Yang Wen-Yi, Thijs Lutgarde, Zhang Zhen-Yu, Asayama Kei, Boggia José, Hansen Tine W, Ohkubo Takayoshi, Jeppesen Jørgen, Stolarz-Skrzypek Katarzyna, Malyutina Sofia, Casiglia Edoardo, Nikitin Yuri, Li Yan, Wang Ji-Guang, Imai Yutaka, Kawecka-Jaszcz Kalina, O'Brien Eoin, Staessen Jan A
a Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.
b Department of Cardiology , Shanghai General hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
Blood Press. 2018 Dec;27(6):341-350. doi: 10.1080/08037051.2018.1476057. Epub 2018 Jun 17.
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.
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.
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 κ 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).
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.
关于动态血压（ABP）读数所需数量的指南侧重于个体患者。临床研究人员常常面临这样的两难境地：要么应用这些建议并舍弃潜在的有价值信息，要么接受较少的读数。
从国际动态血压与心血管结局数据库（IDACO）中八项人群研究的4277名参与者的ABP记录开始，这些记录有≥30/≥10次清醒/睡眠读数，我们在每一步的1000次自抽样中每次随机选择一定数量的读数（从30次到1次清醒读数和从10次到1次睡眠读数）。我们评估了：（i）ABP水平的一致性；（ii）基于诊室血压和ABP的交叉分类的一致性；以及（iii）预测心血管并发症的准确性。对于每个标准，我们拟合了一条回归线，连接将结局与覆盖清醒/睡眠读数范围为30 - 20/10 - 7的读数数量相关的数据点。
减少读数会使清醒时全量（参考）记录与所选记录之间收缩压/舒张压差异的标准差从1.7/1.2（30次读数）扩大到14.3/10.3 mmHg（单次读数），睡眠时从1.9/1.4扩大到10.3/7.7 mmHg；使κ统计量从0.94降至0.63，并使清醒时收缩压/舒张压ABP每增加10/5 mmHg的风险比从1.21/1.14降至1.06/1.04，睡眠时从1.26/1.17降至1.14/1.08。清醒/睡眠期间这些回归线偏离的第一个数据点，对于标准（i）和（iii）分别对应8/3次和8/4次读数，对于标准（ii）对应5次清醒读数。
24小时动态记录有≥8/≥4次清醒/睡眠读数所得到的ABP水平与包含指南推荐的≥20/≥7次读数的记录相似。这些标准在研究环境中能节省有价值的数据，但不适用于临床实践。
