Ambulatory blood pressure monitoring (ABPM) devices, such as the BTL CardioPoint, record the patient’s blood pressure fluctuations with dozens of measurements over 24 hours, even hundreds over two days, in order to confirm or rule out the possibility that you suffer from mild, moderate or severe hypertension.
The main objective will be to check if the people who make us suspect the presence of hypertension show, after one day of analysis, around 30% or 40% of the measurements above the established blood pressure fork as normal (120 /80)”, frames Dr. Carlos Macaya Miguel, world expert in interventional cardiology.
Blood pressure in adults is 120 mm Hg when the heart beats normally (systolic blood pressure or contraction of the heart muscle) and 80 mm Hg when the heart relaxes (diastolic blood pressure). When systolic pressure is equal to or greater than 140 mm Hg and/or diastolic pressure is equal to or greater than 90 mm Hg, blood pressure is considered high.
Dr. Carlos Macaya, professor emeritus of Cardiology at the Faculty of Medicine of the Complutense University, recalls that arterial hypertension (HT) is “a worldwide cardiovascular problem” that kills around 10.4 million people every year.
According to data from the World Health Organization (WHO), more than 1.28 billion people between the ages of 30 and 79 have high blood pressure; more than 700 million live without specific treatment (53% of women and 62% of men).
And the WHO emphasizes that “the burden of morbidity from hypertension is disproportionately high in low- and middle-income countries, where two-thirds of cases are registered, largely due to increased risk factors among these populations in the last decades”.
In most cases, it is of unknown origin, it affects people with overweight, obesity and diabetes, so the first measure to take to control it is to lose weight and restrict salt consumption, abandoning a sedentary lifestyle , if that is the case.
“A patient with HTN increases the risk of coronary artery disease, atherosclerosisangina, heart attack, cerebrovascular problems, stroke, cerebral effusions and, from an advanced age – 70 or 80 years -, atrial fibrillation, a very prevalent arrhythmia”, emphasizes Dr. Carlos Macaya.
The vital control of blood pressure
With each beat, the heart pumps blood that is distributed to the last cell of the body through the blood vessels. Blood pressure is generated by the force of blood pushing against the walls of the blood vessels, network of arteries and veins.
The higher the blood pressure, the harder it is for the heart to pump blood. Therefore, high blood pressure is a disorder in which blood vessels are constantly under high tension.
“Hence, the ideal is to analyze blood pressure for at least a minimum of 24 hours while the patient carries out his daily activities, since both heart rate and blood pressure are very variable, for example, depending on of emotions, stress or simply to do physical exercise or sports”, points out the cardiologist.
Blood pressure, “a medical problem, especially cardiovascular” -indicates-, is the most prevalent pathology in countries like Spain, where more than half of people over 60 suffer from hypertension, if we stick to the figures that decide whether or not you suffer from high blood pressure (140/90).
And another fact should be highlighted: 42.6% of the adult population is hypertensive, more women than men. 37.4% of hypertensives are undiagnosed. 88.3% of hypertensives take some pharmacological treatment. Only 30% of hypertensive patients have their blood pressure controlled.
“But before giving a definitive diagnosis to each patient, putting a hypertensive label on them, which carries their respective treatment, we must be sure that blood pressure is a constant problem, that it exists as such” , points out Dr. Macaya.
It shouldn’t be enough to have a regular medical check-up, assisted in some cases by the self-check that the patient himself performs at home with the Omron type tensiometers.
“Current technology allows us to systematically analyze the data extracted from the patient’s blood pressure readings, at least for 24 hours and continuously. Records are scheduled every fifteen minutes, that is, more than 80 daily measurements, whether in the morning, afternoon or night”, he reiterates.
Following suit, BTL CardioPoint, which meets professional monitoring requirements (BHS and AAMI standards), records time periods of 24, 27, 48 and 51 hours in a lightweight recorder with a completely silent system.
“This device, which makes up to 600 measurements, will offer us the fluctuation of the patient’s blood pressure, with which we can define a pattern and, therefore, a treatment”, explains Dr. Macaya from the Interhospital Foundation for Cardiovascular Research (FIC).
If more than 30% of measurements above the established normal ranges (120/80, maximum and minimum) are registered in 24 hours, the patient will be diagnosed as suffering from hypertension.
“And this hypertension will be labeled as mild, moderate or severe, with tremendous peaks of 200 mm Hg of blood pressure. Hence the great effectiveness of this kind of holter of blood pressure”, he says.
“What’s more – he adds – any patient already diagnosed with hypertension should also undergo this analytical test, since it is not only useful at the time of diagnosis: the specialist will be able to monitor and check how the patient responds to treatment antihypertensive”.
Additionally, once the blood pressure has been diagnosed and controlled by the specialist, the Omron-type device can be used routinely for self-monitoring at home.
The patient becomes familiar with the blood pressure monitor and will record the readings in a monitoring notebook to show to the GP or specialist.
The patient will therefore know how to measure his blood pressure and always reject the first of the measurements, which is usually greater by about 30 mm Hg in the second.
You will also know that blood pressure is usually higher in the morning than in the afternoon.
We will thus seek the complicity of patients in their self-care and self-control, both of blood pressure and adherence to their treatments.
To conclude, it is very important to say that technological companies are developing new MAPA devices, more comfortable and accurate, totally reliable.
Dr. Carlos Macaya Miguel