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Algorithm for diagnosing hypertension using out‐of‐office blood pressure measurements

Authors :
Je Sang Kim
Moo‐Yong Rhee
Chee Hae Kim
Yoo Ri Kim
Ungjeong Do
Ji‐Hyun Kim
Young Kwon Kim
Hyun Jung Lee
Jee Yeon Park
June Namgung
Sung Yun Lee
Deok‐Kyu Cho
Tae‐Young Choi
Seok Yeon Kim
Source :
The Journal of Clinical Hypertension, Vol 23, Iss 11, Pp 1965-1974 (2021)
Publication Year :
2021
Publisher :
Wiley, 2021.

Abstract

Abstract The authors developed and validated a diagnostic algorithm using the optimal upper and lower cut‐off values of office and home BP at which ambulatory BP measurements need to be applied. Patients presenting with high BP (≥140/90 mm Hg) at the outpatient clinic were referred to measure office, home, and ambulatory BP. Office and home BP were divided into hypertension, intermediate (requiring diagnosis using ambulatory BP), and normotension zones. The upper and lower BP cut‐off levels of intermediate zone were determined corresponding to a level of 95% specificity and 95% sensitivity for detecting daytime ambulatory hypertension by using the receiver operator characteristic curve. A diagnostic algorithm using three methods, OBP‐ABP: office BP measurement and subsequent ambulatory BP measurements if office BP is intermediate zone; OBP‐HBP‐ABP: office BP, subsequent home BP measurement if office BP is within intermediate zone and subsequent ambulatory BP measurement if home BP is within intermediate zone; and HBP‐ABP: home BP measurement and subsequent ambulatory BP measurements if home BP is within intermediate zone, were developed and validated. In the development population (n = 256), the developed algorithm yielded better diagnostic accuracies than 75.8% (95%CI 70.1–80.9) for office BP alone and 76.2% (95%CI 70.5–81.3) for home BP alone as follows: 96.5% (95%CI: 93.4–98.4) for OBP‐ABP, 93.4% (95%CI: 89.6–96.1) for OBP‐HBP‐ABP, and 94.9% (95%CI: 91.5–97.3%) for HBP‐ABP. In the validation population (n = 399), the developed algorithm showed similarly improved diagnostic accuracy. The developed algorithm applying ambulatory BP measurement to the intermediate zone of office and home BP improves the diagnostic accuracy for hypertension.

Details

Language :
English
ISSN :
17517176 and 15246175
Volume :
23
Issue :
11
Database :
Directory of Open Access Journals
Journal :
The Journal of Clinical Hypertension
Publication Type :
Academic Journal
Accession number :
edsdoj.29dfb7d1caff4dd2b8caf0e01e4dc718
Document Type :
article
Full Text :
https://doi.org/10.1111/jch.14382