Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring.

Autor: Alves MAM; Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil., Feitosa ADM; Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.; Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.; UNICAP Clinical Research Institute, Recife, PE, Brazil., Mota-Gomes MA; CESMAC University Center/Heart Hospital of Alagoas, Maceió, AL, Brazil., Paiva AMG; CESMAC University Center/Heart Hospital of Alagoas, Maceió, AL, Brazil., Barroso WS; Hypertension League, Cardiovascular Section, Federal University of Goiás, Goiânia, GO, Brazil., Miranda RD; Cardiovascular Section, Geriatrics Division, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.; Hospital Israelita Albert Eistein, São Paulo, SP, Brazil., Barbosa ECD; Department of Hypertension and Cardiometabolism, São Francisco Hospital - Santa Casa de Porto Alegre, Porto Alegre, Brazil., Brandão AA; School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Diniz PGS; Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil., Berwanger O; Academic Research Organization (ARO), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Lima-Filho JL; Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil., Sposito AC; Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil., Coca A; Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain., Nadruz W Jr; Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil. wilnj@fcm.unicamp.br.; Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil. wilnj@fcm.unicamp.br.
Jazyk: angličtina
Zdroj: Hypertension research : official journal of the Japanese Society of Hypertension [Hypertens Res] 2023 Mar; Vol. 46 (3), pp. 742-750. Date of Electronic Publication: 2022 Nov 15.
DOI: 10.1038/s41440-022-01103-y
Abstrakt: This study compared the ability of guideline-proposed office blood pressure (OBP) screening thresholds [European Society of Hypertension (ESH) guidelines: 130/85 mmHg for individuals with an OBP < 140/90 mmHg; American College of Cardiology/American Heart Association (ACC/AHA) guidelines: 120/75 mmHg for individuals with an OBP < 130/80 mmHg] and novel screening scores to identify normotensive individuals at high risk of having masked hypertension (MH) in an office setting. We cross-sectionally evaluated untreated participants with an OBP < 140/90 mmHg (n = 22,266) and an OBP < 130/80 mmHg (n = 10,005) who underwent home blood pressure monitoring (HBPM) (derivation cohort) from 686 Brazilian sites. MH was defined according to criteria suggested by the ESH (OBP < 140/90 mmHg; HBPM ≥ 135/85 mmHg), Brazilian Society of Cardiology (BSC) (OBP < 140/90 mmHg; HBPM ≥ 130/80 mmHg) and ACC/AHA (OBP < 130/80 mmHg; HBPM ≥ 130/80 mmHg). Scores were generated from multivariable logistic regression coefficients between MH and clinical variables (OBP, age, sex, and BMI). Considering the ESH, BSC, and ACC/AHA criteria, 17.2%, 38.5%, and 21.2% of the participants had MH, respectively. Guideline-proposed OBP screening thresholds yielded area under curve (AUC) values of 0.640 (for ESH criteria), 0.641 (for BSC criteria), and 0.619 (for ACC/AHA criteria) for predicting MH, while scores presented as continuous variables or quartiles yielded AUC values of 0.700 and 0.688 (for ESH criteria), 0.720 and 0.709 (for BSC criteria), and 0.671 and 0.661 (for ACC/AHA criteria), respectively. Further analyses performed with alternative untreated participants (validation cohort; n = 2807 with an OBP < 140/90 mmHg; n = 1269 with an OBP < 130/80 mmHg) yielded similar AUC values. In conclusion, the accuracy of guideline-proposed OBP screening thresholds in identifying individuals at high risk of having MH in an office setting is limited and is inferior to that yielded by scores derived from simple clinical variables.
(© 2022. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)
Databáze: MEDLINE
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