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Kinsara AJ, Abuosa A, Meer A, Elsheikh AH, Abrar M, Vriz O. Diagnostic Comparability and Interchangeability Between Daytime Ambulatory Blood Pressure Monitoring and 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Masked Hypertension. Cureus 2020; 12:e11784. [PMID: 33409031 PMCID: PMC7779181 DOI: 10.7759/cureus.11784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The primary aim of this study was to evaluate the level of diagnostic overlap between daytime ambulatory blood pressure (BP) monitoring (DT-ABPM) and 24-hour ambulatory BP monitoring (24-h ABPM) in detecting masked hypertension (MH). Methods This is a prospective study that was performed in a sample of 196 soldiers aged between 21 and 50 years (without a history of hypertension) undergoing ABPM testing. The diagnosis of MH based on DT-ABPM defined as (office blood pressure (OBP) <140/90 and DT-ABPM ≥135/85) was compared with the 24-h ABPM defined as (OBP <140/90 mm Hg and 24-h ABPM ≥130/80 mm Hg). We critically analyzed the results to see the agreement between the two methods. Results The number of subjects classified as having MH based on both DT-ABPM and 24-h ABPM, only on 24-h ABPM, and only on DT-ABPM were 11 (5.6%), 29 (14.8%), and 18 (9.2%), respectively. The sensitivity, specificity, and positive and negative predictive values for DT-ABPM in detecting MH were: sensitivity = 100% (95% CI: 97.82% - 100%), specificity = 62.07% (95% CI: 42.26% - 79.31%), PPV = 93.82% (95% CI: 90.50% - 96.03%), and NPV = 100%, respectively. The level of agreement between DT-ABPM and 24-h ABPM in diagnosing MH was 94.4% and discordance in 5.6% (11/196); (kappa=0.736, p < 0.001). Conclusion The sensitivity, specificity, positive and negative predictive values all showed agreement between the two BP methods to confirm the diagnoses of MH. DT-ABPM can be used as an alternative to the 24-h ABPM. DT-ABPM eliminates sleep disturbance attributable to ABPM and maximizes patient compliance with the ABPM test. A further larger trial is needed for more confirmation and to affect the guidelines for using daytime ABPM.
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Affiliation(s)
- Abdulhalim J Kinsara
- Cardiology, Ministry of National Guard - Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Western Region (COM-WR) - King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmed Abuosa
- Cardiology, National Training Institute, Cairo, EGY
| | - Alaa Meer
- Cardiology, Ministry of National Guard - Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Western Region (COM-WR) - King Abdullah International Medical Research Center, Jeddah, SAU
| | - Aymen H Elsheikh
- Cardiology, Ministry of National Guard - Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Western Region (COM-WR) - King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed Abrar
- Prince Noorah Oncology Center, Ministry of National Guard - Health Affairs, Jeddah, SAU
| | - Olga Vriz
- Cardiology, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, SAU
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Appiah KO, Nath M, Manning L, Davison WJ, Mazzucco S, Li L, John FP, Rothwell PM, Panerai RB, Haunton VJ, Robinson TG. Increasing Blood Pressure Variability Predicts Poor Functional Outcome Following Acute Stroke. J Stroke Cerebrovasc Dis 2020; 30:105466. [PMID: 33197799 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Increasing blood pressure variability has been reported following acute stroke, but there is uncertainty about how best to measure it and about the impact on prognosis following acute ischaemic stroke and transient ischaemic attack. METHODS Enhanced casual blood pressure and ambulatory blood pressure monitoring were completed at baseline (≤48 h post symptom onset). Blood pressure variability was defined by standard deviation and coefficient of variation of systolic, diastolic, mean arterial pressure, and pulse pressure. Modified Rankin scale score ≥3 described poor functional outcome assessed at 1- and 12-months post-stroke. Multivariable logistic regression models incorporating blood pressure variability measurement and other factors were performed, and odds ratio and 95% confidence intervals reported. RESULTS 232 patients were recruited; 45 were dependent at 1-month, and 37 at 12-months. Dependent patients were more likely to be older, with a higher burden of pre-morbid conditions, and with increased blood pressure variability. Enhanced casual standard deviations of diastolic blood pressure [1.19 (1.02 to 1.39)] and mean arterial pressure [1.20 (1.00 to 1.43)] predicted dependency at 1-month. Predictors of 12-month dependency included: enhanced casual standard deviation of mean arterial pressure [1.21 (1.0-1.46)]; 24 h ambulatory monitor standard deviations of diastolic blood pressure [2.30 (1.08-4.90)] and mean arterial pressure [1.72 (1.09-2.72)], and the coefficient of variation of mean arterial pressure [1.76 (1.05-2.94)]; day-time ambulatory monitor coefficient of variation of systolic blood pressure [1.44 (1.02-2.03)] and mean arterial pressure [1.46 (1.02-2.08)]; and night-time ambulatory standard deviation of diastolic blood pressure [1.65 (1.03 -2.63)], and the coefficient of variation of mean arterial pressure and [1.38 (1.00- 1.90)] and pulse pressure [1.29 (1.00-1.65)]. CONCLUSION Increasing blood pressure variability is independently and modestly associated with poor functional outcome at 1- and 12-months following acute stroke.
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Affiliation(s)
- Karen Ob Appiah
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Mintu Nath
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Lisa Manning
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; University Hospitals of Leicester, NHS Trust, Leicester Royal Infirmary Square, LE1 5WW Leicester, UK.
| | - William J Davison
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Sara Mazzucco
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Linxin Li
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - F Potter John
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Peter M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; University Hospitals of Leicester, NHS Trust, Leicester Royal Infirmary Square, LE1 5WW Leicester, UK.
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
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