ABSTRACT Above‐threshold ambulatory systolic blood pressure (SBP) area under the curve (AUC) captures both the magnitude and duration of SBP above daytime and nighttime reference values. We examined whether this measure provided information about left ventricular mass index (LVMI) beyond daytime and nighttime mean SBP. In this cross‐sectional study, 212 Chinese adults with non‐dialysis chronic kidney disease (CKD) underwent ambulatory blood pressure monitoring and echocardiography. Daytime AUC above 135 mmHg and nighttime AUC above 120 mmHg were entered jointly. Together, daytime and nighttime AUC were significantly associated with LVMI (P < 0.001; adjusted R2 = 0.345). From the 25th to the 75th percentile, adjusted LVMI was 3.46 g/m2·7 higher for daytime AUC and 5.56 g/m2·7 higher for nighttime AUC. AUC attributable to daytime and nighttime mean SBP accounted for 89.7% of the cohort‐average above‐threshold burden. The remaining AUC not captured by those period means was not significantly associated with LVMI after adjustment for daytime and nighttime mean SBP (0.69 g/m2·7 per interquartile range; 95% confidence interval, ‐2.00 to 3.37). Above‐threshold AUC was associated with greater LVMI but added limited information beyond daytime and nighttime mean SBP in this cohort.
ABSTRACT This study evaluated the Omron HEM‐7120 automated oscillometric upper‐arm home blood pressure monitor in children and adolescents against the numerical accuracy criteria of the AAMI/ESH/ISO Universal Standard. Test readings were compared with mercury auscultatory readings from two physicians using the same‐arm sequential method. Three cuffs covered arm circumferences of 12–18, 17–22, and 22–32 cm. Of 90 participants, 85 were analyzed, yielding 255 comparisons. Mean differences were −4.0 ± 5.94 mmHg for systolic and −1.8 ± 7.20 mmHg for diastolic blood pressure, meeting Criterion 1. Participant standard deviations were 5.07 and 6.48 mmHg, below Criterion 2 limits. However, the requirements regarding age, reference‐blood‐pressure and cuff distributions, reference‐measurement variability, and observer qualification were not fully met. The device met numerical criteria in this cohort, but it is not fully validated under the Universal Standard.
ABSTRACT Mean blood pressure (BP) differences do not fully characterize treatment response. We examined adjusted BP, target attainment and change distributions after morning versus bedtime antihypertensive dosing. This post hoc secondary analysis of a randomized controlled trial included 60 patients with uncontrolled hypertension and a nondipping pattern, assigned to morning or bedtime dosing (30 per group). Two‐month systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were compared using baseline‐adjusted analysis of covariance. Secondary analyses assessed BP <140/90 mmHg and median and trimmed changes. Adjusted bedtime‐minus‐morning differences were −18.1 mmHg for SBP (95% CI −22.4 to −13.8), −11.6 mmHg for DBP (−14.5 to −8.8) and −13.9 mmHg for MAP (−16.7 to −11.0); all p < 0.001. Bootstrap intervals were similar. BP <140/90 mmHg was achieved by 29/30 (96.7%) versus 3/30 (10.0%) patients (risk ratio 9.67; 95% CI 3.30–28.34). Median SBP and DBP change differences were −9.5 and −3.0 mmHg, respectively, with confidence intervals including zero. Bedtime dosing was associated with lower adjusted two‐month BP and greater target attainment. Change‐based estimates were less precise, indicating uncertainty about the distribution of response. These exploratory findings from a small randomized trial warrant prospective confirmation.
ABSTRACT Sub‐Saharan Africa (sSA) bears a high burden of hypertension and HIV, yet blood pressure measurement often relies on single‐day, conventional office readings, prone to measurement error. We assessed the short‐term repeatability of unattended, automated office BP (uAOBP) and ambulatory blood pressure monitoring (ABPM), and whether reproducibility differs by HIV status in Tanzania. We analyzed data from the Mwanza HIV&CVD cohort study, using measurements from enrollment and 1‐month later. Bland‐Altman plots visualized mean differences and limits of agreement. Reproducibility of hypertension classification was calculated using Cohen's kappa, with differences by HIV status evaluated using large‐sample variance. Of 999 participants enrolled, 750 (384 people with HIV (PWH) and 366 people without HIV (PWoH)) had valid ABPM measurements at both timepoints. The mean difference in systolic blood pressure was significant for uAOBP (−1.02 mmHg; 95% CI −1.76, −0.27) but not 24 h ABPM (−0.46; −1.02, 0.10), with similar results for diastolic blood pressure. Bland‐Altman plots showed narrower limits of agreement for ABPM. Kappa statistics were 0.45 (0.33, 0.56) for uAOBP and 0.56 (0.50, 0.62) for 24 h ABPM. Regression dilution ratios were 0.77 and 0.82 for systolic and diastolic uAOBP and 0.73 and 0.77 for ABPM. Reproducibility did not differ by HIV status. ABPM and uAOBP demonstrated high short‐term reproducibility, with ABPM showing greater stability for hypertension classification. Reproducibility did not differ by HIV status, supporting the use of both approaches in sub‐Saharan Africa.
