Research Output

Predicting Out-of-Office Blood Pressure in the Clinic (PROOF-BP)Novelty and Significance: Derivation and Validation of a Tool to Improve the Accuracy of Blood Pressure Measurement in Clinical Practice

  Patients often have lower (white coat effect) or higher (masked effect) ambulatory/home blood pressure readings compared with clinic measurements, resulting in misdiagnosis of hypertension. The present study assessed whether blood pressure and patient characteristics from a single clinic visit can accurately predict the difference between ambulatory/home and clinic blood pressure readings (the home–clinic difference). A linear regression model predicting the home–clinic blood pressure difference was derived in 2 data sets measuring automated clinic and ambulatory/home blood pressure (n=991) using candidate predictors identified from a literature review. The model was validated in 4 further data sets (n=1172) using area under the receiver operator characteristic curve analysis. A masked effect was associated with male sex, a positive clinic blood pressure change (difference between consecutive measurements during a single visit), and a diagnosis of hypertension. Increasing age, clinic blood pressure level, and pulse pressure were associated with a white coat effect. The model showed good calibration across data sets (Pearson correlation, 0.48–0.80) and performed well-predicting ambulatory hypertension (area under the receiver operator characteristic curve, 0.75; 95% confidence interval, 0.72–0.79 [systolic]; 0.87; 0.85–0.89 [diastolic]). Used as a triaging tool for ambulatory monitoring, the model improved classification of a patient’s blood pressure status compared with other guideline recommended approaches (93% [92% to 95%] classified correctly; United States, 73% [70% to 75%]; Canada, 74% [71% to 77%]; United Kingdom, 78% [76% to 81%]). This study demonstrates that patient characteristics from a single clinic visit can accurately predict a patient’s ambulatory blood pressure. Usage of this prediction tool for triaging of ambulatory monitoring could result in more accurate diagnosis of hypertension and hence more appropriate treatment.

  • Type:

    Article

  • Date:

    21 March 2016

  • Publication Status:

    Published

  • DOI:

    10.1161/hypertensionaha.115.07108

  • Cross Ref:

    10.1161/HYPERTENSIONAHA.115.07108

  • ISSN:

    0194-911X

  • Library of Congress:

    RT Nursing

  • Dewey Decimal Classification:

    610.73 Nursing

Citation

Sheppard, J. P., Stevens, R., Gill, P., Martin, U., Godwin, M., Hanley, J., …McManus, R. J. (2016). Predicting Out-of-Office Blood Pressure in the Clinic (PROOF-BP)Novelty and Significance: Derivation and Validation of a Tool to Improve the Accuracy of Blood Pressure Measurement in Clinical Practice. Hypertension, 67(5), 941-950. https://doi.org/10.1161/hypertensionaha.115.07108

Authors

Keywords

ambulatory blood pressure monitoring, hypertension, masked hypertension, white coat hypertension,

Monthly Views:

Available Documents