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Minimally sufficient numbers of measurements for validation of 24-hour blood pressure monitoring in chronic kidney disease.

ABSTRACT: Ambulatory blood pressure monitoring (ABPM) remains a reference standard, but the minimal number of ABPM readings required to diagnose hypertension has not been empirically validated. Among 360 patients with chronic kidney disease and 38 healthy controls, 24-hour blood pressure was recorded 2 times per hour during the night and 3 times per hour during the day. All subjects had at least 90% of the expected readings recorded. From this full set of ABPM recordings, we selected variable numbers of measurements and compared the performance of the selected readings against that of the full sample under either random or sequential sampling schemes. With 8 randomly selected systolic blood pressure readings, we were able to make diagnostic decisions in concordance with that from the full ABPM sample 91.0% of the time (kappa 0.804). With 15 randomly selected diastolic blood pressure readings, we made concordant decisions 96.3% of the time (kappa 0.810). A serial selection scheme generally required a greater number of readings to achieve the same levels of concordance with the full ABPM data. With a random selection scheme, 26 readings provided 95% confidence that the sample mean will be within 5 mm Hg of the true systolic blood pressure mean, and within 3.5 mm Hg of the true diastolic blood pressure mean.

SUBMITTER: Agarwal R

PROVIDER: S-EPMC6716795 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Minimally sufficient numbers of measurements for validation of 24-hour blood pressure monitoring in chronic kidney disease.

Agarwal Rajiv R Tu Wanzhu W

Kidney international 20181029 6

Ambulatory blood pressure monitoring (ABPM) remains a reference standard, but the minimal number of ABPM readings required to diagnose hypertension has not been empirically validated. Among 360 patients with chronic kidney disease and 38 healthy controls, 24-hour blood pressure was recorded 2 times per hour during the night and 3 times per hour during the day. All subjects had at least 90% of the expected readings recorded. From this full set of ABPM recordings, we selected variable numbers of m ...[more]

PMID: 30385040

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Project description:BACKGROUND:Non-invasive measurements of 24 hour ambulatory central aortic systolic pressure (24 h-CASP) and central pulse pressure (24 h-CPP) are now feasible. We evaluate the relationship between 24 h central blood pressure and diabetes-related complications in patients with type 1 diabetes. METHODS:The study was cross-sectional, including 715 subjects: 86 controls (C), 69 patients with short diabetes duration (< 10 years), normoalbuminuria (< 30 mg/24 h) without receiving antihypertensive treatment (SN), 211 with longstanding diabetes (? 10 years) and normoalbuminuria (LN), 163 with microalbuminuria (30-299 mg/24 h) (Mi) and 186 with macroalbuminuria (> 300 mg/24 h) (Ma).24 h-CASP and 24 h-CPP was measured using a tonometric wrist-watch-like device (BPro, HealthStats, Singapore) and derived using N-point moving average. RESULTS:In C, SN, LN, Mi and Ma mean ± SD 24 h-CASP was: 114 ± 17, 115 ± 13, 121 ± 13, 119 ± 16 and 121 ± 13 mmHg (p < 0.001); and 24 h-CPP: 38 ± 8, 38 ± 7, 44 ± 10, 46 ± 11 and 46 ± 11 mmHg, (p < 0.001).Following rigorous adjustment (24 h mean arterial pressure and conventional risk factors), 24 h-CASP and 24 h-CPP increased with diabetes, albuminuria degree, previous cardiovascular disease (CVD), retinopathy and autonomic dysfunction (p ? 0.031).Odds ratios per 1 standard deviation increase in 24 h-CASP, 24 h-CPP and 24 h systolic blood pressure (24 h-SBP) were for CVD: 3.19 (1.68-6.05), 1.43 (1.01-2.02) and 2.39 (1.32-4.33), retinopathy: 4.41 (2.03-9.57), 1.77 (1.17-2.68) and 3.72 (1.85-7.47) and autonomic dysfunction: 3.25 (1.65-6.41), 1.64 (1.12-2.39) and 2.89 (1.54-5.42). CONCLUSIONS:24 h-CASP and 24 h-CPP was higher in patients vs. controls and increased with diabetic complications independently of covariates. Furthermore, 24 h-CASP was stronger associated to complications than 24 h-SBP.The prognostic significance of 24 h-CASP and 24 h-CPP needs to be determined in follow-up studies. TRIAL REGISTRATION:ClinicalTrials.gov ID NCT01171248.

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Minimally sufficient numbers of measurements for validation of 24-hour blood pressure monitoring in chronic kidney disease.

Publications

Minimally sufficient numbers of measurements for validation of 24-hour blood pressure monitoring in chronic kidney disease.

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