World Hypertension Day 2023 – May 17: Only long-term blood pressure measurement provides a reliable picture

Today on World Hypertension Day, the World Hypertension League is raising awareness that a reliable assessment of blood pressure requires above all long-term recordings and high accuracy during measurements to assess the values correctly and to regain control over the patients’ blood pressure. Common phenomena like white-coat hypertension can only be ruled out with long-term measurements over 24 hours. Long-term measurements also allow masked hypertension to be detected and show the daily course of blood pressure as well as the physiological nocturnal drop (dipping behaviour)[2].

Oscillometric measurement using a blood pressure cuff is considered the gold standard. Nevertheless, this process comes with several methodological limitations that can influence the classification of hypertension and dipping. For example, the measurement should be performed in an upright position and at rest, because motor activity during the measurement can lead to false readings. A recent study showed that 26% of the readings from 24-hour measurements were affected by artefacts (movement, faulty inflation, cardiovascular arousals, and arrhythmias) and this led to incorrect classification of hypertension severity in 23% of cases and incorrect dipping classification in 24% [3]. Also, measuring in the upright position is not always feasible in a long-term measurement, which means that the blood pressure values in the supine position can be distorted by the hydrostatic pressure if using oscillometric devices.

For a valid assessment of blood pressure behaviour, there need to be solutions that reduce these limitations of oscillometric measurement. The ABPMpro records additional parameters and thus offers deeper diagnostic insights: The system continuously records the heart rate – even when the cuff is not inflated. In addition, the patient’s activity and body position are recorded. The measured blood pressure values can now be assessed in correlation to the physical activity during the day or the body position at night. Orthostatic deviations can also be considered in the evaluation. More importantly, by recording the motor activity, the system recognises when the patient is moving during a measurement. If the device detects activity during the inflation process, the measurement is repeated during deflation or postponed to a slightly later time, depending on the level of activity. Blood pressure values that are still measured during movement can be manually assessed and excluded from the analysis thanks to the recording of the pressure curve in the software.

By determining the patient’s activity and body position, sleep/wake can be estimated so that “nocturnal” blood pressure values can be referred to the actual time in bed (TIB) or sleeping time. With traditional devices, by default, a time window of 10:00 p.m. – 6:00 a.m. was set without taking the patient’s actual sleeping time into account. However, since the nocturnal blood pressure during sleep is particularly relevant for the assessment of hypertension, incorrect assignments to sleep/wake can falsify the blood pressure classification.

The ABPMpro, has been validated according to ISO 81060-2:2018, is conveniently worn directly on the cuff and does not require a tube or separate recorder. It thus offers a high level of patient comfort. It is modularly upgradeable: with the 3-channel ECG sensor, a Holter ECG can be recorded and the impedance cardiography can be determined. In the near future, a plethysmogram sensor will also be available. This detects the pulse wave and, together with the ECG, enables continuous blood pressure measurement based on the pulse transit time (PTT). When both sensors are applied, the method of blood pressure measurement can be freely selected: classical, oscillometric measurement and/or beat-to-beat determination of the blood pressure via the PTT, without inflating the cuff.

Further information about the ABPMpro can be found here.

[1] Neuhauser H, et al.: 12-Monats-Prävalenz von Bluthochdruck in Deutschland. Journal of Health Monitoring 2017; 2(1): 57–63

[2] Dolan E, et al.: Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 2005; 46: 156–61

[3] Bothe T et al.: Impact of oscillometric measurement artefacts in ambulatory blood pressure monitoring on estimates of average blood pressure and of its variability: a pilot study. J of Hypertension 2023; 41(1):p 140-149