Show simple item record

dc.contributor.authorSheppard, James Pen
dc.contributor.authorStevens, Richarden
dc.contributor.authorGill, Paramjiten
dc.contributor.authorMartin, Unaen
dc.contributor.authorGodwin, Marshallen
dc.contributor.authorHanley, Janeten
dc.contributor.authorHeneghan, Carlen
dc.contributor.authorHobbs, FD Richarden
dc.contributor.authorMant, Jonathan Williamen
dc.contributor.authorMcKinstry, Brianen
dc.contributor.authorMyers, Martinen
dc.contributor.authorNunan, Daviden
dc.contributor.authorWard, Alisonen
dc.contributor.authorWilliams, Bryanen
dc.contributor.authorMcManus, Richard Jen
dc.identifier.citationHypertension 2016en
dc.description.abstractPatients often have lower (white coat effect) or higher (masked effect) ambulatory/home blood pressure readings compared to 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 two datasets measuring automated clinic and ambulatory/home blood pressure (n=991) using candidate predictors identified from a literature review. The model was validated in four further datasets (n=1,172) 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 datasets (Pearson’s correlation 0.48-0.80) and performed well predicting ambulatory hypertension (AUROC 0.75, 95%CI 0.72-0.79 [systolic]; 0.87, 95%CI 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% [92-95%] classified correctly; US 73% [70-75%]; Canada 74% [71-77%]; UK 78% [76-81%]). This study demonstrates that patient characteristics from a single clinic visit can accurately predict a patient’s ambulatory blood pressure. Utilisation of this prediction tool for triaging of ambulatory monitoring could result in more accurate diagnosis of hypertension and hence more appropriate treatment.
dc.description.sponsorshipThis 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.
dc.publisherWolters Kluwer
dc.rightsAttribution-NonCommercial 4.0 International
dc.rightsAttribution-NonCommercial 4.0 Internationalen
dc.rightsAttribution-NonCommercial 4.0 Internationalen
dc.subjectwhite coat hypertensionen
dc.subjectmasked hypertensionen
dc.subjectambulatory blood pressure monitoringen
dc.subjectprediction toolen
dc.titlePredicting 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 Practiceen
dc.description.versionThis is the author accepted manuscript. The final version is available from Wolters Kluwer via
dc.contributor.orcidMant, Jonathan William [0000-0002-9531-0268]
rioxxterms.typeJournal Article/Reviewen

Files in this item


This item appears in the following Collection(s)

Show simple item record

Attribution-NonCommercial 4.0 International
Except where otherwise noted, this item's licence is described as Attribution-NonCommercial 4.0 International