Procedure for daily monitoring of blood pressure. What is 24-hour blood pressure monitoring (smad)? Long-term blood pressure monitoring

Date: 21.10.2019

From this article you will learn: what is ABPM, indications for daily monitoring of blood pressure, what diseases can be detected by such a study. How the procedure goes, what the patient should do, decoding of the results.

Date of publication of the article: 06.04.2017

Date the article was updated: 05/29/2019

Daily monitoring of blood pressure is diagnostic procedure... It provides for multiple measurements of blood pressure throughout the day using a special device.

This allows you to analyze changes in pressure throughout the day and night: is it always increased (decreased), for what type of activity and how much it increases (decreases), does it change in night period... Some devices measure not only blood pressure, but also heart rate.

A referral for examination is given by a cardiologist or a therapist.

Indications for

The procedure is prescribed for patients who complain about:

rapid fatigue;
headaches, dizziness;
decreased vision, "flies" before the eyes;
noise or ringing in the ears, ear blockage.

Also, ABPM can be prescribed to a person who does not have unpleasant symptoms, but when the pressure is measured by a doctor, it is increased. The reason for this may be the phenomenon of the "white coat": this individual feature, which is expressed in a specific psychological reaction to doctors. A person with a white coat phenomenon becomes overly anxious at any medical manipulations, therefore, his blood pressure and heart rate increase. Measurement of blood pressure and heart rate using daily monitoring allows you to exclude the influence of this phenomenon on the diagnosis.

The procedure allows you to identify arterial hypertension (hypertension), as well as to preliminarily determine its cause - the underlying disease. It is confirmed by further examinations. Also, using this method, you can diagnose chronic hypotension (arterial hypotension) - low blood pressure.

SMAD allows:

predict how dangerous arterial hypertension is for a particular patient;
determine what complications it can lead to or has already led;
understand what level physical activity admissible for a given person;
determine if pressure medications that have already been prescribed for treatment are effective.

Carrying out the procedure

Survey progress:

You come to the doctor. It attaches a portable blood pressure monitor to your body. It consists of a cuff (the same as for a conventional tonometer), a connecting tube and the main part of the device, which records the received data into the built-in memory (most often the device itself is placed in a case on a harness, which is hung over the shoulder or fastened to the patient's belt) ...
You live the day according to your usual schedule, but keep a detailed journal. There you write down everything that you did during the day with the indication of the time.
The device measures the pressure every 15 minutes during the day and every 30 minutes at night. Sometimes this interval can be longer (for example, every 40 minutes during the day and every hour at night), depending on the settings.
If you have been prescribed any medications, then warn your doctor about it. Their reception may be canceled for the duration of the examination. If the doctor said that you do not need to cancel the appointment (for example, in the case when it is necessary to evaluate the effectiveness of treatment), take the medicine according to the previous schedule and write down the time of appointment in a diary. You can also write down at what point you felt the effect of the medication.
A day later, you come to the doctor again. He takes off the camera and says when to get the results. Data processing usually takes no more than one day.

With the results, you go to your treating cardiologist or general practitioner. On the basis of the ABPM data, he can make a diagnosis, as well as prescribe further diagnostic procedures to clarify the cause of hypertension.

Patient memo

There are a few things to keep in mind when going through this diagnostic procedure.

The basic rule: when the device starts measuring blood pressure (you can recognize this moment by inflating the cuff, and some models emit a signal before starting the measurement), stop, relax your hand and lower it down. Otherwise, the device will not be able to measure the pressure, or the result will be incorrect.

Diary rules

Be sure to write down in the afternoon	Time of moderate physical activity (ascent to the 4-5th floor, walking distance from 1000 m)
	Driving time
	Time of stress or increased emotional stress(if there was such a thing)
	Time of taking medications
	Meal time
	The time when you felt any unpleasant symptoms, detailed description these symptoms, what were you doing at that moment
It is advisable to write down during the day	What exactly did you do at the time of each pressure measurement
Be sure to record at night	Time to go to bed and wake up
	Time of night awakenings
	What did you do when you woke up at night

It so happens that the device starts to inflate the cuff again immediately after measuring the pressure. This means that the device failed to measure the last time. Possible reasons this: you strained your arm, or the cuff is loose. If the arm was relaxed at the time of the first measurement attempt, ask someone to tighten the cuff so that it fits snugly against the arm (you can do this yourself, but it will be inconvenient to tighten it with one hand).

Intense physical activity (fitness, gym) on the day when daily monitoring blood pressure are prohibited.

Contraindications and inconveniences of the procedure

The procedure has no contraindications.

From side effects it is possible to distinguish only discomfort in the hand for 1-2 days after the examination, since the cuff can press.

We will also talk about the possible inconveniences that you may encounter during the procedure:

Difficulty sleeping. Since the device measures blood pressure at night, you may wake up from the cuff squeezing your hand or from a preliminary signal. This is especially true for those who are light asleep.
It is impossible to fully bend the arm at the elbow, as the cuff is attached just above the joint. This can make it uncomfortable, for example, to wash your face or brush your teeth.
You will have to refrain from taking a shower or bath, since the device cannot be wetted.

These are all disadvantages of the procedure. They can be tolerated for the sake of an accurate diagnosis, which can be delivered after the ABPM.

Decoding the results

Daily monitoring of blood pressure gives full information about changes in systolic and diastolic blood pressure during the day and night.

You will receive a sheet with the test result the next day after the procedure.

It will indicate:

Determination of the severity of hypertension by mean pressure

	Mean systolic blood pressure	Mean diastolic blood pressure
Low pressure	In the afternoon - below 100 At night - below 90	In the afternoon - below 65 At night - below 50
Normal	In the afternoon - 100-135 At night - 90-120	In the afternoon - 65–85 At night - 50–70
Borderline hypertension	In the afternoon - 136-140 At night - 121-125	In the afternoon - 86–90 At night - 76–85
Mild hypertension (grade 1)	In the afternoon - 141-155 At night - 126-135	In the afternoon - 91-100 At night - 76–85
Moderate hypertension (grade 2)	In the afternoon - 156-170 At night - 136-150	In the afternoon - 101-110 At night - 86-100
Severe hypertension (grade 3)	In the afternoon - more than 170 At night - more than 150	In the afternoon - more than 110 At night - more than 100

The degree of nighttime reduction in blood pressure should normally be 10–20%. Insufficient pressure reduction at night is an indicator of health problems.

Insufficient pressure reduction during sleep

Pulse pressure (difference between upper and lower pressure) should not exceed 53 mmHg. Art. (ideally 30–40 mm Hg). Increased pulse pressure may indicate problems with thyroid gland, as well as about vascular diseases. In patients with large values pulse pressure increased risk of complications of hypertension.

Blood pressure variability is the degree to which it changes during the day. Normally, the variability of systolic blood pressure should be less than 15 mm Hg. Art., diastolic - less than 12 mm Hg. Art. Increased variability indicates low vascular elasticity, which increases the risk of stroke and retinal hemorrhage.

SMAD- a research method based on measuring and fixing blood pressure indicators for 24-72 hours at regular intervals (from 15 to 120 minutes). Daily monitoring of blood pressure is prescribed for the purpose of diagnosis arterial hypertension and hypotension, identifying the causes of fainting and dizziness, selection drug therapy to normalize blood pressure... The duration of the study is determined individually, on average it is from 1 to 3 days (rarely - up to 7). The cost of the procedure depends on the duration of blood pressure monitoring.

Preparation

SMAD does not require preparatory measures. Before starting the study, it is worth informing your doctor about the medications you are taking, as some of them may affect the results of the procedure.

What shows

During the ABPM, blood pressure is measured and recorded at set time intervals for 1-3 days. Many indicators are subjected to statistical processing, as a result of which the doctor receives information about the average diastolic and systolic blood pressure, average night and day blood pressure, the percentage of indicators above normal, blood pressure variability. ABPM data are used to diagnose a number of pathologies:

True arterial hypertension. In patients with true arterial hypertension, the mean daily blood pressure is increased. Peak readings are often found in the morning; blood pressure decreases more slowly at night than in healthy people. During clinical measurement, an increase in blood pressure is also recorded.
White coat hypertension. With hypertension of the "doctor's gown", patients experience stress from the situation medical examination... They celebrate high values Blood pressure in a single measurement in the presence of a doctor or nurse, but the average daily, day and night values are normal.
Latent arterial hypertension. The key sign of latent arterial hypertension is an increase in mean daily blood pressure of more than 135/80 at normal rate Blood pressure obtained by traditional measurement. Another criterion is the average daily blood pressure above 130/80 and normal value clinical indicator.
Symptomatic hypertension. In favor of the diagnosis of secondary hypertension, cases are considered in which the average blood pressure is higher at night than during the day. This result indicates the need for additional diagnostic procedures, explains the low efficiency of the application. drug treatment antihypertensive drugs.
The risk of cardiovascular pathologies. The high risk of heart and vascular diseases is evidenced by the high variability of daily values. In such patients, the likelihood of changes in the vessels of the fundus, atherosclerotic vascular lesions, and hypertrophy of the left ventricular myocardium increases. With an insufficient decrease in blood pressure at night, the risk of stroke and coronary heart disease is diagnosed.

ABP is additional method diagnostics and cannot replace the traditional procedure for measuring blood pressure at a doctor's appointment. The monitoring results are considered in conjunction with the data of examination, clinical survey and blood pressure tonometry.

Advantages

SMAD provides large quantity registrations of blood pressure than the traditional technique. This increases the diagnostic value of the procedure in relation to vascular hypertension, predicting the risks of cardiac and vascular pathologies. Clinical single blood pressure measurement is cheaper than ABPM, but less informative for differential diagnosis and identification of latent forms of hypertension. The disadvantages of ABPM are physical discomfort and movement restrictions due to wearing a pneumatic cuff, decreased accuracy of readings in supraventricular and ventricular arrhythmias.

Daily monitoring of blood pressure is carried out throughout the day in the phases of activity (walking, work, physical, mental stress) and rest (sleep, walk in nature, in a lying and sitting position). A small apparatus is on the human body around the clock and automatically measures the indicators at regular intervals.

Such a diagnosis has great value to monitor the effectiveness of treatment, with a complex history, increased risks of complications.

Daily monitoring of blood pressure is carried out to more accurately diagnose pressure problems in conditions that are as close as possible to a person's everyday life.

It makes it possible to trace the dynamics, patterns of change in readings throughout the day, to establish the dependence of pressure surges on certain factors. In turn, this makes it possible to make a more accurate diagnosis and prescribe a suitable treatment, refute or confirm suspicions of hypertension / hypotension in an incomprehensible situation, establish factors affecting blood pressure jumps, and track the dynamics of treatment.

For a period of 24-48 hours, it is attached to the patient's body special device weighing about 300-500 grams, capable of recording blood pressure values in a variety of living conditions.

The study is carried out on an outpatient basis, and the mechanism will automatically take measurements and record the received data in its memory approximately every 15 minutes in daytime days and every 30 minutes at night during sleep (depending on settings). The patient does not need to write down the blood pressure values obtained, but he should describe in detail his daily routine.

The obtained data can be transferred to a computer and studied in more detail. The doctor will evaluate the following indicators:

Average blood pressure for the entire study period at night and during the day;
Episodes when the blood pressure level rose / fell to the maximum values;
Daily index of indicators of diastolic and systolic pressure;
Blood pressure in the morning and after awakening.

Who is it for?

The indications for the ABPM are:

- some people are afraid of doctors, so they may be worried at the reception. This will be displayed during blood pressure measurement: the device will show an increase in blood pressure, although in fact the person is not sick, but simply worried. Daily monitoring will allow you to accurately determine whether a person has problems with blood pressure or not.
Suspicion on.
Latent hypertension or, as it is also called, hypertension of the working day, when pressure surges are observed only in working conditions.
The need to monitor the effectiveness of treatment of problems with blood pressure.
In the course of treatment, it was revealed that medications do not help correct pressure problems.
To track the rhythm of fluctuations in indicators throughout the day. ABPM allows you to identify the causes and patterns of violations of the circadian rhythm.
With insulin-dependent diabetes mellitus.
For examining pregnant women if they have deviations in blood pressure from the norm.
Genetic predisposition to hypertension.
Clarification of the diagnosis in cases of the presence of pathologies nervous system vegetative nature.
Large pressure surges ( high pressure decreases sharply and vice versa).
There is a threat of complications.
To establish the cause of sudden loss of consciousness (one of these may be hypotension).
To establish the factors influencing the change in blood pressure.
When one-time measurements show borderline values, the symptoms are ambiguous and there is no way to make an accurate diagnosis.

In such situations, daily monitoring of blood pressure provides valuable information that will help to make an accurate diagnosis, suggest the cause of blood pressure problems and prescribe as adequate treatment as possible, as well as correct ineffective medical measures.

Method contraindications

Despite its informativeness and research value, ABPM has some contraindications for conducting. These include:

Blood pathologies during periods of exacerbation, including thrombocytopenia.
Skin diseases and other lesions (wounds, abrasions) in the shoulder region.
Diseases accompanied by vascular lesions on the hands.
Injuries to the hands, shoulder joint.
During the previous ABPM, there were complications, the patient's condition worsened.
Injuries, vascular diseases that can interfere with the procedure (for example, impaired patency of the brachial artery).

Before using the device for ABPM, it is imperative to consult a physician.

Advantages and Disadvantages of Pressure Control Method

Today, ABPM is becoming a very popular method for monitoring pressure readings and tracking the characteristics of the course of hypertension / hypotension. The advantages of this method include:

the ability to get more accurate, objective readings;
the results of such a study are independent and more truthful, since the measurement is carried out in conditions close to ordinary life - this makes it possible to exclude the effect of fear of doctors or one-time, random factors on the examination result;
with the help of ABPM, it is possible to reveal hidden, not having pronounced symptoms, violations of blood pressure;
makes it possible to prevent the development of the disease with a genetic predisposition;
very informative in incomprehensible situations (loss of consciousness of an undetected etymology, constant weakness, incomprehensible or sleep, short-term systematic jumps in blood pressure, etc.);
makes it possible to evaluate the effectiveness of treatment of problems with blood pressure, to adjust the ineffective prescription of drugs or their dosage;
helps to assess the condition of a pregnant woman with blood pressure problems, to identify and prevent the development of complications during childbirth, to decide on the acceptable type of delivery in a particular situation;
you can measure pressure at home.

The disadvantages of this method include only minor inconveniences during the procedure: you cannot take a bath, swim in the river, the sea, visit solariums, baths; care must be taken not to damage the device.

A person may experience some discomfort from constantly wearing the device, especially while sleeping. However, compared to the benefits of ABPM, such temporary inconveniences are negligible.

Daily monitoring of blood pressure is carried out using a device such as a tonometer. Usually, a small, light device (up to 500 grams of weight) is used, which is attached to the belt under the clothes, and the cuff is fixed in the shoulder or wrist area. It records the results and saves them in its memory, and after the completion of the procedure, the instrument data is output to the computer.

A device for daily monitoring of blood pressure can be purchased at pharmacies or stores of medical service, medical equipment.

It is most convenient to take a tonometer with a microcomputer, in this case the measurement results will be automatically saved in the device's memory. Otherwise, you will need to independently record all the readings.

Today, modern blood pressure monitors have been developed that are worn on the wrist. They are very comfortable, like a watch or a bracelet. However, such devices are not suitable for people over 50 years old, since blood vessels lose elasticity with age, and the pressure on the wrist will not be measured accurately.

For more accurate diagnosis human condition, it is recommended to purchase tonometers that record not only pressure readings, but also the pulse. If we talk about specific brands of meters, the most best reviews use such devices:

Price category	Stamps
From budget options	CSMedica
Average price category	B. Well, Microlife, A&D
Of expensive devices	Omron, Qarido

Some blood pressure monitors can analyze the correct cuff attachment, which is also important to obtain accurate readings.

To get truly objective, truthful results, it is very important to choose a high-quality apparatus and an experienced doctor to decipher the values. Cheap, low-quality instruments can give readings with a large error.

Research rules and techniques

Before using the device, be sure to read the instructions for it, and carry out all the actions according to the prescribed instructions. Otherwise, the tonometer may show inaccurate results or even break down.

For determining accurate readings and correct conduct procedures are recommended to follow these rules:

When using a shoulder tonometer, make sure that the lower edges of the cuff are positioned higher elbow joint one or two fingers;
To obtain more accurate readings during blood pressure measurement (the beginning of the measurement can be felt by squeezing the cuff), it is not recommended to move. If it so happens that the movement cannot be stopped, the hand on which the device is fixed should be kept free, relaxed and motionless throughout the measurement time (the device beeps before starting the measurement);
Before going to bed, remove the device (without detaching it from the cuff) and place it next to the pillow or on the bedside table;
Do not pinch the tubing that connects the monitor to the cuff. If the compressor of the monitor is functioning and the cuff does not inflate, the condition of the tube and the reliability of the connection should be checked;
If the conditions for measurement are unsuitable (there is no way to ensure the hand is still), it is better to stop the measurement by pressing the "stop" button, after the set time the device will try again;
If it becomes necessary to remove the cuff, be sure to disconnect it from the monitor;
There should be a time indication on the monitor, if it is not there, this may mean that the device is discharged.

The objectivity of the results also largely depends on the correctness of the preparation and conduct of the procedure.

In order to prepare for the ABPM and ensure the conditions for obtaining accurate data, several actions should be performed before starting the procedure:

Since the device will work for a long time, you need to check if the battery is well charged;
Program the device for the data of a specific patient, set a certain interval through which the pressure will be measured;
Measure the size of the circumference of the forearm to find a suitable cuff;
Install the system: for right-handed people, the cuff is attached to the forearm of the left hand, for left-handers - on the right, in order to avoid displacement of the cuff. It is recommended to fix it with double-sided discs or adhesive tape.
The cuff can be fastened over the sleeve of a thin T-shirt or sweater. Soft cloth will not worsen the test results, but will help to avoid such unpleasant phenomena as sweating, skin irritation and itching.

It is very important not to think about it during the procedure, not to analyze the data yourself. Such thoughts can cause excitement and, accordingly, increase blood pressure.

During sleep, you also need to try to relax and not remember the procedure.

How is the daily monitoring of blood pressure and heart rate done? The procedure is very simple. The main thing is to read the instructions for the device, prepare the device, follow the doctor's instructions and not worry.

The classic way. A cuff is attached to the forearm or wrist, and a small device is connected to it (you can attach it to your belt or put it in your pocket). The device is installed by a doctor, after which instructions are given, and the patient is sent home. Pressure monitoring takes place in outpatient in the daytime and at night. The total duration of the procedure is 24-48 hours, during which the patient must wear the device. The number of measurements and their frequency is set by a specialist (usually within 50 times a day - every 15 minutes during the day and 30 minutes at night).
Holter monitoring. This method involves fixing two indicators at once: blood pressure and heart rate, which allows you to determine the presence of hidden pathologies and give a more detailed assessment of the condition of cardio-vascular system... In addition to the compact tonometer, small electrodes are fixed at certain points in the chest zone (they cannot be removed during the entire study), and the data is displayed on a special device. The pulse rate is calculated according to the principle of electrocardiography. The duration of the study is 24-48 hours, but by the decision of a specialist, the period can be extended several times.

You live your day as usual, unchanged. The main thing is to take care of the device and not to get hung up on measurements, as well as not to be afraid of squeezing the cuff.

After the allotted time, you need to come back to the appointment with the attending physician, remove the device and provide the diary data. Usually, test results are provided after a few days.

During the day, it is imperative to keep a diary in which all the moments associated with the ABPM are recorded, namely:

Data	Characteristic
Periods of activity	Walking, running, driving, watching TV, working at the computer, cooking and eating, different types physical activity- any activity must be recorded in a diary. At the same time, for each type of activity, the specific time of its implementation is indicated.
Rest periods	While sitting and lying down, note the length and quality of rest (presence of distractions or annoyances)
Dream	The period of going to bed is recorded with the obligatory designation of the time. If possible, mark the time of night awakenings and describe your condition.
Change in well-being	It is necessary to indicate cases when the patient felt headache, rapid heartbeat, palpitations, pain in the region of the heart, darkening in the eyes, dizziness, nausea. This column should also describe the change in condition after taking the prescribed drugs.
Food and medicine intake	Be sure to record the time when you ate, drank or had a snack, as well as took the prescribed medication. Additionally, you can specify the composition of the dishes and the name, dosage of drugs
Problems with the device	If during the measurement of blood pressure the cuff has fallen or twisted, this should also be noted with an indication of the time of the subsequent measurement of blood pressure.

The diary must be filled in as accurately as possible so that the doctor can objectively assess the results, make the correct diagnosis and prescribe adequate treatment. If it so happens that the device needs to be removed by yourself (for example, the time when the procedure ended was on a weekend), be sure to turn off the monitor. Do not remove the battery from the device, as the test results will be lost.

For a child, the method of performing ABPM does not differ, the procedure is carried out in the same way as in adults. There are differences only at the stage of decoding the results.

The readings taken by the tonometer during the ABPM are transferred to a personal computer. The results, as a rule, are deciphered by comparison with the average values, which are taken for 24 hours (eight of which are daytime, and eleven are nighttime). After analyzing the data, the doctor makes a conclusion.

The condition of a particular patient is assessed in comparison with blood pressure indicators, which are considered the norm. Have healthy person The following values are considered to be averages:

daily indicators: 120 (± 6) to 70 (± 5);
daily values: 115 (± 7) to 73 (± 6);
night values: 105 (± 7) to 65 (± 6).

The normal level of blood pressure during the daytime is considered to be 135 to 83 and at night: 120 to 70. If the values exceed 140 to 90 during the day and 125 to 75 at night, the pressure is considered high.

High pressure at night or insufficient decrease in pressure (normally during sleep, the blood pressure level decreases by 10-20%) may indicate the presence of a number of diseases or the risk of their development:

Chronic kidney disease.
Sleep problems, including insomnia.
Tumors of the adrenal glands.
Diabetes.
From the side of the cardiovascular system - stroke, hypertension, ischemia, angina pectoris, myocardial infarction, hypertrophy, etc.

The heart rate indicates the state of the heart: if the heart rate reaches 90 or more beats per minute, it may be a tendency to develop tachycardia. If the heart rate is less than 60-50 per minute, this indicates the development of bradycardia.

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Diagnosis of hypertension is the only method that allows you to cope with the disease for another initial stage development. To establish a diagnosis, it is necessary to constantly measure blood pressure.

Two methods are used to measure it:

auscultatory;
oscillometric.

The listed methods are widely used when using household research devices. Fixing indicators in the daytime is not difficult, but how to fix the pressure at night?

To diagnose blood pressure within 24 hours, use daily blood pressure monitoring. It is called - SMAD.

This technique gives a complete, dynamic picture of changes in blood pressure levels during the day.

Indications for performing ABPM

The appointment for daily monitoring is given by the attending doctor.

More often this technique carried out at:

identification of hypertension or hypotension;
when determining the severity of the course of arterial hypertension, depending on blood pressure;
assessment of the effectiveness of conservative and drug treatment;
frequent headaches, attacks of fainting of unexplained etiology;
appointment of examination of a patient with specific diseases (diabetes mellitus, myxedema, etc.).

The ABPM technique allows you to measure the pressure level in an automatic mode, using special equipment - a "monitor".
The device works according to a given program, reading the indicators of heart rate and blood pressure. Automatically writes them to diurnal profile sick. The device also records peak blood pressure readings, which are also recorded in the device's memory.

It has been noticed that in some patients the level of pressure decreases significantly at night. Because of this, the drug effect is adjusted for the morning hours. Such actions are necessary for the patient, since a strong decrease in pressure at night can cause a violation of the blood supply to vital organs (heart or brain). This approach to treating hypertension is called chronotherapy.

How is the daily pressure monitoring carried out?

The full cycle of the study of blood pressure is carried out during the day. The technique involves measuring pressure by means of a mobile device, which is attached to a belt or slung over the shoulder. Moreover, the weight of the device does not exceed 300 grams.

The fixation of indicators takes place on an outpatient basis! In this case, the patient continues ordinary life, without restrictions in the mode of the day or work.

The patient can perform everyday activities, but with one amendment. At the time of taking readings, the hand must remain motionless. After fixing the indicators, they are entered into. His records record all the actions that the patient performed during the day.

These include: the time of waking up, traveling, resting, working, taking food or medicine, taking action, etc.

During the ABPM, it is necessary to note the manifestations of dangerous symptoms in the diary:

heart pain;
headache;
dizziness;
dark spots in the eyes.

The indicators are taken in automatic mode, practically without human intervention.

Daily measurements of blood pressure are taken by the device at specified time intervals. During the day they are equal to 15 minutes, and at night, most often - 30 minutes.

The device records the incoming data in real time. He reads the heart rate for a certain period of time, set by the doctor on an individual basis. At the end of the study, the patient is sent to the clinic, where the equipment is removed from him and given for decryption. The conclusion of the specialist and the finished results are given to the attending physician.

The advantage of SMAD

This technique allows you to objectively track all changes in blood pressure in a patient, regardless of his physical or psycho-emotional activity. ...

ABPM allows you to draw up the correct course of treatment, as well as track the consequences of the prescribed therapy as efficiently as possible. In this case, it is possible to regulate the drug effect on the patient's body and monitor the patient's improvement after taking a particular drug.

The data obtained in the course of the methodology make it possible to confirm or deny the diagnosis of arterial hypertension. They help to find out the factors of impairment of the patient's well-being and make it possible to understand the cause of fainting. The attending physician, based on these results, prescribes correct treatment taking into account all the hemodynamic characteristics of the patient. Also, the research indicators allow for more adequate therapeutic actions.

The technique is completely safe. The only drawback is the inconvenience in the shoulder area at the time of inflation of the cuff. In addition, the patient is not allowed to take a bath or shower, as this may damage the device.

The total number of blood pressure measurements should be at least 50 times.
With mild hypertension, the measurement interval is 15 minutes (day), and 30 minutes (night).
In severe hypertension, the measurement interval is 30 minutes (day), and 60 minutes (night).

The 24-hour blood pressure monitoring technique is quite accurate. Many devices are immune to interference and external influences... but a large number of measurements are rejected during automatic verification and subsequent expert interpretation of the data.

THERE ARE CONTRAINDICATIONS
NECESSARY CONSULTATION OF THE ATTENDANT DOCTOR

The author of the article Ivanova Svetlana Anatolyevna, therapist

In contact with

This is an indicator that determines with what force the blood presses on the walls of blood vessels during movement. Figures that are not within the acceptable range indicate the presence of pathology in the body, requiring diagnostics and the appointment of therapy. One-time measurement of pressure readings is often not enough. Its fixation is required in dynamics (24-hour monitoring of blood pressure - ABPM). What is this diagnostic method and how it is carried out is discussed in the article.

The meaning of research

A special device is attached to the patient who is being diagnosed, which records blood pressure indicators for 24 hours. The measurement is carried out automatically and has a certain periodicity.

If the patient is measured pressure indicators at the reception, due to excitement, the numbers may show improved results... Daily monitoring of blood pressure, the rules for which are discussed below, allows you to record indicators at home, in a calm, comfortable and familiar atmosphere. The study can be carried out while the patient is in the hospital.

How does the device work?

The device "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, the indicators are recorded in dynamics.
Rubber tube - connects the cuff and the recorder.
Cuff - worn on the arm (middle shoulder, heart level). Air is injected into it, and then air is released.
Sensitive sensor - is attached under the cuff and records the moments of appearance and disappearance of pulse waves.

Throughout the day, the 24-hour blood pressure monitor records results every 15 minutes. During the night's rest period, blood pressure is measured every 30 minutes. All data remains in the memory of the device.

Research rules

If the patient is prescribed daily monitoring of blood pressure, how the procedure is carried out is explained to him by the attending physician. The specialist must instruct on the rules of conduct during the diagnostic period in order to obtain reliable results:

if necessary, drug prescriptions are canceled;
rejection of significant physical activity;
prohibition of taking water procedures;
night sleep should be full so as not to distort the monitoring indicators;
clothing should be light so that the cuffs do not squeeze the patient's arms;
the daily routine should be habitual;
during the period of air injection into the cuff, the subject should lower his arm down, straightening along the body, and stop;
constantly make sure that the rubber tube is not bent, and the cuff remains in place;
if the patient has a high sensitivity, the doctor prescribes him to take sleeping pills or sedatives at night.

The nurse gives the patient a special diary, where it is necessary to record data on his health, physical activity, drugs used (if the doctor has not canceled them at the time of diagnosis), to record the time of sleep.

There is a possibility of examining pregnant women. Women who are at risk are diagnosed three times. The first time at the first visit to a specialist for registration, then in the second trimester and just before childbirth. This procedure allows you to prevent the development of complications from the fetus and the mother's body.

Holter monitoring

Simultaneous blood pressure measurement and recording ECG indicators throughout the day - modern method diagnostics of most cardiovascular pathologies, allowing to determine even latent forms.

This method was developed by the American scientist Holter. On chest the examinee is attached to electrodes, 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, which measures blood pressure.

In case of controversial issues, it can be extended for several days (even up to a week). The advantages of the method are that the device allows you to record the slightest changes in the heart rate, which is not always possible with a conventional ECG.

Holter monitoring is performed in patients who have the following symptoms:

pressing pain behind the sternum, radiating to the scapula, shoulder, arm;
night pain in the left side of the chest;
shortness of breath accompanied by cough;
feeling of sinking heart;
frequent dizziness or fainting.

Obesity, burns skin in places where the electrodes are required to be applied - contraindications to the procedure (only due to the impossibility of correct fixation of the device).

Indications

Required to diagnose the following conditions:

Hypertension. Its possible forms are nocturnal hypertension, "white coat hypertension", latent, during pregnancy.
Hypotension - chronic, orthostatic, sudden fainting.
Pathology of the autonomic nervous system.
Monitoring the effectiveness of the drugs used in dynamics.
Insulin-dependent diabetes mellitus.
Elderly patients.
Resistance to the therapy of essential hypertension.

Statistics show that most often ABPM is carried out in order to clarify how effective antihypertensive drugs are in the use.

Contraindications

24-hour blood pressure monitoring is not used if:

mechanical injuries to the hands when compression and cuff application are impossible;
skin pathologies on the upper and lower extremities;
exacerbation of diseases accompanied by blood clotting disorders;
vascular pathology associated with a change in blood permeability or vascular rigidity;
the presence of complications of the underlying disease;
complications after previous daily monitoring.

Diagnosis is carried out in a hospital setting if systolic blood pressure values exceed 200 mm Hg. and there are violations of the cardiac conduction system. Such conditions require increased caution.

Method advantages

Daily blood pressure monitoring has huge advantages over one-time measurements. The method allows you to assess how exactly the indicators change and at what time of the day. Based on the research, the specialist selects drugs for a specific individual clinical case.

In addition, daily monitoring of blood pressure, the instructions for which indicate a significant simplification of the diagnosis of the underlying disease, allows you to determine false-negative cases of research. A one-time measurement can show numbers that fit into the acceptable range, but in fact the patient is hypertensive.

The main advantages of the method:

fixation of blood pressure over a long period of time;
the ability to use in a familiar calm atmosphere;
data logging during night rest;
determination of short-term variability in blood pressure;
irreplaceable aid 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 in the hand, although it passes quickly. Rashes and diaper rash may appear under the cuff.

Another drawback is that the procedure is paid, in contrast to a one-time blood pressure measurement.

Assessment of research results

After 24 hours from the moment of fixing the device on the patient's body, the data obtained are assessed.

The indicators are entered into a special computer program, which allows you to determine the presence of short-term pressure variability, evaluate the morning results, calculate the hypotension index and compare with the average values:

daily indicator - blood pressure 120 ± 6/70 ± 5;
morning figures - blood pressure 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 make it, the attending cardiologist will tell you. In the conditions of the polyclinic, such examinations are not carried out due to the lack of the necessary devices. The procedure is available in cardiology hospitals or specialized diagnostic centers.