Sheppard, James P., Holder, Roger, Nichols, Linda, Bray, Emma, Hobbs, F.D. Richard, Mant, Jonathan, Little, Paul, Williams, Bryan, Greenfield, Sheila and McManus, Richard J. (2014) Predicting out-of-office blood pressure level using repeated measurements in the clinic. Journal of Hypertension, 32 (11). pp. 2171-2178. ISSN 0263-6352
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Official URL: http://dx.doi.org/10.1097/HJH.0000000000000319
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%,
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.
|Uncontrolled Keywords (separate with ;):||home–clinic blood pressure difference; hypertension; masked effect; sensitivity; specificity; white-coat effect|
|Subjects:||B - Subjects allied to medicine > B900 - Others in subjects allied to medicine|
|Schools:||Faculty of Science and Technology > School of Psychology|
|Deposited By:||Emma Bray|
|Deposited On:||22 Feb 2016 13:01|
|Last Modified:||20 Oct 2016 15:25|
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