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

Author:

Bellows Brandon K1ORCID,Xu Jingyu1,Sheppard James P2,Schwartz Joseph E13,Shimbo Daichi1ORCID,Muntner Paul4,McManus Richard J2,Moran Andrew E1,Bryant Kelsey B1,Cohen Laura P1,Bress Adam P5,King Jordan B5,Shikany James M4,Green Beverly B6,Yano Yuichiro7,Clark Donald8,Zhang Yiyi1

Affiliation:

1. Department of Medicine, Columbia University Irving Medical Center , New York, New York , USA

2. Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford , UK

3. Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook , New York , USA

4. Department of Epidemiology, University of Alabama at Birmingham, Birmingham , Alabama , USA

5. Department of Population Health Sciences, University of Utah, Salt Lake City , Utah , USA

6. Kaiser Permanente Washington Health Research Institute, Kaiser Permanente , Seattle, Washington , USA

7. Department of Family Medicine and Community Health, Duke University, Durham , North Carolina , USA

8. Department of Medicine, University of Mississippi Medical Center, Jackson , Mississippi , USA

Abstract

Abstract BACKGROUND The PRedicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm accurately predicted out-of-office blood pressure (BP) among adults with suspected high BP in the United Kingdom and Canada. We tested the accuracy of PROOF-BP in a diverse US population and evaluated a newly developed US-specific algorithm (PROOF-BP-US). METHODS Adults with ≥2 office BP readings and ≥10 awake BP readings on 24-hour ambulatory BP monitoring from 4 pooled US studies were included. We compared mean awake BP with predicted out-of-office BP using PROOF-BP and PROOF-BP-US. Our primary outcomes were hypertensive out-of-office systolic BP (SBP) ≥130 mm Hg and diastolic BP (DBP) ≥80 mm Hg. RESULTS We included 3,058 adults, mean (SD) age was 52.0 (11.9) years, 38% were male, and 54% were Black. The area under the receiver-operator characteristic (AUROC) curve (95% confidence interval) for hypertensive out-of-office SBP was 0.81 (0.79–0.82) and DBP was 0.76 (0.74–0.78) for PROOF-BP. For PROOF-BP-US, the AUROC curve for hypertensive out-of-office SBP was 0.82 (0.81–0.83) and for DBP was 0.81 (0.79–0.83). The optimal predicted out-of-office BP ranges for out-of-office BP measurement referral were 120–134/75–84 mm Hg for PROOF-BP and 125–134/75–84 mm Hg for PROOF-BP-US. The 2017 American College of Cardiology/American Heart Association BP guideline (referral range 130–159/80–99 mm Hg) would refer 93.1% of adults not taking antihypertensive medications with office BP ≥130/80 mm Hg in the National Health and Nutrition Examination Survey for out-of-office BP measurement, compared with 53.1% using PROOF-BP and 46.8% using PROOF-BP-US. CONCLUSIONS PROOF-BP and PROOF-BP-US accurately predicted out-of-office hypertension in a diverse sample of US adults.

Funder

National Heart, Lung, and Blood Institute

Wellcome Trust/Royal Society

Sir Henry Dale Fellowship

National Institute for Health Research

School for Primary Care Research

NIHR Oxford Biomedical Research Centre at Oxford Health National Health System Foundation Trust

NIHR Thames Valley Applied Research Collaboration

NIHR School for Primary Care Research

Health Resources and Services Administration

American Heart Association

National Institute of General Medical Sciences

National Center for Advancing Translational Sciences

University of Alabama at Birmingham

Northwestern University

University of Minnesota

Kaiser Foundation Research Institute

Jackson Heart Study

Jackson State University

Tougaloo College

Mississippi State Department of Health

University of Mississippi Medical Center

National Institute on Minority Health and Health Disparities

Wellcome Trust

Publisher

Oxford University Press (OUP)

Subject

Internal Medicine

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