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Prospective external validation of the Predicting Out-of-Office Blood Pressure (PROOF-BP) strategy for triaging ambulatory monitoring in the diagnosis and management of hypertension : an observational cohort study
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PROOF-BP investigators (Including: Sheppard, James P., Martin, Una, Gill, Paramjit, Stevens, Richard, Hobbs, Richard, Mant, Jonathan, Godwin, Marshall, Hanley, Janet, McKinstry, Brian, Myers, Martin, Nunan, David and McManus, Richard J.). (2018) Prospective external validation of the Predicting Out-of-Office Blood Pressure (PROOF-BP) strategy for triaging ambulatory monitoring in the diagnosis and management of hypertension : an observational cohort study. BMJ, 361 . k2478. doi:10.1136/bmj.k2478 ISSN 0959-535X.
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Official URL: https://doi.org/10.1136/bmj.k2478
Abstract
Objective
To prospectively validate the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm to triage patients with suspected high blood pressure for ambulatory blood pressure monitoring (ABPM) in routine clinical practice.
Design
Prospective observational cohort study.
Setting
10 primary care practices and one hospital in the UK.
Participants
887 consecutive patients aged 18 years or more referred for ABPM in routine clinical practice. All underwent ABPM and had the PROOF-BP applied.
Main outcome measures
The main outcome was the proportion of participants whose hypertensive status was correctly classified using the triaging strategy compared with the reference standard of daytime ABPM. Secondary outcomes were the sensitivity, specificity, and area under the receiver operator characteristic curve (AUROC) for detecting hypertension.
Results
The mean age of participants was 52.8 (16.2) years. The triaging strategy correctly classified hypertensive status in 801 of the 887 participants (90%, 95% confidence interval 88% to 92%) and had a sensitivity of 97% (95% confidence interval 96% to 98%) and specificity of 76% (95% confidence interval 71% to 81%) for hypertension. The AUROC was 0.86 (95% confidence interval 0.84 to 0.89). Use of triaging, rather than uniform referral for ABPM in routine practice, would have resulted in 435 patients (49%, 46% to 52%) being referred for ABPM and the remainder managed on the basis of their clinic measurements. Of these, 69 (8%, 6% to 10%) would have received treatment deemed unnecessary had they received ABPM.
Conclusions
In a population of patients referred for ABPM, this new triaging approach accurately classified hypertensive status for most, with half the utilisation of ABPM compared with usual care. This triaging strategy can therefore be recommended for diagnosis or management of hypertension in patients where ABPM is being considered, particularly in settings with limited resources.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Hypertension -- Diagnosis, Algorithms, Blood pressure -- Measurement | |||||||||
| Journal or Publication Title: | BMJ | |||||||||
| Publisher: | BMJ Publishing Group Ltd. | |||||||||
| ISSN: | 0959-535X | |||||||||
| Official Date: | 27 June 2018 | |||||||||
| Dates: |
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| Volume: | 361 | |||||||||
| Article Number: | k2478 | |||||||||
| DOI: | 10.1136/bmj.k2478 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 9 May 2018 | |||||||||
| Date of first compliant Open Access: | 18 December 2018 | |||||||||
| RIOXX Funder/Project Grant: |
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