Blood pressure is an indicator that determines the force with which blood presses on the walls of blood vessels when moving. The numbers that are not within the acceptable range indicate the presence of a pathology in the body that requires diagnostics and therapy. A one-time measurement of pressure indicators is not enough. Its fixation in dynamics is required (daily blood pressure monitoring - ABPM). What kind of diagnostic method it is and how it is carried out is discussed in the article.
Meaning of research
A special device is attached to the patient who is being diagnosed, which records blood pressure readings for 24 hours. The measurement takes place automatically, has a certain frequency.
If the patient's pressure is measured at the reception, due to excitement, the numbers may showincreased results. Daily monitoring of blood pressure, the rules of which are discussed below, allows you to record indicators at home, in a calm, comfortable and familiar atmosphere. The study can also be carried out at the time when the patient is in the hospital.
How does the device work?
The apparatus "Daily monitoring of blood pressure" is attached to the patient's body. Its components are as follows:
- Recorder - a device that is fixed on the patient's belt. With its help, indicators are recorded in dynamics.
- Rubber tube - connects cuff and registrar.
- Cuff - put on the arm (middle part of the shoulder, heart level). Air is injected into it, and then air is bled.
- Sensitive sensor - fastened under the cuff and captures the moments of the appearance and disappearance of pulse waves.
During the day, the 24-hour blood pressure monitor records results every 15 minutes. During the night's rest, blood pressure is measured every 30 minutes. All data remains in the device's memory.
Research Rules
If a patient is scheduled for 24-hour blood pressure monitoring, the attending physician explains how the procedure is carried out. The specialist must instruct about the rules of conduct during the diagnostic period in order to obtain reliable results:
- medication appointments are canceled if necessary;
- rejection of significant physical activity;
- prohibition of taking water procedures;
- night sleep should be full so as not to distort monitoring indicators;
- clothing should be light so that the cuffs do not squeeze the patient's arms;
- day routine should be habitual;
- during the period of air injection into the cuff, the subject must lower his arm down, straightening along the body, stop;
- constantly make sure that the rubber tube is not bent, and the cuff remains in place;
- if the patient is highly sensitive, the doctor prescribes sleeping pills or sedatives at night.
The nurse gives the patient a special diary, where it is necessary to record data about his he alth, physical activity, drugs used (if the doctor has not canceled them at the time of diagnosis), record sleep time.
There is the possibility of conducting a survey of pregnant women. Women who are at risk are diagnosed three times. The first time at the first contact with a specialist for registration, then in the second trimester and just before the birth. Such a procedure helps prevent the development of complications from the fetus and the mother's body.
Holter monitoring
Simultaneous measurement of blood pressure and fixation of ECG indicators throughout the day is a modern method for diagnosing most cardiovascular pathologies, which makes it possible to identify even hidden forms.
Thisthe method was developed by the American scientist Holter. Electrodes are attached to the chest of the subject, which record data on the electrical activity of the heart and transmit the results to a special portable device. Here, the indicators are processed in the form of an electrocardiogram and stored in memory. In parallel, a cuff is attached to the patient's shoulder to measure blood pressure.
In case of controversial issues, Holter monitoring can be extended for several days (even up to a week). The advantage of the method is that the device allows you to record the slightest changes in heart rate, which is not always possible with a conventional ECG.
Holter monitoring is performed on patients who are concerned about the following symptoms:
- pressive pain in the chest, radiating to the shoulder blade, shoulder, arm;
- night pain in the left half of the chest;
- shortness of breath accompanied by cough;
- feeling of a sinking heart;
- frequent dizziness or fainting.
Obesity, burns of the skin in places where electrodes are required - contraindications to the procedure (only because of the impossibility of correct fixation of the device).
Indications
24-hour blood pressure monitoring is essential to diagnose the following conditions:
- Hypertension. Its possible forms are nocturnal hypertension, "white coat hypertension", latent, during pregnancy.
- Hypotension - chronic, orthostatic, suddenfainting.
- Pathology of the autonomic nervous system.
- Monitoring the effectiveness of drugs used in dynamics.
- Insulin-dependent diabetes mellitus.
- Elderly patients.
- Resistance to hypertension therapy.
Statistics show that most often ABPM is performed in order to clarify how effective antihypertensive drugs are in use.
Contraindications
24-hour blood pressure monitoring not used if available:
- mechanical damage to the hands when compression and cuffing are not possible;
- skin pathologies on the upper and lower extremities;
- exacerbation of diseases accompanied by impaired blood clotting;
- vascular pathology associated with changes in blood flow or vascular stiffness;
- the presence of complications of the underlying disease;
- complications after the previous daily monitoring.
Diagnosis is carried out in a hospital, if the systolic pressure exceeds 200 mm Hg. and there are disorders of the conduction system of the heart. Such conditions require extra care.
Method advantages
24-hour blood pressure monitoring has huge advantages over one-time measurements. The method allows you to evaluate exactly how the indicators change and at what time of the day. Based on the study, the specialist selects drugs forspecific individual clinical case.
In addition, 24-hour blood pressure monitoring, the instructions for which indicate a significant simplification of the diagnosis of the underlying disease, makes it possible to identify false-negative cases of the study. A single measurement may show numbers that fit within the acceptable range, but in fact the patient is hypertensive.
Main advantages of the method:
- fixing blood pressure over a long period of time;
- possibility to use in the usual calm atmosphere;
- recording data during night rest;
- determination of short-term blood pressure variability;
- irreplaceable help in the treatment of patients with serious pathologies (stroke, heart attack, cerebrovascular accident).
Disadvantages of daily monitoring
The main disadvantage, according to patients, is the feeling of discomfort during the injection of air into the cuff. There is a feeling of numbness of the hand, although it passes quickly. Rashes and diaper rash may appear under the cuff.
Another disadvantage is that the procedure is paid, unlike a one-time blood pressure measurement.
Research Evaluation
After 24 hours from the moment the device is fixed on the patient's body, the data obtained is evaluated.
Indicators are entered into a special computer program that allows you to determine the presence of short-term pressure variability, evaluate morning results, calculate the hypotension index and compare with average values:
- daily indicator - BP 120±6/70±5;
- morning numbers - BP 115±7/73±6;
- evening indicators - BP 105±/65±5.
An important diagnostic procedure to clarify the presence of pathology is daily monitoring of blood pressure. Where to do it, the attending cardiologist will tell you. In a polyclinic, such examinations are not carried out due to the lack of necessary devices. The procedure is available in cardiology hospitals or specialized diagnostic centers.
