Key result
Novel BP phenotype score identifies masked hypertension in office-normotensives with ~90% sensitivity.
Why the study?
Blood pressure phenotypes are linked to specific clinical, psychosocial, occupational features, and BP variability, but whether a diagnostic score based on these characteristics can predict BP phenotypes remains to be evaluated.
Does a clinical BP phenotype score accurately identify masked and sustained hypertension in adults without a prior diagnosis of hypertension?
Observational (n=212)
Does a clinical BP phenotype score accurately identify masked and sustained hypertension in adults without a prior diagnosis of hypertension?
A novel BP phenotype score using clinical features and simple provocative tests can accurately predict masked and sustained hypertension, offering an accessible screening tool when 24-hour monitoring is unavailable.
Should not yet change hypertension screening practices; leaves open prospective validation of the phenotype score.
BACKGROUND: Evidence has linked blood pressure (BP) phenotypes with certain clinical, psychosocial, and occupational features, and characteristic BP variability. OBJECTIVE: We aimed to evaluate the value of a diagnostic score developed from these characteristics in predicting BP phenotypes, when used in a manner comparable to the application of out-of-office techniques. METHODS: Adult patients with no prior diagnosis of hypertension attending their office appointments, were prospectively enrolled. Their clinical, psychosocial, and occupational data were collected. 3-consecutive pre-appointment BP measurements, and BP variability with standing and the 6-minute walk test (6MWT) were obtained. All participants underwent 24-hour BP monitoring which was paired with office BP as the reference standard for BP phenotyping. Two scores were developed from the variables selected using linear regression analysis to differentiate between masked hypertension (MH) and normotension, and sustained hypertension (SH) and white coat hypertension (WCH). RESULTS: In total 212 participants completed the study. Among office-normotensives, a score of 7 (calculated from, variables (points): dyslipidemia (3), irritable bowel syndrome (IBS) (3), orthostatic increase in SBP >5 mmHg (1), SBP increase >10 after 6MWT (1), and BP ≥130/80 after 6MWT (3)) identified MH with 90% sensitivity, 86% specificity, 70% positive predictive value (PPV), and 96% negative predictive value (NPV). Conversely, among office-hypertensives, a score of 6 (male sex (2), no IBS (2), ≥3 metabolic syndrome criteria (3), obesity (3), standing BP ≥140/90 (3), BP ≥140/90 after 6MWT (1)) identified SH with 82% sensitivity, 78% specificity, 90% PPV, and 64% NPV. CONCLUSIONS: BP phenotypes correspond to distinct clinical phenotypes and can be predicted with acceptable sensitivity and specificity using BP phenotype scores. This novel approach to BP phenotyping provides an accessible addition, not a replacement, to available out-of-office techniques, particularly useful for screening for MH, and to support office diagnosis of SH when out-of-office measures are unavailable or not tolerated.
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Al‐Mohaissen et al. (2025) conducted an observational in Blood pressure phenotypes (n=212). BP phenotype score vs. 24-hour BP monitoring was evaluated on Identification of masked hypertension and sustained hypertension. A novel BP phenotype score identified masked hypertension with 90% sensitivity and 86% specificity among office-normotensives, and sustained hypertension with 82% sensitivity and 78% specificity.
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