Identifying an Acceptable Number of Ambulatory Blood Pressure Measurements for Accuracy of Average Blood Pressure and Nocturnal Dipping Status

Details

• Personal Author:
  Bowles NP ; Brito LC ; Butler MP ; Emens JS ; McHill AW ; Rice SPM ; Shea SA ; Thosar SS
• Description:
  We aimed to identify the minimum number of ambulatory blood pressure (ABP) measures to accurately determine daytime and nighttime systolic blood pressure (BP) averages and nocturnal dipping status (i.e., relative daytime:nighttime change). A total of 43 midlife participants wore an ABP monitor for 24 h with measurements every 20/30 min during the daytime/nighttime, as identified by a sleep diary. We calculated daytime/nighttime systolic BP average and dipping status from all available measurements per participant (i.e., normative data). We then calculated daytime and nighttime BP per participant based on a random selection of 8-20 and 4-10 measurements and replicated random selections 1,000 times. We calculated accuracy by checking the proportion from 1,000 different randomly selected samples for a particular number of measurements that systolic BP was +/-5 mmHg of normative data, and dipping status remained unchanged for each participant compared with the normative value. The best fit for the regression model estimated the minimal number of measurements for an accuracy of 95% in BP averages. For a 95% accuracy in estimating daytime and nighttime systolic BP, 11 daytime and 8 nighttime measurements were required. The highest accuracy for dipping status was 91.6 +/- 13.4% using 20 daytime and 10 nighttime measures, while the lowest was (83.4 +/- 15.1%) using 8 daytime and 4 nighttime measures. In midlife adults, 11 daytime and 8 nighttime measurements are likely enough to calculate average systolic BPs accurately. However, no minimum number is suggested to accurately calculate dipping status. NEW & NOTEWORTHY We found that a minimum of 11 blood pressure (BP) measures are necessary to calculate an accurate average daytime BP, and 8 nighttime measures are necessary to calculate an accurate nighttime average if 95% accuracy is acceptable. Regarding BP dipping status, the current recommendations (20 daytime/7 nighttime) inaccurately classified the dipping status 10.5% of the time, suggesting that guidelines may need to be updated to classify patients as nocturnal dippers or nondippers correctly. [Description provided by NIOSH]
• Subjects:
  Cardiovascular Diseases Cardiovascular System Occupational Health Safety Sleep
• Keywords:
  Author Keywords: Ambulatory Blood Pressure Awake Blood Pressure Biological Rhythms Blood Pressure Cardiovascular Disease Cardiovascular Risk Dipping And Nondipping Blood Pressure Hypertension
• ISSN:
  0363-6135
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Oregon ; OSHA Region 10
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  327
• Issue:
  2
• NIOSHTIC Number:
  nn:20070207
• Citation:
  Am J Physiol Heart Circ Physiol 2024 Aug; 327(2):H399-H405
• Email:
  thosar@ohsu.edu
• Federal Fiscal Year:
  2024
• NORA Priority Area:
  Healthcare and Social Assistance ; Public Safety
• Performing Organization:
  Oregon Health & Science University, Portland
• Peer Reviewed:
  True
• Start Date:
  20110901
• Source Full Name:
  American Journal of Physiology: Heart and Circulatory Physiology
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:bbb4766602687112c160ec2c366bed851dfddf97479ae0d56c283aebd91a26f32cc19db4c4b6e40c93cc97948d515a8b204ba28771fdb95272aeb3f9846d2ef2
• Download URL:
  https://stacks.cdc.gov/view/cdc/208463/cdc_208463_DS1.pdf
• File Type:
  [PDF - 1.68 MB ]