Daily measurement of blood pressure device name. Ambulatory blood pressure monitoring (textbook for physicians). Measuring averages

Ambulatory blood pressure monitoring (ABPM).

Conditions in which the numbers of blood pressure (BP) exceed the generally accepted indicators of the normal value of blood pressure are called hypertensive. Hypertension is known to be widespread among the population, i.e. high blood pressure, and its complications - myocardial infarction, cerebrovascular accident (stroke), heart rhythm disturbances (interruptions, palpitations), creating favorable conditions for the development of atherosclerosis, diabetes mellitus, etc.

Early diagnosis of the initial stages, when a timely change in lifestyle, the rejection of bad habits and, if necessary, the appointment of drug antihypertensive therapy leads to a decrease in deadly complications, prolongs working age, and allows you to feel relatively healthy. Everyone should know their blood pressure, and at any age.

The main methods for measuring blood pressure are auscultatory - the "gold standard" of non-invasive blood pressure measurement and oscillometric, widely used in household blood pressure meters. It is clear that the method of detecting elevated blood pressure continues to be the traditional measurement of blood pressure by a doctor, the so-called "clinical blood pressure", which is essentially a one-time, one-time, not taking into account a variety of physiological conditions that affect the level of pressure. Even with repeated self- or medical measurements of blood pressure, the information received reflects daily figures. Blood pressure during the night period, the sleep period in this situation remains outside the access zone of both the individual and the doctor. The only method that can show the daily profile of blood pressure is ABPM. Conducting ABPM allows you to answer many questions of the diagnostic, treatment-and-prophylactic and scientific plan.

The indications for ABPM, as agreed by the specialists of the European Association of Cardiology, are:

White-coat hypertension, when elevated blood pressure is always detected when measured by medical personnel or in a medical institution. If the diagnosis is not specified, it is possible for the patient to prescribe drug therapy, which in this situation, at best, will be unjustified.
The question of "hidden, masked" hypertension, hypertension in the workplace or it is called "workday" hypertension. In both indications, the importance of identifying the very fact of an increase in blood pressure and developing the necessary therapeutic and diagnostic measures is understandable.
Increased lability of blood pressure, when there are pronounced fluctuations from low to high crisis values, causing a pronounced disturbance of well-being, at the height of blood pressure fluctuations, the risk of complications remains.
Patients of the older age group. Age is one of the risk factors for the development of hypertension due to both physiological causes and the accumulation of exposure to bad habits, external influences. It should be noted that the clinical manifestations of hypertension are different in different age periods, the approach to prescribing medications is different.
Nocturnal hypertension.
Hypertension, which, with regular monitoring by "clinical measurements", remains resistant to the prescribed therapy; for the patient, a situation is created when the implementation of the doctor's recommendations does not lead to stabilization of the condition: complaints persist, blood pressure does not decrease to normal values, etc.
When choosing a drug therapy that requires strict control.
Patients with type 1 diabetes mellitus (insulin dependent).
Diagnosis of hypertension in pregnancy.
Diagnosis of hypotensive conditions, especially in the presence of objective and subjective data. If hypotension is detected, dose adjustment of prescribed drugs is possible.
If there are complaints indicating insufficiency of the autonomic nervous system. Clarification of the diagnosis allows you to prescribe the necessary therapy.
Determination of the circadian rhythm of blood pressure, which in some cases has prognostic value, adjust therapy in time, prescribe additional examinations to identify the causes of circadian rhythm disturbances.

Contraindications for SMAD are:

Absolute - complications during previous monitoring, skin diseases on the shoulder, thrombocytopenia, thrombocytopathy and other blood diseases during the period of exacerbation, trauma of the upper extremities, diseases with damage to the vessels of the upper extremities, patient refusal.

Relative - poor tolerability of the study, severe rhythm and conduction disturbances, blood pressure over 200 mm Hg.

The department of new methods (BP monitoring group) is one of the pioneers in our country in the development and practical application of the methodology. Setting and processing of monitoring data are carried out according to international protocols on devices that have passed mandatory testing for measurement accuracy according to international protocol positions that have received an accuracy class approved for clinical use. Information about ABPM devices can be found at www.dableducation.org.

Specialists conducting research have certificates for this technique and participate in testing devices according to international (European and American) protocols.

Conclusions on the results of ABPM contain a number of indicators with comments by the doctor on their clinical and functional assessment and significance.

In addition to the standard study in the ABPM group, studies are conducted on a comparative analysis of several monitorings.

What is smad in cardiology?

ABPM - 24-hour blood pressure monitoring is used to obtain a detailed picture of changes in readings in the case of both high and low blood pressure. SMAD allows:

Take readings of blood pressure during rest, during sleep, and even during physical exertion; Individually select the most effective drugs; Blood pressure readings during moments of short-term ailments, such as dizziness. Exclude white coat syndrome, which is expressed in an increase in blood pressure from stress, when measured in the presence of a doctor.

It is advisable to carry out ABPM during pregnancy, especially if there is a risk of preeclampsia in the expectant mother. One of the symptoms of this disease associated with childbearing is an increase in blood pressure.

Daily monitoring of blood pressure in cardiology practice

The accuracy of diagnosis, the adequacy of drug antihypertensive therapy and its safety in arterial hypertension in most cases is determined by the objectivity of measuring blood pressure. Thanks to the discovery of M. S. Korotkov, clinicians have the opportunity to simply, quickly and fairly accurately record the level of blood pressure. But blood pressure is a fairly dynamic indicator, changing depending on the time of day, emotions, physical activity, etc. From this point of view, the traditional three- to four-fold measurement of pressure is a tiny fraction compared to the thousands of readings of this indicator that characterize the 24-hour profile.

The results of measuring blood pressure at a doctor's appointment very often give a distorted idea of its real value due to the anxious reaction of the patient. The phenomenon of "white coat hypertension", the prevalence of which is very high, has been known since the 40s of the XX century. An anticipatory effect with increased blood pressure has been noted both among hypertensive patients and in people who demonstrate normal blood pressure outside the doctor's office. This greatly complicates the identification and comparison of actual blood pressure levels, leads to overdiagnosis of arterial hypertension and errors in assessing the effectiveness of antihypertensive therapy.

Ambulatory blood pressure monitoring (ABPM) opens up additional diagnostic and therapeutic possibilities. One of the main advantages of ABPM is the possibility of recording during sleep, the safety, relative simplicity and high sensitivity of the method, as well as the possibility of multiple repetitions in outpatient, "usual" conditions for patients.

The results of daily monitoring make it possible to reasonably apply the principle of chronotherapy for a differentiated choice of an antihypertensive drug, the frequency and optimal time of its administration, and the determination of drug doses.

Benefits of ambulatory blood pressure monitoring:

1. A large number of measurements during the day.

2. The possibility of recording blood pressure in circumstances as close as possible to normal conditions.

3. Registration of blood pressure during daily activity.

4. Registration of blood pressure during sleep.

5. Ability to assess short-term variability in blood pressure.

6. Ability to assess the circadian rhythm of blood pressure.

7. Diagnosis of "white coat" hypertension.

8. Stronger correlation of mean blood pressure values with target organ damage compared to traditional pressure measurement.

9. ABPM data are of great prognostic value in relation to the development of cardiovascular complications.

10. Regression of lesions of target organs is more closely associated with changes in the average daily values of arterial pressure than with its clinical level.

11. ABPM allows more accurate than "office" blood pressure to determine the degree of reduction in blood pressure in response to treatment, by leveling the effect of "white coat" hypertension.

For the first time, the prognostic value of mean blood pressure values obtained with ABPM and its significant advantage over traditional (one-time) measurements was demonstrated by M. Sokolov et al. (1996). The results of the recent prospective SAMPLE study showed that the regression of left ventricular hypertrophy is more closely associated with changes in mean daily arterial values than in clinical pressure.

At the end of the 1990s, international conferences on ABPM problems were held, the purpose of which was to determine the indications for ABPM and standardize the research procedure.

Recognition of the high clinical value of ABPM is its inclusion in international recommendations for the management of patients with arterial hypertension. The American and Canadian Society of Hypertension, the Brazilian Society of Cardiology, the German League of Hypertension, the Swiss Society of Hypertension have all recommended ABPM for clinical practice. They emphasize the important role of 24-hour blood pressure monitoring and its measurement at home as methods that occupy a significant place in the management of patients with arterial hypertension and provide important additional clinical information.

Indications for ambulatory blood pressure monitoring:

- unusual fluctuations in blood pressure during one or more visits;

- symptoms of hypotension;

- arterial hypertension refractory to treatment.

The emergence of ambulatory blood pressure monitoring has defined a new stage in the diagnosis, treatment and prevention of arterial hypertension. The introduction of ABPM into clinical practice also made it necessary to reconsider the interpretation of the very concept of the "norm" of blood pressure and to expand the understanding of pathological conditions in which the regulation of blood pressure is disturbed.

- Suspicion of "white coat hypertension";

- episodic increase in blood pressure (study of patients with transient hypertension);

- resistance to antihypertensive therapy;

- the need to monitor the effectiveness of antihypertensive drugs;

– diagnosis of hypotension against the background of ongoing therapy;

- Identification of nocturnal hypertension.

– verification of arterial hypertension in pregnant women;

– study of the placebo effect in lowering blood pressure during antihypertensive therapy in placebo-controlled studies.

Additional indications for SMAD include:

- episodic hypertension;

- damage to target organs of unclear etiology;

– diagnosis of the severity of arterial hypertension (according to the level of arterial pressure);

– detection of increased blood pressure variability;

- control over drug correction of circadian rhythm disorders and blood pressure variability.

When conducting ABPM, it should be taken into account that the average value of arterial pressure obtained during monitoring is slightly lower than arterial pressure oriented by the traditional method. Therefore, ABPM results should be considered as not a substitute for traditional clinical blood pressure measurement.

Further research is needed to determine the benefits of ABPM over traditional measurement for predicting morbidity and mortality, promising and other uses of ABPM in clinical practice.

Promising areas of application of SMAD:

– diagnosis of arterial hypertension;

– borderline arterial hypertension;

- arterial hypertension in combination with coronary artery disease, chronic heart failure, cerebrovascular diseases;

- Examination of patients with impaired carbohydrate and lipid metabolism;

- Examination of patients with sleep apnea syndrome;

- suspicion of the symptomatic nature of arterial hypertension;

- suspicion of "hypertension in the workplace";

- examination of young people with a burdened heredity for the occurrence of arterial hypertension.

Diagnostic accuracy:

- forms of arterial hypertension (border / mild);

- patients with left ventricular myocardial hypertrophy;

- cardiopsychoneurosis;

- detection of postural changes in blood pressure associated with the transition from a horizontal to a vertical position of the body and vice versa;

- emergency conditions (hypertensive crisis, acute myocardial infarction, cerebrovascular accident, subarachnoid hemorrhage);

- preparation for a major surgical intervention (to assess the risk of hemodynamic disorders during anesthesia, surgery and in the postoperative period);

- arterial hypertension in pregnant women;

Eliminating underestimation of the importance of arterial hypertension:

- nocturnal rises in blood pressure;

– increased blood pressure variability;

- violation of the circadian rhythm of blood pressure.

Medication control:

- selection of patients for antihypertensive therapy;

- evaluation of the effectiveness and safety of pharmacotherapy;

- assessment of resistance to drug treatment and selection of the optimal treatment regimen for such patients;

- study of the individual daily rhythm of blood pressure in the chronotherapeutic regimen of drug treatment.

Cardiologist N.D. Mikhailiv for INFOMEDNET.RU

Daily monitoring of blood pressure allows you to notice deviations from the norm in time. The procedure is carried out using a special device that allows you to monitor blood pressure parameters throughout the day.

Description of the method

The use of the method of daily monitoring of blood pressure has gained great popularity today. With its help, without interruption, fluctuations in blood pressure are monitored and recorded.

To obtain accurate information about the state of pressure in the arteries, the patient must wear a special device for a day or longer that measures blood pressure every quarter of an hour.

After receiving the results of monitoring, it is possible to determine whether there are violations in the functioning of the body. The patient during the measurement should lead a normal life.

The procedure also evaluates the effectiveness of the prescribed therapy and diagnoses:

minimum and maximum blood pressure indicators in conditions familiar to the patient;
BP rhythm. If it is noticeable that at night the blood pressure in the arteries does not decrease, then the risk of developing or heart attack has increased;
average blood pressure to confirm or refute the presence of hypertension.

If you prepare well and follow all the rules for performing the procedure, you can get accurate information by which the doctor will determine whether there is a need to take medications.

Who is assigned

Daily pressure monitoring is necessary for people who:

get tired quickly;
complain of headaches and dizziness;
suffer from visual impairment and see flies before their eyes;
hear tinnitus or notice other unpleasant symptoms.

Pressure measurements should also be carried out by those who do not have any signs of abnormalities, but when measuring, the doctor noticed an increase in blood pressure. Often this problem is observed in people who are worried at the doctor's appointment. Therefore, the pressure and pulse rise. To determine whether this is a disease or a psychological reaction to a visit to a medical facility, it is necessary to conduct ABPM.

During the procedure, not only the presence of hypertension or hypotension is determined, but also the cause of the development of disorders. Data control allows you to:

Understand how dangerous an increase in performance is for a particular person.
Find out what complications you have.
Decide on an acceptable level of physical activity.

Blood pressure monitoring can also be prescribed before surgery, childbirth, and to assess the risk of developing diseases of the cardiovascular system.

Contraindications

The procedure cannot be carried out with:

hand injuries that make it impossible to install the device;
skin diseases localized in the area of the shoulder and arms;
obstruction or rigidity of the vascular system, which will not allow you to get accurate results.

The awkwardness that arose during the monitoring process includes an unpleasant sensation in the arm due to the fact that the cuff pressed on it. During ABPM, certain inconveniences may occur, including:

difficulty falling asleep and staying asleep. With the help of the device, blood pressure is also measured at night, so people often wake up due to the fact that the hand is squeezed strongly or from a signal. The problem mostly worries people who are light sleepers;
inability to bend the arm at the elbow. The cuff is attached slightly above the joint. Therefore, a person may feel uncomfortable while washing or brushing their teeth;
abstaining from taking a shower. The monitoring period usually takes a day or two. During the determination of indicators, you can not swim, since water should not get on the device.

These are all the inconveniences that the patient may experience. But they can be tolerated in order to get an accurate diagnosis.

Equipment for SMAD

There are different ways to monitor blood pressure. The Holter method of monitoring cardiogram and blood pressure is considered the most effective.

The Holter method consists in the fact that special electrodes are installed on the patient’s chest near the heart, with the help of which they analyze the heart rate and record all changes in the work of the heart throughout the day.

To make the diagnostic procedure more accurate, a medical sleeve can be used, putting it on the shoulder. In this case, to control blood pressure indicators, an oscillometric method is used, in which computer processing of the results is carried out.

The second most popular and accurate method is the use of the BiPiLAB system.

In this case, an apparatus for daily monitoring of blood pressure with a shoulder occlusive cuff is used. Using the oscillometric recording method, auscultatory dips, hypotension, weak Korotkoff sounds are accurately recorded.

One of the main causes of death is diseases of the cardiovascular system. About a million people die from these ailments every year in Russia alone. The problem is not even in bad medicine, but most often due to the fact that people do not seek help in time, and the ambulance already brings them with a stroke or heart attack. It is unlikely that people in their early thirties pay attention to their pressure or periodic headaches. Men are especially frivolous about this, it doesn’t hurt anywhere, which means they’re 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 tricky disease, and can be almost asymptomatic. The patient is experiencing serious ailments, but one-time pressure measurements may not show the problem.

How SMAD stands for

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

The undoubted advantages of the method of monitoring 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, especially this can interfere with 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 rule out white coat hypertension. Such a syndrome is a specific psychological reaction - this is an increase in blood pressure, which manifests itself only at the time of visiting a medical institution. At a medical appointment in some patients, the pressure can suddenly drop or rise sharply (and quite strongly);

To clarify the diagnosis of arterial hypertension, when the patient has high blood pressure for the first time, but the doctor wants to see additional data;

The study is carried out with symptomatic hypertension, in cases where the increase in pressure is a consequence of stress or is associated with some other diseases, especially with ischemia, heart failure, left ventricular myocardial hypertrophy, vascular problems in the brain, metabolic disorders;

In older patients, hypertension is often observed due to age-related changes in body tissues;

The study shows that if low pressure is abruptly replaced by high, such drops for a long 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 pressure figures, especially with diagnoses of neurocirculatory asthenia, vegetovascular dystonia;

Examination during pregnancy with suspected late toxicosis, 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 ongoing treatment, its effectiveness and safety, the resistance of the patient's body to prescribed drugs, the 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 disease, where constant monitoring of indicators is required;

Conducted to examine applicants for 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 the pressure can rise suddenly and, as it were, for no reason. With the outward harmlessness of hypertension in the workplace, 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 for the following complaints:

asthenia and constant fatigue of the patient;

frequent headaches;

deterioration of vision, the appearance of flies before the eyes;

noise, ringing in the ears;

fainting, pre-fainting states, dizziness.

Dizziness and headache
Contraindications for ABPM

The procedure cannot be carried out in the following cases:

If the patient has skin disorders at the site of fixation of the pneumocuff, inflammation or skin disease;

With vascular diseases, especially with exacerbation;

With violations of blood coagulation, hemophilia, with a tendency to bleeding;

With many mental pathologies;

With injuries of both hands;

For problems with the brachial arteries (obstruction);

The study may not be useful when the patient's blood pressure is above 200.

The doctor must inform the doctor about all restrictions to the procedure for monitoring the patient's pressure.

Preparation for the procedure

Before ABPM, your doctor will sometimes stop some blood pressure medications. Unless the doctor decides otherwise, then all drugs should be taken. Light clothing with short sleeves should be worn, and looser clothing should be thrown over the top. The device is usually attached to the belt, and sometimes hung around the neck. Before the study, the patient can lead a normal life, no additional preparation for such a method of measuring pressure is required.

How is the procedure carried out?

Consider the daily monitoring of blood pressure, how is this study carried out? To begin with, a pneumocuff is put on above the patient's elbow, which is connected to the registrar with the help of a tube. This small device, weighing about 300 grams, inflates air at programmed intervals and then bleeds it. The doctor reads the results of pressure measurements from the memory of the device and analyzes them.

During the day, measurements are taken every quarter of an hour, and at night - every half an hour. The pressure study lasts a day or more (as the doctor says), then the patient should turn off the registrar and visit the doctor again.
Taking measurements
A functional diagnostic specialist connects the device to a 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 right hand). It is attached to the forearm of the patient's hand two centimeters above the elbow, and is selected for each patient depending on the size of his hand. After that, the patient can go to work or home, the pressure measurement will be carried out by the device automatically. ABPM does not interfere with normal life, you can even continue to play sports.

Sports
How to behave during the procedure

Consultations on the conduct of ABPM are given by general practitioners and cardiologists.

The doctor issues a special diary before the procedure, where the patient should record everything that was done during the day, some types of mental and physical activity (sports, stress, emergency work at work), note periods of sleep and wakefulness. Record periods of feeling unwell (eg, dizziness, palpitations) and medications, i.e., make notes of anything that can affect blood pressure and heartbeat.

Keeping a diary
If the patient feels that the cuff has slipped during use, then it is necessary to correct it. The tube that connects the monitor to the cuff must not be pinched by clothing.

The patient should pay attention to the battery charge, whether the power supply of the recorder is enough for the duration of the procedure. The instruction says that it is necessary to avoid getting water on the recorder (it is best not to take a shower at this time), it is also highly undesirable to stay close to strong electromagnetic radiation for a long time. If the ABPM equipment stops working, then you should report the incident to the 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 pumps air, you need to stop, relax your arm with the cuff and lower it down. The second beep means that the measurement is over. After the second signal, the person can continue the interrupted activity.

At night, you should try to sleep, 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.

SMAD in childhood

ABPM can be done not only for adult patients, but also for children after seven years. This procedure is completely safe, it is carried out for children with suspected hyper- and hypotension, with violations of the heart, with frequent fainting. 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, what it is for, and that it is painless. The cardiologist should give all the recommendations and tell you how to fill out the diary correctly during the ABPM.

Important! The ABPM procedure is especially important for the diagnosis of vegetative-vascular dystonia.

This pathology in children recently happens very often. Treatment requires an accurate diagnosis, since VVD 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.

SMAD in children
Deciphering 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 the records on the computer and this helps him to make a diagnosis, choose the best method of treatment and avoid possible complications.

What does the doctor learn from the ABPM results?

In addition to the fact that the SMAD device captures an increase in the pressure of the patient under study in different situations, it also monitors the natural daily decrease or rise in blood pressure - circadian rhythms. Rhythm deviations from the norm can signal possible health problems. Based on the information received, the doctor may recommend that the patient change the diet, or undergo additional checks and studies.

When monitoring blood pressure, the doctor evaluates:

Patient's average blood pressure. Normally, the average daily blood pressure should be less than 130 per 80 mm Hg;

Moments when blood pressure is minimal and maximal;

Index of systolic and diastolic pressure of the patient per day;

The rate and magnitude of the rise in pressure in the morning.

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

If the patient's SI is in the range from 10 to 20%, this is the Dipper group. If less than 10% (Non dipper), then such people have insufficient nighttime BP reduction, and they have an increased risk of complications of the cardiovascular system. If the index is less than zero (Night peaker) - these are patients whose average blood pressure at night is higher than during the daytime, they have an increased risk of kidney damage and heart failure is possible. When CI is above 20% (Over dipper), then in such patients the pressure is reduced at night, and they are highly at 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 of unknown etiology and heart rhythm disturbances.

Reliability of the methodology

Having the data of the ABPM study, the cardiologist gets 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 well-being. It is also possible to analyze the changes in the state over the past period of treatment, prescribe a more appropriate therapy, evaluate the results of the treatment already performed and exclude possible complications.

How to wear the device
Many patients ask questions about monitoring pressure and pulse, how is this measurement done at home? Actually, the SMAD 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 much more accurately reflects the level of changes in blood pressure, and gives doctors a more accurate picture of the disease, so treatment will be more timely and effective.

Each person may well undergo ABPM without a special doctor's prescription, on his own initiative, if he considers it useful. Even if monitoring does not detect any abnormalities, it makes sense to keep past results for comparison at a subsequent daily measurement of blood pressure.

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

Deviations in blood pressure may indicate various diseases. Sometimes when diagnosing a single measurement is not enough. In such cases, 24-hour blood pressure monitoring is used for greater clarity. This is a study in which, using a special device, indicators are monitored continuously throughout the day. That is, this is an automatic measurement, which is necessary in order to see what kind of fluctuation occurs over a certain time.

Using this method, various types of hypertension are diagnosed. Monitoring is effective enough to establish therapeutic therapy with antihypertensive drugs, as well as to control the effect of these drugs.

Doctors note that when a person goes to the hospital, his blood pressure is always slightly increased due to excitement, etc. Daily monitoring of pressure allows you to see the true indicators in normal human conditions. Such a diagnosis is much more efficient. It is possible to conduct a study in the case when the patient is treated on an outpatient basis, and sometimes in a hospital.

There is a concept of false negatives. This is when a person's blood pressure can rise once during the day, and at the time of measurement by a doctor, the indicators can be normal. Although in fact this person belongs to hypertensive patients. Such people simply need this study, since the device will record when there was a deviation, what its amplitude was and why it happened.

To do this, use devices that regularly measure and record indicators on a special medium. After that, the information is transferred to a computer, and a graph is created using a special program.

How is SMAD performed?

As in a conventional tonometer, a cuff is installed on the patient's arm (on the middle third of the shoulder). From the cuff comes a tube that connects to the registrar. It is the register that supplies air and bleeds it. The device also has a sensor that is very sensitive to the manifestation of pulse waves.

The number of measurements per day is programmed individually, this is done taking into account the patient's regimen, that is, sleep and wakefulness.

For those whose blood pressure often rises in the morning, the frequency of measurements during this period is programmed once every 10 minutes. As a rule, this is required within 2 hours.

If a patient has an increase in systolic blood pressure up to 190 mm Hg. Art., it is recommended to set the frequency of measurements less, as there is a deterioration in well-being during the operation of the device. Therefore, the intervals are set at about 30 minutes during the day and 60 minutes at night.

Training

As a rule, antihypertensive drugs are canceled before this study, but it should be noted that only the doctor makes this decision. If the doctor did not say this, then you should not do it yourself.

It is recommended to wear the cuff over a thin shirt or jacket to avoid skin irritation, discomfort, and in general for hygienic reasons. Over this should be loose clothing. Sometimes you need to purchase special batteries for this device.

There are no restrictions on the amount of food and drink, and one should not cancel one's usual activities. Since the study is carried out in order to fix fluctuations in blood pressure in a person's daily life.

The doctor also explains to the patient how the device works, how to behave when wearing it, and how to keep a special diary. In the diary, the patient should note his well-being, sensations during the measurement, and also, if he takes any drugs, this should also be noted. Recordings are made only during the daytime.

When a person feels that the device is starting to measure, he should stop and relax his hand, lowering it along the body. After that, everything must be recorded in the diary. After that, you can go about your business.

But at the same time, you must constantly monitor that the tube that connects the resistor and the cuff does not bend or deform. If the cuff slips, then the patient can correct it on his own, only this should be done carefully.

When the cuff is inflated, the pressure on the arm increases and the person may even feel pain. This is normal and you just have to be patient.

Indications for research

The most commonly used daily monitoring of indicators in such diseases and situations as:

According to statistics, 24-hour blood pressure monitoring is most commonly used to assess the effectiveness of antihypertensive therapy.

Contraindications

There are also contraindications to such a study:

With caution, blood pressure monitoring is used if the patient's systolic level exceeds 200 mm Hg. Art., and also, if there are pronounced violations of the conduction system of the heart.

Advantages and disadvantages

The main advantage of daily monitoring over a one-time measurement is that true indicators are displayed. Monitoring provides information about changes in blood pressure over a certain amount of time. As a result, the doctor can make the correct prescription of drugs.

Since this method makes it possible to assess the fluctuation of the indicator throughout the day, the diagnosis of the underlying disease is greatly simplified.

This method allows diagnosing false-negative cases. With a one-time measurement, the indicator is normal, but if monitoring is carried out, it may turn out that the person is hypertensive.

It can be concluded that the main advantages are:

The disadvantages of this study include factors that patients note from their practice, for example, discomfort during the measurement.

Daily monitoring of blood pressure or ABPM is one of the most informative methods for assessing the rhythm of blood pressure in the conditions familiar to a person. Compared to a one-time measurement, 24-hour pressure monitoring makes it possible to most effectively diagnose arterial hypertension and determine dysfunctions of target organs. This is the name of the organs that suffer most from high blood pressure (heart, brain and organs of vision).

Main indications for ABPM

In fact, all indications for non-invasive pressure monitoring are divided into 2 groups: diagnostic, which are necessary to determine the degree and transient episodes of already diagnosed hypertension, and control, which serve to assess the correctness of the prescribed treatment.

Suspicion of symptomatic hypertension.
Syndrome "white coat". Patients experience an increase in pressure, only if its measurement is carried out by medical staff. This phenomenon is explained by the stress that individuals experience when visiting hospitals.
"Borderline" blood pressure readings detected during repeated measurement by the Korotkov method.
Workday hypertension. As in the first case, the pressure rises under the influence of stress, but already at the workplace, and in the hospital, blood pressure readings do not exceed the norm.
When examining patients with hypertension in combination with heart failure, cerebrovascular diseases, syncope, metabolic disorders.
High lability of blood pressure, i.e., the presence of pronounced fluctuations from minimal to maximally high crisis values, causing a deterioration in well-being, the appearance of weakness, headaches, dizziness.
ABPM is prescribed to patients over 60 years of age, since age is the most common risk factor for the development of arterial hypertension.
Nocturnal hypertension. This type of hypertension can occur as a result of vegetovascular dystonia. Very often, "night" hypertension indicates hypertrophy of the left ventricle.
When examining young people with unfavorable heredity for hypertension.
Severe arterial hypertension resistant to treatment and control of selected drug therapy.
ABPM may be predictive, for example, in circadian rhythm disorders.

Contraindications to SMAD

Skin diseases.
Vascular lesions and hand injuries.
Blood diseases in the period of exacerbation.
Significant cardiac arrhythmias.
Tissue conduction disorders.
BP values more than 200 mm Hg. Art.

Equipment for SMAD

To monitor pressure, special devices are used, which are based on the oscillographic and auscultatory method of measuring blood pressure. Both of these methods separately determine blood pressure with large errors, especially in the case of atrial fibrillation, but their combination makes it possible to obtain quite reliable data.

The market of modern non-invasive recorders includes devices of both domestic and foreign companies. The systems that perform bifunctional monitoring (BP + ECG), for example, Cardio Tens devices, are most widely used.

24-hour blood pressure monitoring procedure

A cuff with a built-in sensor is applied to the middle part of the upper arm so that the sensor is located in the region of the best pulsation of the brachial artery. The cuff is connected to a device that records blood pressure. Usually such a device is located on the belt. Recording of indicators occurs in automatic mode with a set interval (15 minutes in the daytime, 30 minutes at night). In addition, the patient needs to keep a diary in which from time to time he must reflect information about his activities and well-being.

ABPM is an uncomplicated procedure and in most cases it is performed without complications. Very rarely, swelling of the hand and forearm, dermatitis, arterial thrombosis, petechial hemorrhages, episodic manifestations of ischemia are observed.

Evaluation of ABPM results

ABPM results are evaluated after 24 hours from the start of the examination. The indicators are entered into a computer, where they are analyzed using a special program. In the medical report, the doctor determines the short-term pressure variability, the dynamics of morning pressure, the hypotension index, comparing the results obtained with the average standard values:

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

How to prepare for daily blood pressure monitoring?

To achieve informative results and minimize errors, the correct behavior of the patient during ABPM is of particular importance. The doctor must explain in detail to the patient the purpose and methodology of the research and ask to adhere to the following rules.

The patient must be prepared that from time to time he will be accompanied by the noise of a pump pumping air, this may interfere with some working moments and distract the patient at night.
At the time of ABPM, the intake of certain drugs that can affect the change in blood pressure is canceled.
During the measurement of pressure, the arm on which the cuff is located should be extended and relaxed.
If the cuff slips a little, it must be carefully adjusted.
Under no circumstances should the pump tube be bent.
If the measurement of blood pressure caught the patient while walking, then it is necessary to stop, relax the arm and wait for the end of the measurement.
At the end of each measurement, the patient should make an entry in the diary.
On the day of SMAD, any physical activity is excluded.
The patient should not take water treatments
The patient is not allowed to look at the measurement results, as this may cause an alarm reaction and lead to data corruption.
At night, the patient must sleep, otherwise the nighttime blood pressure readings will be unreliable.