During the last six years ABPM has become a widely used routine method
in the diagnosis and treatment of hypertensive patients as well as in
correlating the disease to prognosis. Technical improvements with eas
y-to-handle recorders, reliable automatic measurements and correction
of error readings, as well as a standardized protocol have forwarded t
his development. The most important 19 recorders from 13 different man
ufacturers which are marketed in Germany and approved by the ''Physika
lisch-Technisches Bundesanstalt'' (PTB) are partly using auscultation
(7 recorders), oscillometry (7 recorders), or the combination of both
(5 recorders); the oscillometric mode of 2 ''combined'' recorders are
not yet PTB-validated. The auscultatory technique could be improved by
more sensitive microphones as well as by using two microphones at dif
ferent sites. Nevertheless, there may occur problems, e.g. by vigorous
arm movements, in case of an auscultatory gap, and when surrounding n
oise is high. The (optional) ''ECG-gating'' for improving the pressure
reading is only available in 3 recorders. The more easily appliable o
scillometric recorders are less reliable in patients with arrhythmias/
atrial fibrillation and with hypercirculation, e.g. during the pregnan
cy, respectively during strong physical activity. With the increasing
use of recorders, applying a combination of auscultatory and oscillome
tric technique, a number of this restrictions will become neglectable.
The patient's acceptance of the recorder could be improved by a reduc
ed weight (down to 250 g, battery-equiped), low pump noise (use of mem
brane instead of stroke piston pumps), and pressure-adapted cuff-insuf
flation rates; the cuff-fixation at the site of the upper arm needs st
ill further improvement. In order to evaluate the blood pressure profi
le properly the patient's diary is just as helpful as a day-night-butt
on at the recorder site. The computer printout should give at least a
number of basic standardized data (e.g. interval-mean, single-unexpect
ed-readings, upper normal values, proportional deviation in day and ni
ght blood pressure), in order to make results of different recorders c
omparable.