What Is Ambulatory Blood Pressure Monitoring (ABPM)?

Ambulatory blood pressure monitoring (ABPM) is a relatively new technique for assessing a person’s blood pressure. ABPM allows a healthcare provider to assess your blood pressure during your routine daily life, rather than sitting tensely on the healthcare provider’s examination table.

The ABPM is most helpful in deciding whether a person really has hypertension when blood pressure measurements taken at the healthcare provider’s office are very variable or otherwise confusing. Specifically, the ABPM has been used to evaluate people with “white coat hypertension” triggered by the stress of medical appointments.

What is Ambulatory Blood Pressure Monitoring?

Ambulatory Blood Pressure Monitoring (ABPM) is when your blood pressure is measured as follows. You are walking around, living your normal daily life. It is measured up to 24 hours. A small digital blood pressure monitor attaches to a belt around your waist and attaches to a cuff around your upper arm. It is too small to interfere with your normal daily life and even sleep with him.

How does ambulatory BP monitoring work?

Ambulatory blood pressure monitoring is performed with a special device consisting of a blood pressure cuff attached to a small recording device that is worn on your arm and attached to your belt. You wear the ABPM device for 24 or 48 hours, during which time it records your blood pressure periodically (usually at 15-minute or 30-minute intervals) during your routine daily activities and while you sleep.

The ABPM thus provides your healthcare provider with a complete record of your blood pressure over a one or two-day period.

The information ABPM provides is fundamentally different from the information the healthcare provider receives by measuring your blood pressure in the office. The office blood pressure record is a single value intended to reflect your blood pressure during quiet rest (which explains why readings may not always be completely accurate given the busy environment of most healthcare providers’ offices these days).

In contrast, ABPM reports your blood pressures achieved through a wide variety of situations and activities, from running to riding the bus to sleep. And it’s normal for blood pressure to fluctuate drastically during many activities that a person typically performs in a day. Therefore, unlike the blood pressure you get at the healthcare provider’s office, ABPM doesn’t just report a single value for systolic and diastolic blood pressure, which is supposed to represent your official “blood pressure.” Instead, it reports all of the widely variable values ​​(usually) for a day or more.

What are the benefits?

By measuring your blood pressure at regular intervals for up to 24 hours, your doctor can get a clear idea of ​​how your blood pressure changes throughout the day. It also prevents the problems of ‘white coat’ syndrome (high blood pressure because you feel anxious about being tested by your doctor or nurse) because you can continue with your normal routine.

Why do I need this investigation?

  • There are several reasons why we need this:
  • To diagnose high blood pressure (hypertension)
  • To identify patients with higher blood pressure values ​​while in the clinic
  • (known as the “white coat effect”)
  • To decide if blood pressure medication is needed
  • To help you decide if any changes to your medications are needed
  • To further investigate people whose blood pressure is difficult to control
  • To see how well the patient’s blood pressure medications are controlling blood pressure
  • All-day long
  • To see what happens to a patient’s blood pressure at night

Interpreting ABPM Results

Using ABPM to diagnose hypertension, then, requires a different approach to interpreting your blood pressure records.

The technique most commonly used to evaluate ABPM results is to average a person’s systolic and diastolic blood pressures over a full 24 hour period, as well as the hours the person is awake and asleep.

Hypertension is usually diagnosed if the mean blood pressure exceeds one of the following values:

  • 24-hour Mean: systolic blood pressure greater than 135 mmHg, OR diastolic blood pressure greater than 80 mmHg.
  • Average for “Awake” Hours: systolic blood pressure greater than 140 mmHg, OR diastolic blood pressure greater than 90 mmHg.
  • Average for Hours of “Sleep”: systolic blood pressure above 124 mmHg, OR diastolic blood pressure above 75 mmHg.

When to Use ABPM?

The ABPM was helpful in assessing people with white coat hypertension, allowing the healthcare provider to decide whether intra-office blood pressure elevations actually reflect a state of “rest” (i.e., a state of anxiety) rather than “quiet”. The “resting state” is necessary for an accurate record of in-office blood pressure. Although many times in the office high blood pressure readings do indeed show that hypertension is present, sometimes this is not the case.

ABPM has also been useful in situations where determining the effectiveness of an anti-hypertensive treatment regimen is difficult or when a person is suspected of having abnormally wide fluctuations in blood pressure that make hypertension difficult to diagnose and treat. ABPM may also be helpful in the diagnosis and treatment of some types of dysautonomia, particularly when intermittent and unpredictable episodes of very low blood pressure are suspected.

An argument could even be made that ABPM should be the standard for diagnosis and treatment of hypertension, as getting truly accurate resting blood pressure measurements in the healthcare provider’s office can be problematic. In fact, in December 2014 the United States Preventive Services Task Force (USPSTF) released a draft statement recommending the use of ABPM as a “reference standard” to confirm a diagnosis of hypertension in the healthcare provider’s office. So the USPSTF recommends that the ABPM be used much more routinely than it does today.

This recommendation is likely to be controversial, as ABPM is relatively bulky and expensive (costing several hundred dollars for a one or two-day evaluation). However, it makes clinical sense and could really save money spent on healthcare if it prevents overtreatment of white coat hypertension.

Because of the cost of ABPM, researchers are looking at another type of out-of-office blood pressure measurement that is often more convenient than ABPM, home blood pressure monitoring (HBPM).

What do I need to do?

It is important to make sure that the pipe to the machine is not bent or bent so that the machine can run properly. Also, the machine will warn you just before it starts reading. When this happens, you should:

  • sit down if possible
  • keep the cuff level with your heart
  • keep your arm still
  • do not talk or cross your legs while recording
  • It is recommended that you do not drive during your viewing period.

Your clinician may want you to keep a diary while wearing the monitor; When did you go to bed and when did you take medicine? Some people find the 24-hour test distracting and uncomfortable. Your clinician should advise you on what to do in this situation when the monitor is attached.


Do I need to do anything differently because I’m being tested?

No. Because the test is done to find out what your normal daily blood pressure is, it’s important that you continue with your normal routine and do everything you would normally do. However, you should avoid heavy exercises. exercise

What clothes should I wear for the appointment?

You should wear loose-fitting clothing, preferably a short-sleeved top. The monitor will be attached under your top. You should also wear a belt that the monitor can be attached to.

Do I have to sleep with the monitor on?

Yes, it is important to keep the monitor on overnight if requested by the doctor or nurse. This will help us understand what your blood pressure is doing while you sleep

Can I take a bath/shower while watching?

Preferably avoid showering or bathing during the measurement period. If you decide to take a bath or shower, you will need to remove the monitor and cuff as these are not waterproof and you should not get them wet. When reattaching the cuff, you need to make sure it is in the same position as it was originally fitted. If you are unsure, ask your nurse for advice.

Can I exercise with the monitor on?

We advise patients to avoid going to the gym/exercise with the monitor attached. A light or brisk walk is fine

Will I need to keep a log while monitoring is taking place?

When we analyze the results, we rely on the information you provide in your diary. Sometimes there are perfectly good reasons why your blood pressure is high, for example, while running for a bus. Each time your blood pressure is recorded, you may be asked to note the time and your activity (walking, sitting, smoking, etc.). You do not need to do this at night, but you should remember to complete the section of the diary where the times you sleep and wake up are recorded.

Do I have to document when I take all my medications?

You can be informed about this by the nurse/health professional during your appointment. Document the name and dose of the drug and the time it was taken. Also, record any symptoms (pain, dizziness, etc.) felt during monitoring

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  1. Islam MS. Ambulatory Blood Pressure Monitoring in the Diagnosis and Treatment of HypertensionAdv Exp Med Biol. 2017;956:109-116. doi:10.1007/5584_2016_177
  2. Bloomfield DA, Park A. Decoding white coat hypertensionWorld J Clin Cases. 2017;5(3):82-92. doi:10.12998/wjcc.v5.i3.82
  3. Goldberg L, Bar-aluma BE, Krauthammer A, Efrati O, Sharabi Y. Ambulatory blood pressure profiles in familial dysautonomia. Clin Auton Res. 2018;28(4):385-390. doi:10.1007/s10286-018-0507-1
  4. Krakoff LR. Ambulatory blood pressure improves prediction of cardiovascular risk: implications for better antihypertensive managementCurr Atheroscler Rep. 2013;15(4):317. doi:10.1007/s11883-013-0317-9
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638406/

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