Artefact-aware ABPM analysis altered hypertension classification or nocturnal dipping status in nearly 40% of patients compared to conventional analysis.
Observational (n=124)
No
Does artefact-aware ABPM analysis alter hypertension classification and dipping status compared to conventional ABPM in patients referred for clinical ABPM?
Measurement artefacts during routine clinical ABPM are frequent and systematically overestimate BP, leading to misclassification of hypertension and dipping status in nearly 40% of patients.
Objective: Cuff-based 24-hour ambulatory blood pressure monitoring (ABPM) is the clinical gold standard for the diagnosis and management of hypertension (HT). However, ABPM is susceptible to measurement artefacts, including motion artefacts, cuff signal errors, arousal reactions, and arrhythmias. These artefacts are not routinely identified by conventional ABPM. Preliminary work in healthy adults and small exploratory cohorts suggests that artefacts substantially distort mean blood pressure (BP), HT classification, and nocturnal dipping patterns with the clinical extent and relevance remaining insufficiently characterised. This study aimed to quantify the frequency and impact of measurement artefacts during routine clinical ABPM. Design and method: A total of 124 patients referred for clinical ABPM at a tertiary hypertension centre were included. Recordings were obtained using the Somnomedics ABPMpro device, enabling simultaneous assessment of oscillometric BP, actigraphy, body position, pulse wave velocity, and ECG. Predefined artefact criteria were applied to identify measurement artefacts. Analyses focused on the frequency and distribution of artefacts across recordings and on changes in mean BP, hypertension classification, and dipping status following artefact-aware data correction. Results: More than one quarter of all BP measurements obtained during ABPM were affected by at least one artefact, with substantial inter-individual variability (4–55%). Motion artefacts and cuff signal errors were the most prevalent, while arousals predominated during nocturnal periods. BP measurements affected by artefacts exhibited systematically higher systolic and diastolic values, with mean differences exceeding 5 mmHg. Accounting for measurement artefacts resulted in a change in hypertension classification in over 20% of patients and altered nocturnal dipping status in more than 22%. Overall, nearly 40% of patients experienced a change in either hypertension classification, dipping pattern, or both when artefact-aware analysis was applied. Conclusions: Measurement artefacts during routine clinical ABPM are frequent and clinically relevant, substantially distorting mean BP values, hypertension classification, and nocturnal dipping patterns. As a result, conventional ABPM analysis may systematically overestimate BP and misclassify a substantial proportion of patients. Artefact-aware ABPM analysis is essential to improve diagnostic accuracy in hypertension management. Larger confirmatory analyses are required to establish standardised artefact handling strategies.
Bothe et al. (Fri,) conducted a observational in Hypertension (n=124). Artefact-aware ABPM analysis vs. Conventional ABPM analysis was evaluated on Change in hypertension classification, dipping pattern, or both. Artefact-aware ABPM analysis altered hypertension classification or nocturnal dipping status in nearly 40% of patients compared to conventional analysis.