ABPM - ACTUAL TECHNICAL DEVELOPMENTS

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.