Blood Pressure Monitoring
I.E.M. has been manufacturing high-quality, reliable and convenient blood pressure monitors, made in Germany, for clinics, doctors and patients since 1993. The "Technology Expert in Hypertension Management" technological standard includes the measurement methods of screening, diagnostics and taking measurements at home (follow-up) as well as the uniform data structure to care for patients with high blood pressure on a long-term basis. As a leading developer of blood pressure monitoring methods, interventional blood pressure telemetry (blood pressure monitors with Bluetooth interface) was implemented for the care of telemetry patients as early as 1999. In 2008, the blood pressure monitoring was extended to pulse wave measurement. This provides information about blood pressure, hemodynamics and arterial stiffness.
Home blood pressure monitoring (HBPM) means long-term blood pressure monitoring within the home environment. In such cases, the patient normally measures their own blood pressure between 4-5 times daily. The blood pressure record is then usually discussed with the doctor some weeks later.
Telemetric home blood pressure monitoring is an alternative to taking readings in general. Here, the measured values are sent to a healthcare centre immediately via mobile phone or modem (BT terminal), where possible adjustments can be made. (More information under "ePA T5").
Long-Term Blood Pressure Monitoring
ABPM (ambulatory blood pressure monitoring) – predominantly recording of blood pressure data over 24 or 48 hours – is a recognised diagnostic procedure for evaluating the actual blood pressure situation outside the practice and is mainly used to rule out white coat hypertension and masked hypertension or to assess a secondary form of hypertension.
ABPM is an excellent procedure for therapy control if hypertensive patients are being treated with medication. The 24-hour profile is then used to decide what, if any, change is needed to the medication dosage.
The high measurement density throughout the day and night measures the physiological blood pressure fluctuations under day-to-day conditions and provides information about:
- Clinic/white coat hypertension
- Masked hypertension
- Early morning blood pressure changes
- Circadian rhythm (variability is significant for the prognosis)
- Suspected secondary hypertension
Blood pressure follows a characteristic circadian rhythm over 24 hours. Lack of a circadian rhythm is an indicator of secondary hypertension.
In the study, treatment was given by the treating general practitioner without specific recommendations.
The frequency of mortality and morbidity events (stroke, heart attack, sudden cardiac death, hospitalised heart failure and angina pectoris) were compared.
White coat hypertension (WCH) was identified in 13% of the patients. Within the group, the incidence rate of cardiovascular events was 12.1 in 1000 years of treatment. (Increased blood pressure in the doctor's office, normal blood pressure at home).
Masked hypertension was identified in 9% of the patients. At 30.6 in 1000 years of treatment, the event rate was the highest in this group. (Normal blood pressure in the doctor's office, increased blood pressure at home).
The results correlated significantly with the actual blood pressure monitoring values in real-life conditions. The highest mortality rate in the study was found to be in masked hypertension. WCH and masked hypertension can be identified by self-measurement of blood pressure at home over 7 days or, better still, through ABPM. International studies have shown the significance of self-measurement of blood pressure (HBPM) or 24-hour long-term blood pressure monitoring (ABPM) for therapy guidance, particularly in relation to the poorer prognosis of masked hypertension.
An analysis by British researchers from Birmingham University revealed that ABPM is the most cost-effective means of diagnosing hypertension. The evidence was provided by the National Institute of Health and Clinical Excellence (NICE), the British equivalent of the German IQWiG. The diagnosing process, anti-hypertensive therapy and management of resulting cardiovascular diseases was compared against other strategies. The use of ABPM led to significant savings. This is mainly due to the more targeted therapy due to the higher diagnostic accuracy.