Ambulatory BP monitoring (ABPM) summary.
🔹Standardized protocol for ambulatory BP monitoring
(From 2016 Canadian Guideline for HTN)
🔸The appropriate sized cuff should be applied to the nondominant arm unless the SBP difference between arms is > 10 mm Hg, in which case the arm with the highest value obtained should be used.
🔸The device should be set to record for a duration of at least 24 hours with the measurement frequency set at 20 to 30minute intervals during the day and 30to 60 minutes at night.
🔸A patient-reported diary to define daytime (awake), night-time (sleep), activities, symptoms, and medication administration is useful for study interpretation.
🔸Daytime and night-time should preferentially be defined using the patient’s diary. Alternatively, predefined thresholds can be used (eg, 8 AM to 10 PM for awake and 10 PM to 8 AM for night-time).
🔸The ambulatory BP monitoring report should include all of the individual BP readings (numerically and graphically), the percentage of successful readings, the averages for each time frame (daytime, night-time, 24 hours) and the “dipping” percentage (the percentage the average BP changed from daytime to night-time).
🔸Criteria for a successful ambulatory BP monitoring study are:
▫️At least 70% of the readings are successful and
▫️At least 20 daytime readings and 7 night-time readings are successful.
🔹Definition of hypertension based upon the data obtained from ABPM
(From Up To Date)
🔸24-hour average BP:
Normotension is defined as a BP less than 130/80 mmHg
Hypertension is defined as a BP greater than or equal to 135/85 mmHg
🔸Daytime (awake) BP:
Normotension is defined as a BP less than 135/85 mmHg
Hypertension is defined as a BP greater than or equal to 140/90 mmHg
🔸Nighttime (asleep) BP
Normotension is defined as a BP less than 120/70 mmHg
Hypertension is defined as a BP greater than or equal to 125/75 mmHg
PATTERNS INTERPRETATION:
Dipping pattern means lower BP at night than day.
Non dipping same BP at day and night.
Nondipping have been shown to be more closely associated with target organ damage and worsened cardiovascular outcome than in patients with essential hypertension with dipping pattern
Reversed dipping BP is higher at night
Reverse dipping (ie, the phenomenon characterized by higher nighttime compared with daytime blood pressure values) is an alteration of circadian blood pressure rhythm frequently documented in hypertension, type 2 diabetes mellitus, chronic kidney disease, and sleep apnea syndrome, and generally regarded as a harmful condition
Non dipping and reversed dipping is associated with LVH and high cardiovascular risk
🔹Standardized protocol for ambulatory BP monitoring
(From 2016 Canadian Guideline for HTN)
🔸The appropriate sized cuff should be applied to the nondominant arm unless the SBP difference between arms is > 10 mm Hg, in which case the arm with the highest value obtained should be used.
🔸The device should be set to record for a duration of at least 24 hours with the measurement frequency set at 20 to 30minute intervals during the day and 30to 60 minutes at night.
🔸A patient-reported diary to define daytime (awake), night-time (sleep), activities, symptoms, and medication administration is useful for study interpretation.
🔸Daytime and night-time should preferentially be defined using the patient’s diary. Alternatively, predefined thresholds can be used (eg, 8 AM to 10 PM for awake and 10 PM to 8 AM for night-time).
🔸The ambulatory BP monitoring report should include all of the individual BP readings (numerically and graphically), the percentage of successful readings, the averages for each time frame (daytime, night-time, 24 hours) and the “dipping” percentage (the percentage the average BP changed from daytime to night-time).
🔸Criteria for a successful ambulatory BP monitoring study are:
▫️At least 70% of the readings are successful and
▫️At least 20 daytime readings and 7 night-time readings are successful.
🔹Definition of hypertension based upon the data obtained from ABPM
(From Up To Date)
🔸24-hour average BP:
Normotension is defined as a BP less than 130/80 mmHg
Hypertension is defined as a BP greater than or equal to 135/85 mmHg
🔸Daytime (awake) BP:
Normotension is defined as a BP less than 135/85 mmHg
Hypertension is defined as a BP greater than or equal to 140/90 mmHg
🔸Nighttime (asleep) BP
Normotension is defined as a BP less than 120/70 mmHg
Hypertension is defined as a BP greater than or equal to 125/75 mmHg
PATTERNS INTERPRETATION:
Dipping pattern means lower BP at night than day.
Non dipping same BP at day and night.
Nondipping have been shown to be more closely associated with target organ damage and worsened cardiovascular outcome than in patients with essential hypertension with dipping pattern
Reversed dipping BP is higher at night
Reverse dipping (ie, the phenomenon characterized by higher nighttime compared with daytime blood pressure values) is an alteration of circadian blood pressure rhythm frequently documented in hypertension, type 2 diabetes mellitus, chronic kidney disease, and sleep apnea syndrome, and generally regarded as a harmful condition
Non dipping and reversed dipping is associated with LVH and high cardiovascular risk
