations, anxiety, chest discomfort and deterioration in health,
• shortness of breath against the background of the above symptoms,
• the appearance of unexplained weakness and dizziness, fainting, accompanied by the appearance of cold sweat on the face and body,
• feeling of weakness, fatigue and loss of strength in the morning (without physical activity),
• heart rhythm disturbance, which is accompanied by a short-term loss of consciousness, a feeling of palpitations or a feeling that the heart is stopping,
• angina attacks,
• metabolic pathologies: diabetes mellitus, malfunctions thyroid gland,
• period after myocardial infarction,
• increased weather dependence (increased blood pressure, palpitations, noticeable deterioration in general well-being when the weather changes).

Long-term monitoring of ECG and blood pressure can also be carried out to evaluate antiarrhythmic and antihypertensive therapy.

This type of heart monitoring makes it possible to track any changes in the cardiogram during the day, those changes that cannot be reflected in a short period. The development of this technique belongs to the American scientist N. Holter, after whom the method was named.

Daily ECG monitoring is carried out by analogy with long-term blood pressure monitoring. A portable electrocardiograph, which is approximately the size of a mobile phone, is attached to the patient’s belt, and the electrodes are placed on his chest. The device can remain on the patient’s body for a day or more, as prescribed by the doctor.

Simultaneous 24-hour monitoring of both blood pressure and ECG has recently become quite a popular practice. In this case, the patient will not have to undergo the procedure 2 times. In addition, in both cases, the main requirement is keeping a diary, which should indicate the patient’s activities, as well as changes in his well-being during the period of diagnostic measurements.

Joint monitoring allows you to immediately obtain full information about the condition of the heart and blood vessels, including:

• answer of cardio-vascular system for physical activity,
• information about the work of the heart and blood vessels during night rest,
• blood pressure fluctuations depending on physical and emotional stress,
• information about heart rate for a day or more,
• cardiac conduction study.

Such an extensive study makes it possible not only to identify episodes of increased (decreased) pressure, loss of consciousness, etc., but also to establish the cause of these changes, for example, disturbances in heart rhythm or blood supply to the myocardium of the heart.

Normal indicators

The device for long-term blood pressure monitoring remains attached to the patient's shoulder for a certain time, after which it is removed and connected to the computer. Information is read from the Holter memory using a special computer program supplied with the device. The same program was used to initialize the device.

On the computer screen, the doctor sees the processed information in the form of tables and graphs that can be printed on a sheet of paper. On the graph you can observe the curved lines of systolic (SBP), diastolic (DBP) and mean (MAP) blood pressure, as well as pulse rate. What indicators have particular prognostic value for doctors?

First of all, these are the average values ​​of BP, DBP, MAP and heart rate (pulse). Calculation of average values ​​can be carried out per day or certain periods of time (waking from 7 am to 11 am, night time from 11 pm to 7 am). It is the average values ​​of the above values ​​that provide valuable information about blood pressure in a particular person.

Normally, the average daily pressure is 130/80 mmHg. If it increases to 135/85, doctors talk about hypertension. For daytime and nighttime blood pressure, the norm is 135/85 and 120/70, respectively. Doctors diagnose hypertension if these numbers rise to 140/90 and 125/75. How a healthy person differs from a sick person is an increase in average blood pressure by only 5 mm Hg.

It is by analyzing changes in average values ​​that one can judge the degree of effectiveness of antiherpentensive therapy.

Another important indicator can be considered the frequency of increased blood pressure (BP). This indicator in different sources can be called pressure load or hypertensive load, as well as the time index. It represents the number of blood pressure readings that were higher upper limit norms expressed as percentages. During the daytime, this limit is 140/90, and at night, the limit is within 120/80 mmHg.

The NPP indicator allows one to make predictions for the future and draw up effective therapeutic regimens. When not very high rates Blood pressure PPBP is expressed as a percentage as the number of excesses of the norm, and with greatly increased values ​​of blood pressure - as the area under the graph of the dependence of pressure on the time of day and night, limited by the same 140/90 mm Hg.

Not only individual blood pressure indicators, but also changes in these indicators during the day are of great importance in the diagnosis of pathologies of the cardiovascular system. Pressure variability is determined by deviation from the circadian rhythm chart.

STD – indicator standard deviation from the mean arterial pressure graph. It can be measured both per day and during the day or night. If STD systolic pressure at any time of the day equals or exceeds 15 mmHg. (for diastolic daytime indicator is greater than or equal to 14 mm Hg. night - 12 mm Hg), this indicates a developing hypertension. If only one of the indicators is exceeded, this indicates increased blood pressure variability, which may be associated with left ventricular myocardial hypertrophy, atherosclerosis carotid arteries, pheochromocytoma, renal hypertension, etc.

Changes in blood pressure variability can be used to judge the effectiveness of the antihypertensive drugs used. Treatment of hypertension should ideally lead to a decrease in blood pressure variability; if this does not happen, a review of prescriptions is needed.

The daily index is also considered a very important diagnostic indicator. Changes in the daily (circadian) rhythm of blood pressure can be judged by the degree of nocturnal decrease in blood pressure (NOBP). For systolic blood pressure, this indicator is calculated by the formula: (average daytime SBP - average nighttime SBP) x 100% / average daytime SBP. By analogy, SBP for diastolic pressure is calculated, only instead of SBP values, DBP values ​​are taken.

Normal levels of SIBP range from 10-22% (60 to 80% of people classified as Dippers). Insufficient and excessive reduction in SBP has indicators of less than 10% and more than 22%, respectively (Non-dippers and Over-dippers groups). A stable increase in blood pressure is indicated by a negative SIBP indicator (Night-peakers group).

If 24-hour blood pressure monitoring indicates insufficient blood pressure reduction at night, doctors may assume the following consequences: frequent episodes of strokes, high probability of hypertrophy of the left cardiac ventricle And coronary disease heart, there is a high risk of developing microalbiminuria, which will occur with more severe symptoms. Acute myocardial infarction in such patients is often fatal.

As you can see, 24-hour blood pressure monitoring is an extremely important diagnostic procedure, which in many cases helps save a person’s health and life, facilitating timely and effective implementation therapeutic actions to improve the functioning of the cardiovascular system and prevent various unpleasant and even dangerous complications.

One of the main causes of death is diseases of the cardiovascular system. These diseases kill about a million people every year in Russia alone. The problem isn't even bad medicine, and most often due to the fact that people do not seek help in a timely manner, and the ambulance already brings them with a stroke or heart attack. It is unlikely that people over thirty pay attention to their blood pressure or periodic headaches. Men are especially frivolous about this; it doesn’t hurt anywhere, which means it’s healthy, what’s the point of swallowing pills or visiting a doctor in vain.

Pressure

Advantages and disadvantages of the method

Attention! Hypertension is a “cunning” disease and can be almost asymptomatic. The patient is experiencing serious discomfort, but one-time blood pressure measurements may not reveal the problem.

How ABPM stands for

ABPM is 24-hour blood pressure monitoring. The shortened name of the method is most often used. It allows you to automatically record changes in blood pressure over a day or more using a special device. ABPM provides the doctor with the opportunity to identify hidden health threats, especially among practically healthy people. Compared to conventional one-time methods for measuring ABPM pressure, the method gives a much more accurate picture. A key advantage of this study is the ability to record even small changes in pressure.

The undoubted advantages of the method of monitoring blood pressure and pulse include the fact that the patient does not need to undergo complex manipulations, does not need to change his usual lifestyle or go to the hospital.

The disadvantages include some discomfort from the fact that the device is on the body for a long time; the cuff on the arm, when measuring pressure, squeezes the arm quite strongly, this can especially bother the patient at night.

Nevertheless, this method has a very high diagnostic value. ABPM is extremely effective in diagnosing arterial hypertension.

Registrar

Indications for the procedure

Most often, such pressure monitoring is a decisive method in the diagnosis of many pathologies. There are many indications for its implementation:

• In some cases, it is necessary to exclude white coat hypertension. This syndrome is a specific psychological reaction - it is an increase in blood pressure, which manifests itself only at the time of the visit. medical institution. During a medical appointment, some patients’ blood pressure may suddenly drop or rise sharply (and quite strongly);
• To clarify the diagnosis of arterial hypertension, when the patient is diagnosed with high blood pressure for the first time, but the doctor wants to see additional data;
• The study is carried out for symptomatic hypertension, in cases where the increase in pressure is a consequence of stress or is associated with some other diseases, especially ischemia, heart failure, left ventricular myocardial hypertrophy, vascular problems in the brain, metabolic disorders;
• Hypertension is common in older patients due to age-related changes body tissues;
• The study shows that if low pressure is suddenly replaced by high pressure, such changes over a long period of time can lead to serious complications;
• To clarify the diagnosis of hypotension if the patient has frequent fainting. It is carried out for patients with low blood pressure, especially with diagnoses of neurocirculatory asthenia, vegetative-vascular dystonia;
• Examination during pregnancy if late toxicosis is suspected, and to exclude pathology and determine the process of labor management (if the woman in labor has hypertension);

Measurements during pregnancy

ABPM is carried out

• When examining patients of childhood and adolescence with unfavorable heredity in relation to the incidence of hypertension or pathologies of cerebral circulation;
• To select the best therapy for hypertensive patients, to control drug treatment, to assess the treatment, its effectiveness and safety, the patient’s body’s resistance to prescribed medications, correction of prescribed doses of medications, this is especially important for patients after a heart attack and stroke;
• Examination of patients with diabetes mellitus, kidney diseases, where constant monitoring of indicators is required;
• It is carried out to examine applicants to military schools, to determine professional suitability for certain specialties (for pilots, machinists, etc.);
• Monitoring can detect nocturnal hypertension and is also used to diagnose sleep apnea;
• To identify office hypertension, where blood pressure can rise suddenly and seemingly without reason. Although hypertension in the workplace may seem harmless, it can develop into a serious illness, and to prevent this, timely correction of the patient’s working conditions is necessary;

Advice! The study is shown to all those people who monitor their health.

ABPM is usually prescribed if the following complaints are present:

• asthenia and constant fatigue patient;
• frequent headaches;
• deterioration of vision, appearance of spots before the eyes;
• noise, ringing in the ears;
• fainting, presyncope, dizziness.

Dizziness and headache

Contraindications for ABPM

The procedure cannot be performed in the following cases:

• If the patient has problems skin in the place where the pneumatic cuff is fixed, inflammation or skin disease;
• For vascular diseases, especially during exacerbation;
• With blood clotting disorders, hemophilia, with a tendency to bleeding;
• For many mental pathologies;
• For injuries to both hands;
• For problems with the brachial arteries (obstruction);
• The test may not be helpful when the patient's blood pressure is above 200.

The doctor should inform the patient about all restrictions on the blood pressure monitoring procedure.

Preparation for the procedure

Before ABPM, your doctor will sometimes stop certain blood pressure medications. Unless the doctor decides otherwise, you should take all medications. Wear light, short-sleeved clothing with looser clothing over the top. The device is usually attached to the belt, and sometimes hung from the neck. Before the study, the patient can lead a normal lifestyle; no additional preparation is required for this method of measuring pressure.

How is the procedure performed?

Let's consider daily blood pressure monitoring, how it is carried out this study? To begin with, a pneumatic cuff is put on above the patient’s elbow, which is connected to the recorder using a tube. This small device, weighing about 300 grams, pumps air through programmed periods of time and then releases it. The doctor reads the results of pressure measurements from the device’s memory and analyzes them.

During the day, measurements are taken every quarter of an hour, and at night - every half hour. The pressure test lasts a day or more (as the doctor says), then the patient should turn off the recorder and visit the doctor again.

Taking measurements

Specialist in functional diagnostics connects the device to the computer and programs it for a given patient.

The cuff is fixed on the “non-working” arm (for “right-handers” on the left, and for “left-handers” on the left) right hand). It is attached to the patient’s forearm two centimeters above the elbow, and is selected for each patient depending on the size of his hand. After this, the patient can go to work or home, the pressure will be measured automatically by the device. ABPM does not interfere ordinary life, you can even continue to play sports.

Sports activities

How to behave during the procedure

Consultations on ABPM are provided by general practitioners and cardiologists.

Before the procedure, the doctor issues a special diary, where the patient should record everything that was done during the day, some types of mental and physical activity (sports, stress, emergency work), and note periods of sleep and wakefulness. You should record periods of feeling unwell (eg, dizziness, strong throbbing) and information about taking medications, that is, make notes about anything that can affect your blood pressure and heartbeat.

Journaling

If the patient feels that the cuff has slipped during use, then it needs to be adjusted. The tube that connects the monitor to the cuff should not be pinched by clothing.

The patient should pay attention to the battery charge and whether the recorder will have enough power for the duration of the procedure. The instructions say that you need to avoid getting water on the recorder (it is best not to take a shower at this time); it is also extremely undesirable to stay near a strong electromagnetic radiation. If ABPM equipment stops working, you should report the incident to your doctor.

Before each blood pressure measurement, the device beeps.

Advice! If possible, it is advisable not to move or move during the measurement, then the results will be more accurate.

While the device is pumping air, you need to stop, relax your arm with the cuff and lower it down. The second beep indicates that the measurement has ended. After the second signal, the person can continue the interrupted activity.

You should try to sleep at night, and during the day you should also not look at what exactly the device shows, otherwise anxiety about the results can increase blood pressure and distort the final readings.

ABPM in childhood

ABPM can be done not only for adult patients, but also for children after seven years of age. This procedure is completely safe; it is performed on children with suspected hyper- and hypotension, with cardiac dysfunction, or with frequent fainting conditions. Often such a study is combined with ECG monitoring.

The study is carried out in exactly the same way as in adults, except that a different cuff size is selected. Before the procedure, the child needs to be told about the examination, why it is needed, and that it is painless. The cardiologist should give all the recommendations and tell you how to correctly fill out the diary during ABPM.

Important! The ABPM procedure is especially important for diagnosing vegetative-vascular dystonia.

This pathology in children has recently happened quite often. Treatment requires accurate diagnosis, since VSD can easily be confused with arterial hypertension. The use of ABPM allows you to correctly give a medical opinion and determine the tactics of further treatment.

ABPM in children

Decoding the results

Modern ABPM devices themselves carry out the initial classification of the recorded data; pathologies are shown in tables and graphs. The doctor processes records on a computer and this helps him make a diagnosis, choose the best way treatment and avoid possible complications.

What does the doctor learn from the ABPM results?

In addition to the fact that the ABPM device records an increase in the pressure of the subject in different situations, it also tracks the natural daily decrease or increase in blood pressure - circadian rhythms. Deviations of rhythms from the norm may indicate possible problems with health. Based on the information received, the doctor may recommend that the patient change his diet or undergo additional checks and studies.

When monitoring blood pressure, the doctor evaluates:

• Patient's average blood pressure readings. Normally, the average daily blood pressure should be less than 130 per 80 mmHg;
• Moments when blood pressure is minimum and maximum;
• Index of systolic and diastolic pressure of the patient per day;
• Speed ​​and magnitude of pressure rise in the morning.

Analysis of the daily blood pressure index (CI) is important for the treatment of hypertensive patients and the prevention of complications of hypertension. According to this index, hypertensive patients are divided into 4 groups.

If the patient's SI is between 10 and 20%, this is the Dipper group. If less than 10% (Non dipper), then such people have insufficient nocturnal blood pressure reduction and have an increased risk of cardiovascular complications. When the index is less than zero (Night peaker) - these are patients whose average blood pressure readings at night are higher than at night. daytime hours, they have an increased risk of kidney damage and possible heart failure. When SI is above 20% (Over dipper), then in such patients the pressure is reduced at night, and they are at high risk of ischemic stroke.

With some indicators, the doctor can immediately understand that drug therapy will not bring results and the patient is indicated for surgical intervention.

In some cases, the patient is prescribed both ABPM and ECG monitoring (Holter monitoring), especially if he has fainting unknown etiology and heart rhythm disturbances.

Reliability of the method

Having data from the ABPM study, the cardiologist has the opportunity to clarify the diagnosis of hypertension, check whether the patient has problems with the heart rhythm, and find out the reasons for the patient’s impairment of well-being. It is also possible to analyze changes in the condition over the past period of treatment, prescribe more appropriate therapy, evaluate the results of treatment already performed and exclude possible complications.

How to wear the device

Many patients ask questions about monitoring blood pressure and pulse, how do they do this measurement at home? Actually, the ABPM procedure is already done at home; for this you do not need to go to the hospital, you just need to follow the doctor’s instructions.

ABPM reflects the level of changes in blood pressure much more accurately, and gives doctors a more accurate picture of the disease, thus, treatment will be more timely and effective.

Every person can easily undergo ABPM without special purpose doctor, on his own initiative, if he considers it useful. Even if monitoring does not detect any abnormalities, it makes sense to save past results for comparison during subsequent daily blood pressure measurements.

This pressure test helps to easily diagnose many problems of the cardiovascular system, it is painless and highly effective.

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. We are talking 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 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 that's not all positive properties 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 the existing danger of 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 physical activity, 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 enjoy diagnostic procedures and the treatment itself, often this occurs only from a banal 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: you went to the store, to the kitchen, went up to the fourth floor, etc. It is imperative to note unpleasant symptoms - 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 pressure of the person being examined once every 15 minutes during the daytime, once every 30 minutes at night.

However, these intervals depend only on the settings of the device; the intervals between them can be more significant, for example, after 40 minutes during the daytime.

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

Exists 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 each moderate physical activity (climbing to the 4th floor or higher, walking over a distance of 1 km). Do not forget to note the time you spent behind the wheel, periods of high energy, if any.

Taking medications, food, occurrence unpleasant symptoms, detailed description 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 first time the device failed to take measurements due to a loose cuff or excessive tension in the arm.

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 hygiene procedures– 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 making a correct diagnosis is the basis for 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);
• upper limb injuries;
• 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:

Thus, a fairly 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.

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24-hour blood pressure monitoring

In order to maximize objectification of blood pressure indicators, round-the-clock monitoring is recommended. That is, the value of pressure (both upper and lower) is determined not only at rest, but also when the human body is exposed to various stress factors.

Daily monitoring is a procedure that makes it possible to determine exactly the dynamics general condition and the adaptive potential of the cardiovascular system, that is, an indicator of how adequately a person can adapt to intensively changing environmental conditions.

Indications for the procedure

Daily blood pressure monitoring (abbreviated as ABPM) is a rather complex cardiological study, which is recommended for absolutely all patients without exception who have experienced cardiocirculatory problems at least once. The feasibility of conducting this study is due to the fact that ABPM increases the accuracy of assessing the true blood pressure, especially if there is a suspicion of the initial degree of arterial hypertension (AH) in the subject. The procedure is extremely simple for the patient, since he is not required to do anything particularly complicated, unless, of course, you count keeping a diary. Moreover, 24-hour blood pressure monitoring is a non-invasive procedure that is completely painless and safe. 24-hour blood pressure monitoring is carried out in the following situations:

1. Elderly age. People whose age reaches 60-70 years have a tendency to manifest hypertension. This is due to the fact that over time the results of adverse effects accumulate, body tissues age and some other age-related changes appear.
2. Suspicion of the so-called. In the situation under consideration, elevated blood pressure may be a banal psychological reaction of a person to the presence of a doctor. Many people have an animal fear of people in white coats. Therefore, daily blood pressure monitoring allows you to obtain the most reliable and objective information.
3. Nocturnal hypertension. By implementing daily monitoring, you can easily identify this violation.
4. Hidden hypertension. Changes in blood pressure that occur at work are often referred to by clinicians as workday hypertension.
5. Drug therapy that requires strict monitoring and control of blood pressure. Occurs during therapy with centrally acting hypotonic drugs, as well as when using ganglion blockers.
6. Assessment of the rhythm of changes in blood pressure parameters during the day. When identifying a violation of the circadian (daily) rhythm, the procedure allows one to obtain very valuable information about the patient’s condition and determine the most likely causes of the pathology in question. Also diagnostic test allows you to adjust therapeutic measures.
7. Lack of effect from using synthetic ones. If the pressure does not decrease despite hypotonic therapy, this procedure must be performed.
8. Serious fluctuations in SBP and DBP. Research is definitely required if low performance quickly give way to high levels or there is a threat of cardiac complications.
9. Specifying the diagnosis if available clinical signs pathology nervous system, which has a vegetative nature.
10. Identification of conditions in which persistent hypotension occurs.
11. The presence of a hereditary predisposition to manifesto, as well as to other cardiocirculatory pathologies.
12. The patient has a history of insulin-dependent type 1 diabetes. In such a situation, it is definitely necessary to systematically monitor indicators.

Preparation for the procedure

No special preparation is required. Admission or cancellation the day before and on the day of the study must be agreed upon with the attending physician.

24-hour blood pressure monitoring should never be carried out on the day of intensive diagnostic examinations, including blood draws for various analyzes, X-ray examination, as well as physiotherapeutic procedures.

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 should strictly adhere to the recommendations listed below:

1. Ensure that the blood pressure recorder is properly charged during the procedure. When using batteries, consider whether they will be enough for 1 day of uninterrupted operation.
2. Connect the recorder to a PC and program it with individual patient data. It is also necessary to set the functional mode of the device. For this purpose, determine the interval at which blood pressure will be measured.
3. It is necessary to measure the circumference of the forearm. This is required to make the optimal selection of the appropriate air cuff that will suit the patient.
4. Install a device designed for 24-hour blood pressure monitoring.
5. The cuff is fixed to the forearm. Accordingly, for right-handers, the left hand is used, and for left-handers, it is attached to the right. In order to avoid displacement during the procedure, it is necessary to securely fix it. Sometimes double-sided discs with a sticky surface are used for this.
6. Proper and timely training is of great importance. This will help the patient choose the right behavior during the examination.
7. When performing automatic blood pressure measurements, it is important to ensure that the arm is positioned exclusively along the body and its muscles are as relaxed as possible.
8. You should not think about the indicators or be interested in them during the test. This will help to avoid the influence of stress factors on the examination result.
9. At night, a hypertensive patient definitely needs to sleep without focusing on the current measurement process, as this can lead to unreliable results. If a person suddenly hears a signal about the start of the next one, he needs to stop, lower his hand with the cuff attached to it down and relax. It is in this position that you must wait until the measurement is completed.

It is necessary to conduct during monitoring, in which all types of activities that a person engages in throughout the day will be noted. And not only that, you also need to note the time and sensations that accompany the workload. This document is fundamentally important because it contains valuable information about 24-hour blood pressure monitoring.

Contraindications

The procedure has no absolute contraindications- if only because it is non-invasive and completely safe. The only side effects that can be identified are discomfort in the arm for 1–2 days after the examination, since the cuff may press.

As a casuistry, the instructions contain information that, in theory, absolute complications are possible during previous monitoring, namely, skin diseases on the shoulder, thrombocytopenia, thrombocytopathy and other hematological pathologies during an exacerbation, trauma to the upper limb girdle, diseases accompanied by vascular damage upper limbs. But until now there has been no evidence to suggest that such incidents have occurred. Another question is that there are possible inconveniences that you are likely to encounter during the procedure:

1. Difficulty sleeping and falling asleep. Based on the considerations that the device measures blood pressure at night, a person can wake up from squeezing the arm with a cuff or from a preliminary signal. This will be especially true for those who sleep lightly.
2. It will be impossible to fully bend the arm at the elbow, based on the consideration that the cuff is attached just above the joint. Inconvenience may arise the moment you decide to wash your face or brush your teeth. You will also have to refrain from taking a shower or bath, because this device cannot be wet.
3. Of course, these are all the disadvantages of the procedure in question, but all of them are completely insignificant against the advantages of the procedure - you agree, they can be tolerated in order to establish an accurate diagnosis, which after ABPM can be considered reliable.

Manufacturers of devices intended for round-the-clock monitoring indicate in the instructions relative contraindications:

• Thrombocytopenia and thrombocytopathies, as well as other blood pathologies during clinical exacerbation.
• Skin lesions localized in the shoulder area.
• Pathologies are accompanied by damage to the blood vessels of the hands.
• Upper limb injuries.
• Poor tolerance of the procedure, noted last time.
• Significant disturbances in the conductivity and rhythm of the heart, SBP more than 200 mm Hg. Art.

How is the procedure performed?

In an outpatient setting (that is, at home), a person is equipped with special medical devices that will be fixed on him and remain there throughout the day, while recording the dynamics of blood pressure, but the doctor carries out preparatory measures in the hospital.

1. For this purpose, securely attach the pneumatic cuff to the shoulder.
2. The main device is fixed on the belt. It weighs about 300 g and does not cause any discomfort to a person.
3. After receiving all the necessary instructions, the patient can safely go home and do their usual activities.
4. The device, fixed on the human body, will automatically measure blood pressure at certain time intervals and record the obtained values.
5. The patient must be extremely careful about recording all necessary information in the diary. This will allow the doctor to obtain an objective picture of changes in blood pressure parameters and establish the most likely causes of fluctuations. After finishing clinical trials the device should be turned off.
6. All that remains is to come to an appointment with a specialist in order to give him the device and the diary for further decoding.

During the actual session, you must adhere to the recommendations listed below:

1. Avoid squeezing any tubing that may be used to connect the device to the cuff.
2. If there are signs of malfunction of the device, you should return to the doctor.
3. You should not even try to repair the device yourself.
4. The cuff is fixed two fingers above the elbow. If the device has changed its position in a certain way, the patient should try to correct it independently.
5. During the procedure, a person should not enter areas where sources of electromagnetic radiation are localized.
6. It is important to temporarily refrain from performing water procedures, since the device should never be wetted.
7. When taking measurements, it is recommended to relax your hand. Before the start and end of the measurement, a characteristic signal appears.

Advantages and disadvantages of the method

Daily measurement of SBP and DBP has a number of clinically significant advantages:

1. The most important advantage is the ability to capture even minor fluctuations in the indicator in different categories of patients.
2. ABPM data more objectively reflect the level of blood pressure in the conditions of everyday life of patients, taking into account the impact on their body of external and internal factors. Average blood pressure values ​​obtained from ABPM are more closely related to the resulting target organ damage than data from clinical measurements;
3. ABPM data before the start of therapeutic measures may have a predictive value in the manifestation of cardiovascular complications;
4. Regression of target organ damage is more closely related to changes in ABPM values ​​than to clinical blood pressure levels.

Decoding results

In addition to the direct change in blood pressure values ​​in different situations, a cardiologist examines a person’s circadian rhythms - the natural fluctuations of this indicator during the day.

Some deviations from the normal rhythm may be harbingers of hypertension or other cardiac pathologies.

When carrying out ABPM, the following indicators are assessed and interpreted:

1. Average blood pressure readings for the period of the study.
2. Episodes of maximum increase in blood pressure.
3. Daily profile (daily index) of SBP and DBP indicators.
4. The magnitude and intensity of the morning increase in blood pressure.

Depending on the obtained indicators of the daily blood pressure profile, all patients with hypertension can be divided into four main groups:

• “Dipper” is a daily index fluctuating between 10-20% (22%).
• “Non dipper” – daily index less than 10%.
• “Night peaker” – daily index less than 0.
• “Over dipper” – the daily index is more than 20%.

Patients who develop a nocturnal BP fall that is insufficient (“Non dipper”) have an increased risk of cardiogenic complications and target organ damage of hypertension. Patients whose data at night exceed those during waking hours (“Night peaker”) have a high risk of heart failure and renal pathologies.

Identification of a daily index less than 0 is typical for patients with secondary (symptomatic) hypertension and can help in the further diagnosis of nosologies associated with high blood pressure.

The information obtained during ABPM will allow not only to verify the diagnosis of hypertension, but also to correct therapeutic measures.

Evaluation of the study results

ABPM data is processed automatically using a PC. When performing the procedure, the following indicators are of leading importance:

1. Circadian rhythm of blood pressure. In medicine, this parameter is called the circadian rhythm. Oscillations given value in a wide range indicates the need to search for the root cause of headache.
2. Average blood pressure readings.
3. Blood pressure variability. This parameter makes it possible to determine how strongly blood pressure readings deviate in correlation with the circadian rhythm.
4. The identified features or any specific pathology should be shown by graphs of blood pressure changes for the corresponding period of daily monitoring. In other words, analysis of ABPM results makes it possible to calculate average blood pressure values ​​per day, as well as during the day and at night, blood pressure variability, assess the severity of blood pressure hypotension at night relative to daytime, and identify blood pressure levels in the morning.

ECG monitoring should not be confused with Holter; these are completely different procedures, and one does not exclude the other. Moreover, it very often happens that in some cases (for example, when monitoring ABPM indicators) all values ​​are within the normal range, and the Holter cardiogram shows pronounced deviations. Accordingly, we can conclude that both procedures need to be done. They will perfectly complement each other and will allow you to get the most complete picture of the patient’s clinical condition.

It is also very important to compare heart rate indicators over time and evaluate the data obtained as a whole. Ideally, make sure that all of them are sent from the monitors to the display of the gadget, and there is no need for the patient to fill out any logs.