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Cardiovascular disease (CVD) is the leading cause of death worldwide with Hypertension, specifically, affecting over 1.1 billion people annually. The goal of the package is to provide a comprehensive toolbox for analyzing blood pressure (BP) data using a variety of statistical metrics and visualizations to bring more clarity to CVD.
You can install the released version of bp from CRAN with:
install.packages("bp")
You can install the development version from GitHub with:
# install.packages("devtools")
::install_github("johnschwenck/bp") devtools
For installation with vignettes:
::install_github("johnschwenck/bp", build_vignettes = TRUE) devtools
The package includes six sample data sets:
bp_hypnos
: The data set contains ABPM measurements from
n= 5subjects with type 2diabetes and obstructive sleep apnea. The
recordings are taken every hour during the 24-hour period for each of
the two visits that are 3 months apart. Additional information includes
sleep/wake indicator for each recording inferred from a wrist-worn
actigraphy device. The aim of original study (Rooney et al.2021) is to
determine the effect of positive airway pressure treatment of sleep
apnea on glycemic control and blood pressure of patients with type
2diabetes. The included data is a subset of the full data described in
Rooneyet
al.(2021)bp_jhs
: The data set consists of HBPM measurements from
a 2019
single-subject pilot study during an endured aerobic (endurance)
exercise: cycling 5,775 miles from New York City, New York to Seward,
Alaska over the course of 95 days. Data was collected using an Omron
Evolv wireless blood pressure monitor twice per day (in the morning upon
waking up and in the evening before bed). The aim of original study
(Schwenck 2019) is to assess blood pressure variability across different
environments through time.bp_ghana
: The data set contains HBPM measurements on n=
757subjects across 32 community health centers from cluster-randomized
trial in Ghana: 389 subjects are in the health insurance coverage (HIC)
group and 368 subjects are in another group consisting of a combination
of HIC with a nurse-led task-shifting strategy for hypertension control
(TASSH)(this group is denoted TASSH + HIC). Baseline blood pressure
measurements were collected, with 85% of subjects having available 12
month follow-up measurements. The aim of original study (Ogedegbe et
al.2018) is to assess the comparative effectiveness of HIC alone versus
the combination of TASSH + HIC on reducing systolic blood pressure among
patients with uncontrolled hypertension in Ghana.bp_preg
: The data set contains HBPM measurements from
n= 209women, each of whom were recorded every 30 minutes during the
Pregnancy Day Assessment Clinic (PDAC) observation window for up to a
maximum of 240 minutes (i.e. a maximum of 8 total readings per subject
per observation window) in addition to an initial “booking” reading
before the PDAC assessment. The aim of the original study (McCarthy et
al.2015) is to investigate the pregnancy-induced hypertension and
pre-eclampsia prediction to determine whether the blood pressure
assessment of the first observation window of 1 hour (60 minutes) is
sufficiently accurate relative to the standard 4 hour (240 minute)
window.bp_children
: The data set contains HBPM measurements on
n= 1,283 children from Bristol, UK. Three blood pressure readings per
visit were collected over the course of two observation periods (at ages
9 and 11). Additionally, information on their physical activity has been
collected. The aim of original study (Solomon-Moore et al.2020) is to
examine how sedentary behavior affect children progressing through
primary school, and to understand the relationship between elevated
blood pressure in children and its impact on the development of
cardiovascular disease into adulthood.bp_rats
: The data set contains AP measurements sampled
at 100 Hz of the SS (n1= 9) and SS.13 (n2= 6) genetic strains of Dahl
rats. Each mouse was administered either a low sodium or a high sodium
diet. The aim of original study (Bugenhagen et al.2010) is to
investigate the connection between the dysfunction of the baroreflex
control system in Dahl rats and salt-sensitive HypertensionThe bp
package is designed to allow the user to
initialize a processed dataframe through the process_data
function by specifying any combination of the following variables
present in the user-supplied data set (with the minimum requirement that
SBP
and DBP
are included). The package will
then utilize the processed dataframe to calculate various metrics from
medical and statistical literature and provide visualizations. Perhaps
the most useful user-friendly feature of the package is the ability to
generate a visualization report to discern relationships and assess
blood pressure stage progression among subjects.
The package has the ability to make use of the following physiological variables (expressed as integers):
SBP
) measured in mmHgDBP
) measured in mmHgAP
) (if applicable)HR
) measured in bpmPP
) measured in mmHg which is
calculated as SBP - DBPMAP
) measured in mmHgRPP
) which is calculated as SBP
multiplied by resting HRThere are also processing functionality for arterial pressure (AP)
data which include the following inputs: * A column corresponding to the
AP data (AP
) * Time elapsed (time_elap
)
Furthermore, there are a suite of processing capabilities within the
process_data
function such as:
DATE_TIME
: A column coreresponding to a date/time
object (typically as.POSIXct
format) such as
12/1/2020 13:42:07
ID
: Identification of individualsVISIT
: The visit of each individual, if more than one
(integer)WAKE
: A binary indicator where 1 denotes awake and 0
denotes asleep (binary 1 or 0)GROUP
: An arbitrary column that can be used to group
data according to this category (such as gender or age)EOD
: Denotes the end-of-day which can be adjusted for
situations where individuals may take readings after midnightDATA_SCREEN
: A screening proceedure to remove outliers
based on upper and lower limits of BP readingsAGG
: An aggregation option to average consecutive
readings taken within quick successionCHRON_ORDER
: Adjust the chronology of the readings
(chronological vs reverse-chronological)TZ
: Time zone adjustmentAfter all available variables are identified and processed, the resulting processed dataframe is used for all other functions.
Unique to the bp
package is the ability to create
additional columns that might not originally be present in the supplied
data set. At current, the following additional columns will be
created:
TIME_OF_DAY
- Corresponds to the Time of Day (Morning,
Afternoon, Evening, or Night) based on DATE_TIME
columnDAY_OF_WEEK
- Corresponds to the Day of the week: a
useful column for table visuals. Based on DATE_TIME
columnSBP_CATEGORY
- Systolic Blood Pressure Stages (Low,
Normal, Elevated, Stage 1, Stage 2, Crisis) as defined by the American
Heart Association (AHA)DBP_CATEGORY
- Diastolic Blood Pressure Stages (Low,
Normal, Elevated, Stage 1, Stage 2, Crisis) as defined by the American
Heart Association (AHA)BP_CLASS
- A two-to-one mapping of SBP and DBP readings
that expands on the original AHA categories using a more recent
adaptation by (Lee et al 2018)See examples below for further details.
The package will then utilize the above variables to calculate various metrics from medical and statistical literature in order to quantify and classify the variability of the readings into their respective categories of hypertension (normal, elevated, or hypertensive).
The following metrics are currently offered through the
bp
package:
Function | Metric Name | Source |
---|---|---|
bp_arv |
Average Real Variability | Mena et al (2005) |
bp_center |
Mean and Median | Amaro Lijarcio et al (2006) |
bp_cv |
Coefficient of Variation | Munter et al (2011) |
bp_mag |
Blood Pressure Magnitude (peak and trough) | Munter et al (2011) |
bp_range |
Blood Pressure Range | Levitan et al (2013) |
bp_sv |
Successive Variation | Munter et al (2011) |
bp_sleep_metrics |
Blood Pressure Sleep Metrics | (Multiple - see documentation) |
bp_stages |
Blood Pressure Stages Classification | American Heart Association |
bp_stats |
Aggregation of statistical summaries | N/A |
dip_calc |
Nocturnal Dipping % and Classification | Okhubo et al (1997) |
The following visualization functions are currently offered through
the bp
package:
Function | Visualization Type |
---|---|
bp_scatter |
Scatter plot of BP stages |
bp_ts_plots |
Time series plots |
bp_hist |
Histograms of BP stages |
dip_class_plot |
Dipping % category plot |
bp_report |
Exportable report of BP summary |
There are two main steps involved with the bp
package:
The data processing step and the functionality / analysis step.
process_data
function#devtools::install_github("johnschwenck/bp")
library(bp)
## Load bp_hypnos
data(bp_hypnos)
## Process bp_hypnos
<- process_data(bp_hypnos,
hypnos_proc sbp = 'syst',
dbp = 'diast',
date_time = 'date.time',
hr = 'hr',
pp = 'PP',
map = 'MaP',
rpp = 'Rpp',
id = 'id',
visit = 'Visit',
wake = 'wake')
#> 2 values exceeded the DUL or DLL thresholds and were coerced to NA
NOTE: the process_data
function is
insensitive to capitalization of the supplied data column names. For
this example, even though the original column name “SYST” exists in the
bp_hypnos
, “syst” is still an acceptable name to be given
to the function as shown. For emphasis, all of the above column names
were intentionally entered using the wrong capitalization.
SBP
and DBP
must be specified for any other
functions to work properly.
hypnos_proc
, we can now
calculate various metrics. Now that the included raw
bp_hypnos
dataset has been processed into
hypnos_proc
, we can now instead rely on this new dataframe
to calculate various metrics and visualizations. The calculation of the
nocturnal dipping classification is shown below, using a subset of only
two of the subjects for comparison (subjects 70417 and 70435):dip_calc(hypnos_proc, subj = c(70417, 70435))
#> [[1]]
#> # A tibble: 8 x 6
#> # Groups: ID, VISIT [4]
#> ID VISIT WAKE avg_SBP avg_DBP N
#> <fct> <fct> <fct> <dbl> <dbl> <int>
#> 1 70417 1 0 123. 60.5 10
#> 2 70417 1 1 128 66.6 20
#> 3 70417 2 0 136. 60.5 8
#> 4 70417 2 1 136. 65.6 17
#> 5 70435 1 0 106. 63 6
#> 6 70435 1 1 129. 82.1 23
#> 7 70435 2 0 136. 79.2 9
#> 8 70435 2 1 123. 72.5 20
#>
#> [[2]]
#> # A tibble: 4 x 6
#> # Groups: ID [2]
#> ID VISIT dip_sys class_sys dip_dias class_dias
#> <fct> <fct> <dbl> <chr> <dbl> <chr>
#> 1 70417 1 0.0359 non-dipper 0.0916 non-dipper
#> 2 70417 2 -0.00450 reverse 0.0784 non-dipper
#> 3 70435 1 0.179 dipper 0.233 extreme
#> 4 70435 2 -0.104 reverse -0.0927 reverse
In terms of statistical metrics, the bp_stats
function
aggregates many of the variability and center metrics into one table
which makes comparing the different measures to one another very
convenient. Let’s suppose for this example that we wanted to further
analyze these two subjects by their BP_CLASS
: we would
include add_groups = "BP_CLASS"
as an additional argument
(note that capitalization does not matter).
bp_stats(hypnos_proc, subj = c(70417, 70435), add_groups = "bp_class", bp_type = 1)
#> # A tibble: 35 x 16
#> # Groups: ID, VISIT, WAKE [8]
#> ID N VISIT WAKE BP_CLASS SBP_mean SBP_med SD ARV SV CV
#> <fct> <int> <fct> <fct> <ord> <dbl> <dbl> <dbl> <dbl> <dbl> <dbl>
#> 1 70417 5 1 0 Normal 114. 114 3.51 3.5 4.74 3.07
#> 2 70417 3 1 0 Elevated 125. 125 1.53 1.5 1.58 1.22
#> 3 70417 2 1 0 ISH - S2 143 143 2.83 4 4 1.98
#> 4 70417 3 1 1 Normal 116. 118 4.04 3.5 4.95 3.49
#> 5 70417 9 1 1 Elevated 125. 124 2.54 3.25 3.71 2.03
#> 6 70417 6 1 1 ISH - S1 134. 133 2.42 2.4 2.83 1.81
#> 7 70417 2 1 1 ISH - S2 144 144 1.41 2 2 0.982
#> 8 70417 3 2 0 Elevated 124 122 4.36 4 5 3.52
#> 9 70417 2 2 0 ISH - S1 133 133 1.41 2 2 1.06
#> 10 70417 3 2 0 ISH - S2 151 151 0 0 0 0
#> # ... with 25 more rows, and 5 more variables: SBP_max <dbl>, SBP_min <dbl>,
#> # SBP_range <dbl>, Peak <dbl>, Trough <dbl>
Here is an example of the bp_scatter
function for
subject 70417:
bp_scatter(hypnos_proc, subj = 70417)
These binaries (installable software) and packages are in development.
They may not be fully stable and should be used with caution. We make no claims about them.