Predict abnormal nighttime blood pressure feature by home blood pressure feature by using a machine learning approach

Abstract Objective Abnormal nighttime blood pressure (BP) feature including early morning surge (EMS), nocturnal hypertension (NH) and non-dipping systolic blood pressure (NDSBP) are predictors for cardiovascular events (CVE) and mortality. This study aimed to try to determine which of the home blood pressure monitor (HBPM) parameters can predict abnormal BP feature. Methods The study population consisted of participants with prehypertension and stage 1 hypertension, recruited from 11 medical centers within the Taiwan Hypertension-Associated Cardiac Disease Consortium (TCHC). We selected participants who underwent both HBPM and 24-hour ambulatory blood pressure monitoring (ABPM) within a six-month period. Using machine learning, we analyzed various detailed home blood pressure measurement parameters, including morning blood pressure, evening blood pressure, morning-evening blood pressure difference, morning-evening blood pressure average, and various blood pressure variability indicators. Separate analyses were conducted for systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure to identify which home blood pressure parameters could predict nocturnal hypertension. Results A total of 1,129 patients were enrolled. For those with a history of previous cardiovascular disease (CVD), the difference between morning and evening average blood pressure was the best predictor of abnormal blood pressure features. On the other hand, for patients without a history of CVD, the maximum evening pulse pressure was the most predictive of abnormal blood pressure features. Using a machine learning-assisted model, the accuracy was 0.882, precision was 0.889, F1 score was 0.889, and AUC was 0.972. Conclusion Our results highlight the potential of machine learning-based Abnormal BP feature prediction using HBPM. The accuracy of the predictions demonstrated that HBPM feature that can predict EMS, NH and NDSBP.