Predicting Out-of-Office Blood Pressure in the Clinic (PROOF-BP)Novelty and Significance: Derivation and Validation of a Tool to Improve the Accuracy of Blood Pressure Measurement in Clinical Practice

Sheppard, James P.; Stevens, Richard; Gill, Paramjit; Martin, Una; Godwin, Marshall; Hanley, Janet; Heneghan, Carl; Hobbs, F.D. Richard; Mant, Jonathan; McKinstry, Brian; Myers, Martin; Nunan, David; Ward, Alison; Williams, Bryan; McManus, Richard J.

Abstract

Patients often have lower (white coat effect) or higher (masked effect) ambulatory/home blood pressure readings compared with clinic measurements, resulting in misdiagnosis of hypertension. The present study assessed whether blood pressure and patient characteristics from a single clinic visit can accurately predict the difference between ambulatory/home and clinic blood pressure readings (the home–clinic difference). A linear regression model predicting the home–clinic blood pressure difference was derived in 2 data sets measuring automated clinic and ambulatory/home blood pressure (n=991) using candidate predictors identified from a literature review. The model was validated in 4 further data sets (n=1172) using area under the receiver operator characteristic curve analysis. A masked effect was associated with male sex, a positive clinic blood pressure change (difference between consecutive measurements during a single visit), and a diagnosis of hypertension. Increasing age, clinic blood pressure level, and pulse pressure were associated with a white coat effect. The model showed good calibration across data sets (Pearson correlation, 0.48–0.80) and performed well-predicting ambulatory hypertension (area under the receiver operator characteristic curve, 0.75; 95% confidence interval, 0.72–0.79 [systolic]; 0.87; 0.85–0.89 [diastolic]). Used as a triaging tool for ambulatory monitoring, the model improved classification of a patient’s blood pressure status compared with other guideline recommended approaches (93% [92% to 95%] classified correctly; United States, 73% [70% to 75%]; Canada, 74% [71% to 77%]; United Kingdom, 78% [76% to 81%]). This study demonstrates that patient characteristics from a single clinic visit can accurately predict a patient’s ambulatory blood pressure. Usage of this prediction tool for triaging of ambulatory monitoring could result in more accurate diagnosis of hypertension and hence more appropriate treatment.

• Journal Article Type: Article
• Acceptance Date: Feb 3, 2016
• Online Publication Date: Mar 21, 2016
• Publication Date: 2016-05
• Deposit Date: Aug 3, 2016
• Publicly Available Date: Nov 22, 2019
• Journal: Hypertension
• Print ISSN: 0194-911X
• Electronic ISSN: 1524-4563
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 67
• Issue: 5
• Pages: 941-950
• DOI: https://doi.org/10.1161/hypertensionaha.115.07108
• Keywords: ambulatory blood pressure monitoring, hypertension, masked hypertension, white coat hypertension,
• Public URL: http://researchrepository.napier.ac.uk/Output/322982
• Additional Information: Correction; In the article by Sheppard et al (Sheppard JP, Stevens R, Gill P, Martin U, Godwin M, Hanley J, Heneghan C, Hobbs FDR, Mant J, McKinstry B, Myers M, Nunan D, Ward A, Williams B, McManus RJ. Predicting out-of-office blood pressure in the clinic [PROOF-BP]: derivation and validation of a tool to improve the accuracy of blood pressure measurement in clinical practice. Hypertension. 2016;67:941–950, doi: 10.1161/HYPERTENSIONAHA.115.07108), which published online ahead of print March 21, 2016, and appeared in the May 2016 issue of the journal, corrections were needed.; ; On p 945, Table 3, the Diastolic Prediction Model values for age were incorrect. The β-coefficient −0.33 has been changed to −0.08, the 95% confidence interval range −0.62 to −0.05 has been changed to −0.16 to 0.01, and the P value 0.022 has been changed to 0.060.; ; In Figure S6 in the online-only Data Supplement, coefficients were rounded to two decimal places. However, such rounding does in fact alter the estimate of home clinic blood pressure difference arising from this equation, and Figure S6 has been revised with coefficients given to 7 decimal places.; ; The authors apologize for these errors.; ; These corrections have been made to the current online version of the article, which is available at http://hyper.ahajournals.org/content/67/5/941.full.