Do you know your 24-hour blood pressure pattern?

What is ABPM?

ABPM stands for “Ambulatory Blood Pressure Monitoring”. It refers to the monitoring of a person’s blood pressure (BP) over a period of 24 hours as he or she carries on with the normal daily activities. The BP fluctuations over this period form the ABPM patterns. This enables the doctor to decide whether the pattern is normal or if the patient has high blood pressure that needs treatment.

Example of an ABPM report by BPro

ABPM report
ABPM report | Source

What is high blood pressure?

"Blood pressure" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and remains constantly high, it can damage the body in many ways. The medical term for high blood pressure is “hypertension”.

Blood pressure is typically recorded as two numbers separated by a slash, like 110/70 mm Hg. Systolic, the top number, measures the pressure in the arteries when the heart beats. Diastolic, the bottom number, measures the pressures in the arteries between heartbeats.

Hypertension can damage many parts of the body. It increases the risks for stroke, heart failure, heart attacks, kidney failure and other health problems.

According to the American Heart Association (AHA), one in three U.S. adults has been diagnosed with hypertension. This disease is known as the “silent killer” because it is typically symptomless but can have deadly health consequences, if left untreated.

Hypertension is prevalent in both developing and developed countries. Today, approximately 1 billion people worldwide have high blood pressure. By the year 2025, this figure is expected to increase to 1.56 billion.

For optimal health, AHA recommends adults to maintain a blood pressure of less than 120/80 mm Hg.

24-hour BP data
24-hour BP data | Source

Why the need for ABPM?

An ABPM is particularly useful in helping doctors to assess conditions such as:

· White coat hypertension

Currently, diagnosis of hypertension is based on the blood pressure readings at the clinic on three separate appointments. If all the three readings are constantly high, then the patient is diagnosed as hypertensive and might be put on treatment.

However, some people’s BP tend to rise when seeing a doctor, most probably due to anxiety. This is called “White coat hypertension”, or commonly known as “White Coat Syndrome”. This type of raised blood pressure may not require treatment.

An ABPM can help in determining whether the high BP readings taken at the clinic is due to the “White coat effect”.

24-hour BP pattern
24-hour BP pattern | Source

· Nocturnal hypertension

Some people might have night-high condition and their blood pressure only shoots up at night. This cannot be detected at a daytime clinical visit. Such kind of BP pattern will show up in a 24-hour BP monitoring. Many stroke victims have this kind of BP pattern.

· Non-dipper hypertension

During sleep, our blood pressure should dip by 10 – 15%. Taking nocturnal blood pressure helps to determine whether the patient is a dipper or non-dipper. This is very important because non-dippers have three to five times the risk of stroke.

· Wide fluctuations in blood pressure

Some patients might be suspected of having abnormal wide fluctuations in blood pressure that make diagnosis and treating hypertension difficult.

Arterial Pulse Waveform analysis
Arterial Pulse Waveform analysis | Source

When measuring blood pressure at regular intervals over 24 hours, a clearer picture of how the blood pressure changes throughout the day will show up. Knowing the specific BP pattern enables the doctor to assess the condition better and more accurately prescribe medication according to the individual’s needs.

Generally, the first ABPM session is to establish your status. A repeat ABPM session after treatment is important to show the effectiveness of treatment.

Wrist-worn ABPM device: BPro

There are different brands of ABPM devices. The conventional ones are the cuff-based method of measuring blood pressure, which is rather cumbersome and uncomfortable for patients.

BPro is the first wrist-worn device launched in 2006. It is capable of capturing both the 24-hour BP readings and Pulse waveform analysis at the same time. The device was invented by a Singapore doctor, Dr Ting Choon Meng.

No special preparation is required when undergoing a 24-hour BP monitoring by BPro. Patients just need to make an appointment with a clinic that has BPro service. After putting on the medical watch, patients can leave the clinic and need to return only after 24 hours.

Normal daily routine can be carried out as usual. The blood pressure reading will be taken every 15 minutes, even during sleep. BPro takes the blood pressure measurement even without the wearer knowing about it.

Upon return to the clinic, the data will be downloaded to a computer that analyses their 24-hour BP patterns and arterial pulse waveform.

So far, nine main patterns have been identified:-

1. Normal Blood Pressure

2. White Coat Hypertension

3. Borderline Hypertension

4. Nocturnal Hypertension

5. Systolic and Diastolic High with Night-time Dip

6. Systolic and Diastolic High without Night-time Dip (Non-Dipper)

7. Isolated Systolic Hypertension

8. Isolated Diastolic Hypertension

9. White Coat Normal Tension

Omron HEM-711 DLX Automatic Blood Pressure Monitor with Comfit Cuff
Omron HEM-711 DLX Automatic Blood Pressure Monitor with Comfit Cuff

Regularly taking your BP at home is a good way to take part in managing your own health and recognizing changes.

 
Omron HEM-650 Wrist Blood Pressure Monitor with APS (Advanced Positioning Sensor)
Omron HEM-650 Wrist Blood Pressure Monitor with APS (Advanced Positioning Sensor)

Portable, accurate and easy to use. For those who have trouble using conventional cuff-based monitor.

 

Global awards for BPro

In 2006, the BPro became the first Singapore’s bio-monitoring device to receive certification from the U.S. Food and Drug Administration. FDA certification is considered to be the gold-standard validation for many countries.

In 2007, it was awarded the prestigious Technology Pioneer Award by the Swiss-based World Economic Forum - placing it in the same league as previous winners Google and Napster. Also, it clinched the Monitoring Device of the Year Award from global research consultancy Frost & Sullivan, another first for a Singaporean firm.

BPro has been validated independently by the National Heart Centre of Singapore, in compliance with the protocols set by the Association for the Advancement of Medical Instrumentation (AAMI) and European Society of Hypertension (ESH). This device is now used in more than 30 countries in the world.

Importance of an ABPM

It is important to know your 24-hour ABPM pattern, especially so if you have fluctuating blood pressure. The 24-hour ABPM pattern let you know whether your BP is normal and the duration that you are exposed to high pressure or low pressure. This helps you to know when you are most at risk.

High blood pressure is a life-long disease. While there is no cure, it is manageable. As the disease has no symptoms, 20% of those who have hypertension are unaware of their condition. Are you one of them?

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