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Analysis of the Accuracy of Unattended Automated Blood Pressure Measurements and Control of Blood Pressure
Shijie Yang1, Zhanyang Zhou2, Huanhuan Miao2
1Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Insights
Unattended automated office blood pressure (u-AOBP) shows potential for hypertension diagnosis in China. While optimal cut-off values were identified, low specificity may impact accuracy in identifying non-hypertensive individuals.
Area of Science:
- Cardiology
- Hypertension Management
- Diagnostic Accuracy
Background:
- Accurate blood pressure measurement is crucial for hypertension diagnosis and management.
- Unattended automated office blood pressure (u-AOBP) is a proposed method for blood pressure assessment.
- Limited evidence exists on u-AOBP's diagnostic utility for hypertension in Chinese clinical practice.
Purpose of the Study:
- To evaluate the diagnostic accuracy of u-AOBP for hypertension in a Chinese population.
- To determine optimal cut-off values for diagnosing elevated blood pressure using u-AOBP.
- To compare u-AOBP measurements with standard office blood pressure and 24-h ambulatory blood pressure monitoring.
Main Methods:
- Prospective study involving participants from three hospitals (October 2023 - February 2024).
- Standardized, validated upper arm monitors used for blood pressure measurement.
- ROC curve analysis employed to determine optimal u-AOBP cut-off values against a gold standard of awake ambulatory blood pressure (135/85 mmHg).
Main Results:
- Optimal u-AOBP cut-off values for elevated blood pressure were determined as 130.75/83.75 mmHg (sensitivity 89.73%, specificity 27.27%).
- No significant difference was found between standard office blood pressure and u-AOBP in participants with a normal 'dipper' blood pressure diurnal rhythm (p > 0.05).
- Low specificity of u-AOBP was observed, potentially affecting the accurate identification of non-hypertensive individuals.
Conclusions:
- Standardized u-AOBP, with optimal cut-offs of 130.75/83.75 mmHg, can be equivalent to standard office blood pressure in individuals with a normal 'dipper' circadian rhythm.
- The low specificity of u-AOBP necessitates caution in its application for diagnosing hypertension, particularly in excluding non-hypertensive cases.
- Further research is needed to validate u-AOBP's role in clinical hypertension management within China.
Abstract:
Accurate blood pressure measurement is fundamental for the diagnosis and management of hypertension. The emergence of u-AOBP has been proposed as a potential alternative or complementary approach for assessing patients' blood pressure status within clinical settings. However, robust evidence is lacking to determine its application in diagnosing hypertension within the clinical practice in China. The study involved participants recruited from October 2023 to February 2024 at three different hospitals. Participants were provided with comprehensive study information, and informed consent was obtained. Standardized, validated upper arm blood pressure monitors were used to measure blood pressure. Baseline demographic data, anthropometric measurements, u-AOBP, and standard office blood pressure data were collected, along with additional examination results, including echocardiograms and 24-h ambulatory blood pressure monitoring. The optimal cutoff values for diagnosing elevated blood pressure using u-AOBP, determined by ROC curve analysis with the awake ambulatory blood pressure threshold of 135/85 mmHg as the gold standard, were 130.75/83.75 mmHg (sensitivity 89.73%, specificity 27.27%). In participants with a dipper blood pressure diurnal rhythm, there was no statistically significant difference between standard office blood pressure and u-AOBP measurements (p > 0.05). In conclusion, unattended automated office blood pressure measurement with the optimal cut-off values for diagnosing elevated blood pressure being 130.75/83.75 mmHg, and in the population with a normal dipper circadian rhythm, the standardized u-AOBP values can be equivalent to standard office blood pressure, but the low specificity of u-AOBP may affect the accuracy of identifying nonhypertensive individuals.
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