Predicting Isolated Nocturnal Hypertension Using Dawn and Dusk Home Blood Pressure Monitoring

Hypertension is a major global cause of morbidity and mortality. Home Blood Pressure Monitoring (HBPM) has the potential to help diagnose patients experiencing isolated nocturnal hypertension who may otherwise be missed. This paper investigates potential diagnostic thresholds for diagnosing isolated nocturnal hypertension using dawn and dusk HBPM measurements in the BP-Eth ambulatory blood pressure monitoring (ABPM) database. Depending on whether European or American diagnostic guidelines for hypertension were used, incidence of isolated nocturnal hypertension in the BP-Eth database was 17.1% or 16.8%, respectively. Using averaged dawn and dusk HBPM measurements to diagnose isolated nocturnal hypertension yielded an AUROC of 0.79 (European guidelines) or 0.84 (American guidelines). The SBP and DBP diagnostic thresholds required to detect 80% of cases of isolated nocturnal hypertension were found to be 125.4 mmHg and 75.7 mmHg, respectively (European guidelines) or 117.6 mmHg and 74.3 mmHg, respectively (American guidelines). These thresholds corresponded to a sensitivity of 80% and specificity of 63% (European guidelines) or sensitivity of 83% and specificity of 65% (American guidelines). These results demonstrate the potential for HBPM to function as an intermediate step in screening patients, determining which patients require more intensive ABPM monitoring for detection of isolated nocturnal hypertension. Clinical Relevance — This study investigates the incidence of isolated nocturnal hypertension, and the possibility of using home blood pressure monitoring (HBPM) to screen for it. Isolated nocturnal hypertension is otherwise only detectable using more expensive and burdensome ambulatory blood pressure monitoring (ABPM).