Key result
SHINE study protocol aims to identify the optimal in-hospital BP threshold for diagnosing hypertension.
Why the study?
Many hospitalised patients have undiagnosed hypertension, but current guidelines lack defined blood pressure thresholds outside emergency settings to indicate when inpatients need postdischarge assessment.
What is the optimal in-hospital mean blood pressure threshold to identify patients who should receive postdischarge blood pressure assessment for hypertension?
Observational
What is the optimal in-hospital mean blood pressure threshold to identify patients who should receive postdischarge blood pressure assessment for hypertension?
This study protocol aims to identify the optimal in-hospital blood pressure threshold for diagnosing hypertension to guide post-discharge assessment.
In-hospital BP has modest accuracy for postdischarge hypertension; leaves open its utility as a screening trigger pending prospective validation.
INTRODUCTION: A significant percentage of patients admitted to hospital have undiagnosed hypertension. However, present hypertension guidelines in the UK, Europe and USA do not define a blood pressure threshold at which hospital inpatients should be considered at risk of hypertension, outside of the emergency setting. The objective of this study is to identify the optimal in-hospital mean blood pressure threshold, above which patients should receive postdischarge blood pressure assessment in the community. METHODS AND ANALYSIS: Screening for Hypertension in the INpatient Environment is a prospective diagnostic accuracy study. Patients admitted to hospital whose mean average daytime blood pressure after 24 hours or longer meets the study eligibility threshold for mean daytime blood pressure (≥120/70 mm Hg) and who have no prior diagnosis of, or medication for hypertension will be eligible. At 8 weeks postdischarge, recruited participants will wear an ambulatory blood pressure monitor for 24 hours. Mean daytime ambulatory blood pressure will be calculated to assess for the presence or absence of hypertension. Diagnostic performance of in-hospital blood pressure will be assessed by constructing receiver operator characteristic curves from participants' in-hospital mean systolic and mean diastolic blood pressure (index test) versus diagnosis of hypertension determined by mean daytime ambulatory blood pressure (reference test). ETHICS AND DISSEMINATION: Ethical approval has been provided by the National Health Service Health Research Authority South Central-Oxford B Research Ethics Committee (19/SC/0026). Findings will be disseminated through national and international conferences, peer-reviewed journals and social media.
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Armitage et al. (2019) conducted an observational in Undiagnosed hypertension. In-hospital mean blood pressure threshold vs. Ambulatory blood pressure monitoring (reference test) was evaluated on Diagnostic performance of in-hospital blood pressure (ROC curves) versus diagnosis of hypertension determined by mean daytime ambulatory blood pressure. The SHINE study is a protocol for a prospective diagnostic accuracy study to identify the optimal in-hospital blood pressure threshold for diagnosing hypertension; no results are reported.
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