OPTIMAL DURATION OF UNATTENDED AUTOMATIC BLOOD PRESSURE MEASUREMENTS IN SUBJECTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES. (April 2021)

• Record Type: Journal Article
• Authors: Olesen, Thomas; Jøhnk, Frederik; Nielsen, Jens Steen; Højlund, Kurt; Olsen, Hecht
• Is Part Of: Journal of hypertension. Volume 39(2021)e-Supplement 1
• Publication Date: 2021-04
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000745680.60900.e6
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Unobserved automated office blood pressure (AOBP) measurement is better correlated to daytime ambulatory blood pressure (Day-ABPM) than traditional office blood pressure (BP) measurements. However, prolonged AOBP duration may underestimate BP-levels especially in subjects with increased risk of cardiovascular disease. The aim of this study was to determine optimal duration of AOBP in subjects with newly diagnosed type 2 diabetes (DM2). Design and method: A subsample of participants from the "Specialist supervised individualized multifactorial treatment of new clinically diagnosed type 2 diabetes in general practice" (IDA) study underwent 24 hour ABPM as well as unattended AOBP. AOBP recordings were taken in the sitting position and started without prior rest for 25 minutes at 3 minute intervals (with a minimum of 7 valid recordings). Multiple intervals/protocols were compared with Day-ABPM by mean difference and Pearsons correlation coefficients. Logistic regression for each time-interval was used to evaluate the area under the curve (AUC) for prediction of uncontrolled hypertension defined as Day-ABPM>135mmHg. The same type of BP device (Mobil-O-Graph, IEM) was used for both AOBP and Day-ABPM. Results: We evaluated 159 subjects (39% female) with a mean age of 58 ± 11 years. 93 (58%) subjects were treated for hypertension. Average Day-ABPM was 129 ± 12/79 ± 9 mmHg. The optimal AOBP protocol was found when taking the average of 15 minute recordings after discarding the initial 10 minute recordings with a mean difference between systolic AOBP and Day-ABPM of 1.4mmHg with 95% limits of agreement between -16.5 and 19.4mmHg (Pearson correlation coefficient = 0.74). In comparison, duration of AOBP of 10 minutes without prior rest yielded a mean difference to Day-ABPM of 4.5mmHg with 95% limits of agreement between -16.12 and 25.3mmHg (Pearson correlation coefficient = 0.69). The prediction of uncontrolled hypertension was superior in the optimal protocol AUC = 0.853 (0.795–0.910) compared to all protocols derived from measurement duration up to 10 minutes, P = 0.029 (highest AUC = 0.812, from 10 minute duration, discarding the first recording). Similar observations were made for diastolic BP measurements. Conclusions: In patients with newly diagnosed DM2 extending AOBP duration beyond 10 minutes improved correlation to Day-ABPM and improved predictive capability of detecting uncontrolled hypertension.