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Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring

Hypertension Research volume 46, pages 742–750 (2023)Cite this article

A Comment to this article was published on 16 January 2023

Abstract

This study compared the ability of guideline-proposed office blood pressure (OBP) screening thresholds [European Society of Hypertension (ESH) guidelines: 130/85 mmHg for individuals with an OBP < 140/90 mmHg; American College of Cardiology/American Heart Association (ACC/AHA) guidelines: 120/75 mmHg for individuals with an OBP < 130/80 mmHg] and novel screening scores to identify normotensive individuals at high risk of having masked hypertension (MH) in an office setting. We cross-sectionally evaluated untreated participants with an OBP < 140/90 mmHg (n = 22,266) and an OBP < 130/80 mmHg (n = 10,005) who underwent home blood pressure monitoring (HBPM) (derivation cohort) from 686 Brazilian sites. MH was defined according to criteria suggested by the ESH (OBP < 140/90 mmHg; HBPM ≥ 135/85 mmHg), Brazilian Society of Cardiology (BSC) (OBP < 140/90 mmHg; HBPM ≥ 130/80 mmHg) and ACC/AHA (OBP < 130/80 mmHg; HBPM ≥ 130/80 mmHg). Scores were generated from multivariable logistic regression coefficients between MH and clinical variables (OBP, age, sex, and BMI). Considering the ESH, BSC, and ACC/AHA criteria, 17.2%, 38.5%, and 21.2% of the participants had MH, respectively. Guideline-proposed OBP screening thresholds yielded area under curve (AUC) values of 0.640 (for ESH criteria), 0.641 (for BSC criteria), and 0.619 (for ACC/AHA criteria) for predicting MH, while scores presented as continuous variables or quartiles yielded AUC values of 0.700 and 0.688 (for ESH criteria), 0.720 and 0.709 (for BSC criteria), and 0.671 and 0.661 (for ACC/AHA criteria), respectively. Further analyses performed with alternative untreated participants (validation cohort; n = 2807 with an OBP < 140/90 mmHg; n = 1269 with an OBP < 130/80 mmHg) yielded similar AUC values. In conclusion, the accuracy of guideline-proposed OBP screening thresholds in identifying individuals at high risk of having MH in an office setting is limited and is inferior to that yielded by scores derived from simple clinical variables.

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Funding

The study was supported by the Brazilian National Council for Scientific and Technological Development (CNPq; grant 310869/2021-8 to WN and grant 313481/2020-2 to WSB).

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Authors and Affiliations

  1. Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil

    Marco A. M. Alves, Audes D. M. Feitosa, Paulo G. S. Diniz, José L. Lima-Filho & Wilson Nadruz Jr

  2. Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil

    Audes D. M. Feitosa

  3. UNICAP Clinical Research Institute, Recife, PE, Brazil

    Audes D. M. Feitosa

  4. CESMAC University Center/Heart Hospital of Alagoas, Maceió, AL, Brazil

    Marco A. Mota-Gomes & Annelise M. G. Paiva

  5. Hypertension League, Cardiovascular Section, Federal University of Goiás, Goiânia, GO, Brazil

    Weimar S. Barroso

  6. Cardiovascular Section, Geriatrics Division, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil

    Roberto D. Miranda

  7. Hospital Israelita Albert Eistein, São Paulo, SP, Brazil

    Roberto D. Miranda

  8. Department of Hypertension and Cardiometabolism, São Francisco Hospital - Santa Casa de Porto Alegre, Porto Alegre, Brazil

    Eduardo C. D. Barbosa

  9. School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Andréa A. Brandão

  10. Academic Research Organization (ARO), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

    Otavio Berwanger

  11. Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil

    Andrei C. Sposito & Wilson Nadruz Jr

  12. Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Antonio Coca

Authors
  1. Marco A. M. Alves
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  2. Audes D. M. Feitosa
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  5. Weimar S. Barroso
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  6. Roberto D. Miranda
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  7. Eduardo C. D. Barbosa
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  14. Wilson Nadruz Jr
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Correspondence to Wilson Nadruz Jr.

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Conflict of interest

ADMF, MAM-G, WSB, AAB, RDM, and ECDB are the owners of the online TELEMRPA platform (Beliva, Brazil). ADMF, MAM-G and WSB are consultants for Omron.

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Alves, M.A.M., Feitosa, A.D.M., Mota-Gomes, M.A. et al. Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring. Hypertens Res 46, 742–750 (2023). https://doi.org/10.1038/s41440-022-01103-y

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