Key result
Borderline office BP thresholds yielded weak likelihood ratios for a positive and negative test, failing to sufficiently rule in or rule out masked hypertension.
Why the study?
The 2017 ACC/AHA BP guideline recommends ambulatory BP monitoring to diagnose masked hypertension in adults not on antihypertensives with borderline office BP, prompting evaluation of the diagnostic accuracy of these thresholds.
Do borderline office BP thresholds accurately diagnose masked hypertension in adults with office BP <130/80 mm Hg?
Cross-Sectional (n=263)
Do borderline office BP thresholds accurately diagnose masked hypertension in adults with office BP <130/80 mm Hg?
The borderline office BP thresholds recommended by the 2017 ACC/AHA guidelines have weak likelihood ratios and do not sufficiently rule in or rule out masked hypertension.
Answers are grounded in this paper and cite their sources.
Borderline office BP thresholds lack sufficient accuracy to diagnose masked hypertension; hypothesis-generating and should not yet change practice.
BACKGROUND: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline recommends ambulatory BP monitoring (ABPM) for diagnosing masked hypertension among adults not taking antihypertensive medication with borderline office BP (i.e., office systolic BP [SBP] 120 to < 130 mm Hg or diastolic BP [DBP] 75 to < 80 mm Hg). METHODS: Using data from the Improving the Detection of Hypertension Study, sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios for a positive and negative test of having borderline office BP (i.e., office SBP 120 to < 130 mm Hg or DBP 75 to < 80 mm Hg) for diagnosing masked hypertension (i.e., mean awake SBP ≥ 130 mm Hg or mean awake DBP ≥ 80 mm Hg) were determined among 263 participants who had a mean office SBP < 130 mm Hg and mean DBP < 80 mm Hg. Likelihood ratios for a positive test > 10, 5-10, and < 5 were considered strong, moderate, and weak, respectively. Likelihood ratios for a negative test < 0.1, 0.1-0.2, and > 0.2 were considered strong, moderate, and weak, respectively. RESULTS: Among the 263 participants, mean ± SD age was 39.2 ± 12.8 years, 62.4% were female, 38.4% had borderline office BP, and 26.2% had masked hypertension. SN, SP, PPV, and NPV were 0.754, 0.747, 0.515, and 0.895, respectively. The likelihood ratios for a positive and negative test were 2.984 (weak) and 0.330 (weak), respectively. CONCLUSIONS: The use of borderline office BP thresholds recommended in the 2017 ACC/AHA BP guideline did not sufficiently rule in or rule out masked hypertension.
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Walsh et al. (2025) conducted a cross-sectional in Masked hypertension (n=263). Borderline office blood pressure thresholds vs. Non-borderline office blood pressure was evaluated on Diagnosis of masked hypertension (mean awake SBP ≥ 130 mm Hg or mean awake DBP ≥ 80 mm Hg) (LR+ 2.984, LR- 0.330). Borderline office BP thresholds yielded weak likelihood ratios for a positive and negative test, failing to sufficiently rule in or rule out masked hypertension.
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