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Screening for hypertension: an elevated office blood pressure measurement is valuable, adding an automated one is
André Michaud1, Maxime Lamarre-Cliche2, Lyne Cloutier1
1Department of Nusing, Université du Québec à Trois-Rivières, Trois-Rivières.
Insights
Hypertension screening in walk-in clinics can be improved. An elevated office blood pressure (OBP) followed by automated office blood pressure (AOBP) helps identify patients needing further ambulatory blood pressure measurement (ABPM) referral.
Area of Science:
- Cardiology
- Public Health
- Clinical Medicine
Background:
- Hypertension (HTN) screening is crucial in walk-in clinics.
- No established algorithm exists for integrating HTN screening in these settings.
- This study addresses the need for an effective HTN screening strategy in walk-in clinics.
Purpose of the Study:
- To assess a hypertension screening strategy in walk-in clinics.
- To evaluate the utility of automated office blood pressure (AOBP) after an initial high office blood pressure (OBP) measurement.
- To determine the effectiveness of AOBP in guiding referrals for 24-hour ambulatory blood pressure measurement (ABPM).
Main Methods:
- Adults with nonemergent conditions and initial OBP between 140/90 mmHg and 180/110 mmHg were included.
- Automated office blood pressure (AOBP) was performed unattended.
- 24-hour ambulatory blood pressure measurement (ABPM) served as the diagnostic standard.
Main Results:
- The study included 50 participants.
- Overall HTN prevalence confirmed by ABPM was 46%.
- AOBP after elevated OBP had a positive predictive value of 62.5% and a negative predictive value of 83.3% for confirming HTN.
Conclusions:
- Elevated OBP in walk-in clinics is a valuable initial screening tool for hypertension.
- Incorporating AOBP refines the diagnostic process and guides management decisions.
- This strategy improves the targeting of patients requiring ABPM referral, optimizing resource allocation.
Background:
Previous studies have examined the relevance of hypertension (HTN) screening in walk-in clinics. So far, no valid algorithm has been proposed on how to integrate HTN screening in this context. The aim of our study was to assess, in a walk-in clinic setting, the HTN screening strategy for performing an automated office blood pressure (AOBP) measurement following an initially high office blood pressure (OBP) measurement.
Patients And Methods:
Included participants were adults with nonemergent medical conditions and an initial walk-in clinic OBP between systolic 140 and/or diastolic 90 mmHg and systolic 180 and/or diastolic 110 mmHg. AOBP was performed with patients unattended. The 24-h ambulatory blood pressure measurement (ABPM) was used as the diagnostic threshold.
Results:
Fifty participants were included in the study. The overall HTN prevalence as confirmed by the 24-h ABPM was 46% [95% confidence interval (CI): 32.19-59.81]. After an elevated OBP, AOBP over diagnostic thresholds occurred in 32 patients and were confirmed by ABPM in 20 participants, leading to a 62.5% positive predictive value (95% CI: 51.5-72.3%). Measurements under the AOBP diagnostic threshold occurred in 18 patients and were confirmed by ABPM in 15 participants, leading to a negative predictive value of 83.3% (95% CI: 62.3-93.8%).
Conclusion:
In a walk-in clinic, an elevated OBP is a useful screening tool due its ability to recognize nearly one in two patients as actually hypertensive. Adding an AOBP makes it possible to specify what course of action to take. This ultimately results in better targeting of patients for an ABPM referral.
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