Ambulatory blood pressure monitoring: from fundamentals to confident interpretation

Course curriculum

• Arterial blood pressure measurement
• Evolution of blood pressure (BP) measurement methods: from the mercury sphygmomanometer to modern techniques
• Limitations of single BP measurements: variability, the “white coat” effect, technical errors
• Errors in blood pressure measurement: incorrect cuff size, environmental conditions, patient position
• WHO recommendations on cuff selection in adults and children
• The influence of external factors on measurement results: noise, cold, patient position
• Classical auscultatory technique by N.S. Korotkov: phases of sounds, measurement technique
• Clinically significant Korotkoff phases (1st and 5th, and the 4th under special conditions)
• Oscillometric method: working principles, points for determining SBP, DBP and mean BP
• The significance of heart rate in interpreting blood pressure data
• Criteria for arterial hypertension: diagnostic thresholds of SBP and DBP
• Arterial hypertension as a cardiovascular risk factor: statistics, mortality, disability
• The effect of elevated blood pressure on the development of CHD, stroke, CHF, AF, cognitive impairment, and dementia
• Age-related features of hypertension: diastolic hypertension in the young, pulse pressure in the elderly
• Diagnosis of arterial hypertension
• Stages of arterial hypertension diagnosis: from complaints and history to laboratory and instrumental methods
• Threshold blood pressure values based on ABPM data according to the 2024 RKO (Russian Society of Cardiology) guidelines
• Home blood pressure monitoring (HBPM): when and why it is used
• Comparison of ABPM and HBPM: significance in diagnosis and assessment
• Diagnostic criteria for arterial hypertension: in a medical facility and outside it
• Strategy for a hypertensive crisis at the initial visit
• Diagnosis of isolated office and ambulatory hypertension (white-coat and masked hypertension)
• Secondary (symptomatic) hypertension: clinical signs, criteria for suspicion
• Endocrine causes of arterial hypertension, chronic kidney disease, obstructive sleep apnea
• Pheochromocytoma: diagnosis, hereditary history
• Central blood pressure: measurement difficulties and clinical significance
• Orthostatic hypotension and hypertension: criteria, mechanism, risk factors
• Differentiated therapeutic approach in different age groups
• Target SBP and DBP values accounting for age, ISH, and treatment tolerability
• Prevention of excessively low diastolic blood pressure (<70 mmHg) as a risk marker
• The importance of individualizing therapy in arterial hypertension
• The role of the cardiologist in risk management and achieving target blood pressure values
• ABPM procedure technique
• The essence of the ABPM method: continuous recording of blood pressure under natural conditions, diagnosis, and assessment of treatment efficacy
• Advantages of ABPM over office measurements: absence of the white-coat effect, accurate correlation with target-organ damage
• Limitations of the method: arrhythmias, nighttime discomfort, errors of non-certified devices
• Indications and contraindications for ABPM
• ABPM methodology: a step-by-step algorithm for conducting the study from programming to conclusion
• Device setup: intervals, modes, pressure levels, measurement algorithms
• Types of devices: auscultatory, oscillometric, combined, ECG-synchronized
• Correct cuff selection. The impact of incorrect cuff size on measurement accuracy
• Pressure delivery modes: fixed, dynamic, decompression parameters
• Criteria for sufficiency of measurements
• Special ABPM modes: workday/day off, load restriction, functional tests
• Control measurements before starting monitoring — accuracy check
• Artifacts and their impact on study reliability, the need for repeat ABPM
• Patient instruction. The role of the patient diary in ABPM interpretation: activity, symptoms, medication intake
• Analysis and assessment of ABPM indicators
• Main quantitative parameters of ABPM: daily mean, daytime mean, nighttime mean values of SBP, DBP, mean and pulse BP, HR. Hourly analysis, minimum and maximum values. Indices: hypertension time, hypotension time, hypertension area, measurement index
• Daily index (DI) and the degree of nocturnal blood pressure decline (DND): Calculation formulas, significance, the influence of sleep quality and daily routine. Types of the daily profile: Dipper, Non-dipper, Over-dipper, Night-peaker. Clinical associations of each profile: risk of cardiovascular complications, target organ damage, mortality predictors
• Morning blood pressure surge: magnitude and rate as risk markers
• Hypotensive episodes and hypotension time index
• Requirements for ABPM data quality. Correction of ABPM results: Detection and exclusion of abnormal values. Recalculation of parameters after editing
• Using a patient diary: Correlation with physical activity, sleep pattern, food intake, and symptoms. Exclusion of daytime naps and on-waking measurements from the nighttime analysis
• Nocturnal hypertension
• Pressure load indices
• Pressure load indices: Hypertension time index (TI), Measurement index (MI), Area index (AI)
• Variability of BP and HR: Norms, Influencing factors: intervals between measurements, emotional and physical load. Clinical significance: a risk marker, even with normal average BP values
• Pulse pressure (PP)
• Morning blood pressure surge
• Hypotensive episodes
• Assessment of the efficacy of ongoing therapy and dynamic follow-up
• Goals of antihypertensive therapy
• Target blood pressure (BP) levels
• Resistant and pseudoresistant hypertension
• Methods of assessing treatment efficacy by ABPM
• Criteria for the hypotensive effect
• Optimal characteristics of antihypertensive therapy
• Dynamic follow-up in ABPM
• Analysis of indicator dynamics during repeated ABPM
• Hypertension time index over time
• Clinical application of ABPM
• Clinical indications for ABPM
• White coat hypertension (IWCH)
• Masked arterial hypertension (MUCH)
• Isolated systolic hypertension (ISH)
• Isolated diastolic hypertension (IDH)
• ABPM in pregnant women and during lactation
• Features and advantages of ABPM in clinical practice
• Elderly patients, diabetes mellitus, and COPD
• Ambulatory blood pressure monitoring in type 1 and type 2 diabetes mellitus. Pathogenesis of arterial hypertension in diabetes: insulin resistance, hyperinsulinemia, hypervolemia, activation of the sympathetic nervous system and RAAS. Diabetic nephropathy as a cause of secondary hypertension. Features of the daily blood pressure profile in patients with diabetes. Target blood pressure values in patients with diabetes and evidence of their prognostic significance. Use of ABPM to assess the risk of cardiovascular complications in patients with diabetes mellitus
• Features of hypertension in the elderly. Use of ambulatory blood pressure monitoring in the elderly: detection of nocturnal hypertension, clarification of the circadian BP rhythm and prognosis. Strategy for selecting target BP levels in the elderly with poor treatment tolerance
• Arterial hypertension in chronic obstructive pulmonary disease (COPD): pulmogenic hypertension as a secondary form of AH. Features of the blood pressure profile in COPD
• Features of ambulatory blood pressure monitoring in children and adolescents
• Features of blood pressure regulation in children and adolescents. Diagnosis of arterial hypertension in children based on percentile charts
• Use of blood pressure distribution curves based on international and Russian studies (Soergel, Leontyeva, etc.)
• Arterial hypotension in children: percentile-based criteria, hypotension time index