When you go to see a doctor, you definitely get your blood pressure checked, right? They put a cuff on your arm, pump it up, and take a reading. But think about it, can the reading you take at that moment really give you a complete picture of what's going on in your body? Probably not. That's when your doctor tells you about a special way to check your blood pressure 24 hours a day. That's what we're talking about today.
Simply put, what is Ambulatory Blood Pressure Monitoring?
It's very simple. It involves continuously measuring your blood pressure for 24 hours, while you go about your normal daily activities. It also takes readings while you sleep. It uses a small machine. A cuff is placed around your upper arm, and it's connected to a small radio-sized machine that you can wear around your waist with a small tube.
Usually, your doctor will only check your blood pressure once or twice a day. But with this method, they take readings many times throughout the day. To be precise, the strap will automatically tighten and measure your blood pressure every 15-30 minutes during the day and once an hour at night while you sleep . Not only that, it can also measure your heart rate. At the end of the day, using all these readings, the doctor will be able to get a very clear idea of your blood pressure.
Why do we do a test like this? What can we learn from it?
There may be several reasons why a doctor might ask you to do this test.
- Make sure you really have high blood pressure: Sometimes, your blood pressure can be a little high just by going to the doctor. This method allows you to see how your blood pressure is throughout the day and determine exactly whether you really have high blood pressure (hypertension).
- Watch how your blood pressure changes at different times of the day: Your blood pressure changes when you're working, resting, and sleeping. In a healthy person, blood pressure usually drops by 10% to 20% at night when they're sleeping. But for some people, that doesn't happen. This can help you identify patterns.
- Check if your blood pressure medication is working properly: If you are already taking blood pressure medication, this will help you know for sure if your medication is controlling your blood pressure well over the 24-hour period. This can help your doctor decide if you need to change the timing of your medication, change the dosage, or add another medication.
- Find out if there is a difference in your blood pressure between the doctor's office and at home: This is very important. This difference can also give you some idea of whether you are at risk for heart disease.
Various pressure patterns can be found using this method.
This test can identify several different pressure conditions. To understand them simply, see the table below.
| The nature of pressure | Simply put, what is it? |
|---|---|
| White coat hypertension | This is the problem that many people have. When they see the doctor or go to the hospital, their blood pressure rises with a little fear and anxiety. But when they are at home, their blood pressure is at a normal level. |
| Sustained hypertension | This means that the pressure is always high, even at home, just like the doctor said. This condition definitely requires treatment. |
| Masked hypertension | This is the other side. Doctor, your blood pressure is normal. But at home, in your normal life, your blood pressure goes up. This is a little scary, because it's a hidden problem that's not easily detected. |
| Nocturnal hypertension | Normally, blood pressure should decrease at night. However, in people with this condition, their blood pressure increases while they sleep at night. This is commonly seen in people with diabetes and kidney disease. |
Who wants to take this test?
Your doctor may ask you to have this test if you have any of the following conditions.
- For those who haven't started medication yet, even though the doctor's blood pressure measurement shows that they are high.
- For those who want to change their current blood pressure medication.
- For those whose blood pressure is still not well controlled despite taking medication.
- For those taking other medications that can affect blood pressure.
- If you feel dizzy or have low blood pressure (hypotension).
- For those who have high blood pressure during pregnancy.
How do you prepare before the test?
This doesn't require much preparation, but you need to be careful about a few things.
Things to do
- Choose a typical day for your test: Choose a day that is as close to your usual routine as possible. A typical day when you go to work is best, rather than a weekend.
- Keep a diary: Your doctor will tell you to write down everything you do in the past 24 hours. For example, the time you woke up in the morning, the time you took your medicine, the time you ate, the time you exercised, and the time you slept. Also, if you feel dizzy or have trouble breathing, write it down along with the time.
Things not to do
- Excessively strenuous exercise: It's okay to do normal activities, but avoid sweaty, strenuous exercise on this day.
- Bathing or swimming: This device is not waterproof, so you cannot bathe or swim for 24 hours.
- Removing the machine: Never remove the machine or the strap on your arm without your doctor's advice.
How do I do this? What happens on the day of the test?
First, you will be given an appointment to meet the doctor. When you go,
1. A cuff will be placed around your arm and the machine will be attached to you.
2. It explains everything about how it works, what you should do, and what you shouldn't do.
3. Then you can go home. The machine is attached to your body.
This is what happens after you go home:
- The wrist strap tightens automatically: As mentioned earlier, the wrist strap tightens at the right time and the pressure is measured. At that time, you will feel a slight tightness in your arm. It will disappear after a few seconds. The most important thing is to keep your arm straight and not move it as much as possible when the strap tightens. Only then can you get an accurate reading.
- Your sleep may be a little disturbed at night: You may wake up once an hour at night when the belt gets stuck. This is normal. Don't worry about it. Try to ignore it as much as possible and go back to sleep.
- Stay normal: Go about your daily routine as usual. Keep a diary as directed by your doctor.
The most important thing is to ask your doctor about taking your medication during this test and follow his instructions exactly.
What are the advantages and disadvantages of this method?
Like anything, this can have its advantages as well as some minor inconveniences.
Benefits
- Get a more accurate picture of your pressure: Readings taken throughout the day can give you a clearer idea of your true condition, rather than just looking at it at one time.
- You can confirm whether you have "white coat syndrome": This can prevent you from having to take blood pressure medication unnecessarily.
- Masked Hypertension can be detected: Identifying this can help protect against future heart attacks and strokes.
- It is a great help in planning treatment: This helps the doctor to ensure that the medication you are being given is appropriate, the dosage is correct, and to provide you with the most appropriate treatment.
Disadvantages
- A little pain in the arm: The upper arm may hurt a little because the belt keeps getting stuck.
- Sleep disturbance: Taking readings at night may disrupt sleep.
- Minor skin irritation: Rarely, some people may develop a minor rash where the belt is worn. This usually resolves on its own.
What is in the report I receive?
After the 24 hours are up, you need to return the machine. The doctor will then enter the data into a computer and analyze it. Your report will mainly contain information like this.
- 24-hour average blood pressure: The average value for the entire day.
- Normal daytime blood pressure: The average value when you are awake.
- Normal nighttime blood pressure: The average value while you are sleeping.
- Nocturnal dipping: The amount by which the pressure drops at night compared to during the day.
Generally, healthy levels are:
- 24-hour average: 125/75 mmHg or less.
- During the day: 130/80 mmHg or less.
- Nighttime: 110/65 mmHg or less.
- Nighttime decrease: Decrease between 10% and 20%.
Based on your results, your doctor will provide you with the necessary treatment, lifestyle changes, and advice.
Take-Home Message
- 24-hour Ambulatory Blood Pressure Monitoring is a very important test that can provide a very clear and accurate picture of your blood pressure.
- There may be minor discomfort (sore hands, sleep disturbance) on the day of the test, but it's not a big deal when compared to the benefits.
- This helps to stop taking unnecessary medications due to conditions like "white coat hypertension" (high blood pressure when you see a doctor).
- This helps to identify hidden pressure problems and protect against major illnesses that may arise in the future.
- Follow your doctor's instructions exactly when performing this test. If you have any problems, call them.
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