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Advice from the BP Measurement Experts

9 Common Signs and Symptoms of High Blood Pressure

Symptoms of Hypertension

Since Blog @ SunTech launched in July 2009, there has been a great amount of knowledge shared about blood pressure and blood pressure technologies.

We have covered the importance of accurate blood pressure, ambulatory blood pressure, and even discussed selecting the correct size blood pressure cuff. All the topics we've covered are important, but in many cases, people with high blood pressure are unaware that they have an issue they need to accurately manage.

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High Blood Pressure Leads To Memory Troubles:

Memory problems

Another Reason for Accurate BP Measurement

While many people view blood pressure as simply two numbers, the importance of accurate blood pressure measurement continues to gain visibility. Typically, problems associated with high blood pressure cause us to think about heart disease, stroke, kidney failure and diabetes, but there is another negative effect of hypertension. This week, U.S. researchers released information that suggests people as young as 45 with high blood pressure are much more likely to have memory troubles.[1] The indicating factor was a high diastolic blood pressure (the bottom number).

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Ambulatory Blood Pressure Monitoring Used for “The Dr. Oz Show”

Dr. Oz uses ABPMOn Tuesday, September 22, The Dr. Oz Show explored how stress is destroying women's bodies and revealed an Ultimate Anti-Stress Checklist. Ambulatory blood pressure monitoring was used to assess how stress affected a busy mom's blood pressure throughout the day. The data produced an overall blood pressure profile which is a key indicator of her overall health. Dr. Oz pointed out a few hypertensive readings during the test, which were directly related to stressful tasks (e.g. her son spilling candy all over the grocery store).

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The Importance of Ambulatory Blood Pressure Monitoring...continued

Oscar 2 ABPM in use

Part 2 of 2: What is ABPM?  Why should I get a test? ABPM Blood Pressure Guidelines.

Most hypertension opinion leaders regard ambulatory blood pressure monitoring as the gold standard for risk assessment since it is superior to both clinic and home BP measurement [4],[5]. Ambulatory blood pressure monitoring (ABPM) is a 24 hour blood pressure test in which readings are taken every 15-30 min during the day and 20-60 min during asleep hours. To learn more about ABPM, please, check out this ABPM video.


Why should I get an ambulatory blood pressure test?

ABPM provides information which home BP and clinic BP cannot including:

  1. an estimate of true, or mean, blood-pressure level
  2. diurnal rhythm of blood pressure
  3. blood pressure variability

More benefits to ABPM are summarized in the table below.

Benefits of Ambulatory Blood Pressure Monitoring over Home BP and Office BP [4]

  ABPM
Home BP
Office BP
Mean (true blood pressure)
Yes Maybe No
White-coat hypertension Yes Maybe No
Masked hypertension
Yes Maybe No
Diurnal blood pressure rhythm Yes No No
Dipping status
Yes No No
Morning surge
Yes Maybe No
Blood pressure variability
Yes Maybe No
Duration effects of BP meds
Yes Maybe No

You can see from the table above that there are several key benefits to ABPM, but you may not know why they are important. I'll highlight a few on the list.

  • White-coat hypertension: White-coat hypertension is when a patient's BP is measured high in the office because the patient might be nervous in that environment. As many as 30% of diagnosed hypertensive patients are later found to have white-coat hypertension. It is important to differentiate between white-coat and sustained hypertension, since white-coat patients do not actually need anti-hypertensive medications.
  • Night-time BP: ABPM also provides a night-time BP profile. Night-time hypertension is correlated with higher risk of cardiovascular end outcomes.
  • BP medication assessment: Finally, ABPM is especially useful for recently diagnosed hypertension or the assessment of BP meds. As mentioned earlier, the majority of Americans with hypertension do not have it under control, but they may not know that. An ABPM test can help physicians prescribe the right medications to keep blood pressure in control and reduce future cardiovascular risk. In fact, when ABPM is incorporated into the hypertension diagnostic and treatment process, up to a 14% savings in the cost of healthcare has been calculated.[6]

What are blood pressure guidelines for ABPM?

Most people are familiar with the 140/90 mmHg guidelines for blood pressure. Blood pressure guidelines for ambulatory monitoring are a little lower. The American Heart Association recommends an overall 24-hr average of 130/80 or lower. The 7th Joint National Committee states that awake ambulatory bp measurements should be below 135/85 and asleep measurements should be below 120/75. The European Society of Hypertension (ESH) states that normal awake bp is 135/85, but optimal awake 130/80. The ESH also recommends that normal asleep bp is 120/70, but optimal asleep 115/65.

If you have any questions or comments regarding your experiences with ABPM, we'd love to hear about it!

 

Back to Part 1 of "The Importance of Ambulatory Blood Pressure Monitoring"

 


 

[1] http://familydoctor.org/online/famdocen/home/common/heartdisease/treatment/770.html

[2] World Health Organization. (2003). 2003 World Health Organization (WHO)/ International Society of Hypertension (ISH) statement on the management of hypertension. Journal of Hypertension, 21, 1983-1992.

[3] American Heart Association Statistics Committee and Stroke Statistics Committee. (2009). Circulation, 119, e21 - e181.

[4] Pickering, TG, Shimbo, D, and Haas, D. (2006). Ambulatory Blood-Pressure Monitoring. New England Journal of Medicine, 354, 2368-2374.

[5] Urbina, E. et al. (2008). Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment. A Scientific Statement from the American Heart Association Arthrosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension, 52, 433-451.

[6] Krakoff, LR. (2006). Cost-Effectiveness of Ambulatory Blood Pressure. Hypertension, 47, 29-34.

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The Importance of Ambulatory Blood Pressure Monitoring

Oscar 2 ABPM in use

Part 1 of 2: Defining Blood Pressure, Office and Home Blood Pressure Measurement.

In order to understand the importance of ambulatory blood pressure monitoring, one first needs to understand why blood pressure is important to measure. While hypertension specialists understand the value of ambulatory blood pressure monitoring, some family practice physicians don't understand the utility of ABPM over home blood pressure monitoring. Let's start with the basics....

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Hypertension in Children: The Importance of Patient Interaction

doctor and childAs a follow-up to our post, "Hypertension in Children: An Easier Method of Identification", the measurement and diagnosis of high blood pressure in children brings up another issue...the importance of how blood pressure is measured. Automated measurement is so prevalent with the use of home BP devices and patient monitors in hospitals and clinics that it is often assumed that automated techniques must always match the tried-and-true approach of manual measurement with a sphygmomanometer. Unfortunately, this is not always the case.

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Online Blood Pressure Measurement Resources

a simple guide to blood pressure

Since our initial blog post '10 steps to Accurate Manual Blood Pressure Measurement', we've had a few readers contact us seeking some more resources related to taking manual blood pressures and hypertension in general. Below are a couple of websites we've found helpful on these topics.

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Hypertension in Children: An Easier Method of Identification

Pediatric blood pressure

When you walk down a busy street or visit a popular fast food restaurant it's easy to see that we have a growing problem: obesity. Not only are a growing number of adults overweight, but now more children are becoming overweight. What may not be so obvious are the other risk factors that are generally elevated with obesity, one of which is blood pressure.

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