Predicting Out-of-Office Blood Pressure in a Diverse US Population

Area of Science:

• Cardiovascular Medicine
• Hypertension Research
• Predictive Analytics in Healthcare

Background:

• The PRedicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm demonstrated accuracy in predicting out-of-office blood pressure (BP) in UK and Canadian populations.
• This study aimed to validate PROOF-BP in a diverse US population and assess a newly developed US-specific algorithm, PROOF-BP-US.

Purpose of the Study:

• To evaluate the accuracy of the PROOF-BP algorithm in predicting out-of-office hypertension among a diverse US adult population.
• To assess the performance of a newly developed US-specific algorithm (PROOF-BP-US) for predicting out-of-office hypertension.
• To compare the predictive capabilities of both algorithms against established hypertension guidelines for referral for out-of-office BP measurement.

Main Methods:

• Utilized data from 4 pooled US studies, including 3,058 adults with at least two office BP readings and ten awake BP readings from 24-hour ambulatory BP monitoring.
• Compared mean awake BP with predicted out-of-office BP using both the original PROOF-BP and the PROOF-BP-US algorithms.
• Defined primary outcomes as hypertensive out-of-office systolic BP (SBP) ≥130 mm Hg and diastolic BP (DBP) ≥80 mm Hg.

Main Results:

• Both PROOF-BP and PROOF-BP-US demonstrated strong predictive accuracy for hypertensive out-of-office SBP (AUROC 0.81 and 0.82, respectively) and DBP (AUROC 0.76 and 0.81, respectively).
• Optimal referral ranges for out-of-office BP measurement were identified as 120-134/75-84 mm Hg for PROOF-BP and 125-134/75-84 mm Hg for PROOF-BP-US.
• Compared to the 2017 ACC/AHA guideline's referral rate of 93.1%, PROOF-BP and PROOF-BP-US referred significantly fewer patients (53.1% and 46.8%, respectively) for out-of-office measurement.

Conclusions:

• The PROOF-BP algorithm and the PROOF-BP-US algorithm are accurate tools for predicting out-of-office hypertension in a diverse US adult population.
• These algorithms offer a more targeted approach to identifying individuals who would benefit from out-of-office blood pressure monitoring compared to current broad guideline-based referrals.
• The findings support the clinical utility of PROOF-BP and PROOF-BP-US in optimizing hypertension management strategies.