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Number and timing of ambulatory blood pressure monitoring measurements

Abstract

Ambulatory blood pressure (BP) monitoring (ABPM) may cause sleep disturbances. Some home BP monitoring (HBPM) devices obtain a limited number of BP readings during sleep and may be preferred to ABPM. It is unclear how closely a few BP readings approximate a full night of ABPM. We used data from the Jackson Heart (N = 621) and Coronary Artery Risk Development in Young Adults (N = 458) studies to evaluate 74 sampling approaches to estimate BP during sleep. We sampled two to four BP measurements at specific times from a full night of ABPM and computed chance-corrected agreement (i.e., kappa) of nocturnal hypertension (i.e., mean asleep systolic BP ≥ 120 mmHg or diastolic BP ≥ 70 mmHg) defined using the full night of ABPM and subsets of BP readings. Measuring BP at 2, 3, and 4 h after falling asleep, an approach applied by some HBPM devices obtained a kappa of 0.81 (95% confidence interval [CI]: 0.78, 0.85). The highest kappa was obtained by measuring BP at 1, 2, 4, and 5 h after falling asleep: 0.84 (95% CI: 0.81, 0.87). In conclusion, measuring BP three or four times during sleep may have high agreement with nocturnal hypertension status based on a full night of ABPM.

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References

  1. O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731–68.

    Article  Google Scholar 

  2. Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359–66.

    Article  CAS  Google Scholar 

  3. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.

    Article  Google Scholar 

  4. Friedman O, Logan AG. Can nocturnal hypertension predict cardiovascular risk? Integr Blood Press Control. 2009;2:25 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172086/.

    Article  CAS  Google Scholar 

  5. Yano Y, Tanner RM, Sakhuja S, Jaeger BC, Booth JN, Abdalla M, et al. Association of daytime and nighttime blood pressure with cardiovascular disease events among African American individuals. JAMA Cardiol. 2019;4:910–7. https://doi.org/10.1001/jamacardio.2019.2845.

  6. Kario K. Nocturnal hypertension: new technology and evidence. Hypertension. 2018;71:997–1009.

    Article  CAS  Google Scholar 

  7. Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354:2368–74.

    Article  CAS  Google Scholar 

  8. Kario K, Hoshide S, Chia Y-C, Buranakitjaroen P, Siddique S, Shin J, et al. Guidance on ambulatory blood pressure monitoring: a statement from the HOPE Asia Network. J Clin Hypertens. 2021;23:411–21.

    Article  Google Scholar 

  9. Ernst ME, Bergus GR. Favorable patient acceptance of ambulatory blood pressure monitoring in a primary care setting in the United States: a cross-sectional survey. BMC Fam Pract. 2003;4:15.

    Article  Google Scholar 

  10. Degaute JP, Kerkhofs M, Dramaix M, Linkowski P. Does non-invasive ambulatory blood pressure monitoring disturb sleep? J Hypertens. 1992;10:879–85.

    CAS  PubMed  Google Scholar 

  11. Agarwal R, Light RP. The effect of measuring ambulatory blood pressure on nighttime sleep and daytime activity—implications for dipping. Clin J Am Soc Nephrol. 2010;5:281–5.

    Article  Google Scholar 

  12. Gaffey AE, Schwartz JE, Harris KM, Hall MH, Burg MM. Effects of ambulatory blood pressure monitoring on sleep in healthy, normotensive men and women. Blood Press Monit. 2021;26:93–101.

  13. Stergiou GS, Nasothimiou EG, Destounis A, Poulidakis E, Evagelou I, Tzamouranis D. Assessment of the diurnal blood pressure profile and detection of non-dippers based on home or ambulatory monitoring. Am J Hypertens. 2012;25:974–8.

    Article  Google Scholar 

  14. Ishikawa J, Hoshide S, Eguchi K, Ishikawa S, Shimada K, Kario K, et al. Nighttime home blood pressure and the risk of hypertensive target organ damage. Hypertension. 2012;60:921–8.

    Article  CAS  Google Scholar 

  15. Kario K, Hoshide S, Haimoto H, Yamagiwa K, Uchiba K, Nagasaka S, et al. Sleep blood pressure self-measured at home as a novel determinant of organ damage: Japan Morning Surge Home Blood Pressure (J-HOP) study. J Clin Hypertens. 2015;17:340–8.

    Article  CAS  Google Scholar 

  16. Ishikawa J, Shimizu M, Edison ES, Yano Y, Hoshide S, Eguchi K, et al. Assessment of the reductions in night-time blood pressure and dipping induced by antihypertensive medication using a home blood pressure monitor. J Hypertens. 2014;32:82–9.

    Article  CAS  Google Scholar 

  17. Fujiwara T, Tomitani N, Kanegae H, Kario K. Comparative effects of valsartan plus either cilnidipine or hydrochlorothiazide on home morning blood pressure surge evaluated by information and communication technology–based nocturnal home blood pressure monitoring. J Clin Hypertens. 2018;20:159–67.

    Article  CAS  Google Scholar 

  18. Kario K, Saito I, Kushiro T, Teramukai S, Ishikawa Y, Mori Y, et al. Home blood pressure and cardiovascular outcomes in patients during antihypertensive therapy: primary results of HONEST, a large-scale prospective, real-world observational study. Hypertension. 2014;64:989–96.

    Article  CAS  Google Scholar 

  19. Yang W-Y, Thijs L, Zhang Z-Y, Asayama K, Boggia J, Hansen TW, et al. Evidence-based proposal for the number of ambulatory readings required for assessing blood pressure level in research settings: an analysis of the IDACO database. Blood Press. 2018;27:341–50.

    Article  Google Scholar 

  20. Rinfret F, Ouattara F, Cloutier L, Larochelle P, Ilinca M, Lamarre-Cliche M. The impact of unrecorded readings on the precision and diagnostic performance of home blood pressure monitoring: a statistical study. J Hum Hypertens. 2018;32:197–202.

    Article  Google Scholar 

  21. Taylor HA Jr, Wilson JG, Jones DW, Sarpong DF, Srinivasan A, Garrison RJ, et al. Toward resolution of cardiovascular health disparities in African Americans: design and methods of the Jackson Heart Study. Ethn Dis. 2005;15:S6–4.

    PubMed  Google Scholar 

  22. Friedman GD, Cutter GR, Donahue RP, Hughes GH, Hulley SB, Jacobs DR, et al. CARDIA: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol. 1988;41:1105–16.

    Article  CAS  Google Scholar 

  23. O’Brien E, Mee F, Atkins N, O’Malley K. Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society protocol. J Hypertens. 1991;9:S25–31.

    Google Scholar 

  24. de Greeff A, Shennan AH. Validation of the Spacelabs 90227 OnTrak device according to the European and British Hypertension Societies as well as the American protocols. Blood Press Monit. 2020;25:110–14. https://doi.org/10.1097/MBP.0000000000000424.

  25. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J: Cardiovasc Imaging. 2015;16:233–71.

    Google Scholar 

  26. Efron B. Better bootstrap confidence intervals. J Am Stat Assoc. 1987;82:171–85.

    Article  Google Scholar 

  27. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.

    Article  Google Scholar 

  28. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.

  29. R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. 2021. https://www.R-project.org/.

  30. Wickham H, Averick M, Bryan J, Chang W, McGowan L, François R, et al. Welcome to the tidyverse. J Open Source Softw. 2019;4:1686.

    Article  Google Scholar 

  31. Landau WM. The drake R package: a pipeline toolkit for reproducibility and high-performance computing. J Open Source Softw. 2018;3:550. https://doi.org/10.21105/joss.00550.

  32. Buuren S van, Groothuis-Oudshoorn K. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45:1–67.

  33. Jaeger B. table.glue: make and apply customized rounding specifications for tables. R package version 0.0.2. https://github.com/bcjaeger/table.glue/.

  34. Steen MS van der, Lenders JW, Thien T. Side effects of ambulatory blood pressure monitoring. Blood Press Monit. 2005;10:151–5.

    Article  Google Scholar 

  35. Agarwal R, Light RP. The effect of measuring ambulatory blood pressure on nighttime sleep and daytime activity—implications for dipping. Clin J Am Soc Nephrol. 2010;5:281–5.

    Article  Google Scholar 

  36. Mokwatsi GG, Hoshide S, Kanegae H, Fujiwara T, Negishi K, Schutte AE, et al. Direct comparison of home versus ambulatory defined nocturnal hypertension for predicting cardiovascular events: the Japan morning surge-home blood pressure (J-HOP) study. Hypertension. 2020;76:554–61.

    Article  CAS  Google Scholar 

  37. Kario K, Yano Y. Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertens Res. 2012;35:695. https://doi.org/10.1038/hr.2012.26.

    Article  PubMed  Google Scholar 

  38. Yano Y, Tanner RM, Sakhuja S, Jaeger BC, Booth JN, Abdalla M, et al. Association of daytime and nighttime blood pressure with cardiovascular disease events among African American individuals. JAMA Cardiol. 2019;4:910–7.

    Article  Google Scholar 

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Acknowledgements

The JHS is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I/HHSN26800001), and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I, and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities. The authors also wish to thank the staff and participants of the JHS. The CARDIA study is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (HHSN268201800005I and HHSN268201800007I), Northwestern University (HHSN268 201800003I), University of Minnesota (HHSN2682018000 06I), and Kaiser Foundation Research Institute (HHSN268201 800004I). Funding to conduct ambulatory BP monitoring in the CARDIA study was provided by grant 15SFRN2390002 from the American Heart Association.

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The study was designed by PM, JES, DS, and BCJ. Data analysis and interpretation were conducted by BCJ, OPA, SS, JDB, CEL, YY, GH, DS, PM, and JES. The manuscript was written and approved by all authors.

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Correspondence to Byron C. Jaeger.

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Jaeger, B.C., Akinyelure, O.P., Sakhuja, S. et al. Number and timing of ambulatory blood pressure monitoring measurements. Hypertens Res 44, 1578–1588 (2021). https://doi.org/10.1038/s41440-021-00717-y

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