Guidelines for Conducting Ambulatory BP Monitoring (ABPM)
- Training
- Provide knowledge about BP measurements that can be obtained through ABPM
- Provide training in the specialized equipment, techniques, and devices needed to conduct ABPM
- Provide training in preparing patients for ABPM
- Train clinicians to prepare/initialize devices for recording
- Train clinicians to fit the device, cuff, and tubing on the patient
- Train clinicians in ABPM software and downloading data
- Devices, cuffs, and equipment
- Use validated upper-arm cuff oscillometric devices
- Use a cuff that is the appropriate size for the patient’s nondominantarm
- Use new or recharged batteries
- Patient preparation and instruction
- Provide instruction on what ABPM involves and how to cope with the procedure
- Inform patients that ABPM may disrupt sleep
- Inform patients to avoid showering and swimming, and tell them not to remove the ABPM device, cuff, and tubing
- Tell patients to follow their usual daily activities, but to keep their body still during each BP measurement
- Provide a brief summary of ABPM procedures on a reference card
- Teach the patient how to refit the cuff if it migrates from its ideal position
- Show the patient how to place the device on the bed or beneath a pillow during sleep
- Show the patient how to turn off the device in case of malfunction
- Provide instructions for filling out a diary documenting sleep and awakening times, times of antihypertensive medication intake, occurrence of symptoms, and meals
- Frequency and number of readings
- Every 15-30 minutes during the 24 hour period (48-96 total readings)
- Duration of monitoring
- Ideal period is 24 hours
- Analyzing readings
- Commonly-recommended criteria are ≥20 readings during the day and ≥7 readings during the night, but an ABPM recording with fewer may still be valid
- For each period (day, night, and 24 hours), calculate the average of all readings
Guidelines for Home BP Monitoring (HBPM)
- Patient training provided by clinicians
- Provide information on hypertension diagnosis and treatment
- Provide information on proper device selection
- Teach patients how to measure their own BP
- Instruct patients to bring the HBPM device and BP readings to healthcare visits
- Teach patients that individual BP readings may vary greatly during the monitoring period
- Preferred devices and cuffs
- A validated upper-arm cuff oscillometric device
- A device that can automatically store all readings
- A device that can print results or electronically send BP values to clinicians
- A cuff that is appropriately sized for the patient’s arm circumference
- Best practices
- Preparation
- Have an empty bladder
- Rest in seated position for ≥5 minutes
- Do not talk or text
- Position
- Sit with back supported
- Keep both feet flat on the floor
- Do not cross legs
- Place BP cuff on bare arm
- Place BP cuff directly above the antecubital fossa
- Place the center of the bladder of the cuff over the arterial pulsation of the bare upper arm
- Pull cuff taut around the bare upper arm, with comparable tightness at the top and bottom edges
- Support the cuffed art on a flat surface
- Preparation
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This article originally appeared on The Cardiology Advisor
