What is Ambulatory blood pressure monitoring? This is a diagnostic test to determine the presence of hypertension by taking measurements during normal daily activities.
What is the purpose of Ambulatory blood pressure monitoring? This allows a person’s blood pressure readings to be recorded over a 24-hour period, whether they are awake or asleep. It helps to diagnose as well as monitor high blood pressure (a systolic pressure of 140 mm Hg or more and a diastolic pressure of 90 mm Hg or more). It also calculates changes in heart rate, the blood pressure distribution pattern as well other statistics.
The monitoring is done with the aid of a portable blood pressure machine worn as a belt, with the cuff being attached around the upper arm. It yields many readings over a continuous period. Readings are taken at about every 15-30 minutes throughout the day and every half hour to one hour at night. The cuff is worn throughout the period and the machine can be kept under the pillow or beside the patient on the bed when they retire to sleep. The machine stores all the readings which are then analysed once it is removed and taken back to the hospital.
The monitor is attached at the hospital. The patient isn’t to change their normal routine to enable a more accurate picture of how the blood pressure changes in the course of different physical activities.
When the machine is about to take a reading, it issues a warning beep. When this happens, the patient should sit down if possible, check to see that the cuff tube is well positioned and not bent, avoid talking, keep the arm with the cuff at the same level as the heart and keep the arm as still as possible while the machine is taking the reading. The patient should also note the activity they were engaged in at the time of the reading, and also note the time they retired to sleep, woke up, and whether medication was taken at the time. The patient may need to keep some sort of diary for ease of recording.
For a couple of people who may not initially feel at ease with ambulatory blood pressure monitoring, their readings may be inaccurate or unreliable as such readings would reflect their emotional reactions rather than their blood pressures. It is best to communicate all concerns to your doctor or health care provider. Ask for explanations and clarification where necessary. Also recall that you may engage in all types of activities, including sleep, while wearing the machine.
Generally, the patient’s doctor or health care provider would determine whether or not they are to undergo ambulatory blood pressure monitoring. However, it is highly recommended for the following groups of people:
Pregnant women with hypertension
People with “borderline” hypertension (also known as prehypertension, this is a systolic blood pressure between 140 and 159 mm Hg and/or diastolic blood pressure between 90 and 94 mm Hg. Here, blood pressures are above the upper boundary of normal—120/80 mm Hg—but have not yet crossed into hypertensive territory)
People who experience fainting episodes or hypotension (low blood pressure)
If you have changed your prescription medications that may impact your blood pressure
People who experience difficulty in controlling blood pressure with medication
People who have experienced a change in blood pressure due to other drugs
Here are a few reasons why ambulatory blood pressure monitoring is recommended:
Unlike the one or two measurements taken during a normal clinic visit, ambulatory blood pressure monitoring adequately mirrors the normal variations in blood pressure as it takes multiple measurements
It yields the average or mean blood pressure, heart rate and some other parameters
It reveals if the blood pressure increases at night or while the patient is asleep
It can detect masked and sustained hypertension to enable patients receive the necessary treatment. Masked hypertension is when the blood pressure reading is normal in the hospital but high during normal activity. Sustained hypertension on the other hand, is a persistently high blood pressure which is associated with higher risk of heart attacks and renal injury
Surveillance of pregnancy with hypertension
Monitoring borderline hypertension
Useful in the case of refractory hypertension (uncontrolled blood pressure despite the use of antihypertensive agents of different classes)
It shows the effect of medications on controlling the blood pressure throughout the day (the normotensive effect of current medications)
It shows the heart rate of the patient
It helps predict the chances of stroke or heart attacks
Due to the fact that it gives an accurate picture of a patient’s blood pressure throughout the day and even when they are asleep, it can prevent unnecessary prescribing of hypertension-reducing medication for white coat hypertension. The “white coat effect” is an occurrence where the blood pressure measurements taken by a doctor in a hospital are on average 9/7 mm Hg—systolic/diastolic pressure—higher than corresponding readings obtained by a nurse or other trained practitioner in the same setting. This occurs in some people who don’t take blood pressure-lowering drugs and can result in misclassification of patients whose blood pressure is actually normal
It reduces the risk of stroke, heart disease and organ damage caused by hypertension
The above notwithstanding, if you fall under any of the categories of people listed as recommended to undergo ambulatory blood pressure monitoring, it doesn’t automatically mean that you must take the test. The final decision always lies with your doctor or health care provider. As always, each case is treated independently and the doctor or health care provider will make their decision after individual medical evaluation and their clinical impression in each case.
It should also be noted that there are still many undiagnosed cases of hypertension. It is therefore necessary for people to strive to take regular check-ups seriously. A lot of problems can be nipped in the bud if discovered on time. Book an appointment with your doctor today.
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