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dc.contributor.authorSheppard, James P
dc.contributor.authorHolder, Roger
dc.contributor.authorNichols, Linda
dc.contributor.authorBray, Emma
dc.contributor.authorHobbs, FD Richard
dc.contributor.authorMant, Jonathan
dc.contributor.authorLittle, Paul
dc.contributor.authorWilliams, Bryan
dc.contributor.authorGreenfield, Sheila
dc.contributor.authorMcManus, Richard J
dc.description.abstractOBJECTIVES: Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. METHODS: This study used an observational cohort design and included 220 individuals aged 35-84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. RESULTS: The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. CONCLUSION: Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice.
dc.description.sponsorshipThis study presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-1209–10051). R.J.Mc.M. holds an NIHR Professorship. J.S. was funded by the NIHR Birmingham and Black Country Collaboration for Leadership in Applied Health Research and Care during part of this work, but now holds a Medical Research Council Strategic Skills Postdoctoral Fellowship. B.W. is a NIHR Senior Investigator and is supported by the NIHR UCL Hospitals Biomedical Research Centre. The TASMINH2 trial was funded by the UK Department of Health Policy Research Programme and the National Coordinating Centre for Research Capacity Development. The views and opinions expressed are those of the authors and do not necessarily reflect those of the NHS, NIHR, or the Department of Health. All equipment used in the study was purchased commercially.
dc.publisherOvid Technologies (Wolters Kluwer Health)
dc.rightsAttribution 4.0 International
dc.subjectBlood Pressure Monitoring, Ambulatory
dc.subjectLogistic Models
dc.subjectSensitivity and Specificity
dc.subjectCohort Studies
dc.subjectBlood Pressure
dc.subjectMiddle Aged
dc.subjectAmbulatory Care Facilities
dc.subjectWhite Coat Hypertension
dc.subjectMasked Hypertension
dc.titlePredicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study.
prism.publicationNameJ Hypertens
dc.contributor.orcidMant, Jonathan [0000-0002-9531-0268]
rioxxterms.typeJournal Article/Review

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