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Introduction
Dynamic blood pressure monitoring (ambulatory blood pressure monitoring, ABPM) has great advantages in the diagnosis of hypertension . The measurement method is to let the subject wear a dynamic blood pressure recorder and return to the daily living environment to act freely. The instrument will automatically perform blood pressure measurement at the set time interval (usually 15~30min), providing blood pressure measurement data of up to dozens to hundreds of times during the 24-hour period.
ABPM data include systolic blood pressure , diastolic blood pressure , 24-hour mean arterial pressure , heart rate , daytime average blood pressure, nighttime average blood pressure, highest blood pressure and lowest blood pressure, hourly average blood pressure, blood pressure load, 24-hour circadian rhythm and variability, etc. This article will comprehensively summarize the clinical significance of these parameters.
1. Average blood pressure
ABPM provides systolic blood pressure (SBP) and diastolic blood pressure (DBP) values monitored within 24 hours, average SBP and DBP per hour, average SBP and DBP during the 24-hour period, average SBP and DBP during the day, average changes in blood pressure in normal people: mean daytime blood pressure > mean 24h blood pressure > mean nocturnal blood pressure.
Figure 1 Average blood pressure value recorded by ABPM: Blood pressure control is still possible
Currently, the normal value of ABPM is mostly used refers to the normal reference value standard recommended in 2018 " Chinese Hypertension Prevention and Treatment Guidelines " [1]. That is, the average SBP/DBP/80mmHg at 24 hours, the average SBP/DBP/DBP ≥135/85mmHg during the day, and the average SBP/DBP ≥120/70mmHg at night.
2. Blood pressure load
refers to the percentage of systolic blood pressure and diastolic blood pressure readings exceeding the normal range of times respectively. Generally, the blood pressure load of normal people in should be <10%.>ABPM is important information for diagnosing hypertension and predicting damage to its target organs. Blood pressure load exceeds 40% is an alarm for hypertensive heart involvement, and treatment should be considered.
Figure 2 Daytime and night blood pressure load recorded by ABPM: Blood pressure load control is still possible
3. Blood pressure circadian rhythm
Normal people's blood pressure is at a low point between 0:00 and 3:00, and then it tends to rise. It rises rapidly after getting up in the morning, reaching a peak between 8:00 and 10:00 am (the first peak); it is basically at a relatively high level during the day, and it can rise slightly again from 16:00 to 18:00 pm (the second peak); it starts to fall slowly from 18:00 am. Therefore, the ABPM curve shows "two peaks and one valley".
Blood pressure circadian rhythm can be expressed by the night blood pressure drop rate, that is, the difference obtained by subtracting the average systolic blood pressure (or diastolic blood pressure) during the day is divided by the average systolic blood pressure (or diastolic blood pressure) to obtain the night systolic blood pressure (or diastolic blood pressure) decrease rate. Generally, it should drop by 10~15%, or the systolic blood pressure and diastolic blood pressure should be reduced by 10mmHg and 5mmHg respectively. Most people define the rate of nocturnal blood pressure drop >10% as normal, while <10%>
Figure 3 Blood pressure circadian rhythm recorded by ABPM: Recognition of diurnal variation patterns of diurnal and night blood pressure
When the average night blood pressure is lower than the average daytime blood pressure ≥10%, the patient is classified as "normal dipper";
When the reduction is <10%>
The dipper with a decrease of ≥20% is called "super dipper";
The non-dipper with an average night blood pressure higher than the average daytime blood pressure is defined as "anti-dipper".
Figure 4 Normal dipper blood pressure
Normal healthy people have fluctuations in their daily blood pressure, generally with two peaks and one valley. The daily blood pressure has the highest value between 6-8 am and 5-7 pm, and 2-3 am is the lowest value of daily blood pressure
Figure 5 Changes in blood pressure sap type of patients with hypertension
0 The dipper curve of patients with hypertension is the most common curve of patients with hypertension, with two valleys and one peak, 6-8 am and 4-6 pm, and the blood pressure peak at night is 10% to 20% lower than the average daytime blood pressure during the day
Figure 6 Non-dipper hypertension: the blood pressure drops at night <10%,>
Figure 7 Ultra-dipper blood pressure: the blood pressure drops at night ≥20%
Figure 8 Reverse dipper blood pressure: the blood pressure drops at night less than 5%, and even increases
4. Variation of blood pressure
, that is, the fluctuation of blood pressure, that is, the degree of blood pressure fluctuation in an individual unit time. It usually reflects the amplitude of blood pressure variation with the mean standard deviation of 24-hour dynamic blood pressure monitoring, and reflects the speed of variation by spectrum analysis.
Generally speaking, 24-hour blood pressure variation > daytime blood pressure variation > nighttime blood pressure variation; systolic blood pressure variation > diastolic blood pressure variation.
Figure 9 Blood pressure coefficient recorded by ABPM: roughly normal
5. Pulse frequency change
is used to represent the pulse pressure change in 24 hours
Figure 10 Pulse frequency recorded by ABPM: roughly normal
6. 24 hours blood pressure specific blood pressure, pulse pressure, pulse rate value
0 According to the patient's blood pressure, pulse pressure and pulse rate pulse rate value in different time periods
Figure 11 ABPM record of the whole day blood pressure change value
summary
With the application of dynamic blood pressure measurement methods, people have improved their understanding of the variability of blood pressure, the impact of environmental stimulation on blood pressure, the observation of distinguishing high-risk and low-risk patients among people with similar blood pressure measured in clinics, and the effect of antihypertensive treatment effects, providing a new way for the clinical and epidemiological research of [3].
Therefore, in the current domestic and foreign hypertension prevention and treatment guidelines, dynamic blood pressure monitoring is recommended to place important positions, which can better and more realistically evaluate the patient's blood pressure level, and is more conducive to guiding doctors to formulate reasonable drug treatment measures.
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References:
[1] China Hypertension Prevention and Treatment Guide (Revised Version in 2018)[J]. China Cardiovascular Magazine, 2019, 24(01): 24-56.
[2] China Dynamic Blood Pressure Monitoring Guide [J]. China Circulation Magazine, 2021, 36(04) :313-328.
[3] Su Hai, Li Xue, Tang Songtao. Issues worth thinking about in the application of family blood pressure monitoring and dynamic blood pressure monitoring [J]. Chinese Journal of Hypertension, 2022, 30(06):501-502+500
Source of this article: Medical Cardiovascular Channel
Author of this article: GingerJia
Review of this article: Zhao Jiehui
Editor-in-chief: Peng Jianping
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