From this article you will learn: what is SMAD, indications for conducting a 24-hour monitoring of blood pressure, what diseases can be detected by such a study. How the procedure goes, what the patient should do, decipher the results.
Contents of the article:
- Indications for
- Procedure
- Reminder for patient
- Contraindications and inconveniences of procedure
- Decoding of results
Daily monitoring of arterial pressure is a diagnostic procedure. It provides for a multiple measurement of blood pressure throughout the day with the help of a special device.
This allows you to analyze the changes in pressure throughout the day and night: is it always increased( lowered), at what type of activity and how much it increases( decreases), whether it changes in the night period. Some instruments measure not only blood pressure, but also the heart rate.
The referral is given by a cardiologist or therapist.
Indications for
The procedure is prescribed for patients who complain of:
- rapid fatigue;
- headaches, dizziness;
- decreased vision, "flies" before the eyes;
- noise or ringing in the ears, pocketing the ears.
Also, SMD can be prescribed to a person who does not have unpleasant symptoms, but when pressure is measured by a doctor, it is increased. The reason for this may be the phenomenon of the "white coat": this is an individual feature that is expressed in a specific psychological response to the doctors. A person with the phenomenon of a "white coat" begins to worry excessively in any medical manipulation, so his pressure and heart rate increase. Measurement of blood pressure and heart rate with the help of daily monitoring makes it possible to exclude the effect of this phenomenon on diagnosis.
The procedure allows to detect arterial hypertension( hypertension), and also to determine its cause - the main disease. It is confirmed in the course of further surveys. Also, using this method, it is possible to diagnose chronic hypotension( arterial hypotension) - low blood pressure.
SMD allows:
- to predict how dangerous the arterial hypertension is for a particular patient;
- determine to what complications it may lead or has already led;
- to understand what level of physical activity is acceptable for this person;
- determine whether the pressure medications are effective, which have already been prescribed for treatment.
Carrying out the procedure
Course of the examination:
- You come to the doctor. It fixes on your body a portable device for daily monitoring of blood pressure. It consists of a cuff( the same as a normal tonometer), a connecting tube and the main part of the device, which records the received data in the built-in memory( most often the device is placed in a sheath on a harness, which is hung over the shoulder or fastened to the patient's belt).
- You live the day on your normal schedule, but keep a detailed diary. There you record everything you did throughout the day with the time.
- The device measures the pressure every 15 minutes during the day and every 30 minutes at night. Sometimes this gap can be longer( for example, every 40 minutes in the afternoon and every hour at night), depending on the settings.
- If you are prescribed any medications, then tell your doctor about it. Their reception can be canceled for the duration of the examination. If the doctor said that you do not need to cancel the appointment( for example, if you need to evaluate the effectiveness of the treatment), drink the medication on the previous schedule and write down the time of admission to the diary. You can also record when you felt the effect of medication.
- After a day, you again come to the doctor. He takes off the phone and says when to come for the results. Usually data processing takes no more than one day.
With the results you go to your treating cardiologist or therapist. He can make a diagnosis on the basis of SMART data, and also prescribe further diagnostic procedures to clarify the cause of hypertension.
Reminder for patient
When passing through this diagnostic procedure, you will need to remember some things.
General rule: when the machine starts BP measurement( you can recognize this moment by injecting the cuff, and some models issue a signal before the measurement starts), stop, relax your hand and lower it down. Otherwise, the instrument will not be able to measure the pressure, or the result will be incorrect.
Diary rules
| Must record in the daytime | Time of moderate exercise( rise to 4-5 floors, walk from 1000 m) |
|---|---|
| Driving time | |
| Time of stress or increased emotional stress( if any) | |
| Medication time | |
| Timefood intake | |
| The time when you felt any unpleasant symptoms, a detailed description of these symptoms, what did you do at that time | |
| It is advisable to record in the afternoon | What exactly did you do at the time of each measuredI |
| pressure required to record at night | waste time to sleep and wake |
| nighttime awakenings Time | |
| What did you do when you wake up at night |
It so happens that the device starts pumping the cuff again immediately after the measurement of pressure. This means that last time the device failed to measure. Possible reasons for this: you strained your arm, or the cuff loosened. If the hand was relaxed at the time of the first measurement attempt, ask someone to tighten the cuff so that it fits snugly against the arm( you can do it yourself, but with one hand it will not be comfortable to tighten it).
Intensive physical activity( fitness, gym) per day, when daily monitoring of blood pressure is carried out, are prohibited.
Contraindications and inconveniences of procedure
The procedure has no contraindications.
Of the side effects can be identified only discomfort in the arm for 1-2 days after the examination, because the cuff can crush.
Also, let's talk about possible inconveniences that you may encounter during the procedure:
- Difficulty with sleep. Since the device measures the pressure at night, you can wake up from squeezing the arm with a cuff or from a preliminary signal. This is especially true for those who are sensitive to sleep.
- It is impossible to completely bend the arm at the elbow, since the cuff is attached slightly above the joint. Because of this, it may be inconvenient, for example, to wash or brush your teeth.
- It is necessary to refrain from taking a shower or a bath, since the apparatus can not be wetted.
This is all the disadvantages of the procedure. They can be tolerated for the sake of an accurate diagnosis, which can be put after the SMAD.
Interpretation of results
Daily monitoring of blood pressure gives complete information about changes in systolic and diastolic blood pressure during the day and night.
You will receive a sheet with the result of the examination on the next day after the procedure.
There will be indicated:
- Blood pressure at different times of the day in the form of a graph.
- Mean daily systolic blood pressure.
- Mean daily diastolic blood pressure.
- Mean nocturnal systolic blood pressure.
- Mean nocturnal diastolic blood pressure.
- Degree of night decrease in systolic and diastolic blood pressure.
- Variability of systolic and diastolic blood pressure.
- Mean pulse BP( difference between systolic and diastolic pressure).
Determination of severity of hypertension by mean pressure
| Average systolic blood pressure | Mean diastolic blood pressure | |
|---|---|---|
| Low pressure | Day - below 100 At night - below 90 | Day - below 65 At night - below 50 |
| Normal | Day - 100-135 At night - 90-120 | In the afternoon - 65-85 night - 50-70 |
| Border hypertension | Day - 136-140 night - 121-125 | Day - 86-90 night - 76-85 |
| mild hypertension( 1 degree) | Day - 141-155 night -126-135 | Day - 91-100 night - 76-85 |
| moderate hypertension( grade 2) | Day - 156170 night - 136-150 | Day - 101-110 night - 86-100 |
| Severe hypertension( grade 3) | Day - greater than 170 night - more | Day 150 - 110 over night - more than 100 degree night fall |
Blood pressure should normally be 10-20%.Insufficient pressure decrease at night is an indicator of health problems.
Insufficient pressure drop during sleep
| may indicate diseases such | increases the risk of these complications of hypertension |
|---|---|
| Chronic kidney disease | Left ventricular hypertrophy |
| Pheochromocytoma( adrenal gland tumor) | Chronic heart ischemia angina |
| Diabetes | Myocardial infarction |
| insomnia, neurosisStroke |
Pulse pressure( difference between the upper and lower pressure) should not exceed 53 mm Hg. Art.(ideally 30-40 mm Hg).Elevated pulse pressure can indicate problems with the thyroid gland, as well as vascular diseases. In patients with large values of pulse pressure, the risk of complications of hypertension is increased.
The variability of blood pressure is the degree of its change during the day. Normally, the variability of systolic blood pressure should be less than 15 mm Hg.diastolic - less than 12 mm Hg. Art. Increased variability suggests a low elasticity of blood vessels, which increases the risk of stroke and bleeding in the retina.
