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Evaluation of Criteria to Detect Masked Hypertension
John N Booth1, Paul Muntner1, Keith M Diaz2
1University of Alabama at Birmingham, Birmingham, AL.
Insights
A new clinic blood pressure (CBP) index helps identify adults needing screening for masked hypertension, a condition where blood pressure is high outside the clinic but normal inside. This index aids in targeted ambulatory blood pressure monitoring (ABPM) referrals.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Tools
Background:
- Masked hypertension, defined by out-of-clinic daytime systolic/diastolic blood pressure (SBP/DBP) ≥135/85 mm Hg on ambulatory blood pressure monitoring (ABPM) despite clinic SBP/DBP <140/90 mm Hg, is prevalent.
- Identifying individuals for masked hypertension screening remains a challenge.
Purpose of the Study:
- To derive and validate a clinic blood pressure (CBP) index for identifying adults who should undergo ABPM screening for masked hypertension.
Main Methods:
- A CBP index (clinic SBP + 1.3 * clinic DBP) was derived in a cohort of 695 adults.
- The index was validated in an external cohort (n=675) and applied to National Health and Nutrition Examination Survey data (n=11,778) to estimate screening referrals.
Main Results:
- The derived CBP index demonstrated high sensitivity (98.5% for index ≥190 mm Hg) for identifying masked hypertension in validation cohorts.
- Estimated thresholds for the CBP index could refer millions of US adults for ABPM screening, with varying referral numbers based on sensitivity and prehypertension status.
Conclusions:
- The clinic blood pressure index is a valuable tool for efficiently identifying individuals who may benefit from ambulatory blood pressure monitoring for masked hypertension screening.
- This approach facilitates targeted screening, potentially improving the detection and management of masked hypertension.
Abstract:
The prevalence of masked hypertension (out-of-clinic daytime systolic/diastolic blood pressure (SBP/DBP) ≥135/85 mm Hg on ambulatory blood pressure monitoring [ABPM] among adults with clinic SBP/DBP <140/90 mm Hg) is high. It is unclear who should be screened for masked hypertension. The authors derived a clinic blood pressure (CBP) index to identify populations for masked hypertension screening. Index cut points corresponding to 75% to 99% sensitivity and prehypertension were evaluated as ABPM testing criterion. In a derivation cohort (n=695), the index was clinic SBP+1.3*clinic DBP. In an external validation cohort (n=675), the sensitivity for masked hypertension using an index ≥190 mm Hg and ≥217 mm Hg and prehypertension status was 98.5%, 71.5%, and 82.5%, respectively. Using National Health and Nutrition Examination Survey data (n=11,778), the authors estimated that these thresholds would refer 118.6, 44.4, and 59.3 million US adults, respectively, to ABPM screening for masked hypertension. In conclusion, the CBP index provides a useful approach to identify candidates for masked hypertension screening using ABPM.
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