# Evaluating novel approaches for estimating awake and sleep blood pressure

> **NIH NIH R01** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2020 · $913,796

## Abstract

In the US, hypertension is diagnosed by measuring blood pressure (BP) in the clinic by a healthcare provider
or technician (attended clinic BP). However, this approach provides a poor estimate of a person's BP.
Ambulatory BP monitoring (ABPM) measures BP automatically every 15 to 30 minutes outside of the clinic
setting typically for 24 hours including while a person is awake and asleep. Although ABPM is considered to be
the reference standard for diagnosing hypertension, it is not available in most clinics in the US and, when
available, it is not tolerated by many patients. These issues highlight the need for new approaches for
diagnosing hypertension. Canadian studies suggest that BP measured in the clinic using an automatic
oscillometric device without an observer being present (unattended clinic BP) may be closer to awake BP on
ABPM than attended clinic BP. However, these studies were uncontrolled with unattended clinic BP being
measured after attended clinic BP; attended clinic BP was performed using a mercury sphygmomanometer,
which is no longer the recommended for measuring BP; and often participants with very high attended clinic
BP were enrolled. A recent analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT) did
not find a difference between clinic BP when measured attended or unattended. However, participants did not
have both attended and unattended BP measured at the same visit; all participants were taking
antihypertensive medication; and data from ABPM were not available as a reference standard. In addition to
elevated awake BP, elevated BP during sleep is associated with an increased risk of CVD. ABPM has been
the only method that could measure sleep BP. A home BP monitoring (HBPM) device has recently been
developed that can measure BP during sleep. In contrast to ABPM, these HBPM devices are worn for a shorter
period of time (only during sleep) with fewer BP measurements, and thus may be better tolerated than ABPM.
The goal of this study is to compare novel non-ABPM approaches to ABPM for measuring BP during
the awake and sleep periods and diagnosing hypertension. For Aim 1, we will test whether unattended
clinic BP provides a more accurate estimate of awake BP on ABPM than attended clinic BP. For Aim 2, we will
determine the accuracy of a new HBPM device for measuring sleep BP. We will also evaluate whether the
HBPM device is better tolerated than ABPM. For Aim 3, we will compare the associations of unattended clinic
BP and attended clinic BP versus awake BP on ABPM and sleep BP on HBPM versus ABPM with left
ventricular mass index and albuminuria. We will enroll 630 adults, not taking antihypertensive medication, with
systolic BP of 110 to 159 mm Hg and diastolic BP of 70 to 99 mm Hg in New York, NY and Birmingham, AL.
Participants will undergo both unattended and attended clinic BP, in random order, and ABPM and HBPM, also
in random order. This rigorously designed study will provide important data on whet...

## Key facts

- **NIH application ID:** 9930674
- **Project number:** 5R01HL139716-03
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Paul Muntner
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $913,796
- **Award type:** 5
- **Project period:** 2018-07-15 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9930674

## Citation

> US National Institutes of Health, RePORTER application 9930674, Evaluating novel approaches for estimating awake and sleep blood pressure (5R01HL139716-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9930674. Licensed CC0.

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