Defining the nocturnal period in 24-h ambulatory blood pressure monitoring: a comparison of three methods.

Abstract

The purpose of our study was to compare three definitions of ambulatory blood pressure (BP) nocturnal period and to assess their agreement in determining nocturnal BP dipping patterns. We investigated 69 subjects with metabolic syndrome, aged 50-55 years. In all subjects, we assessed 24-h BP monitoring, electrocardiogram and actigraphy profiles. The nocturnal period was defined in three ways: as a fixed narrow nighttime period from 01:00 to 06:00, as a self-reported sleeping period and as a disappearance and onset of physical activity recorded by the actigraph. Our study revealed a significant discrepancy between the self-reported and actigraphy-based nocturnal periods (P < 0.001). In addition, different definitions of the nighttime yielded significant differences in determining nondipping, extreme dipping and dipping BP patterns, the identification of the latter being affected the most. The actigraphy-based approach best aligned with the fixed-time determination of the nocturnal period: Cohen's kappa coefficient for the nondipping pattern was 0.78 (0.58-1), for the dipping pattern 0.75 (0.59-0.91) and for the extreme dipping pattern 0.81 (0.65-0.97). In comparison to the self-reported determination of the nocturnal period, using the actigraphy-based approach resulted in reclassifying the nocturnal BP pattern in 20.3% of subjects. The lack of agreement between fixed-time, self-reported and actigraphy-based determinations of the nighttime period affects the identification of the nocturnal BP patterns. In comparison to the self-reported nocturnal period estimation, the actigraphy-based approach results in the reclassification of BP dipping status in every fifth subject.