A count-based decision method for target blood pressure achievement in home blood pressure monitoring data interpretation for clinical practices

Jinho Shin,Jin-Kyu Park,Hwan-Cheol Park,Young-Hyo Lim,Byung-Sik Kim,Yonggu Lee,Jeong-Hun Shin,Ran Heo,Sang-Hyun Ihm,Hyun-Jin Kim,Woo-Hyun Kim

doi:10.1038/s41598-022-04913-9

Abstract

Home blood pressure (HBP) is useful to decide whether blood pressure (BP) is controlled. However, applying HBP to daily clinical practices is still challenging without easy access to the average HBP. Therefore, we developed a simple method to make a quick decision regarding the controlledness of HBP through high BP counts. We simulated 100 cases of HBP series for each combination of 3 numbers of BP readings (K = 16, 20, 24) and 4 levels of the standard deviations (SDs = 5, 10, 15, 20). A high BP was defined as an individual BP ≥ 135/85 mmHg, and an uncontrolled HBP was defined as a mean HBP ≥ 135/85 mmHg. Validation for the decision method was conducted using actual HBP data. The C-statistics and the accuracy of the high BP counts for the uncontrolled HBP were generally high (> 0.85) for all combinations of Ks and SDs and decreased as SDs increased but remained steady as Ks increased. In validation, the C-statistic of the high BP count-to-total BP reading (C/T) ratio was 0.985, and the C/T ratio ≥ 0.5 showed a sensitivity of 0.957, a specificity of 0.907, and an accuracy of 0.927. The count-based decision method can provide an accurate quick assessment of the controlledness of HBP.

Highlights

Home blood pressure (HBP) is useful to decide whether blood pressure (BP) is controlled
We developed a quick interpretation method to determine whether BP was controlled using the high BP counts in simulated HBPs and validated the method using real HBP monitoring (HBPM) data from patients under antihypertensive medications
In these analysis results from the real HBPM data, we found that the decision method using the count-to-total BP reading (C/T) ratio could allow physicians to (1) accurately diagnose uncontrolled BP, (2) estimate the approximate mean BP, and (3) rapidly rule in or rule out uncontrolled BP with high confidence in a patient with HBPM records

Summary

Introduction

Home blood pressure (HBP) is useful to decide whether blood pressure (BP) is controlled. Roughly half of people worldwide still have no access to the internet, and the rates of internet accessibility are much lower in developing and underdeveloped countries[11], and the rates of daily internet utilization are even lower than the rate of internet access These new HBPM devices with internet or mobile connectivity may not be familiar to elderly individuals who comprise the absolute majority of hypertensive patients, and the majority of HBPM devices still do not provide such functions. In this regard, despite the improvement in HBPM device connectivity, physicians still need simple and accurate methods to quickly interpret HBP records to broaden the use of HBPM in daily clinical practice. We created a simple count-based method to make a quick decision regarding whether BP was controlled using simulated HBPs and validated the count-based method in a real-world HBPM dataset

Methods

Results

Conclusion