Nocturnal home blood pressure monitoring accurately identified nocturnal hypertension in patients with chronic kidney disease compared to ambulatory monitoring (AUC 0.837; 95% CI 0.717-0.957).
Cross-Sectional (n=46)
Random sequence of measurements
Does home BP monitoring accurately diagnose nocturnal hypertension compared to 24-hour ambulatory BP monitoring in patients with chronic kidney disease?
Nocturnal home blood pressure monitoring provides high diagnostic accuracy for nocturnal hypertension and non-dipper status in patients with chronic kidney disease.
Effect estimate: AUC 0.837 (95% CI 0.717-0.957)
Objective: A unique advantage of 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is the availability of measurements during the period of sleep that enables the diagnosis of nocturnal hypertension. In this study, we assess the accuracy of a novel home BP monitor in diagnosing nocturnal hypertension in chronic kidney disease (CKD) patients. Design and method: Over a period of 2 weeks, 46 patients with CKD underwent assessment of hypertension with 2 different methods: (i) 24-hour ABPM (20-min intervals; Microlife WatchBP O3 device) and (ii) home BP monitoring (HBPM) (duplicate morning and evening BP measurements for 7 days and 3 BP measurements per night for 3 nights; Microlife WatchBP Home N). The sequence of measurements (HBPM-ABPM or vise versa) was random, according to the availability of the devices and the patient's preference. Results: The study included 46 patients (73.9% males) with a median serum creatinine of 1.7 mg/dl. The mean difference between home daytime systolic BP (SBP) and ambulatory daytime SBP was -0.05 mmHg with wide 95% limits of agreement (-17.2 to 17.1 mmHg). Similarly, home nighttime SBP underestimated ambulatory nighttime SBP on average by 2.2 mmHg (mean difference: -2.2 mmHg; 95% limits of agreement: -21.7 to 17.4 mmHg). In receiver-operating-characteristics (ROC) analysis, nocturnal HBPM provided high accuracy for the identification of patients with an average ambulatory nighttime SBP equal or greater than 120 mmHg area under the curve (AUC): 0.837; 95% confidence interval (CI): 0.717-0.957. At the cut-off point of 116.5 mmHg, home nighttime SBP provided the greatest combination of high sensitivity (86.4%) and high specificity (77.3%) in diagnosis nocturnal hypertension. Of the overall study population, 10 patients (21.7%) were classified as dippers by both ABPM and HBPM. Furthermore, in another 22 patients (47.8%), there was absolute agreement between these 2 techniques in the detection of a non-dipper pattern in diurnal BP variation. Conclusions: The present study shows that among patients with CKD, the novel technique of nocturnal HBPM provides high accuracy in the diagnosis of nocturnal hypertension and detection of non-dipper status, as confirmed by the reference-standard method of ABPM.
Kontogiorgos et al. (Fri,) conducted a cross-sectional in Chronic kidney disease (n=46). Home blood pressure monitoring (HBPM) vs. 24-hour ambulatory blood pressure monitoring (ABPM) was evaluated on Identification of patients with an average ambulatory nighttime SBP ≥120 mmHg (AUC 0.837, 95% CI 0.717-0.957). Nocturnal home blood pressure monitoring accurately identified nocturnal hypertension in patients with chronic kidney disease compared to ambulatory monitoring (AUC 0.837; 95% CI 0.717-0.957).