Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study
| Autor: | Bryan Williams, Richard J McManus, Linda Nichols, Emma P Bray, Jonathan Mant, Sheila Greenfield, James P Sheppard, Roger Holder, FD Richard Hobbs, Paul Little |
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| Přispěvatelé: | Mant, Jonathan [0000-0002-9531-0268], Apollo - University of Cambridge Repository |
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty hypertension Physiology specificity White coat hypertension home–clinic blood pressure difference Blood Pressure Logistic regression Ambulatory Care Facilities Sensitivity and Specificity Cohort Studies Internal medicine Positive predicative value Masked Hypertension Internal Medicine Medicine Humans white-coat effect Aged business.industry Middle Aged Blood Pressure Monitoring Ambulatory medicine.disease sensitivity Blood pressure Logistic Models ORIGINAL PAPERS: Blood pressure measurement masked effect Ambulatory Observational study Female Cardiology and Cardiovascular Medicine business White Coat Hypertension Cohort study |
| Zdroj: | Journal of Hypertension |
| ISSN: | 1473-5598 0263-6352 |
| Popis: | © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Objectives: Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. Methods: This study used an observational cohort design and included 220 individuals aged 35-84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. Results: The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. Conclusion: Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice. |
| Databáze: | OpenAIRE |
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