Ambulatory blood pressure monitoring (ABPM) also called Holter blood pressure (call ABPM to distinguish it from Holter arrhythmia) is a small computerized device approximately the same size of a cell phone. It is used to regularly test your blood pressure over the course of the day. The results will allow your doctor to know if your blood pressure requires medication to allow tighter control, or if further investigation is required.
It is a very effective technique and offers an insight into the blood pressure throughout the day, highlighting the circadian rhythm of blood pressure, since blood pressure does not behave similarly along day, accumulated evidence now points to greater prognostic significance of ABPM in determining risk for target-organ damage compared with that of office blood pressure measurements, where often the blood pressure usually higher (syndrome” white-coat “).
ABPM has evolved from a research tool of limited clinical use into an important tool for stratifying cardiovascular risk and guiding therapeutic decisions. Since there are a variety of criteria in the evaluation and interpretation of the results, it is necessary to present the current criteria for the use of this technique in clinical practice. Normal values of blood pressure through the ABPM differs from those taken in a timely manner, either in the office or by self-measurement at home, as well as if determined during the activity or during sleep.
Currently the ABPM is a method that not only evaluate the profile of blood pressure in hypertensive patients, but based on the same has been allowed always decides with greater certainty the correlation of morbidity and mortality than conventional point takes blood pressure. Therefore, the medical personnel involved in the evaluation and treatment of the hypertensive patient should be familiar with the method, its scope and limitations, to do a proper use for the benefit of patients. In the past 10 years, applications of ABPM in the diagnosis and management of hypertension have been well documented and the results of numerous studies have recommended its use, not only for diagnosis but also for the monitoring, evaluation and treatment of patient’s hypertensive.
With features and advantages of the ABPM, the treating physician can monitor and control blood pressure when the patient is at home/work, which ultimately allows the necessary information on the treatment, so that you can get optimal control of blood pressure in each patient. The resulting diagnostic possibilities allow proper diagnosis and monitoring of each hypertensive patient and facilitate the diagnosis of subtypes of hypertension.
Many studies have shown a close correlation between cerebrovascular measurements with ABPM and systolic and diastolic function, left ventricular hypertrophy, fundus changes, microalbuminuria, atherosclerosis, kidney damage and accidents that casual blood pressure determination performed in the physician’s office; the correlation of risk is directly related to the behavior of blood pressure, which is evaluated through the elements as the circadian variation: standard ” dipper ” or ” non-dipper ” load blood pressure, ambulatory pulse pressure and blood pressure variability .
The test is performed on an outpatient basis. The patient should seek medical center for placement of Holter monitor. To attach the monitor you have a cuff placed onto your arm, much in the same way as you would have done at your doctor’s surgery. A rubber cable comes from this cuff and is attached to the front of the blood pressure monitor itself. Once attached, the Blood Pressure Monitor is placed within a small pouch and then worn around your waist by way of a belt. The monitor will inflate the cuff and perform a blood pressure recording, usually every 15-20 minutes while awake and 20-30 min while sleeping. The record obtained is transmitted to a recording device that will store the data.
The patient will be given a diary to help with the analysis and to make a more accurate evaluation of your 24 hour blood pressure recording. The patient must keep a concise note of his activities as well as recording any symptoms he may have during the recording, along with their time, duration and circumstance. Log data obtained by the Holter monitor are then evaluated by a specialist in the context of daily activity recorded by the patient.
The monitors are automatic, lightweight, silent and it uses auscultatory or oscillometric methods to determine the pressure. (Our modern equipment working with both methods, we prefer to use auscultatory method, because it is more accurate than oscillometric). The auscultatory system uses a microphone and captures the values of blood pressure by the Korotkoff noises. The oscillometric system senses the oscillations of the arterial wall and calculates the systolic and diastolic values using a mathematical algorithm. Each system has its advantages, the auscultatory allows higher activities, however can be very sensitive to environmental sounds. The oscillometric, despite having a smaller margin of error, does not work well during physical activity, when there may be considerable movement artifact.
Meanwhile, the bracelet is connected to the recorder shall meet the requirements established by the consensus of the AHA -ACC, which vary in diameter and length as in the inflatable cuff, according to the patient’s arm; it shall be placed following the same established rules outlined above.
Some monitors are attached to an electrocardiogram in order to associate the R waves with Korotkoff sounds and reduce errors due noisy artifacts. There are other monitors that can simultaneously analyze the ST segment and rhythm (Holter) and take measurements of blood pressure.
The blood pressure of normotensive features a clear circadian rhythm. Values tend to reach the same maximum value during daylight hours and decrease to reach its minimum value around midnight. In the early morning, with the awakening and the beginning of the activities the pressure increases rapidly reaching levels of day in a relatively short time. The activity of the patient at the time of measurement of pressure is a major determinant of the same and can affect hypertensive disease.
Requirements for examination and recommendations: (Only for patients between 18 and 75 years with written physician’s order)
- Request an appointment, take note of the date and time of placement ( Monday through Thursday , preferably 8:00 am).
- Assist exactly when you are instructed to place and remove the equipment, because it needs to be downloaded, processed and deleted to be used on other patients. You WILL NOT require a medical consultation. The setting time is about 10 minutes.
- You can eat food, not need of fasting.
- You must bring the physician’s order.
- You should take a bath before putting the device, because during the monitoring can not showering, whilst wearing the monitor to be removed. You should not use creams, powders, oils, colonies, as this may damage the equipment
- Be careful not to get the Blood Pressure Monitor or cuff wet.
- You must bring a preferably open loose comfortable clothing with buttons below. Wear a two-piece outfit with a loose top, as you will need to remove your top (women may keep their bra on). Your top will also need to be placed comfortably over the cuff that will be placed on your arm.
- Keep taking all medications as directed by your physician, especially antihypertensive.
- It is important for the patient to continue with their everyday daily activities, except bathing and exercise.
- AVAILABLE BRACELETS FOR OBESE PATIENTS!
You can request the completion of this test in our office (Monday-Thursday), with immediate availability, both for those patients seen by our practice and those with other treating physician.
The exam includes:
- Determination of ambulatory blood pressure for 24 hours with auscultatory and oscillometric dual methods.
- Interpretation of results with recommendations and suggestions for the applicant therapeutic study doctor.
- Detailed report by email of blood pressure and heart rate behavior (24 hours), statistical analysis of the results obtained in both active period and rest period graphic media trends and outcome data, delivered in 24 working hours.
- Payment is accepted by credit and debit cards (Visa, MasterCard and Maestro)