BTL CARDIOPOINT-ABPM

USER’S MANUAL
CONTENTS
1 GENERAL CHARACTERISTICS ....................................................................................................................... 4
1.1 Intended Use ................................................................................................................................................. 4
1.2 Indications ..................................................................................................................................................... 4
1.3 User Profile ................................................................................................................................................... 4
1.4 Operating Environment ................................................................................................................................. 4
1.5 Patient Profile ................................................................................................................................................ 4
1.6 Contraindications........................................................................................................................................... 5
1.7 Possible Side-effects ..................................................................................................................................... 5
2 SAFETY PRECAUTIONS ................................................................................................................................... 6
3 USED SYMBOLS ............................................................................................................................................... 7
4 INSTALLATION AND ASSEMBLY .................................................................................................................... 8
4.1 Installation of BTL CardioPoint Software ....................................................................................................... 8
4.2 Product Protection ......................................................................................................................................... 8
4.3 DEMO Mode.................................................................................................................................................. 8
4.4 Assembly of the BTL CardioPoint-ABPM System ......................................................................................... 8
4.5 Communication Settings ............................................................................................................................... 8
5 OPERATING INSTRUCTIONS ........................................................................................................................... 9
5.1 Start the Examination Using The BTL CardioPoint-ABPM Software ............................................................. 9
5.1.1 Settings Examination Parameters ......................................................................................................... 10
5.1.2 Sending The Examination Setting to the Device .................................................................................... 12
5.2 How to Import the Examination ................................................................................................................... 14
5.2.1 Loading the Examination Data from the Device to a Computer ............................................................. 14
5.3 Evaluation of an Examination ...................................................................................................................... 15
5.3.1 Main Screen Description........................................................................................................................ 15
5.3.2 Blood Pressure Table ............................................................................................................................ 15
5.3.3 Blood Pressure Trend ............................................................................................................................ 17
5.3.4 Statistical Values Table ......................................................................................................................... 18
5.3.5 Medical Findings .................................................................................................................................... 20
5.3.6 Software Settings .................................................................................................................................. 20
6 ADDITIONAL SOFTWARE SETTINGS ........................................................................................................... 27
6.1 Changing the Layout Colour ........................................................................................................................ 27
6.2 Export the Examination Data ....................................................................................................................... 27
7 LIST OF ERROR CODES WITH EXPLANATION ............................................................................................ 28
7.1 Unsuccessful Measurements ...................................................................................................................... 28
7.2 Cuff Related Errors...................................................................................................................................... 28
7.3 Faulty Device............................................................................................................................................... 28
8 FORMULAS USED FOR STATISTICAL CALCULATIONS ............................................................................. 29
8.1 Measured Data ............................................................................................................................................ 29
8.1.1 SYS: Systolic Blood Pressure ................................................................................................................ 29
8.1.2 DIA: Diastolic Blood Pressure ................................................................................................................ 29
8.1.3 Pulse: Heart Rate, Heart Frequency and Pulse Rate ............................................................................ 29
8.2 Calculated Data ........................................................................................................................................... 29
8.2.1 PP: Pulse Pressure................................................................................................................................ 29
8.2.2 MAP: Mean Arterial Pressure ................................................................................................................ 29
8.2.3 Mean...................................................................................................................................................... 29
8.2.4 Night Fall Index (Diurnal Index) [%]: (D/N Index) ................................................................................... 30
8.2.5 PTE [%]: (Percentage Time Elevation) .................................................................................................. 30
8.2.6 LOAD [mmHg]: (Hyperbaric Impact) ...................................................................................................... 30
8.2.7 PTD [%]: (Percentage Time Depression)............................................................................................... 30
8.2.8 Leese [mmHg]: (Hypotensive Load) ...................................................................................................... 31
8.2.9 Morning Surge ....................................................................................................................................... 31
8.2.10 SD (SYS/DIA) [mmHg]: (Standard Deviation) ........................................................................................ 31
8.2.11 CV (SYS/DIA) [%]: (Coeficient of variation) ........................................................................................... 31
9 HOT KEYS........................................................................................................................................................ 32
10 REFERENCES ................................................................................................................................................. 33
11 MANUFACTURER ........................................................................................................................................... 34

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 1 GENERAL CHARACTERISTICS

The BTL CardioPoint is a software system designed for multiple cardiology and spirometric examinations.
Moreover, BTL CardioPoint serves as a joint patient database, provides functionality to support teamwork and
possibility of integration with third party systems. The BTL CardioPoint is consisted up to five modules:
the BTL CardioPoint-ECG, BTL CardioPoint-Holter, BTL CardioPoint-Ergo, BTL CardioPoint-Spiro and
BTL CardioPoint-ABPM. BTL CardioPoint is widely used by cardiologists, pneumologists as well as general
practitioners.
The BTL CardioPoint-ABPM software, together with the compatible ABPM recorder, serves as a system for
ambulatory non-invasive blood pressure measurements and consequent evaluation of the measured data. The
software allows its user to define measuring intervals and select a suitable standard for data evaluation. When the
data is recorded, it is possible to review it, edit it and evaluate it according to the selected standard. The software
displays the data in a well-arranged layout. All examination data including a medical report are digitally stored in
the unified patient database and can be opened or printed anytime later.

1.1 INTENDED USE

The BTL CardioPoint is intended for acquisition, processing, recording, storage, analysis and presentation of
examination-related data.
The BTL CardioPoint-ABPM module is intended for acquisition, processing, recording, analysis and presentation
of long-term blood pressure recording and other related data.

1.2 INDICATIONS

The indications for ambulatory blood pressure monitoring include among others:
 Hypertension
 Masked hypertension
 Suspected white-coat hypertension
 Establishment of dipper status
 Resistant hypertension
 Antihypertensive drug treatment guide
 Evaluation of hypotension
 Autonomic failure, Collapse
 Syncope

1.3 USER PROFILE

The BTL CardioPoint-ABPM shall be used by medically educated personnel. The user shall be familiar with all
safety precautions, operating procedures and maintenance instructions given in this User’s Manual.

1.4 OPERATING ENVIRONMENT

The BTL CardioPoint-ABPM is intended to be used primarily in hospitals, but it can also be used in clinics,
medical centres or wherever the ambulatory blood pressure monitoring is performed. The BTL CardioPoint-ABPM
is not intended for home-use.

1.5 PATIENT PROFILE

The BTL CardioPoint-ABPM can be used on all adult or paediatric patients without limitation of age, gender,
weight, height, etc. The patient must not show any symptoms listed within the list of contraindications. The user
should take into account a detailed patient’s medical history and examine the patient thoroughly to determine
whether or not this particular diagnostic method is suitable for the patient.

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1.6 CONTRAINDICATIONS

The contraindications for ambulatory blood pressure monitoring include cardiac rate is irregularity, as in atrial
fibrillation.
There may be technical reasons why ambulatory readings fail in some patients (e.g. problems with cuff fitting in
patients with conical-shaped arms, movement artefact, tremor, weak or irregular pulse, auscultatory gap). ABPM
may not be accurate during exercise or when driving.

1.7 POSSIBLE SIDE-EFFECTS

Possible side-effects for use of ambulatory blood pressure monitoring may include petechiae, bruising under the
inflating cuff and sleep disturbance.

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2 SAFETY PRECAUTIONS

Read the User’s Manual carefully and become familiar with all its safety requirements and
operating procedures before using the product. It is not allowed to use the product in any
manner other that is in accordance with the User’s Manual. It is prohibited to use the product
in the way that is not in accordance with the Intended use.

Before the use of this product please read carefully User's Manual for a compatible device.

The BTL CardioPoint offers no diagnostic opinions to the user. Instead, it provides interpretive
statements of morphology, rhythm and conduction for the qualified healthcare professionals in
order to render their own medical opinion.

Use only original BTL accessories and compatible devices. Do not use any device or
accessories other than approved by BTL.

Before the start of examination, verify that all parameters that can affect the examination are
set.

No modification of the product is allowed.

In case a remote service of the product is required, disconnect the patient from the system.
Remote service cannot be carried out while a patient is connected to the system.
If the product or its accessories shows any signs of defects or you are in doubt about its
correct operation, stop working with the product immediately. If you cannot detect the source
of your concerns, even after a careful reading through of the User’s Manual, contact
an authorised BTL service without delay. If the product is used contrary to this instruction
manual or it is used in despite of the product showing functional divergences from those
stated in this User’s Manual, then the user is responsible for any damage caused by or
caused to the product.

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3 USED SYMBOLS

Follow the instructions for use

Caution

CE mark

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4 INSTALLATION AND ASSEMBLY

4.1 INSTALLATION OF BTL CARDIOPOINT SOFTWARE

The installation of the BTL CardioPoint software is described in the BTL CardioPoint User’s Manual.

4.2 PRODUCT PROTECTION

BTL CardioPoint software users are asked to register their new product. Please ask your
vendor to supply you with the license file. The word “Unregistered” will be displayed next
to the mouse cursor and on all final reports until the product has been officially registered.

4.3 DEMO MODE

There is a DEMO patient in the database which allows you to see the software working
even without the protection mentioned above. However, when the DEMO patient is
selected, the BTL-08 ABPM will not communicate with the software, the BTL
CardioPoint-ABPM will only display simulated values.

4.4 ASSEMBLY OF THE BTL CARDIOPOINT-ABPM SYSTEM

The BTL CardioPoint-ABPM software only works only with the BTL-08 ABPM.
For communication with the computer, use the special optical/USB interface. This connector can be found on the
right side of the BTL-08 ABPM device.
Connection process:
1) Respect the red mark on the cable – see the picture below.
2) Connect the optical/USB interface to the USB port on the computer.
3) Connect the small ending of the optical/USB interface to the optical port on the BTL-08 ABPM device.
You should hear a soft click.

For safety and compatibility, only use an authentic optical/USB interface.

4.5 COMMUNICATION SETTINGS

There are no special settings. The BTL CardioPoint-ABPM will locate the device automatically.

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5 OPERATING INSTRUCTIONS

Complete instructions how to operate BTL-08 ABPM unit is described in its own User’s Manual. Below you will
find instructions how to operate the BTL CardioPoint-ABPM only.

Possible ways how to start the examination:

1) Start the examination using the BTL CardioPoint-ABPM software (see Chapter 5.1)
2) Start the examination directly from the unit (see User´s manual of BTL-08 ABPM)

5.1 START THE EXAMINATION USING THE BTL CARDIOPOINT-ABPM SOFTWARE

The main window of the program (Database)
Start the BTL CardioPoint.
opens from which all basic functions of the
program are available.
Create a new patient or select
one from the list.

Continue by starting a new ABPM examination.

After clicking “New ABPM”, the window displaying the parameters for the examination will open.

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5.1.1 SETTINGS EXAMINATION PARAMETERS
All parameters can be set in these tabs before you send the data to the connected BTL ABPM-08 device:

SUMMARY

Summary is an overview of the main ABPM examination settings.

Review the Select start time of Save current settings Program the unit. The examination settings
settings for the the BP measuring as default settings for will be entered in the recorder and then
examination. and length of the future examinations. may be disconnected from the computer
examination. and the patient can leave.

BP SETTINGS

You can set measuring intervals for the day and night periods. Default setting is to measure every 15 minutes
during day and every 30 min during night. It is possible to add special or morning measuring intervals as well.

Adds the next

measuring interval.

Selects a value in the

table to edit the time
and date.

Deletes a value from

the schedule.

List of all
measurements.

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 Allow or restrict some special periods. You can set the intervals for morning, day, night and
special period.
For example: If you change the start of the day interval,
the end of the night interval will be changed automatically.

You can set the intervals for blood pressure measuring.

The intervals are: 5, 10, 15, 20, 25, 30, 40, 60 and 90
minutes.
If you select a value from the list, the list of measurements
will be recalculated automatically.

The colour representation of planned measurments.

BP SPECIAL SETTINGS

If you change the cuff size or want to change the maximum cuff pressure limit, you can do it on the “BP special
settings” tab.

Enables the displaying

the measured values
while measuring.

Select proper cuff type.

Select the maximum

cuff pressure limit,
which the recorder will
inflate the cuff to during
measuring.
The recorder will not
exceed this limit. If the
systolic blood pressure
is higher than this value,
it will not be measured.

There may be set the following maximum pressures:

 200, 210, 220, 230, 240, 250, 260, 270, 280, 290 and 300 mmHg

There may be set the following cuff types:

 Normal, Large, Small and Unknown

Be sure to select the proper cuff size each time! If the wrong cuff size is used, inaccurate results may
occur.

Consider, whether it is really necessary to tick the “Display during measurements” option. The changing numbers
can attract the patient’s attention and might influence the blood pressure measuring.

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 PATIENT DATA

If the patient uses any medications, you can enter them here and their dosages.

Enter the resting BP

(e.g. just before the
patient leaves the
office).

Input the patient’s

weight and height.

Add any medicine that

the patient uses (if any).

Copy the medicines from a previous examination. Select a row in the table
If the medicines have changed, you can add or and remove it by clicking
remove them. this button.

5.1.2 SENDING THE EXAMINATION SETTING TO THE DEVICE

Click the button “Send to device” after setting all the parameters for your new ABPM examination.

Should there be a record in your ABPM recorder that has not been imported to the BTL CardioPoint yet, a
warning message will pop up. Click “Yes” to erase this record and start new recording.

Note! This message can also appear when starting a new recording with a brand new ABPM recorder. The BTL-
08 ABPM recorders are tested during production and may already contain some data.

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While sending the examination settings from a computer to the BTL-08 ABPM recorder, you will see the
communication symbol on the ABPM recorder display:

You will be notified about successful transmission of the examination plan to the device.

When the computer confirms that the examination settings were sent, you can disconnect the recorder even
though you still see the communication with the computer symbol on the ABPM recorder display.

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 5.2 HOW TO IMPORT THE EXAMINATION

How to import the examination data from the BTL-08 ABPM to a computer and how to do an evaluation of that
examination data is described here.

5.2.1 LOADING THE EXAMINATION DATA FROM THE DEVICE TO A COMPUTER

The main window of the program

Start BTL CardioPoint (Database) opens from which all basic
functions of the program are available.

The Load ABPM form opens and will be

Click “Load looking for the connected ABPM recorder
ABPM” device. You can check this on the progress
bar.

If the recorder is not connected (or recognized) during the loading of the
examination data, you will see an error message. In this event, connect the
BTL-08 ABPM recorder and click the “Find ABPM device” button. The
procedure will be repeated.

After successfully finding the ABPM recorder, the big window will change
to the smaller ABPM form. This will be the case if the patient’s data is in
the database and the ID of the examination in the recorder is the same as
on the computer (meaning that the examination was started from the
same computer).

If the examination was started from another computer, the “Load Abpm” dialogue box will opened showing the
possibility to select an already existing patient’s file or to create a new patient file.

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 Select the patient from the list or use the
filters to find it.
Then click “Load and Edit” to load and open
the examination record or click “Load” to
only transfer the examination record without
opening the record.

If the patient does not exist, select “New

Patient”.
A dialogue box will open for entering the
new patient’s data with possibility to load
the examination record.

5.3 EVALUATION OF AN EXAMINATION

5.3.1 MAIN SCREEN DESCRIPTION

After successful transfer of the examination data, the examination record overview will be displayed.

All measured values in the To switch between the chart and All measured values in the trend-chart.
table. histograms.

Settings and print buttons. Space for your medical findings. Table with statistical values.

5.3.2 BLOOD PRESSURE TABLE

You can see all of the measured values in this table. The values marked by the green checkmark are valid
and will be used in statistics. If you disagree with the value and you do not want to use it in the statistics, you can
click the green icon and the icon will change to blue . The colour blue means that the recorder measured the
value, but the physician disagrees with the value and has marked the value as invalid. The value will still be
present in the table and will be shown in the final report, but it will be marked as invalid and will not be used for
statistics calculation.

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If the patient pushed the medication button or day/night button, this will be indicated in the table by this icon .
The undeletable label “medication” (if the medication button was pressed) or “bedtime marker” (if the day/night
button was pressed) will be shown in the note column. The medications and day/night notes will be shown in the
trend-chart as well as the tablet or day/night icon.
The red button means that an error has occurred during measuring. For example, the cuff was not connected;
the batteries went dead; etc…

Used to switch the table between listing the data The red highlighted values are over the limit in comparison
measurement by measurement or by the hourly to the selected standard.
averages and events.

The fields in the “note” and “Error” columns are not possible
to edit. These are reserved for system messages.

In this column, you can input your comment about the

value/measurment. This will only be avaliable if the “Blood
pressure list” option is selected.

The number in the brackets means the day of the

examination. If the value is from the second day, it will be
indicated by “(2)” in front of the time.

The letter “A” means automatic blood pressure measuring.

The letter “M” means manually blood pressure measuring.
The letter “B” means that the medication button was pressed.
The letter “D” represents the day/night button was pressed and the recorder noted a day=>night event into the log.
The letter “U” represents the day/night button was pressed and the recorder noted a night=>day event into the log.

Used to switch the table between listing measurement by measurement and the hourly averages.
Errors, medication, bedtime indicators and remarks relevant to particular measurement will be hidden
in the table. However, remarks to hourly average can be added.

If you untick one of specific measurements/events, the other ones will disappear from the list and will
not be printed in the final report.

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5.3.3 BLOOD PRESSURE TREND

Switches to to
the the Medication, daytime and night- The red line shows the limit of
histogram. time icons. systolic blood pressure.
The blue line shows the limit of
diastolic blood pressure.
Limit values are defined in the
criteria.

If you click a value on the chart,

that value in the table will also be
marked and vice versa.

Different colors indicate the borderline between Change the graph style and the
the different periods: Morning, day, night and length of the graph.
special.

If you select “Pathologies” layout, you

will see the areas which are over the
pressure limit highlighted in red.

If you select “BP Only” layout, you will

see the measure as a line between
systolic and diastolic blood pressure.

TIP: If you untick “MAP” and “HR,” you

will only see the values and the
predicted borderline.

If you select “Full Envolope” layout,

you will see the all systolic and all the
diastolic blood pressure values
connected by a thin line and the area
between each of those points will be
highlighted in green.

Tick “HR” to disabling/enabling the heart rate trent and tick

“MAP” to disabling/enabling middle arterial pressure points.

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 If you deselect ”MAP” and “SYS/DIA
spread”, you will see clean BP curve
and shaded areas above hypertension
threshold (red) and below threshold
(blue).

5.3.4 STATISTICAL VALUES TABLE

Time interval used for Periods and their time range which were selected
calculation of these statistics. for the examination.

You will find the calculated statistics in this area.

The parameters may be changed in Settings =>
Report Settings.

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DESCRIPTION OF THE LABELS FROM THE STATISTICAL VALUES TABLE
Label
Successfully Readings
All Readings
Successfully Ratio [%]
SYS/DIA avg [mmHg]
SBP Interpretation Label
DBP Interpretation Label
SBP Borderline values
DPB Borderline values
MAP avg [mmHg]
Pulse avg [bpm]
Night fall index SYS/DIA [%]
SYS/DIA day/night
difference [mmHg]
Morning Surge
SYS max [mmHg]
SYS min [mmHg]
DIA max [mmHg]
DIA min [mmHg]
PTE SYS/DIA [%]
PTE SYS [%]
PTE DIA [%]
PTD SYS/DIA [%]
PTD SYS [%]
PTD DIA [%]
SYS/DIA hyper readings
SYS hyper readings
DIA hyper readings
SYS/DIA hypo readings
SYS hypo readings
DIA hypo readings
Time range
All/Successfully readings
SYS/DIA max [mmHg]
SYS/DIA min [mmHg]
SYS/DIA load [mmHg x h]
SYS load [mmHg x h]
DIA load [mmHg x h]
SYS/DIA leese [mmHg x 24h]
SYS leese [mmHg x 24h]
DIA leese [mmHg x 24h]
SD (SYS/DIA) [mmHg]
CV (SYS/DIA) [%]
BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 19 OF 36
Description
Represents how many measurements were successfully measured.
Represents how many measurements were measured, both programmed and manual.
Represents the percentages of the measurements that were successfully measured.
Represents the average systolic and diastolic blood pressure through measured
interval. This interval is shown above the table. This pressure does not have to be
measured during the examination. It could be composed from two different pressures.
For more details, see the formula in Chapter 8.2.3.
Written interpretation of the systolic blood pressure.
Written interpretation of the diastolic blood pressure.
Limit values for systolic blood pressure (it is defined in the criteria).
Limit values for diastolic blood pressure (it is defined in the criteria).
Represents averaged middle arterial pressure throughout the whole examination. For
more details, see the formulas in Chapters 8.2.2 and 8.2.3.
Represents the average pulse. For more details, see the formula in Chapter 8.2.3.
Gives the difference between active (daytime) and passive (night-time) means as a
percentage of the active mean. The DI is abnormally narrow if it is below 10%. For more
details, see the formula in Chapter 8.2.4.
Represents difference of average values between day and night period.
The morning surge is the difference between the mean systolic blood pressure during
the first two hours after waking and getting up minus the mean systolic blood pressure
of the lowest blood pressure reading during sleep and its two adjacent values (total of
3 values). The software interprets the last nightly measurement at the time when the
patient wakes up. For more details, see the formula in Chapter 8.2.9.
Represents the maximum systolic blood pressure.
Represents the minimum systolic blood pressure.
Represents the maximum diastolic blood pressure.
Represents the minimum diastolic blood pressure.
Hypertensive time index SYS/DIA. For more details, see the formula in Chapter 8.2.5.
Hypertensive time index SYS. For more details, see the formula in Chapter 8.2.5.
Hypertensive time index DIA. For more details, see the formula in Chapter 8.2.5.
Hypotensive time index SYS/DIA. For more details, see the formula in Chapter 8.2.7.
Hypotensive time index SYS. For more details, see the formula in Chapter 8.2.7.
Hypotensive time index DIA. For more details, see the formula in Chapter 8.2.7.
Measuring of increase SYS/DIA blood pressure.
Measuring of increase SYS blood pressure.
Measuring of increase DIA blood pressure.
Measuring of decrease SYS/DIA blood pressure.
Measuring of decrease SYS blood pressure.
Measuring of decrease DIA blood pressure.
The time range of the measure intervals (e.g. night, day, special…).
Represents the ratio between all readings and the successfully measured values.
Represents the maximum systolic and diastolic blood pressure during the measuring.
This pressure did not have to be measured during the examination. This number could
be composed from two different pressures.
Represents the minimum systolic and diastolic blood pressure during the measuring.
This pressure did not have to be measured during the examination. This number could
be composed from two different pressures.
Represents the load of the body with SYS and DIA blood pressure. For more details
see the formula in the Chapter 8.2.6.
Represents the load of the body with SYS blood pressure. For more details, see the
formula in Chapter 8.2.6.
Represents the load of the body with DIA blood pressure. For more details, see the
formula in Chapter 8.2.6.
Represents systolic/diastolic hypotensive load on the patient's cardiovascular system.
For more details, see the formula in Chapter 8.2.8.
Represents systolic hypotensive load on the patient's cardiovascular system. For more
details, see the formula in Chapter 8.2.8.
Represents diastolic hypotensive load on the patient's cardiovascular system. For more
details, see the formula in Chapter 8.2.8.
Standard deviation. For more details, see the formula in Chapter 8.2.10
Coeficient of variation. For more details, see formula in Chapter 8.2.11
5.3.5 MEDICAL FINDINGS
You may write your medical findings in this window. This text will be included in the final report.

Here, you can input your medical findings. If this tab is dark, the “Auto Complete” function is enabled.

Input frequently used text formula, select the text and then use
these buttons to add or remove the phrase from the dictionary.

For the acceleration and facilitation of the typing of the final reports, it is possible to utilize the auto-complete
function. This function enables you to pre-set your own templates of the final reports and to save any phrases
which you frequently use.

Auto Complete To switch on / off the auto-complete function

Add selected phrase To add the phrase selected in the edit field to the list of phrases
Remove selected phrase To delete the phrase selected in the edit field from the list of phrases

5.3.6 SOFTWARE SETTINGS

Click the setting button: You can go through all the settings by using these four tabs:

A new dialogue box will opened:

BP SETTINGS:

The tabs for browsing

the settings.

Save the settings of

current examination as
default settings for all
future examinations.

Apply or cancel the

changes.

You can add or remove a “Morning” or Here, you can view and change the start time and end time for
“Special” period. It will have an impact on statistics calculation.
the statistic calculation. The statistics do not have to be calculated from all of the
examination data.

If you change the “Statistical range”, all values will be recalculated! It is possible to this do after printing the report,
as well! However, in this case, the values will be different.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 20 OF 36

PATIENT DATA

This window is the

same as the dialogue
box described in
Chapter Settings
Examination
Parameters.
It shows only a part of
the patient’s data. The
patient’s weight and
height data cannot be
changed at this point.
These values are part
of the examination
record, but they are
not a part of the
patient’s data. They
can be changed
during the next
examination.

RECOMMENDATIONS AND GUIDELINES

The recommendations and guidelines for using in the BTL CardioPoint-ABPM software are described here.

The BTL CardioPoint-ABPM contains following recommendations and guidelines for hypertension:

Guideline Description Population

AHA 2005 Optimal Normal Borderline Abnormal Adult
[1] Overall <125/75 <130/80 <136/86 >=136/86 (17+
Morning <130/80 <135/85 <141/91 >=141/91 years)
Day <130/80 <135/85 <141/91 >=141/91 Not
Night <115/65 <120/70 <126/76 >=126/76 pregnant

AHA 2008 This recommendation is divided into “Normal” and “Abnormal” values. In these tables, Children
[2] only normal values are mentioned. The abnormal values are opposite to these stated (5 -16
values. years)
Examples:
NORMAL BP, Overall time int. Male Female
5y-5y11m <=116/74 <=115/74

Abnormal BP, Overall time int. Male Female

5y-5y11m >116/74 >115/74
Definitions:
NORMAL BP, Overall time int. Male Female
5y-5y11m <=116/74 <=115/74
6y-6y11m <=118/75 <=116/74
7y-7y11m <=119/75 <=118/74
8y-8y11m <=120/75 <=119/74
9y-9y11m <=121/75 <=120/74
10y-10y11m <=122/75 <=121/75
11y-11y11m <=125/76 <=122/75
12y-12y11m <=127/76 <=123/76
13y-13y11m <=130/76 <=124/76
14y-14y11m <=133/77 <=124/76
15y-15y11m <=136/77 <=125/77
16y-16y11m <=138/78 <=126/77

NORMAL BP, Morning and day time int. Male Female

5y-5y11m <=123/81 <=121/82
6y-6y11m <=124/81 <=122/82
7y-7y11m <=125/82 <=123/82
8y-8y11m <=125/82 <=124/82

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 21 OF 36

 9y-9y11m <=126/82 <=125/82
10y-10y11m <=127/82 <=126/81
11y-11y11m <=129/82 <=127/81
12y-12y11m <=132/82 <=128/82
13y-13y11m <=135/82 <=129/82
14y-14y11m <=138/82 <=130/82
15y-15y11m <=141/83 <=130/82
16y-16y11m <=144/84 <=131/82

NORMAL BP, Night time int. Male Female

5y-5y11m <=106/65 <=108/68
6y-6y11m <=108/66 <=110/68
7y-7y11m <=110/67 <=111/67
8y-8y11m <=111/67 <=112/67
9y-9y11m <=112/67 <=112/67
10y-10y11m <=113/67 <=113/66
11y-11y11m <=115/67 <=114/66
12y-12y11m <=116/66 <=114/66
13y-13y11m <=119/66 <=114/66
14y-14y11m <=121/66 <=114/65
15y-15y11m <=123/66 <=114/65
16y-16y11m <=126/66 <=114/65

ESH 2003 Optimal Normal Borderline Abnormal Adult

[3] (17+
Morning <130/80 <135/85 <141/91 >=141/91
years)
Day <130/80 <135/85 <141/91 >=141/91
Night <115/65 <120/70 <126/76 >=126/76 Not
pregnant
ESH 2016 Children
pediatrics – Boys (5 – 16
by age 24h Day Night years)
Percentile 90th 95th 90th 95th 90th 95th
Evaluation Borderline Abnormal Borderline Abnormal Borderline Abnormal
Age (y)
5 113/72 116/74 120/79 123/81 103/62 106/65
6 115/73 118/75 121/79 124/81 105/63 108/66
7 116/73 119/75 122/80 125/82 106/64 110/67
8 117/73 120/75 122/80 125/82 108/64 111/67
9 118/73 121/75 123/80 126/82 109/64 112/67
10 119/73 123/75 124/80 127/82 110/64 113/67
11 121/74 125/76 126/80 129/82 111/64 115/67
12 124/74 127/76 128/80 132/82 113/64 116/67
13 126/74 130/76 131/80 135/82 115/64 119/67
14 129/75 133/77 134/80 138/82 118/64 121/67
15 132/75 136/77 137/81 141/83 120/64 123/66
16 135/76 138/78 140/81 144/84 123/64 126/66

Girls
24h Day Night
Percentile 90th 95th 90th 95th 90th 95th
Evaluation Borderline Abnormal Borderline Abnormal Borderline Abnormal
Age (y)
5 112/72 115/74 118/80 121/82 105/66 108/69
6 114/72 116/74 120/80 122/82 106/65 110/68
7 115/72 118/74 121/80 123/82 107/65 111/67
8 116/72 119/74 122/80 124/82 108/64 112/67
9 117/73 120/74 122/80 125/82 109/64 112/67
10 118/73 121/75 123/79 126/81 110/64 113/67
11 119/73 122/75 124/79 127/81 110/63 114/66
12 120/74 123/76 125/80 128/82 110/63 114/66

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 22 OF 36

 13 121/74 124/76 126/80 129/82 111/63 114/66
14 122/74 125/76 127/80 130/82 111/63 114/65
15 123/75 125/77 128/80 130/82 111/63 114/65
16 123/75 126/77 129/80 131/82 111/63 114/65

AHA 2017 Adult

[7] Normal Borderline Stage 1 Stage 2 (17+
hypertension hypertension years)
Overall <115/75 <125/80 <130/80 >=130/80 Not
Day <120/80 <130/85 <135/85 >=135/85 pregnant
Night <100/65 <110/70 <120/70 >=120/70

ESH 2016 Note: Patient´s height must be entered into the software, either during programming of Boys
pediatrics – the unit, or after loading of examination, otherwise the automatic interpretation will not (120-185
by height work. Go to Examination settings -> tab Patient data. cm)
Girls
(120-175
Boys cm)
24h Day Night
Percentile 90th 95th 90th 95th 90th 95th
Evaluation Borderline Abnormal Borderline Abnormal Borderline Abnormal
Height (cm)
120 114/74 117/77 122/80 125/82 103/61 106/63
125 115/74 118/77 122/80 125/82 105/61 108/63
130 116/74 119/77 122/80 126/82 106/62 110/64
135 117/74 120/77 123/80 126/82 108/63 111/65
140 118/75 121/77 123/80 126/82 109/63 113/65
145 120/75 123/77 124/79 127/81 111/64 114/66
150 121/75 124/77 125/79 128/81 112/64 116/66
155 123/75 126/77 127/79 130/81 113/64 117/66
160 124/75 127/77 129/79 133/81 114/64 118/66
165 126/75 129/78 132/80 135/82 116/64 119/66
170 128/75 131/78 134/80 138/82 117/64 121/66
175 130/75 133/78 136/81 140/83 119/64 122/66
180 131/76 134/78 138/81 142/83 120/64 124/66
185 133/76 136/78 140/81 144/84 122/64 125/66

Girls
24h Day Night
Percentile 90th 95th 90th 95th 90th 95th
Evaluation Borderline Abnormal Borderline Abnormal Borderline Abnormal
Height (cm)
120 112/71 114/72 118/80 120/82 103/63 106/65
125 113/71 116/73 119/80 121/82 104/63 107/66
130 114/72 117/73 120/80 122/82 106/63 108/66
135 115/72 118/74 120/80 123/82 107/63 109/66
140 116/73 119/75 121/80 124/82 108/63 110/66
145 117/73 120/75 123/80 125/82 109/63 112/66
150 119/74 121/76 124/80 127/82 110/63 113/66
155 120/74 123/76 125/80 128/82 111/63 114/66
160 121/74 123/76 126/80 129/82 111/63 114/66
165 122/74 124/76 127/80 130/82 112/63 114/66
170 123/74 125/76 128/80 131/82 112/67 115/71
175 124/75 126/76 129/81 131/82 113/63 115/66

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 23 OF 36

ESH/ESC Adult
2018 [8] Normal Abnormal (17+
Overall <130/80 >=130/80 years)
Day <135/85 >=135/85 Not
Night <120/70 >=120/70 pregnant

Chaloupec Boys Children

ky 2006 [4] Height (cm) Overall Day Night (5 – 17
years)
120 113/72 123/85 104/63 Adult
130 117/75 125/85 107/65 (18+)
140 121/77 127/85 110/67
150 124/78 129/85 113/67
160 126/78 132/85 116/67
170 128/77 135/85 119/67
180 130/77 137/85 122/67

Girls
Height (cm) Overall Day Night
120 113/73 120/84 107/66
130 117/75 124/84 109/66
140 120/76 127/84 111/66
150 122/76 129/84 112/66
160 124/76 131/84 113/66
170 124/76 131/84 113/66
180 124/76 131/84 114/66

NHFA 2002 Normal Abnormal Adult

[5] Overall <130/80 >=130/80 (17+
Morning <135/85 >=135/85 years)
Day <135/85 >=135/85 Not
Night <120/75 >=120/75 pregnant

NICE 2011 Adult

[6] Normal Stage 1 Hypertension Stage 2 Hypertension (17+
Morning <135/85 <150/95 >=150/95 years)
Day <135/85 <150/95 >=150/95 Not
pregnant
User If you want to create your own criteria, you may do it using the build-in editor. The user _
can enter “Normal” and “Abnormal” values only.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 24 OF 36

If you do not see the table with prediction values in the software (see an example on the picture below) the
situation is caused by the patient’s age. This means that the patient’s age does not correspond the criteria’s
definition.

Select a
Select a
recommendation for
recommendation/guid
hypertension.
eline for hypertension.

Edit your own criteria.

Configure the
hypotension values. It
is possible to enter
only your values for
hypotensive blood
pressure, because
there are no special
recommendations for
this kind of the blood
Table with predicted values. pressure. Therefore
It is not possible to edit the default recommandation/guidelines values. If you want to no recommendations
edit one of them, it will be saved as user BP criteria. are present.
The rows represent the borderlines for each stage and the columns represent the
blood pressure clasifications during the stages.

How to create new BP criteria

1) Select blood pressure level and
time interval.

2) Select the period for separation

and click “New age row.”

3) Divide the interval and confirm it

by clicking “OK.”

4) Insert your values and confirm it

by clicking “OK” when finished.
5) It is necessary to respect the
following text strings:

(<|=|<=|=<)(-|[0-9]+)/( -|[0-9]+)
Empty spaces and tabs will be
automatically deleted.

Repeat the procedure until you have entered all intervals and blood pressure levels.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 25 OF 36

REPORT SETTINGS

Select the values that

you want to calculate
and view in the
BTL CardioPoint-ABPM.
All selected value will be
printed as well.

Set the order of the

items selected. Select a
item in the table and
move it up or down by
clicking these buttons.

Select the pages you want If you select more than 13 items, you will see
to print. this warning message.
You will be able to view all of your selected
parameters, but only the first 13 will be printed.

If you select more than 13 items, you will be able to view all of your selected values, but only the first 13 values
will be printed! You will see a warning message in the window for report settings.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 26 OF 36

6 ADDITIONAL SOFTWARE SETTINGS

6.1 CHANGING THE LAYOUT COLOUR

BTL uses two different colour layout defaults for your comfort while using the software. You may change the
layout colours from the “Design” menu:

6.2 EXPORT THE EXAMINATION DATA

You may export data from the examination. These data will be exported as *.csv data which will be possible to
open and view in Microsoft Excel.
You can do this by clicking “Examination” => “Export to MS Excel” and then select the target directory for
exporting.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 27 OF 36

7 LIST OF ERROR CODES WITH EXPLANATION

The ERROR codes which you may see in the BTL CardioPoint-ABPM are described here. You will see these
codes in the blood pressure table in the column labelled “Error”. The first number is the error code and the second
one is a number for development. You will find a description of the error codes in the tables below. In the “note”
column, there will be a short written interpretation of the error code.

7.1 UNSUCCESSFUL MEASUREMENTS

Code Name Explanation

1 Aborted measurements
2 Cancelled by user
3 Low batteries
4 Batteries changed
The previous measurement
5 The measurement was started too close to the previous one.
was too close
8 Pressure limit exceeded
9 Temporary disturbance
The measurement timeout is over or the measurement had to be aborted. For
example, the patient was moving.
The measurement was stopped by the pressing a button or one of the buttons
was pressed and held more than 30 seconds and therefore the automatic
measurement did not start.
The batteries went dead during measurement.
The batteries were replaced during measurement.
The pressure in the pneumatic system exceeded the pre-set pressure limit.
External electric signal (e.g. static discharge) disturbed the operation of the
device.

7.2 CUFF RELATED ERRORS

Code Name Explanation

31 Cuff not connected There was no cuff connected to the device.
32 Cuff is clogged The cuff is clogged or the rubber tubing is broken.
33 Cuff leaking or to loose There is a hole in the cuff or the device is leaking.
34 Cuff not on the arm Cuff is connected, but the patient is not wearing the cuff.

7.3 FAULTY DEVICE

Code Name Explanation

90 Hardware error The device could not measure due to a hardware error.
99 Pressure sensor failure The device did not start automatic measurement (until the next programming).

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 28 OF 36

 8 FORMULAS USED FOR STATISTICAL CALCULATIONS

Here is the description of the formulas and procedures which are used for the statistical analysis and
the calculated data types.

8.1 MEASURED DATA

8.1.1 SYS: SYSTOLIC BLOOD PRESSURE

The systolic blood pressure is the greatest pressure value that the blood exerts on the inner wall of the artery.
It can be measured at the moment when the contracted heart starts another beat and forces the blood out
into the arteries. The systolic BP is the highest blood pressure value.

8.1.2 DIA: DIASTOLIC BLOOD PRESSURE

Diastolic blood pressure is the lowest pressure value that the blood exerts on the inner wall of the artery. This
value can be measured when the heart is in its relaxed state and is filled with blood. The diastolic BP is the lowest
blood pressure value.

8.1.3 PULSE: HEART RATE, HEART FREQUENCY AND PULSE RATE

The heart frequency is the number of times the heart contracts in a minute. The pulse rate is the number of pulses
detectable above the peripheral arteries. These two are often the same, but the pulse rate can sometimes
be lower. ECG monitors measure the heart frequency and the blood pressure monitors measure the pulse rate.
Pulse rate is abbreviated as “pulse” and heart rate as “HR”.

8.2 CALCULATED DATA

8.2.1 PP: PULSE PRESSURE

;

8.2.2 MAP: MEAN ARTERIAL PRESSURE

8.2.3 MEAN
Statistics can be the result of simple arithmetic calculations or they can be weighted averages. As blood pressure
is measured sequentially, the profile is not continuous. When using weighted averages, the program will treat an
average like it was a continuous value within a time interval, which is calculated by dividing the time period
weighting for time the program counts with a reading as a valid continuous value within a time range defined
by halving the times to its neighbouring readings.

a0, a1 and a2: The consecutive measurements

t1 and t2: The total time represented by the a1 measurement where:

and
This means that a measurement will represent half of the elapsed time
between its two nearest measurements. To avoid distorting the input,
the program uses the following rules which are valid for both t1 and t2:

- If t1 <= 30 minutes Weighted normally.

- If 30 minutes < t1 <= 120 minutes Weighting uses 30 minutes instead.
- If t1 > 120 minutes Weighting uses 0 minutes instead.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 29 OF 36

 - If the reading is at the edge of region of interest, only the t within the region will be taken into consideration. For
example, t2 with left-end data or t1 with right-end data.

Simple means:

; ai: The value of each measurement.

n: The total number of measurements.

Weighted means:

; ai: The value of each measurement.

n: The total number of measurements.
(t1i + t2i): The times represented by a measurement.

8.2.4 NIGHT FALL INDEX (DIURNAL INDEX) [%]: (D/N INDEX)

Gives the difference between active (daytime) and passive (night-time) means in percentage of the active mean.
DI is abnormally narrow if it is below 10 %.

8.2.5 PTE [%]: (PERCENTAGE TIME ELEVATION)

Shows what percentage of the total analysed time blood pressure was above cut-off lines. In other words, it
calculates an elevated time to total time ratio. The 140/90 mmHg cut-off line for casual blood pressure
measurements approximately equals to the ambulatory overall (24-hour) mean cut-off line of 135/85 mmHg. The
PTE for MAP is abnormally high if it is over 25 %.

t1i+t2i: The times represented by a measurement.

; ai: The value of each measurement.
norm: The value of the corresponding cut-off line.
nex: The number of measurements above the cut-off line.
n: The total number of measurements.

8.2.6 LOAD [MMHG]: (HYPERBARIC IMPACT)

Shows how large the hypertension load is on the patient. In other words, it shows the area under the curve
between the cut-off line and the data curve standardized for 24 hours can be found. It shows how long blood
pressure was higher than normal during 24-hour time range and how much higher it is than the upper limit of
normal blood pressure. It is an important factor to evaluate the effects of therapy.

t1i+t2i: The times represented by a measurement.

; ai: The value of each measurement.
norm: The value of the corresponding cut-off line.
nex: The number of measurements above the cut-off line.
n: The total number of measurements.

8.2.7 PTD [%]: (PERCENTAGE TIME DEPRESSION)

The PTD is similar to PTE (hypertensive time index) shows what percent of the total analysed time blood pressure
was below hypotensive cut-off lines. In other words, it calculates a depressed time to total time ratio.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 30 OF 36

 t1i+t2i: The times represented by a measurement.
; ai: The value of each measurement.
norm: The value of the corresponding cut-off line.
nex: The number of measurements above the cut-off line.
n: The total number of measurements.

8.2.8 LEESE [MMHG]: (HYPOTENSIVE LOAD)

The leese (Hypotensive load) analogue with the Load (hyperbaric impact) shows the impact of hypotensive load
on the patient's cardiovascular system. In other words, it shows for how long and with how much on average, the
blood pressure reading below the normal level during the 24-hour period was.

t1i+t2i: The times represented by a measurement.

; ai: The value of each measurement.
norm: The value of the corresponding cut-off line.
nex: The number of measurements above the cut-off line.
n: The total number of measurements.

8.2.9 MORNING SURGE

The morning surge is the difference between the mean systolic blood pressure during the first two hours after
waking and getting up minus the mean systolic blood pressure of the lowest blood pressure reading during sleep
and its two adjacent values (total of 3 values). The software interprets the last nightly measurement at the time
when the patient wakes up.

8.2.10 SD (SYS/DIA) [MMHG]: (STANDARD DEVIATION)

Statistic value that can show it how much variation can occur in correlation with the medium value of all
measurements

k: Ranges from 1 to n.

: One blood pressure measurement.

: Mean blood pressure.

n: The total number of measurements.

8.2.11 CV (SYS/DIA) [%]: (COEFICIENT OF VARIATION)

Statistic value that shows the ratio of the standard deviation to the mean

SD: Standard deviation of SYS/DIA

: Mean blood pressure.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 31 OF 36

9 HOT KEYS

The following is a list of the hotkeys used in the software program to facilitate your work.

The hotkeys used in the BTL CardioPoint-ABPM:

Delete: The selected blood pressure will be marked as invalid and the values in the statistical table will
be recalculated.

Backspace: Resets an invalid blood pressure value back to valid and the values in the statistical table will be
recalculated.

Ctrl + P: Print the examination report from the default printer.

Ctrl + Alt + P: Preview the examination report. It is possible print the final report from the preview page as well.

Up Arrow: Jumps to previous row in the table (measured value table and calculated values table) or to the
previous blood pressure reading on the chart.

Down Arrow: Jumps to next row in the table (measured value table and calculated values table) or to the next
blood pressure reading on the chart.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 32 OF 36

10 REFERENCES

[1] AHA 2005

PICKERING, Thomas G. Part 1: Blood Pressure Measurement in Humans A Statement
for Professionals From the Subcommittee of Professional and Public Education of the American Heart
Association Council on High Blood Pressure Research, Recommendations for Blood Pressure
Measurement in Humans and Experimental Animals, Hypertension, 2005.

[2] AHA 2008

URBINA, Elaine. Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations
for Standard Assessment A Scientific Statement From the American Heart Association Atherosclerosis,
Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young
and the Council for High Blood Pressure Research, Hypertension, 2008.

[3] ESH 2003

O’BRIEN, Eoin. European Society of Hypertension recommendations for conventional, ambulatory and
home blood pressure measurement, Journal of Hypertension, 21:821–848, 2003.

[4] Chaloupecky 2006

CHALOUPECKY, Vaclav. Dětská kardiologie, ISBN:978-80-7262-406-5.

[5] NHFA 2002

MCGRATH, Barry P. Position Statement: Ambulatory blood pressure monitoring by National Blood
Pressure Advisory Committee of the National Heart Foundation of Australia, MJA, 2002.

[6] NICE 2011

UK's National Institute for Health and Clinical Excellence Hypertension, The clinical management
of primary hypertension in adults, Clinical Guideline 127, Methods, evidence, and recommendations, 2011.

[7] AHA 2017

Carey RM et al. 2017 AHA Hypertension Guideline: Prevention, Detection, Evaluation, and Management
of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology. Ann Intern Med.
2018 Mar 6;168(5):351-358. doi: 10.7326/M17-3203. Epub 2018 Jan 23.

[8] ESH/ESC 2018

Willams B. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension., Eur Heart J.
2018 Sep 1;39(33):3021-3104. DOI: 10.1093/eurheartj/ehy339.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 33 OF 36

11 MANUFACTURER

BTL Industries Ltd.

161 Cleveland Way

Stevenage

Hertfordshire

SG1 6BU

United Kingdom

E-mail: sales@btlnet.com

For service, please contact the service department at service@btlnet.com

th
Date of last revision: 30 April 2019
ID: 591-80MANEN02203

© All rights reserved. No part of this manual may be reproduced, saved or transferred by any means including
electronic, mechanical, and photographic without the prior written approval from BTL Industries Limited.

BTL CARDIOPOINT-ABPM – USER’S MANUAL I PAGE 34 OF 36

591-80MANEN02203