IEEE J Biomed Health Inform. 2018 Sep;22(5):1691-1698. doi: 10.1109/JBHI.2017.2776946. Epub 2017 Nov 23.
Hypertension is one of the greatest contributors to premature morbidity and mortality worldwide. It has been demonstrated that lowering blood pressure (BP) by just a few mmHg can bring substantial clinical benefits, reducing the risk of stroke and ischemic heart disease. Properly managing high BP is one of the most pressing global health issues, but accurate methods to continuously monitoring BP at home are still under discussion. Indeed, the BP for any given individual can fluctuate significantly during intervals as short as a few minutes. In clinical settings, the guidelines suggest to wait for 5 or 10 minutes in seated rest before taking the measure, in order to alleviate the effect of the stress induced by the clinical environment. Alternatively, BP measured in the home environment is thought to provide a more accurate measure free of the stress of a clinical environment, but there is currently a lack of extensive studies on the trajectory of serial BP measurements over minutes in the home setting. In this paper, we aim at filling this gap by analyzing a large dataset of more than 16 million BP measurements taken at home with commercial BP monitoring devices. In particular, we propose new techniques to analyze this dataset, taking into account the limitations due to the uncontrolled data collection, and we study the characteristics of the BP trajectory for consecutive measures over several minutes. We show that the BP values significantly decrease after 10 minutes minutes from the initial measurement (4.1 and 6.6 mmHg for the diastolic and systolic BP, respectively), and continue to decrease for about 25 minutes. We also describe statistically the clinical relevance of this change, observing more than 50% misclassifications for measurements in the hypertension region. We then propose a model to study the inter-subject variability, showing significant variations in the expected decrease in systolic BP. These results may provide the initial evidence for future large clinical studies using participant-monitored BP.
高血压是全球导致过早发病和死亡的最大因素之一。已经证明，仅仅将血压（BP）降低几个 mmHg 就可以带来显著的临床益处，降低中风和缺血性心脏病的风险。适当管理高血压是全球最紧迫的健康问题之一，但在家中连续监测血压的准确方法仍在讨论中。实际上，任何给定个体的血压在短短几分钟的间隔内都会发生显著波动。在临床环境中，指南建议在坐姿休息 5 或 10 分钟后再进行测量，以减轻临床环境引起的压力的影响。或者，认为在家中环境中测量的血压提供了更准确的测量结果，而不受临床环境的压力影响，但目前缺乏关于家庭环境中连续几分钟内血压测量轨迹的广泛研究。在本文中，我们旨在通过分析使用商业血压监测设备在家中进行的超过 1600 万次血压测量的大型数据集来填补这一空白。特别是，我们提出了新的技术来分析这个数据集，考虑到由于不受控制的数据收集而导致的局限性，我们研究了连续几分钟内连续测量的血压轨迹的特征。我们表明，血压值在初始测量后 10 分钟（分别为舒张压和收缩压 4.1 和 6.6 mmHg）后显著下降，并在接下来的 25 分钟内继续下降。我们还描述了这种变化的临床相关性，观察到高血压区域测量值的 50%以上的错误分类。然后我们提出了一个模型来研究个体间的变异性，显示出收缩压预期下降的显著差异。这些结果可能为未来使用参与者监测的 BP 进行的大型临床研究提供初步证据。
