Ambulatory blood pressure monitoring

Overview

Ambulatory blood pressure monitoring (ABPM) is a test where you wear a small device that measures your blood pressure throughout the day and night for 24 hours. It gives a more complete picture of your blood pressure than a single reading at the doctor’s office.

Ambulatory blood pressure monitoring is increasingly common as a routine test for diagnosing and managing high blood pressure. Many GP practices and hospitals in the UK offer it.

It is used for anyone who might have high blood pressure, especially if office readings are uncertain. It is also used for people with certain conditions like diabetes, kidney disease, or sleep apnoea.

Symptoms

Common symptoms

• High blood pressure usually has no symptoms, but some people may experience headaches, shortness of breath, or nosebleeds.
• These symptoms are not specific and many people with high blood pressure feel perfectly fine.

Symptoms in children

• Children often have no symptoms of high blood pressure. If symptoms occur, they may include headaches, vision problems, or fatigue.

Symptoms in older adults

• Older adults may experience dizziness, tiredness, or no symptoms at all. ABPM can help detect high blood pressure even without symptoms.

Causes

Main causes

• Primary (essential) hypertension: no single cause, but develops over time due to factors like age and genetics.
• Secondary hypertension: caused by an underlying condition such as kidney disease, thyroid problems, or sleep apnoea.

Risk factors

• Age (risk increases with age)
• Family history of high blood pressure
• Being overweight or obese
• High salt intake
• Lack of physical activity
• Excessive alcohol consumption
• Smoking
• Stress

When to see a doctor

See a doctor urgently if:

• If you have symptoms of a hypertensive crisis (see emergency symptoms above)
• If your home blood pressure readings are very high and do not come down

Book a routine appointment if:

• Your doctor may recommend ABPM if your blood pressure readings at the clinic are borderline, high, or vary a lot.
• If you have risk factors for high blood pressure, talk to your GP about whether ABPM could help.

Diagnosis

Your doctor will recommend ABPM if they suspect you have high blood pressure, white coat hypertension (high readings only in clinic), or masked hypertension (normal in clinic but high elsewhere). The device takes measurements every 30 minutes during the day and every hour at night.

Tests that may be done

• Ambulatory blood pressure monitoring (ABPM)
• You may also be asked to keep a diary of your activities and symptoms during the 24-hour period

What to expect at your appointment

You will visit your doctor or clinic to have the device fitted. It is a small monitor worn on a belt or strap around your waist. The cuff on your upper arm inflates automatically at set times – it may feel tight but is not painful. You go about your normal day and sleep as usual. After 24 hours, you return the device. The readings are downloaded and analysed by your doctor.

Treatment

If ABPM shows that you have high blood pressure, your doctor will discuss treatment options. The goal is to lower your blood pressure to a safe level and reduce your risk of heart disease, stroke, and kidney problems.

Self-care at home

• Eat a healthy, low-salt diet – plenty of fruits, vegetables, and whole grains.
• Be physically active – aim for at least 150 minutes of moderate exercise each week.
• Limit alcohol to recommended amounts.
• Stop smoking – your GP or local stop smoking service can help.
• Manage stress with relaxation techniques, hobbies, or talking to someone you trust.

Medical treatments

If lifestyle changes are not enough, your doctor may prescribe medication to help lower your blood pressure. There are several types of blood pressure medicines. Your doctor will choose the one that is best for you based on your age, overall health, and any other conditions. It is important to take any prescribed medicine exactly as directed and attend follow-up appointments.

Living with this condition

If you have high blood pressure, you can manage it well with regular monitoring, healthy habits, and following your doctor’s advice. ABMP may be repeated from time to time to check how well your treatment is working.

Lifestyle tips

• Check your blood pressure at home if your doctor advises it.
• Take any prescribed medications as directed.
• Attend regular check-ups with your GP or nurse.
• Keep a record of your readings to share with your healthcare team.

Diet and exercise

A heart-healthy diet rich in fruits, vegetables, whole grains, and low in salt is key. Aim for at least 30 minutes of moderate exercise, like brisk walking, on most days. Your doctor can help you create a plan that suits you.

Mental health and emotional wellbeing

Living with high blood pressure can sometimes cause worry or stress, but most people manage it well with support. Talk to your doctor about any concerns you have – they can offer guidance and reassurance.

Prevention

High blood pressure can often be prevented or delayed with a healthy lifestyle – eating well, staying active, limiting salt and alcohol, not smoking, and managing stress. ABPM is a test, not a prevention method, but it helps detect problems early.

Screening programmes

Routine blood pressure checks are important. Your doctor may suggest ABPM as a screening tool if they suspect white coat or masked hypertension, or if your readings are borderline.

Complications

If left untreated

• If high blood pressure is not treated, it can increase the risk of heart attack, stroke, heart failure, kidney disease, and vision loss.

Long-term outlook

With proper diagnosis and management, most people with high blood pressure can live a long, healthy life. ABPM helps ensure an accurate diagnosis so you get the right care. It is a powerful tool in protecting your heart and overall health.

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