Key result
A derived clinic blood pressure index (clinic SBP + 1.3*clinic DBP) demonstrated a c-statistic of 0.77 for detecting masked daytime hypertension in an external validation cohort.
Why the study?
Does a clinic blood pressure index accurately identify candidates for masked hypertension screening among adults with clinic BP <140/90 mm Hg?
Cross-Sectional (n=13,148)
Yes
Does a clinic blood pressure index accurately identify candidates for masked hypertension screening among adults with clinic BP <140/90 mm Hg?
Effect estimate: c-statistic 0.77 (95% CI 0.73-0.81)
A novel clinic blood pressure index (SBP + 1.3*DBP) provides a highly sensitive method to identify adults who should undergo ambulatory blood pressure monitoring to detect masked hypertension.
May facilitate targeted ABPM screening; observational data leave open clinical utility and need for prospective trials.
The prevalence of masked hypertension (out-of-clinic daytime systolic/diastolic blood pressure (SBP/DBP) ≥135/85 mm Hg on ambulatory blood pressure monitoring [ABPM] among adults with clinic SBP/DBP <140/90 mm Hg) is high. It is unclear who should be screened for masked hypertension. The authors derived a clinic blood pressure (CBP) index to identify populations for masked hypertension screening. Index cut points corresponding to 75% to 99% sensitivity and prehypertension were evaluated as ABPM testing criterion. In a derivation cohort (n=695), the index was clinic SBP+1.3*clinic DBP. In an external validation cohort (n=675), the sensitivity for masked hypertension using an index ≥190 mm Hg and ≥217 mm Hg and prehypertension status was 98.5%, 71.5%, and 82.5%, respectively. Using National Health and Nutrition Examination Survey data (n=11,778), the authors estimated that these thresholds would refer 118.6, 44.4, and 59.3 million US adults, respectively, to ABPM screening for masked hypertension. In conclusion, the CBP index provides a useful approach to identify candidates for masked hypertension screening using ABPM.
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Booth et al. (2016) conducted a cross-sectional in Masked hypertension (n=13,148). Clinic blood pressure (CBP) diagnostic index vs. Prehypertension status was evaluated on Discrimination of masked daytime hypertension in the validation cohort (c-statistic) (c-statistic 0.77, 95% CI 0.73-0.81). A derived clinic blood pressure index (clinic SBP + 1.3*clinic DBP) demonstrated a c-statistic of 0.77 for detecting masked daytime hypertension in an external validation cohort.
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