Ambulatory blood pressure monitoring
Ambulatory blood pressure monitoring (Holter BP monitoring) involves the automatic measurement of blood pressure at predetermined intervals over a period of 24 hours or more, during which the patient engages in their usual daily activities.
The purpose of this study is to record blood pressure readings in the patient's normal living conditions, outside a medical facility, in an automatic manner, allowing the physician to better understand the severity and progression of the disease under treatment.
Indications
This procedure is useful for the accurate diagnosis of arterial hypertension under specific conditions and for better monitoring of patients already diagnosed with arterial hypertension, to refine the effectiveness of the prescribed treatment.
It is often prescribed by a physician in the following situations:
- For initial diagnosis and assessment of the severity of arterial hypertension, especially in unclear cases: elevated blood pressure readings in isolation, undocumented symptoms that may suggest the presence of elevated blood pressure without corresponding documentation, significant differences between blood pressure values measured in ambulatory conditions and in the office: suspicion of "white coat" hypertension;
- With high readings in the office or "masked" arterial hypertension;
- With normal readings in the office and elevated readings in ambulatory conditions;
- For hypertensive patients on treatment, who are at risk of episodes of significant blood pressure reduction (hypotension) under certain conditions: upon standing from a sitting position, after meals, at a certain interval after taking medications, etc.;
- For patients suspected of having treatment-resistant arterial hypertension - to assess blood pressure levels during the night, especially in patients with sleep apnea, chronic kidney diseases, diabetes mellitus;
- When blood pressure may be elevated at night inappropriately, which is important for treatment and prognosis in these patients;
- For pregnant women with elevated blood pressure readings in the doctor's office or in the case of "pregnancy-induced" or pre-eclampsia arterial hypertension.
Test Procedure
Holter BP monitoring involves attaching a small device that records blood pressure values using a cuff similar to that used in routine blood pressure measurement.
Depending on the physician's indications for the study, the blood pressure cuff is inflated at specific time intervals (usually every 15 minutes during the day and every 30 minutes at night), and the device records systolic and diastolic blood pressures, as well as heart rate. The information is stored in the device's memory.
It is important to note symptoms occurring during physical activity during the registration period. During Holter BP monitoring, it is recommended to keep the arm in a relaxed position without bending at the moment of cuff inflation to avoid inaccuracies in recording.
Risks
Apart from the discomfort caused by periodic cuff inflation, which may be particularly bothersome at night, there are no risks associated with ambulatory blood pressure monitoring.
Preparation
Performing this procedure does not require any special preparation. There is no need to discontinue medication if the treating physician has prescribed this procedure.
It is important to note that during Holter monitoring, the device should not be exposed to water, so taking a shower/bath is not advisable.
Results
After completing the monitoring, the patient needs to see the doctor to remove the recording device and interpret the data.
The physician who prescribed the procedure will analyze the blood pressure values and their variation throughout the day, as well as the correlation of abnormal blood pressure values with symptoms reported by the patient, and formulate a report, usually including data related to maximum, minimum, and average readings during the monitoring period, as well as any decrease/increase in blood pressure during the night.
Based on this data, the physician will decide whether the patient needs adjustments to the prescribed treatment or further investigation.