24-hour blood pressure monitor

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


Blood pressure


Blood pressure (BP) is a simple but powerful predictor of cardiovascular risk. A blood pressure taken in a clinic or GP surgery can however widely fluctuate and often be elevated due to stress in an unfamiliar environment (‘white coat hypertension’ although nowadays most doctors don’t wear white coats!). Wrong diagnosis of hypertension may mean unnecessary life-long medication.

Measuring BP repeatedly over 24 hours in patient's normal home and work environment overcomes this problem . It gives a much better idea of what is happening with the blood pressure during usual day-to-day activities than a recording 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 diagnosis 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 the arm. Upon completion of the test, the data are downloaded to computer and individual readings analyzed to give daytime, nighttime and 24 hour BP average.

The monitor is about the size of a mobile phone and attached to a belt or hung around the neck. The patient is asked to keep a diary of any symptoms so that they can be correlated to the recorded blood pressure. The patient is encouraged to go about their normal daily routine as usual with the monitor in place to get a representative recordings.

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 a 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 with no known risks. 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 indication for 24-hour blood pressure monitor will be thoroughly discussed during the consultation with Dr Ruzicka. The monitor will be usually arranged in the week following the consultation. If desired, the monitor can be also requested on NHS with usual waiting time.

When you come for the monitor to be fitted, one of the cardiac physiologists will again explain you the process and answer your questions. You will be asked to remove all your clothing above the waist, excluding any underwear. A cuff will be placed around your arm and attached to the recorder. The recorder works automatically and will measure 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 can be worn over the shoulder like a shoulder bag, or it can be clipped to a belt or pocket.

You will be given a diary card. You should record any symptoms, the time you had them and what you were doing at the tame you had the symptoms. This is helpful when analysing the recording for correlation of your symptoms to the changes in blood pressure. 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, including work, household chores and exercise. You should go about your normal routine so that a representative recording of your blood pressure can be obtained. As explained above, you will be instructed to keep a diary of your activities and corresponding symptoms.

After the procedure

You must return the following day to the hospital to have the recorder removed which will take only a few minutes. The Alexandra Hospital physiologists will analyse the recording and deliver to Dr Ruzicka. The report will then be discussed with you during your follow-up appointment or Dr Ruzicka will write to you and your GP with results. Depending on the results, your antihypertensive medication may need to be adjusted.

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