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  • Title: Reproducibility of ambulatory blood pressure and assessing treatment withdrawal in hypertension trial.
    Author: Reeves RA, Myers MG.
    Journal: Am J Hypertens; 1993 Jun; 6(6 Pt 2):229S-232S. PubMed ID: 8347325.
    Abstract:
    Ambulatory blood pressure monitoring (ABPM), like casual blood pressure (BP), is imperfectly reproducible between visits. The reproducibility of ABPM is less than the reproducibility predicted from a simple model of random variation of BP. This suggests either increased technical error in the technique, an element of increased biologic variability, or both. In addition, ABP shows a between-day variation (add about 6 to 7 mm Hg diastolic, similar in magnitude to what is observed with casual BP) which cannot be obviated by the average of many within-day measurements. The reliability of ABPM, although conventionally judged excellent at about RI = 0.75, is insufficient to avoid misclassification errors and regression to the mean when BP cutpoints are employed. About 40% of patients apparently failing treatment withdrawal at a threshold of +2 SD, or about 95 mm Hg diastolic ABP, will be false-positive failures when categorized by a single ABP. Despite the inconvenience, obtaining an average of two or more ABP measurements on different days may be cost-saving to a clinical trial because of the improved reproducibility; other costs may exceed $1000 per entrant.
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