2. Introduction
History
ABPM v/s CBPM
Recommended Levels
Indications
Types
Various Clinical
Scenarios of ABMP
Ecquipment
Method Of
Measurement
Analysis.
3. A 40 year old male not a K/C/O HTN came to the
clinic for regular check up.
Patient blood pressure in sitting positions seems
to 150mmHg systolic and 90 mmHg diastolic.
Patient says his BP one week back in health
screen camp was 120/80 mmHg.
Will you start on Anti-hypertensives for this
patient ???
4. A 55 year old female comes to your clinic and
gives H/O varying BP levels at different
measurement at different places
HOME[self] BP measurements:140/90mmHg
CLINIC BP measurement:120/80mmHg
Medical Health camp:110/70mmHg
Should we start on Antihypertensives ?
5. Ambulatory blood pressure monitoring is one
of the key methods of BP measurement which
helps to elucidate conditions which are
otherwise undetectable or rarely discernable
by the clinic BP measurement.
Ambulatory blood pressure monitoring
involves measuring blood pressure at regular
intervals[usually every 20-30 minutes] over a
24 hour period while patient undergo normal
daily activites including sleep.
6. Ever since arterial blood pressure was first
measured by Stephen Hales’ more than 250 yeas
ago,
It has been understood that such pressure is not
static, but a constantly “varying” entity.
The development of ABPM originates with the
work of Maurice Sokolow ,an internist in San
Francisco.
It was introduced in late 1970’s.
7. ABPM CBPM
Shows BP behavior over a 24
hour period
Decision based on one or few
CBPM confined to short period of
the diurnal cycle
It can demonstrate the efficiency
of antihypertensive medication
over a 24 hour period
Decision based on one or few
CBPM confined to short period
ABPM can identify BP values in
Dippers ,Non dippers, isolated
HTN, Hypotension at night time
CBPM has no role in dippers and
non dippers
9. White coat hypertension
Masked hypertension
Deciding diagnosis in borderline hypertension
Elderly patients
Identification of nocturnal hypertension
Hypertensive patient resistant to treatment
As a guide to antihypertensive drug treatment
Hypertension in pregnancy
Diagnosis of hypotension
Episodic hypertension
Episodic hypotension
10.
11. Definition:
◦ Abnormal blood pressure>140/90mmHg in clinical
setting
◦ Normal daytime ABPM<135/85mmHg
Prevalence of White coat HTN:
◦ 15-30% General population
◦ 30% Pregnancy
Risks from white coat HTN :
◦ Considerably less than sustained Hypertension
◦ Probable small risk compared to Normotensives
◦ Possible a pre-Hypertensive State
◦ May be an entirely innocent condition
12. Few clinical characteristics to assist diagnosis
Must be considered in Newly diagnosed Hypertensives
Should be considered before Drug Prescribing
Must be placed in Context of overall Risk profile
Reassurance for Employment
Common in elderly and pregnancy
Less Drug Prescribing
Need for follow up and Pre Monitoring
13. It is defined when Office BP levels are normal in
an untreated Subjected and ABPM levels are
elevated.
It is present in 10-20% of subjects who are
considered to be normotensive according To
office BP measurements.
It is more common in diabetic patients.
Several studies have shown that Cardiovascular
risk in patients with Masked HTN is elevated in
similar to risk in patients with Sustained HTN.
14. Physiologically BP falls by > 10% during Night time
When BP raises >20% of Normal range it is called as
Dipping
When BP falls < 10% during Night time it as defined as
Non-Dipping
Nocturnal Non-Dipping is associated with increased
Risk of
◦ Stroke
◦ End Organ damage
◦ Cardiovascular Risk
◦ Diabetes
◦ Obstructive Sleep apnea.
◦ Diabetic Nephropathy
15. ◦ Normal Dipper :Average Decrease of BP>10% &<20%
◦ Extreme Dippers : >20% Fall
◦ Non Dippers : < 10% fall
◦ Reverse Dippers : Higher than Day time average.
16.
17. The use of ABPM in pregnancy is the
identification of white coat hypertension
which may occur in nearly 30% pregnant
women.
It is better predictor of hypertensive
complications.
Women with white coat HTN tend to have
more caesarean section than normotensive
women.
18. Early morning surge:
◦ The BP abruptly rises upon arising from sleep.
◦ The early morning BP Increases in conditions
like
Stroke
Cardiac Arrest
19. ABPM may guide management of HTN.
Progressive decrease in sleep BP in non-dipping
individuals reduces cardiovascular morbidity and
mortality and therefore should be a therapeutic
target.
Excessive usage of antihypertensive medication can
result in hypotensive episodes which can be clearly
elucidated with APBM data.
ABPM data can aid in distinguishing patients who
show “false or pseudo resistance and determine
whether additional therapy is needed.
20.
21. Device
Cuff
USB cable
CD ( Software )
It is essential to choose the correct CUFF size
because BP obtained from Oscillometric
devices may vary , depending on Cuff size
and Cuff arm Compliance.
22. Ambulatory BP monitors use cuff oscillometry.
The cuff is inflated until the pressure occludes flow
within the brachial artery.
As the pressure released , blood begins to flow
causing fluctuations[osscillations] in the arterial wall
that are detected by monitor.
These oscillations increase in intensity then diminish
and cease when blood is flowing normally.
The monitor defines the maximal oscillations as
mean arterial BP and then use an algorithm to
calculate systolic and diastolic BP.
23. When measuring 24-Hour blood pressure care
should be taken to follow certain procedures.
◦ Use only device validated by international protocols.
◦ Use cuff of appropriate size.
◦ Set automatic readings at not more than 30 min interval.
◦ Instruct the patient to engage in normal activity but not
to refrain from strenuous exercise.
◦ keep the arm extended and still at the time of
measurement.
24. The ABPM should be done on a normal work
day rather than a Rest day to obtain a typical
BP profile
The reading should be taken every 20-30
minutes during day and 30-60 minutes
during night to avoid interfering with activity
or sleep.
25. Several studies have shown that ABPM
predicts cardiovascular events better than
office BP levels.
ABPM was the most cost effective strategy for
diagnosis of HTN for men and women of all
ages.
It can prevent unnecessary treatment [in case
of white coat and false resistant
hypertension].
