Daily monitoring of blood pressure: the rules for conducting

Arterial pressure is an indicator that determines how much blood pressure is applied to the walls of blood vessels during movement. The figures that are not within the limits of the permissible, indicate the presence of pathology in the body, which requires the diagnosis and the appointment of therapy. One-time measurement of pressure values is not enough. It requires fixation in dynamics (daily monitoring of blood pressure - SMAD). What is this diagnostic method and how is it conducted, is considered in the article.

Sense of research

On the patient, who is being diagnosed, a special device is fixed, fixing blood pressure values for 24 hours. The measurement is automatic, has a certain periodicity.

If the patient measures the pressure at the reception, because of the excitement, the numbers can show increased results. Daily monitoring of blood pressure, the rules of which are discussed below, allows you to record indicators at home, quiet, comfortable and familiar atmosphere. The study can also be conducted at the time when the patient is in the hospital.

How does the device work?

The device "Daily monitoring of arterial pressure" is attached to the patient's body. Its components are as follows:

1. The registrar is a device that is fixed on the patient's belt. With it, records are recorded in the dynamics.
2. Rubber tube - connects the cuff and the recorder.
3. The cuff is put on the arm (the middle part of the shoulder, the level of the heart). It injects and then bleeds air.
4. Sensitive sensor - attached under the cuff and fixes the moments of appearance and disappearance of pulse waves.

Throughout the day, the device for daily monitoring of blood pressure records the results every 15 minutes. During the night rest, blood pressure is measured every 30 minutes. All data remains in the device memory.

Research Rules

If the patient is assigned 24-hour blood pressure monitoring, how the procedure is performed, the treating doctor explains to him. The specialist must instruct about the rules of conduct during the diagnosis period in order to obtain reliable results:

• If necessary, medical appointments are canceled;
• Refusal from significant physical exertion;
• Prohibition of 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 hands;
• The mode of the day should be familiar;
• During the period of air injection into the cuff, the examinee should lower his hand down, straighten along the trunk, to stop;
• Always ensure that the rubber tube is not bent, and the cuff remains in place;
• If the patient has high sensitivity, the doctor prescribes to him the use of sleeping pills or sedatives for the night.

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

There is an opportunity to conduct a survey of pregnant women. Women who are at risk are diagnosed three times. First time at the first reference to a specialist for registration, then in the second trimester and before the very birth. This procedure prevents the development of complications from the fetus and the mother's body.

Monitoring by Holter

Simultaneous measurement of blood pressure and fixation of ECG values throughout the day is a modern method of diagnosing the majority of cardiovascular pathologies, allowing to determine even hidden forms.

This method was developed by the American scientist Holter. The electrodes are attached to the patient's chest, which fix the 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 that measures blood pressure is attached to the patient's shoulder.

In case of controversial issues Holter monitoring can be extended for several days (even up to a week). Advantages of the method is that the device allows you to fix the slightest changes in the heart rate, which is not always possible with the usual ECG.

Holter monitoring is carried out by patients who are troubled by the following symptoms:

• Pressing pain behind the sternum radiating to the scapula, shoulder, arm;
• Night pain in left side of thorax;
• Dyspnea followed by cough;
• A feeling of sinking heart;
• Frequent dizziness or fainting.

Obesity, burns of the skin in places where the electrodes are needed is contraindications to the procedure (only because the apparatus can not be fixed correctly).

Indications

Daily monitoring of blood pressure is necessary to diagnose the following conditions:

1. Hypertension. Its possible forms are hypertension of the night type, "hypertension of white coats", hidden during pregnancy.
2. Hypotension - chronic, orthostatic, sudden syncope.
3. Pathology of the autonomic nervous system.
4. Monitoring the effectiveness of the drugs used in the dynamics.
5. Insulin-dependent diabetes mellitus.
6. Patients of advanced age.
7. Resistance to the treatment of hypertension.

Statistics show that most often SMAD is conducted in order to clarify how effective anti-hypertensive agents are used in the application.

Contraindications

Daily monitoring of blood pressure is not used if there are:

• Mechanical damage to the hands, when compression and cuff application are not possible;
• Skin pathologies on the upper and lower limbs;
• Exacerbation of diseases accompanied by blood clotting disorder;
• Vascular pathology associated with changes in blood flow or rigidity of blood vessels;
• Presence of complications of the underlying disease;
• Complications after the previous 24-hour monitoring.

Diagnosis is performed in a hospital setting if the systolic pressure exceeds 200 mm Hg. And there are violations of the conduction system of the heart. Such conditions require increased caution.

Advantages

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

In addition, daily monitoring of blood pressure, the instruction of which indicates a significant simplification of the diagnosis of the underlying disease, allows to determine false negative cases of the study. A one-time measurement can show numbers that fit within an acceptable framework, but in fact the patient is hypertensive.

The main advantages of the method:

• Fixation of blood pressure over a long period of time;
• The possibility of using in a familiar quiet atmosphere;
• Data registration during night rest;
• Definition of short-term variability of blood pressure;
• Irreplaceable help in the therapy of patients with serious pathologies (stroke, heart attack, cerebral circulation disorder).

Disadvantages of daily monitoring

The main disadvantage, according to the patients, is the feeling of discomfort during the air injection into the cuff. There is a feeling of numbness of the hand, although it quickly passes. Under the cuff may appear rashes, intertrigo.

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

Evaluation of research results

After 24 hours from the moment of fixation of the device to the patient's body, the data obtained are evaluated.

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

• Daily indicator - blood pressure 120 ± 6/70 ± 5;
• Morning figures - blood pressure 115 ± 7/73 ± 6;
• Evening indices - blood pressure of 105 ± / 65 ± 5.

An important diagnostic procedure for clarifying the presence of pathology is daily monitoring of blood pressure. Where to make it, will tell the treating cardiologist. In the conditions of a polyclinic, such examinations are not carried out because of the lack of necessary apparatuses. The procedure is available in cardiology hospitals or diagnostic profiling centers.