The Clinical Utility of Ambulatory Blood Pressure and Heart Rate Monitoring in Psychiatric Inpatients

Alterations in heart rate and blood pressure (BP) may occur in patients receiving psychiatric medication. Twenty-four–hour ambulatory blood pressure (ABP) monitoring was compared with nurses’ conventional vital signs (CVS) for systolic (SBP) and diastolic (DBP) and heart rate (HR) measurements in psychiatric inpatients receiving multidrug treatments. Twelve consecutive subjects were enrolled. ABP monitoring and CVS measurements were concurrent but independent in each subject. Ambulatory BP monitoring recorded SBP, DBP, and HR thrice hourly from 6:00 to 10:00 and once hourly between 10:00 and 6:00 ; CVS were obtained an average of 3.6 times/24 h. The frequency with which each BP and HR measurement method detected Level-1 (SBP 90 to 100 or 180 to 209 mm Hg; DBP 40 to 60 or 110 to 119 mm Hg; HR 50 to 60 or 110 to 119 beats/min) or Level-2 (SBP < 90 or ≥ 210 mm Hg; DBP < 40 or ≥ 120 mm Hg; HR < 50 or ≥ 120 beats/min) events was determined, and disagreements between the two measurement systems were analyzed using the McNemar test for paired sample data. Ambulatory BP monitoring detected significantly more Level-1 and Level-2 events than CVS. A significant number of mostly low BP were documented by ABP monitoring and were undetected by the CVS obtained by the nursing staff. This finding may be of clinical relevance in view of the potential hemodynamic consequences of hypotension, especially in older patients receiving psychotropic multidrug treatment.