The Diagnostic Accuracy of Using Borderline High Office Blood Pressure Thresholds to Diagnose Masked Hypertension According to the 2017 American College of Cardiology / American Heart Association Blood Pressure Guideline.

Abstract

Background: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline recommends ambulatory BP monitoring (ABPM) for diagnosing masked hypertension among adults not taking antihypertensive medication with borderline office BP (i.e., office systolic BP [SBP] 120 to <130 mmHg or diastolic BP [DBP] 75 to <80 mmHg).

Methods: Using data from the Improving the Detection of Hypertension Study, sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios for a positive and negative test of having borderline office BP (i.e. office SBP 120 to <130 mmHg or DBP 75 to <80 mmHg) for diagnosing masked hypertension (i.e. mean awake SBP ≥130 mmHg or mean awake DBP ≥80 mmHg) were determined among 263 participants who had a mean office SBP <130 mmHg and mean DBP <80 mmHg. Likelihood ratios for a positive test >10, 5 to 10, and <5 were considered strong, moderate, and weak, respectively. Likelihood ratios for a negative test <0.1, 0.1 to 0.2, and >0.2 were considered strong, moderate, and weak, respectively.

Results: Among the 263 participants, mean±SD age was 39.2±12.8 years, 62.4% were female, 38.4% had borderline office BP, and 26.2% had masked hypertension. SN, SP, PPV, and NPV were 0.754, 0.747, 0.515, and 0.895, respectively. The likelihood ratios for a positive and negative test were 2.984 (weak) and 0.330 (weak), respectively.

Conclusions: The use of borderline office BP thresholds recommended in the 2017 ACC/AHA BP guideline did not sufficiently rule in or rule out masked hypertension.