期刊
BLOOD PRESSURE
卷 27, 期 6, 页码 341-350出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/08037051.2018.1476057
关键词
Blood pressure monitoring; cardiovascular risk; diagnosis; hypertension; population science
资金
- European Union [HEALTH-F7-305507 HOMAGE, LSHM-CT-2006-037093, HEALTH-F4-2007-201550]
- European Research Council [2011-294713-EPLORE, 713601-uPROPHET]
- European Research Area Net for Cardiovascular Diseases [JTC2017-046-PROACT]
- Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium [G.0881.13]
- Ministry of Education, Culture, Sports, Science, and Technology, Japan [23249036, 23390171, 24390084, 24591060, 24790654, 25253059, 25461083, 25461205, 25860156, 26282200, 26860093, 16H05243, 16K09472, 16K11850, 16K15359]
- Japan Society for the Promotion of Science (JSPS) [25*7756, 25*9328, 26*857, 27*656]
- Japan Arteriosclerosis Prevention Fund
- Intramural Research Fund for Cardiovascular Diseases of National Cerebral and Cardiovascular Center [22-4-5]
- Ministry of Health, Labor, and Welfare, Japan [H26-Junkankitou [Seisaku]-Ippan-001]
- Asociacion Espanola Primera en Salud
- Danish Heart Foundation [01-2-9-9A-22914]
- Lundbeck Fonden [R32-A2740]
- National Natural Science Foundation of China [81170245, 81270373, 81470533, 91639203]
- Ministry of Science and Technology, Beijing, China [2013CB530700, 1012]
- Shanghai Commission of Science and Technology [14ZR1436200, 15XD1503200]
- Shanghai Commission of Education [20152503]
Background: Guidelines on the required number of ambulatory blood pressure (ABP) readings focus on individual patients. Clinical researchers often face the dilemma of applying recommendations and discarding potentially valuable information or accepting fewer readings. Methods: Starting from ABP recordings with >= 30/>= 10 awake/asleep readings in 4277 participants enrolled in eight population studies in the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO), we randomly selected a certain number of readings (from 30 to 1 awake and 10 to 1 asleep readings) at a time over 1000 bootstraps at each step. We evaluated: (i) concordance of the ABP level; (ii) consistency of the cross-classification based on office blood pressure and ABP; and (iii) accuracy in predicting cardiovascular complications. For each criterion, we fitted a regression line joining data points relating outcome to the number of readings covering the ranges of 30-20/10-7 for awake/asleep readings. Results: Reducing readings widened the SD of the systolic/diastolic differences between full (reference) and selected recordings from 1.7/1.2 (30 readings) to 14.3/10.3 mm Hg (single reading) during wakefulness, and from 1.9/1.4 to 10.3/7.7 mm Hg during sleep; lowered the kappa statistic from 0.94 to 0.63, and decreased the hazard ratio associated with 10/5 mm Hg increments in systolic/diastolic ABP from 1.21/1.14 to 1.06/1.04 during wakefulness and from 1.26/1.17 to 1.14/1.08 during sleep. The first data points falling off these regression lines during wakefulness/sleep corresponded to 8/3 and 8/4 readings for criteria (i) and (iii) and to 5 awake readings for criterion (ii). Conclusions: 24-h ambulatory recordings with >= 8/>= 4 awake/asleep readings yielded ABP levels similar to recordings including the guideline-recommended >= 20/>= 7 readings. These criteria save valuable data in a research setting, but are not applicable to clinical practice.
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