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The optimal night-time home blood pressure monitoring schedule: agreement with ambulatory blood pressure and association with organ damage

Kollias, Anastasiosa; Andreadis, Emmanuelb; Agaliotis, Gerasimosb; Kolyvas, George, N.b; Achimastos, Apostolosa; Stergiou, George, S.a

doi: 10.1097/HJH.0000000000001562

Objective: Night-time home blood pressure (HBP) monitoring has emerged as a feasible, reliable and low-cost alternative to ambulatory blood pressure (ABP) monitoring. This study evaluated the optimal schedule of night-time HBP monitoring in terms of agreement with night-time ABP and association with preclinical target-organ damage.

Methods: Untreated hypertensive adults were evaluated with ABP (24-h) and HBP monitoring (daytime: six days, duplicate morning and evening measurements; night-time: three nights, three-hourly automated measurements/night), and determination of left ventricular mass index, common carotid intima–media thickness and urinary albumin excretion.

Results: A total of 94 patients with all nine night-time HBP measurements were analysed [mean age 51.8 ± 11.1 (SD) years, men 57%). By averaging an increasing number of night-time systolic HBP readings, there was a consistent trend towards stronger association of night-time HBP with night-time ABP (correlation coefficients r increased from 0.69 to 0.81), and with target-organ damage indices (for left ventricular mass index r increased from 0.13 to 0.22, carotid intima–media thickness 0.12–0.25, urinary albumin excretion 0.33–0.41). However, no further improvement in the association was observed by averaging more than four to six night-time readings. The diagnostic agreement between HBP and ABP in detecting nondippers was improved by averaging more readings, with a plateau at four readings (single reading: agreement 81%, kappa 0.37; four readings: 88%, 0.49; nine readings: 84%, 0.40).

Conclusion: A two-night HBP schedule (six readings) appears to be the minimum requirement for a reliable assessment of night-time HBP, which gives reasonable agreement with ABP and association with preclinical organ damage.

aHypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital

bHypertension and Cardiovascular Disease Prevention Center, Fourth Department of Medicine, Evangelismos Hospital, Athens, Greece

Correspondence to George S. Stergiou, MD, FRCP, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria, Hospital, 152 Mesogion Avenue, Athens 11527, Greece. Tel: +30 2107763117; fax: +30 2107719981; e-mail:

Abbreviations: ABP, ambulatory blood pressure; BP, blood pressure; cIMT, common carotid intima-media thickness; HBP, home blood pressure; LVMI, left ventricular mass index; UAE, urinary albumin excretion

Received 21 June, 2017

Revised 28 July, 2017

Accepted 16 August, 2017

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