24-Hour Blood Pressure Monitor

Gold standard test for diagnostics of high blood pressure (hypertension)

The clinic blood pressure is a simple but powerful predictor of cardiovascular risk. The clinic blood pressure can however widely fluctuate and often be elevated due to stress in an unfamiliar environment (so called ‘white coat hypertension’ although nowadays most doctors don’t wear white coats!). Wrong diagnosis of high blood pressure may mean unnecessary life-long treatment with medication with potential side effects.

Sending patients home with recorders in position is common practice. It gives a much better idea of what is happening with the blood pressure during your day-to-day activity, than when recording is taken during a visit to the doctor in the clinic. NICE (National Institute of Clinical Excellence) recommends 24-hour blood pressure (BP) monitoring as a gold standard in diagnostics of hypertension. 24-hour BP monitor records the blood pressure every 30 minutes during the day and every hour at night with a pressure cuff fitted to your arm. Upon completion of the test, the data are downloaded to computer and individual reading analyzed to give day time, night time and 24 hour average for your blood pressure.

The monitor is about the size of a mobile phone and attached to a belt or hung around the neck. You will be asked to keep a diary of any symptoms so that their correlation to the recorded blood pressure is possible. You should go about your normal daily routine as usual with the monitor in place to get a representative recording of your blood pressure.

Indications

  • To confirm or exclude hypertension in a patient with borderline clinic blood pressure readings
  • To assess the degree of blood pressure control in patient with known and treated hypertension
  • To assess the effectiveness of new or changed medication on blood pressure control
  • To see if low blood pressure (hypotension) is responsible for symptoms such as tiredness, breathlessness, dizziness and blackouts

Risks and complications

24-hour blood pressure monitor is a noninvasive test and there are no known risks with this investigation. Some people do not like the feeling of the cuff tightening on their arm but this is nothing to worry about.

Before the procedure

The 24-hour blood pressure monitor, if indicated, will normally be attached immediately after the consultation with Dr Ruzicka. Occasionally, if no monitor is available, you will be asked to come for monitoring on a separate occasion. The procedure will be explained and you will be offered the opportunity to ask any questions about the test.

You will be asked to remove all your clothing above the waist, excluding any underwear and to sit. A cuff will be placed around your arm and attached to the recorder. The recorder works automatically and will take your blood pressure in the same way as the doctor does, by tightening the cuff and slowly releasing it. It will do this every 30 minutes during the day and every hour at night. The monitor box may be worn over the shoulder like a shoulder bag, or it may clip to a belt or pocket.

You will be given a diary card. You should record any symptoms you have, the time you had them (including whether it is am or pm) and what you were doing at the tame you had the symptoms. This is helpful when playing through the recording to compare your symptoms with what your blood pressure is actually doing. You will also be asked to record when you go to bed, when you get up and what medication you are taking and when. The whole process takes approximately 15 minutes.

During the procedure

Once the monitor has been hooked up and you received instructions, you can return to your usual activities, such as work, household chores and exercise. You should go about your normal routine so that a representative recording of your blood pressure can be obtained.

You will be instructed to keep a diary of your activities. You should write down the date and exact time of your activities and corresponding symptoms, such as chest pain, breathlessness, dizziness or lightheadedness.

After the procedure

You must return the following day to have the recorder removed, a visit lasting approximately 5 minutes. The recording will be played through and analyzed. The report will be discussed with you during follow-up appointment and depending on the result, an appropriate action will be taken. You will be able to resume your normal activities; there is no special care following blood pressure monitoring.


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