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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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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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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DOI: https://doi.org/10.1038/s41440-021-00717-y
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