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LETTER
A Complication of Ambulatory Blood Pressure Monitoring
M. D. Baetz, MD;
George Pylypchuk, MD; and
Marilyn Baetz, MD
15 September 1994 | Volume 121 Issue 6 | Pages 468-469
TO THE EDITOR:
A recent review noted the rapid increase in the use of ambulatory blood pressure monitoring [1]. This procedure is considered to be well tolerated and is associated with few complications [2]. We report a case involving significant complications from such monitoring.
A 46-year-old woman was placed on 24-hour ambulatory blood pressure monitoring. Measurements were set at 20-minute intervals during the day and hourly at night. She had no history of diabetes, bleeding disorders, or easy bruisability. After 12 hours on the machine, the patient noted that she had pain in her arm and a rash on her wrist and fingers. By 24 hours, the rash had progressed and her arm was "raw and sore." The left arm had a petechial rash, erythematous streaks, and a large raw area (Figure 1). Hematologic and clotting indices were normal, and her mean 24-hour blood pressure was 145/93 mm Hg (range, 113 to 185 mm Hg [systolic] and 68 to 125 mm Hg [diastolic]). The result of a Rumpel-Leede test for capillary fragility was negative.
We believe this to be a significant complication of ambulatory blood pressure monitoring in a patient who did not have increased capillary fragility [3], one that could lead to more serious complications [4]. The cause could be the many cuff inflations—80 attempts were required to obtain 46 successful readings. The major reasons were the inability of the pump to exceed systolic pressure (30%), movement artifacts (25%), and inadequate pulse pressure (25%). The duration of each inflation is also important. If the machine does not read correctly on the first attempt, it reinflates, maintaining pressure for up to 180 seconds. The duration of each inflation is not recorded, but, with an initial cuff failure of almost 50%, this may be significant.
It is important to be aware of this complication in ambulatory blood pressure monitoring. It may be avoided by previous patient education and discontinuation of monitoring in cases of repeated machine error and cuff inflation.
1. Appel LF, Stason WB. Ambulatory blood pressure monitoring in the diagnosis and management of hypertension. Ann Intern Med. 1993; 118:867-83.
2. White WB, Manoor GA. Ambulatory blood pressure monitoring. Current Opinion in Nephrology and Hypertension. 1993; 2:928-34.
3. White WB. The Rumpel-Leede sign associated with a non-invasive ambulatory blood pressure monitor (Letter). JAMA. 1985; 253:1724.
4. Creevy PA, Burris JF, Mroczek WJ. Phlebitis associated with noninvasive 24-hour ambulatory blood pressure monitor (Letter). JAMA. 1985; 254:2411.
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