Cutoffs for white-coat and masked blood pressure effects: an ambulatory blood pressure monitoring study

IF 2.7 4区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of Human Hypertension Pub Date : 2024-07-10 DOI:10.1038/s41371-024-00930-5

Christian S. Dal Pont, Audes D. M. Feitosa, Rodrigo Bezerra, Arthur H. B. Martins, Gustavo M. Viana, Siegmar Starke, Guilherme S. A. Azevedo, Marco A. Mota-Gomes, Weimar S. Barroso, Roberto D. Miranda, Eduardo C. D. Barbosa, Andréa A. Brandão, Camila L. D. M. Feitosa, Thales A. T. Gonçalves, Fernando Nobre, Decio Mion Jr, Andrei C. Sposito, Wilson Nadruz

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引用次数: 0

Abstract

The values used to define white-coat and masked blood pressure (BP) effects are usually arbitrary. This study aimed at investigating the accuracy of various cutoffs based on the differences (ΔBP) between office BP (OBP) and 24h-ambulatory BP monitoring (ABPM) to identify white-coat (WCH) and masked (MH) hypertension, which are phenotypes coupled with adverse prognosis. This cross-sectional study included 11,350 [Derivation cohort; 45% men, mean age = 55.1 ± 14.1 years, OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg, 24 h-ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg, 25% using antihypertensive medications (AH)] and 7220 (Validation cohort; 46% men, mean age = 58.6 ± 15.1 years, OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg, 24 h-ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg; 32% using AH) unique individuals who underwent 24 h-ABPM. We compared the sensitivity, specificity, positive and negative predictive values and area under the curve (AUC) of diverse ΔBP cutoffs to detect WCH (ΔsystolicBP/ΔdiastolicBP = 28/17, 20/15, 20/10, 16/11, 15/9, 14/9 mmHg and ΔsystolicBP = 13 and 10 mmHg) and MH (ΔsystolicBP/ΔdiastolicBP = −14/−9, −5/−2, −3/−1, −1/−1, 0/0, 2/2 mmHg and ΔsystolicBP = −5 and −3mmHg). The 20/15 mmHg cutoff showed the best AUC (0.804, 95%CI = 0.794-0.814) to detect WCH, while the 2/2 mmHg cutoff showed the highest AUC (0.741, 95%CI = 0.728–0.754) to detect MH in the Derivation cohort. Both cutoffs also had the best accuracy to detect WCH (0.767, 95%CI = 0.754–0.780) and MH (0.767, 95%CI = 0.750–0.784) in the Validation cohort. In secondary analyses, these cutoffs had the best accuracy to detect individuals with higher and lower office-than-ABPM grades in both cohorts. In conclusion, the 20/15 and 2/2 mmHg ΔBP cutoffs had the best accuracy to detect hypertensive patients with WCH and MH, respectively, and can serve as indicators of marked white-coat and masked BP effects derived from 24 h-ABPM.

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白大衣效应和掩盖血压效应的临界值：流动血压监测研究。

用于定义白大衣和掩蔽血压（BP）效应的值通常是任意的。本研究旨在调查基于诊室血压（OBP）和 24 小时非卧床血压监测（ABPM）之间的差异（ΔBP）的各种截断值在识别白大衣高血压（WCH）和掩蔽性高血压（MH）方面的准确性，白大衣高血压和掩蔽性高血压是与不良预后相关的表型。这项横断面研究纳入了 11,350 人[衍生队列；45% 男性，平均年龄 = 55.1 ± 14.1 岁，OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg，24 h-ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg，25% 使用抗高血压药物 (AH)]和 7220 名（验证队列；46% 男性，平均年龄 = 58.6 ± 15.1 岁，OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg，24 h-ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg；32% 使用 AH）接受 24 h-ABPM 的独特个体。我们比较了不同ΔBP 临界值检测 WCH 的灵敏度、特异性、阳性和阴性预测值以及曲线下面积 (AUC)（Δ收缩压/Δ舒张压 = 28/17, 20/15、20/10、16/11、15/9、14/9 mmHg 和 ΔSystolicBP = 13 和 10 mmHg）和 MH（ΔSystolicBP/ΔDiastolicBP = -14/-9、-5/-2、-3/-1、-1/-1、0/0、2/2 mmHg 和 ΔSystolicBP = -5 和 -3mmHg）。在衍生队列中，20/15 mmHg 临界值显示出检测 WCH 的最佳 AUC（0.804，95%CI = 0.794-0.814），而 2/2 mmHg 临界值显示出检测 MH 的最高 AUC（0.741，95%CI = 0.728-0.754）。在验证队列中，这两个临界值检测 WCH（0.767，95%CI = 0.754-0.780）和 MH（0.767，95%CI = 0.750-0.784）的准确性也最好。在二次分析中，这些临界值在检测两个队列中办公室比 ABPM 分级更高和更低的个体方面具有最佳准确性。总之，20/15 和 2/2 mmHg ΔBP 临界值在检测 WCH 和 MH 高血压患者方面分别具有最佳准确性，可作为 24 h-ABPM 产生的明显白大衣和掩蔽血压效应的指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Human Hypertension 医学-外周血管病

CiteScore

5.20

自引率

3.70%

发文量

126

审稿时长

6-12 weeks

期刊介绍： Journal of Human Hypertension is published monthly and is of interest to health care professionals who deal with hypertension (specialists, internists, primary care physicians) and public health workers. We believe that our patients benefit from robust scientific data that are based on well conducted clinical trials. We also believe that basic sciences are the foundations on which we build our knowledge of clinical conditions and their management. Towards this end, although we are primarily a clinical based journal, we also welcome suitable basic sciences studies that promote our understanding of human hypertension. The journal aims to perform the dual role of increasing knowledge in the field of high blood pressure as well as improving the standard of care of patients. The editors will consider for publication all suitable papers dealing directly or indirectly with clinical aspects of hypertension, including but not limited to epidemiology, pathophysiology, therapeutics and basic sciences involving human subjects or tissues. We also consider papers from all specialties such as ophthalmology, cardiology, nephrology, obstetrics and stroke medicine that deal with the various aspects of hypertension and its complications.