Ambulatory blood pressure monitoring involves measuring blood pressure at regular intervals over 24 hours using a portable monitor worn by patients as they go about normal daily activities. It provides average systolic and diastolic blood pressure readings for 24 hours as well as separate daytime and nighttime averages. ABPM is recommended by guidelines for diagnosing white-coat hypertension, masked hypertension, nocturnal hypertension, and assessing patients with suspected hypertension despite treatment or those at high risk of cardiovascular events.

1. Avoid extremely intense ideology because it ruins your mind
-Charlie Munger
AMBULATORY BP MONITORING
INTRODUCTION
Hypertension increasing prevalence
AHA/ASA guidelines 2017 stress on proper and accurate recording as the most important
step
Practical definition of hypertension is ‘the level of BP at which the benefits of treatment
outweigh the costs and hazards
Accurate BP measurement is vital for diagnosis and monitoring
- Created with love
by Dr. Eashan Srivastava

2. Avoid extremely intense ideology because it ruins your mind
-Charlie Munger
Two techniques have been developed to improve the estimate of true blood pressure
1) Ambulatory monitoring
2) Home monitoring (or self-monitoring).
ABPM DEFINTION
Involves measuring blood pressure (BP) at regular intervals (usually every 20–30 minutes)
over a
24 hour period while the patients undergo normal daily activities including sleep
DEVICE
The portable monitor is worn on a belt connected to a standard cuff on the upper arm
When complete, the device is connected to a computer that prepares a report of the 24 hour,
day time, night time, and sleep and awake (if recorded) average systolic and diastolic BP and
heart rate.
- Created with love
by Dr. Eashan Srivastava

3. Avoid extremely intense ideology because it ruins your mind
-Charlie Munger
TECHNIQUE
Use cuff oscillometry
Cuff is inflated until the pressure occludes flow within the brachial artery
As the pressure is released, blood begins to flow causing fluctuations (oscillations) in the
arterial wall that are detected by the monitor.
These oscillations increase in intensity then diminish and cease when blood is flowing
normally.
The monitor uses an algorithm to calculate systolic and diastolic BP.
DEFINTION OF HT
24 hour average <115/75 mmHg (hypertension threshold
130/80 mmHg)
Day time (awake) <120/80 mmHg (hypertension threshold 135/85 mmHg)
Night time (asleep) <105/65 mmHg (hypertension threshold 120/75 mmHg).
INDICATIONS FOR ABPM
Suspected white-coat hypertension (including in pregnancy)
Suspected masked hypertension (untreated subject with normal clinic BP and elevated ABP)
Suspected nocturnal hypertension or no night time reduction in BP (dipping)
Hypertension despite appropriate treatment
Patients with a high risk of future cardiovascular events (even if clinic BP is normal)
Suspected episodic hypertension
Titrating antihypertensive therapy
Borderline hypertension
Hypertension detected early in pregnancy
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by Dr. Eashan Srivastava

4. Avoid extremely intense ideology because it ruins your mind
-Charlie Munger
Suspected or confirmed sleep apnoea
Syncope or other symptoms suggesting orthostatic Hypotension
WHITE COAT HYPERTENSION
Clinic blood pressure of 140/90 mm Hg or higher on at least three occasions, with at least two
sets of
measurements of less than 140/90 mm Hg in non-clinic settings, plus the absence of
target-organ damage.
MASKED HYPERTENSION
Normal clinic blood pressure and a high ambulatory blood pressure.
The clinic blood pressure of patients with masked hypertension may
underestimate the risk of cardiovascular events.
ABPM AS PART OF NICE GUIDELINES 2011
- Created with love
by Dr. Eashan Srivastava

5. Avoid extremely intense ideology because it ruins your mind
-Charlie Munger
- Created with love
by Dr. Eashan Srivastava