Ambulatory Blood Pressure Monitoring

Ambulatory Blood Pressure Monitoring commonly referred to as ABPM, is a comparatively newer technique that helps to monitor the blood pressure of a patient while performing normal day to day activities. This helps the doctors to determine how the fluctuations in the blood pressure levels are associated with the patient’s sleep pattern and daily routine. Ambulatory Blood Pressure Monitoring may be recommended to:

• Pregnant women with elevated blood pressure levels
• Patients with “borderline” hypertension
• Patients who do not respond well to the medication for controlling hypertension.
• Fluctuation in blood pressure levels due to the use of certain drugs
• Syncope or low blood pressure.

Systolic blood pressure alleviates by almost 10 to 20 per cent while a person is sleeping. However, in some cases, the blood pressure escalates instead of decreasing. Ambulatory Blood Pressure Monitoring can help to detect the abnormal fluctuations that usually go unnoticed. This makes it very ideal for detecting coat hypertension, masked hypertension, and sustained hypertension:

• White coat hypertension – People who do not take antihypertensive drugs usually have escalated blood pressure readings when recorded using the standard method in a medical setting.This happens because the blood pressure of a person can escalate due to stress and a lot of people feel tense while they are in hospitals or clinics which adds to the problem. Around 15 to 30 per cent of the people detected with hypertension face this problem.
• Masked hypertension: This happens when a person’s blood pressure readings are normal when taken at a clinic or a hospital but escalate at home. Around 20 per cent of the people suffering hypertension face the problem.
• Sustained hypertension: This happens when a person’s blood pressure readings are mostly on the higher side whether taken at home or in a medical setting. This is usually a result of chroniccardiovascular and renal damage.

Uses of Ambulatory Blood Pressure Monitoring

• It can help to establish the diagnosis of hypertension
• It can be used to identify patients with white coat hypertension
• It is used to decide whether a particular patient needs medication or not
• It helps to determine if the patient’s medication or dosage needs to be changed
• It can help to assess how a person’s blood pressure fluctuates at night.

Interpreting Ambulatory Blood Pressure Monitoring Results

A person is diagnosed with hypertension if the average blood pressure is higher than the following values:

• 24-hour Average: Systolic blood pressure > 135 mmHg or diastolic blood pressure >80 mmHg.
• Average for “Awake” Hours: Systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg.
• Average for “Asleep” Hours: Systolic blood pressure > 124 mmHg or diastolic blood pressure > 75 mmHg.

Precautions and risks:

The patient is required to wear the device at all time, even while he/she is sleeping. This should not be removed during the monitoring period. The patient should avoid swimming or taking a shower as it may damage the device and interfere with readings.

The patient is also required to maintain a record of all the activities that might interfere with the blood pressure readings.

Benefits of 24-hour ambulatory blood pressure monitoring

• Ambulatory blood pressure monitoring can help to rule out the possibility of white coat hypertension, thereby preventing the prescription of unnecessary blood pressure-lowering drugs.
• Ambulatory blood pressure monitoring can help to assess the risks of cardiovascular problems like stroke as well as organ failure due to increased hypertension by enabling the doctors to take the necessary measures.
• Ambulatory blood pressure monitoring can help to monitor the effectiveness of antihypertensive medication on patients by evaluating their response to the same. Disadvantages of 24-hour blood pressure monitoring
• Patients might experience slight discomfort while the apparatus is attached to them.
• There might be slight soreness and rashes in the arm due to repetitive inflammation of the arm cuff.
• The readings may fluctuate while the patient is sleeping.