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Predicting Out-of-Office Blood Pressure in the Clinic (PROOF-BP): Derivation and Validation of a Tool to Improve the Accuracy of Blood Pressure Measurement in Clinical Practice.

Accepted version
Peer-reviewed

Repository DOI


Type

Article

Change log

Authors

Sheppard, James P 
Stevens, Richard 
Gill, Paramjit 
Martin, Una 
Godwin, Marshall 

Abstract

Patients often have lower (white coat effect) or higher (masked effect) ambulatory/home blood pressure readings compared with clinic measurements, resulting in misdiagnosis of hypertension. The present study assessed whether blood pressure and patient characteristics from a single clinic visit can accurately predict the difference between ambulatory/home and clinic blood pressure readings (the home-clinic difference). A linear regression model predicting the home-clinic blood pressure difference was derived in 2 data sets measuring automated clinic and ambulatory/home blood pressure (n=991) using candidate predictors identified from a literature review. The model was validated in 4 further data sets (n=1172) using area under the receiver operator characteristic curve analysis. A masked effect was associated with male sex, a positive clinic blood pressure change (difference between consecutive measurements during a single visit), and a diagnosis of hypertension. Increasing age, clinic blood pressure level, and pulse pressure were associated with a white coat effect. The model showed good calibration across data sets (Pearson correlation, 0.48-0.80) and performed well-predicting ambulatory hypertension (area under the receiver operator characteristic curve, 0.75; 95% confidence interval, 0.72-0.79 [systolic]; 0.87; 0.85-0.89 [diastolic]). Used as a triaging tool for ambulatory monitoring, the model improved classification of a patient's blood pressure status compared with other guideline recommended approaches (93% [92% to 95%] classified correctly; United States, 73% [70% to 75%]; Canada, 74% [71% to 77%]; United Kingdom, 78% [76% to 81%]). This study demonstrates that patient characteristics from a single clinic visit can accurately predict a patient's ambulatory blood pressure. Usage of this prediction tool for triaging of ambulatory monitoring could result in more accurate diagnosis of hypertension and hence more appropriate treatment.

Description

Keywords

ambulatory blood pressure monitoring, hypertension, masked hypertension, white coat hypertension, Adult, Aged, Algorithms, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Canada, Circadian Rhythm, Cohort Studies, Databases, Factual, Female, Humans, Linear Models, Male, Masked Hypertension, Middle Aged, Office Visits, Predictive Value of Tests, ROC Curve, Risk Assessment, Sensitivity and Specificity, United Kingdom, United States, White Coat Hypertension

Journal Title

Hypertension

Conference Name

Journal ISSN

0194-911X
1524-4563

Volume Title

67

Publisher

Ovid Technologies (Wolters Kluwer Health)
Sponsorship
This work was funded by an Medical Research Council (MRC) Strategic Skills Post-doctoral Fellowship (MR/K022032/1) held by JS, with support from a National Institute for Health Research (NIHR) Programme Grant (RP-PG-1209–10051). RJMcM holds an NIHR Professorship and leads the self-management theme of the NIHR Oxford CLAHRC. BW is a NIHR Senior Investigator and his research is supported by the NIHR UCL Hospitals Biomedical Research Centre. FDRH is part funded as Director of the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR), Theme Leader of the NIHR Oxford Biomedical Research Centre (BRC), and Director of the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford. The views and opinions expressed are those of the authors and do not necessarily reflect those of the MRC, NHS, NIHR, or the Department of Health.