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24-h-Langzeitblutdruckmessung (ABDM)

Statement der Deutschen Hochdruckliga e. V. DHL® (Deutsche Gesellschaft für Hypertonie und Prävention), Sektion Hochdruckdiagnostik

Ambulatory blood pressure monitoring (ABPM)

Statement of the German Hypertension League DHL® (German Society of Hypertension and Prevention), working group for hypertension diagnostics

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Der Kardiologe Aims and scope

Zusammenfassung

Die ambulante 24-h-Blutdruckmessung (ABDM) ist ein unverzichtbarer Pfeiler in der Hypertoniediagnostik und Therapieüberwachung. Es besteht kein Zweifel, dass die ABDM entscheidend dazu beiträgt, eine Unter- bzw. Überschätzung (Praxisnormotonie/Praxishypertonie) des Blutdruckniveaus zu vermeiden. Dies gilt auch für Kinder und Jugendliche, bei denen bis zu 20% Hypertoniker trotz Selbst- und Praxisblutdruckmessung übersehen werden würden. Mit der ABDM ist auch die Beurteilung des nächtlichen Blutdruckverhaltens möglich. Der diagnostische und prognostische Wert der ABDM als nichtinvasives Verfahren zur Blutdruckmessung ist abgesichert. Voraussetzungen sind neben der Benutzung eines validierten Systems (z. B. International Protocol 2 der European Society of Hypertension [ESH] oder Prüfsiegel der Deutschen Hochdruckliga [DHL]) die richtige Indikationsstellung, eine ordnungsgemäße Programmierung und Durchführung der Messung sowie die korrekte Klassifikation des Blutdruckniveaus nach DHL-Kriterien. Die Einteilung des Blutdruckniveaus erfolgt in die 6 Klassen „optimal“ bis „Hypertonie Schweregrad 3“. Es erscheint sinnvoll, diese Analogwerte für die individuelle kardiovaskuläre Risikostratifizierung zu benutzen, da sich das kardiovaskuläre Risiko mit steigenden ABDM-Werten erhöht und die ABDM das kardiovaskuläre Risiko deutlich besser abbildet als die Praxisblutdruckmessung.

Neben der computertechnischen Auswertung ist eine schriftliche Beurteilung der Blutdruckwerte und des Blutdruckprofils mit Feststellung des Schweregrads durch den untersuchenden Arzt obligat. An computergenerierten standardisierten Befundberichten mittels entsprechender Software wird derzeit von mehreren Fachgesellschaften und Herstellern gearbeitet. Wünschenswert wäre die Darstellung aller wichtigen Parameter und einer graphischen Darstellung auf einer Seite.

Abstract

Ambulatory blood pressure monitoring (ABPM) is an essential component of the clinical evaluation of patients with hypertension. Without any doubt ABPM plays an important role in avoiding misclassification of blood pressure (white coat hypertension or masked hypertension). This is also true for children and adolescents where up to 20% of hypertensives would not be detected without ABPM. Furthermore, ABPM is the only commonly used non-invasive method to determine nocturnal blood pressure. Prerequisites are the use of a validated system, e.g. International Protocol 2 of the European Society of Hypertension (ESH) or seal of approval by the German Hypertension League (DHL), the correct indications, a precise devided carried programming and the correct classification of blood pressure according to the DHL criteria. The blood pressure is into six classes ranging from “optimal” to “hypertension severity grade 3”. It seems advisable to use these analogue values for the individual cardiovascular risk stratification as end-organ damage associated with hypertension is more closely related to ABPM and this procedure thus gives a better prediction of clinical outcome than clinical blood pressure measurements.

The technique and clinical use of ABPM should follow certain standards to obtain valid results. Interpretation of ABPM profiles and norm values are discussed in this paper. Additionally some new parameters which have been published during recent years are described and discussed.

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  1. Klinik für Innere Medizin, St. Josefs-Hospital, Krankenhausstr. 13, 49661, Cloppenburg, Deutschland

    S. Lüders

  2. HELIOS Klinikum Berlin-Buch, Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    R. Dechend

  3. Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein/Westfalen, Bad Oeynhausen, Deutschland

    S. Eckert

  4. Kerckhoff Rehabilitationsklinik, Herz- und Gefäß-Campus Bad Nauheim, Bad Nauheim, Deutschland

    T. Mengden

  5. Klinik für Nephrologie und Dialyse, HELIOS Kliniken Schwerin GmbH, Schwerin, Deutschland

    J. Nürnberger

  6. St.-Antonius-Hospital gGmbH Kleve, Katholische Kliniken im Kreis Kleve Trägergesellschaft mbH, Kleve, Deutschland

    U. Tholl

  7. Medizinische Klinik, Agaplesion Bethesda Krankenhaus Wuppertal gGmbH, Wuppertal, Deutschland

    B. Sanner

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Lüders, S., Dechend, R., Eckert, S. et al. 24-h-Langzeitblutdruckmessung (ABDM). Kardiologe 7, 194–208 (2013). https://doi.org/10.1007/s12181-013-0497-0

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