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Appendix 1
Ovid MEDLINE search strategy:
1. Blood Pressure Monitoring, Ambulatory/
2. (ABPM or ambulatory blood pressure monitor* or ambulatory BP monitor* or ambulatory blood
pressure measur* or ambulatory BP measur*).mp.
3. ((24-h or 24 hour or 48h or 48 hour or diurnal) adj1 (BP or blood pressure)).mp.
4. Reproducibility of Results/
5. (variability or repeatability or reproducibility or reliability).mp.
6. 1 or 2 or 3
7. 4 or 5
8. 6 and 7
9. limit 8 to humans
10. limit 9 to "all adult (19 plus years)"
EMBASE search strategy:
1. blood pressure monitoring/
2. (ABPM or ambulatory blood pressure monitor* or ambulatory BP monitor* or ambulatory blood
pressure measur* or ambulatory BP measur*).mp.
3. ((24-h or 24 hour or 48h or 48 hour or diurnal) adj1 (BP or blood pressure)).mp.
4. reproducibility/
5. (variability or repeatability or reproducibility or reliability).mp.
6. 1 or 2 or 3
7. 4 or 5
8. 6 and 7
9. limit 8 to human
10. limit 9 to adult <18 to 64 years> or aged <65+ years>)
CINAHL Complete search strategy:
S1. (MH "Blood Pressure Monitoring, Ambulatory")
S2. TX ABPM or ambulatory blood pressure monitor* or ambulatory BP monitor* or ambulatory
blood pressure measur* or ambulatory BP measur*
S3. TX ((24-h or 24 hour or 48h or 48 hour or diurnal) n1 (BP or blood pressure)
S4. (MH "Reproducibility of Results")
S5. TX variability or repeatability or reproducibility or reliability
S6. S1 OR S2 OR S3
S7. S4 OR S5
S8. S6 AND S7
S9. S8 Limiters - Human
S10. S9 Limiters - Human; Age Groups: All Adult
Appendix 2 (a) List and characteristics of included studies
Study Country ABPM model Frequency of BP measurements Definition of night-
time
Interval between
ABPM
Ash2013 [9] USA Accutracker II 20 minutes (awake); 30 minutes
(asleep)
NA 1 week
Boesby2012[22] Denmark Spacelabs 90207 monitor 15 minutes (awake); 30 minutes
(asleep)
Fixed interval Median 7 days
Cavelaars1999[23] Netherlands Spacelabs 90207 monitor 15 minutes (awake); 20 minutes
(asleep)
Actigraphy 2-6 weeks
Chaves2005[10] Brazil Spacelabs 90207 monitor 10 minutes (awake); 20 minutes
(asleep)
Fixed interval 8-15 days
Chung1991[24] Netherlands Oxford Medilog system 15 minutes (awake); 30 minutes
(asleep)
Fixed interval At least 1 week
Cornish1995[44] USA Spacelabs 90202 monitor 30 minutes (awake); 30 minutes
(asleep)
Patient diary 1 week
Cuspidi2006[30] Italy Spacelabs 90207 monitor 15 minutes (awake); 20 minutes
(asleep)
Fixed interval Within 4 weeks
Cuspidi2011[45] Italy Spacelabs 90207 monitor 15 minutes (awake); 20 minutes
(asleep)
Fixed interval 1-4 weeks
Eguchi2010[11] Japan TM2425; AND Inc. 30 minutes (awake); 30 minutes
(asleep)
Diary 2 weeks
Gardner1994[18] USA Spacelabs 90207 monitor 30 minutes (awake); 60 minutes
(asleep)
Fixed interval 1 week; then 1 month
Hansen1991[25] Denmark Spacelabs 90202 monitor 20 minutes (awake); 60 minutes
(asleep)
NA 21.5d
Hensken2008[26] Netherlands Spacelabs 90207/90217
monitor
15 minutes (awake); 30 minutes
(asleep)
Diary Median 1 week (IQR
5,9 days)
Hensken2008b[33] Netherlands Spacelabs 90207/90217
monitor
15 minutes (awake); 30 minutes
(asleep)
Various methods
used
7 days (range 2-28
days)
Hernandez-
delRey2007[31]
Spain Spacelabs 90207 monitor 20 minutes (awake); 20 minutes
(asleep)
Diary 1 day, consecutive
Hietanen1996[46] Finland Novacor Diasys 20 minutes (awake); 60 minutes
(asleep)
Diary 2-4 weeks
Hinderliter2013[47] USA OSCAR II monitor 20 minutes (awake); 30 minutes
(asleep)
Autography (mini-
mitter)
1 week
Mancia1992[48] Italy SpaceLabs 5300 monitor 15 minutes (awake); 20 minutes
(asleep)
Fixed interval 4 weeks
Mochizuki1998[49] Japan ABPM-630 30 minutes (awake); 30 minutes
(asleep)
Diary 1 day, consecutive
Musso 1997[20] USA Spacelabs 90207 monitor NA Fixed interval 28 days
Perkarski2002[50] Russia Spacelabs 90207 monitor 15 minutes (awake); 15 minutes
(asleep)
Multiple method
(diary, fixed, self-
developed method)
1 day, consecutive
RahbariOskoui2011[29] USA Spacelabs 90207 monitor 20 minutes (awake); 30 minutes
(asleep)
Fixed interval 7-15 days
Shapio1998[51] USA Accutracker II 20 minutes (awake); 60 minutes
(asleep)
Diary 7 days
Shinagawa2002[52] Japan TM-2431 30 minutes (awake); 60 minutes
(asleep)
Fixed interval 1 day, consecutive
Stenehjem2004[27] Norway Tycos Quiet Trak 20 minutes (awake); 30 minutes
(asleep)
Fixed interval 4 weeks
Stergiou2002[53] Greece Spacelabs 90207 monitor 20 minutes (awake); 20 minutes
(asleep)
Diary 2 weeks
Stergiou2010[54] Greece Spacelabs 90207 monitor 20 minutes (awake); 20 minutes
(asleep)
Diary 2-4 weeks
Thijs1992[55] Europe Spacelabs 90207/90202
monitor
<30 minutes Fixed interval 1 month
Trazzi1991[19] Italy SpaceLabs 5300 monitor 10 minutes (awake); 20 minutes
(asleep)
Fixed interval 4 weeks
Tsuchihashi2002[32] Japan ES-H531 30 minutes (awake); 30 minutes
(asleep)
Diary 1 month
Uen2009[28] Germany ABPM-04 20 minutes (awake); 45 minutes
(asleep)
Fixed interval 7 days
VanBergeLandry2010[56] USA Spacelabs 90207 monitor 15 minutes (awake); 30 minutes
(asleep)
Diary 1 month
VanDerSteen1999[14] Netherlands Oxford Medilog system 15 minutes (awake); 30 minutes
(asleep)
Fixed interval 2-3 weeks
Verdecchia1991[21] Italy Spacelab90202 15 minutes (awake); 15 minutes
(asleep)
NA 2-5 days
Viera2010[57] USA OSCAR II monitor 30 minutes (awake); 60 minutes
(asleep)
Fixed interval 1 week
Viera2014[58] USA OSCAR II monitor 30 minutes (awake); 60 minutes
(asleep)
Fixed interval/diary 1 week
Weber1982[59] USA Dinamap 7.5 minutes (awake); 7.5 minutes
(asleep)
Fixed interval 2 weeks; 4 patients
had extra one at 6
weeks later
Zakopoulos2001[60] Greece Spacelabs 90207 monitor 15 minutes (awake); 15 minutes
(asleep)
Fixed interval 4 weeks
Appendix 2(b). Participants’ characteristics in the included studies
Study Participants
no.
Percentage of
male
Percentage of
hypertension patients
Percentage of using
hypertension meds
Age of participants
Ash2013 [9] 145 88% 0% 0% 22.4+/-0.3
Boesby2012[22] 83 71% 94% 90% Median 62; range
(31-80)
Cavelaars1999[23] 16 50% 81% 81% 49.5 (range 28-68)
Chaves2005[10] 101 48% 73% NA 53.2+/-15.1
Chung1991[24] 18 48% 0% 0% 33+/-10
Cornish1995[44] 30 50% 0% 0% 29.5 (range 21-43)
Cuspidi2006[30] 97 60% 100% 37% 65.3+/-6.3
Cuspidi2011[45] 658 62% 100% 0% 46+/-12
Eguchi2010[11] 42 50% 100% 38% 57.8+/-9.7
Gardner1994[18] 16 100% 0% 0% 44.8+/-2
Hansen1991[25] 29 69% NA 55% Median 65; range
(52-74)
Hensken2008[26] 213 51% 100% 0% 52.5+/-12.6
Hensken2008b[33] 150 49% 100% 0% 52.2+/-11.7
Hernandez-
delRey2007[31]
611 56%
62% 58+/-13
Hietanen1996[46] 10 30% 0% 0% 22 to 49
Hinderliter2013[47] 115 57% NA 0% 46+/-9
Mancia1992[48] 15 69% 100 0% 42.1+/-2.1
Mochizuki1998[49] 253 53% 100 0% 22 to 80 year old
Musso 1997[20] 32 56% 0 0% 30.84+/-1.17
Perkarski2002[50] 33 48% 100 NA 36-60
RahbariOskoui2011[29] 25 48% 100 100% 43.1 +/-8.6
Shapio1998[51] 104 45% 0 0% 55-79
Shinagawa2002[52] 54 54% NA NA 51.5 +/-10.8
Stenehjem2004[27] 65 72% 100 0% 47.6+/-9.3
Stergiou2002[53] 133 55% NA 0% 48.4+/-10.2
Stergiou2010[54] 126 56% 100 100% 48.2+/-10.7
Thijs1992[55] 42 34% 100 0% median 70; range 60-
92
Trazzi1991[19] 20 74% 100 NA 43.2+/-2.8
Tsuchihashi2002[32] 37 5% 38 11% 86+/-6.1
Uen2009[28] 97 57% 71 24% 52+/-12
VanBergeLandry2010[56
]
139 0% NA 0% 39+/-9
VanDerSteen1999[14] 45 40% 100 0% 46+/-13.7
Verdecchia1991[21] 44 52% 100 0% 52+/-11
Viera2010[57] 50 44% 0 0% 49+/-10
Viera2014[58] 420 44% NA 0% 48+/-12
Weber1982[59] 6 100% 100 0% 51; range 36-66
Zakopoulos2001[60] 20 55% 100 0% 52+/-3.2
Further references:
44. Cornish PJ, Blanchard EB, Jaccard J. Test-retest reliability of 24-hour ambulatory blood pressures. Biofeedback Self Regul 1995; 20 (2):137-154.
45. Cuspidi C, Sala C, Valerio C, Negri F, Mancia G. Nocturnal blood pressure in untreated essential hypertensives. Blood Press 2011; 20 (6):335-341.
46. Hietanen E, Wendelin-Saarenhovi M. Ambulatory blood pressure reproducibility and application of the method in a healthy Finnish cohort. Scand J
Clin Lab Invest 1996; 56 (5):471-480.
47. Hinderliter AL, Routledge FS, Blumenthal JA, Koch G, Hussey MA, Wohlgemuth WK et al. Reproducibility of blood pressure dipping: Relation to
day-to-day variability in sleep quality. J Am Soc Hypertens 2013; 7 (6):432-439.
48. Mancia G, Omboni S, Parati G, Trazzi S, Mutti E. Limited reproducibility of hourly blood pressure values obtained by ambulatory blood pressure
monitoring: Implications for studies on antihypertensive drugs. J Hypertens 1992; 10 (2):1531-1535.
49. Mochizuki Y, Okutani M, Donfeng Y, Iwasaki H, Takusagawa M, Kohno I et al. Limited reproducibility of circadian variation in blood pressure
dippers and nondippers. Am J Hypertens 1998; 11 (4):403-409.
50. Pekarski SE, Mordovin VF, Triss SV, Semke GV, Kolodina MV. Improved automatic analysis of ambulatory blood pressure data based on precise
detection of individual night-time from diurnal profile of heart rate. Blood Press Monit 2002; 7 (2):117-121.
51. Shapiro D, Goldstein IB. Wrist actigraph measures of physical activity level and ambulatory blood pressure in healthy elderly persons.
Psychophysiology 1998; 35 (3):305-312.
52. Shinagawa M, Otsuka K, Murakami S, Kubo Y, Cornelissen G, Matsubayashi K et al. Seven-day (24-h) ambulatory blood pressure monitoring, self-
reported depression and quality of life scores. Blood Press Monit 2002; 7 (1):69-76.
53. Stergiou GS, Baibas NM, Gantzarou AP, Skeva II, Kalkana CB, Roussias LG et al. Reproducibility of home, ambulatory, and clinic blood pressure:
Implications for the design of trials for the assessment of antihypertensive drug efficacy. Am J Hypertens 2002; 15 (2):101-104.
54. Stergiou GS, Kollias A, Rarra VC, Roussias LG. Ambulatory arterial stiffness index: Reproducibility of different definitions. Am J Hypertens 2010;
23 (2):129-134.
55. Thijs L, Amery A, Clement D, Cox J, De Cort P, Fagard R et al. Ambulatory blood pressure monitoring in elderly patients with isolated systolic
hypertension. 1992; 10 (7):693-699.
56. Van Berge-Landry HM, Bovbjerg DH, James GD. The reproducibility of ethnic differences in the proportional awake-sleep blood pressure decline
among women. Am J Hum Biol 2010; 22 (3):325-329.
57. Viera AJ, Hinderliter AL, Kshirsagar AV, Fine J, Dominik R. Reproducibility of masked hypertension in adults with untreated borderline office blood
pressure: Comparison of ambulatory and home monitoring. Am J Hypertens 2010; 23 (11):1190-1197.
58. Viera AJ, Lin FC, Tuttle LA, Olsson E, Stankevitz K, Girdler SS et al. Reproducibility of masked hypertension among adults 30 years or older. Blood
Press Monit 2014; 19 (4):208-215.
59. Weber MA, Drayer JIM, Wyle FA, Deyoung JL. Reproducibility of the whole-day blood pressure pattern in essential hypertension. Clin Exp
Hypertens A 1982; 4 (8):1377-1390.
60. Zakopoulos N, Nanas SN, Lekakis JP, Vemmos KN, Kotsis VT, Pitiriga VC et al. Reproducibility of ambulatory blood pressure measurements in
essential hypertension. Blood Press Monit 2001; 6 (1):41-45.
Appendix 3 Subgroup analysis of mean difference between first and second ABPM; subgroup:
normotensive patients vs patients with hypertension: (a) 24-SBP, (b) daytime SBP, (c) night-time
SBP, (d) 24-DBP, (e) night-time SBP, (f) night-time DBP
(a)
(b)
(c)
(d)
(e)
(f)
Appendix 4 Meta-analysis results of Bland-Altman statistics
Overall# Spacelabs 90207 Other ABPM Patients with possible
higher BP variability
Studies involving patients
who received anti-
hypertension drugs
Studies with only
normotensive
participants
Repeat interval 20-30
minutes
Repeat-interval
≤15min
24-hour SBP -14.2 to 14.7
(10 studies)
-12.1 to 13.1
(4 studies)
-13.9 to 14.0
(6 studies)
-10.1 to 9.3 (2
studies)
-15.3 to 14.3
(4 studies)
-3.7 to 5.5
(2 studies)
NA NA
Day-SBP -16.7 to 18.4
(5 studies)
-14.8 to 15.5
(2 studies)
-14.0 to 17.0 (3
studies)
NA -20.4 to 27.0 (1 study
only)
-8.5 to 5.7 (1 study
only)
-11.2 to 14.9
(2 studies)
-18.8 to 19.4
(3 studies)
Night-SBP -19.6 to 21.3
(6 studies)
-18.8 to 20.3
(3 studies)
-17.9 to 19.8 (3
studies)
NA -23.9 to 22.2
(2 studies)
-10.3 to 7.3 (1 study
only)
-20.8 to 21.6
(5 studies)
-11.3 to 21.3
(1 study only)
24-hour DBP -9.3 to 10.2
(10 studies)
-8.4 to 9.20
(4 studies)
-9.3 to 10.2
(6 studies)
-4.4 to 4.2
(2 studies)
-7.9 to 7.2
(4 studies)
-4.3 to 5.7 (2 studies) NA NA
Day-DBP -10.4 to 12.3 (5
studies)
-13.7 to 14.7
(2 studies)
-7.4 to 10.3 (3
studies)
NA -12.0 to 13.8 (1 study
only)
-10.3 to 7.3 (1 study
only)
-6.9 to 9.0
(2 studies)
-12.6 to 14.4
(3 studies)
Night-DBP -11.3 to 12.4
(6 studies)
-12.1 to 12.7
(3 studies)
-9.7 to 11.4
(3 studies)
NA -14.1 to 12.5
(2 studies)
-6.8 to 5.8 (1 study
only)
-11.6 to 12.0
(5 studies)
-6.6 to 14.6
(1 study only)
*NA represented “not available”, BP = blood pressure; SBP = systolic BP; DBP = diastolic BP; ABPM = ambulatory blood pressure monitoring
# all BP numbers are in mmHg
Appendix 5. Analysis of degree of dipping for (a) SBP (b) DBP after the outliner was removed
(subgroup by normotension/hypertension)
(a)
(b)
Appendix 6 Prevalence of inconsistent dipping by different subgroups (a) ABPM model (b) if
participants with high BP variability were included (c) if participant on anti-hypertension
drugs (d) definition of night-time (e) different daytime frequency of BP measurement and (f)
different night-time frequency of BP measurement (g) studies with normotensive/hypertensive
participants
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Appendix 7 Sensitivity analysis of proportion of inconsistent dipper values after removal of the
outliner
Appendix 8 Funnel plots for reproducibility of BP
(a) 24hr SBP; (b) day SBP; (c) night SBP; (d) 24hr DBP; (e) day DBP; (f) night DBP
(a)
(b)
02
46
se(W
MD
)
-10 -5 0 5 10 15WMD
(c)
02
46
se(W
MD
)
-10 -5 0 5 10 15WMD
02
46
8
se(W
MD
)
-10 -5 0 5 10 15WMD
(d)
(e)
02
46
se(W
MD
)
-10 -5 0 5 10WMD
01
23
4
se(W
MD
)
-10 -5 0 5 10WMD
(f)
01
23
4
se(W
MD
)
-10 -5 0 5 10WMD
