Loading…
Blood pressure cutoffs for white-coat and masked effects in a large population undergoing home blood pressure monitoring
The values used to define the presence of white-coat or masked blood pressure (BP) effects are arbitrary. The aim of this study was to investigate the accuracy of several cutoff points based on the difference between office and home BP (ΔBP) values to detect white-coat uncontrolled (WUCH) and masked...
Saved in:
Published in: | Hypertension research 2019-11, Vol.42 (11), p.1816-1823 |
---|---|
Main Authors: | , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c353t-a73446f7cb040cb9ef31d11773598faf505f7769dfe77dcefeb6e765b0c640613 |
---|---|
cites | cdi_FETCH-LOGICAL-c353t-a73446f7cb040cb9ef31d11773598faf505f7769dfe77dcefeb6e765b0c640613 |
container_end_page | 1823 |
container_issue | 11 |
container_start_page | 1816 |
container_title | Hypertension research |
container_volume | 42 |
creator | Feitosa, Audes D M Mota-Gomes, Marco A Barroso, Weimar S Miranda, Roberto D Barbosa, Eduardo C D Pedrosa, Rodrigo P Oliveira, Paula C Feitosa, Camila L D M Brandão, Andréa A Lima-Filho, José L Sposito, Andrei C Coca, Antonio Nadruz, Wilson |
description | The values used to define the presence of white-coat or masked blood pressure (BP) effects are arbitrary. The aim of this study was to investigate the accuracy of several cutoff points based on the difference between office and home BP (ΔBP) values to detect white-coat uncontrolled (WUCH) and masked uncontrolled (MUCH) hypertension, which are phenotypes with adverse prognoses, in a large cohort of treated hypertensive patients. This multicenter cross-sectional study included 6,049 treated hypertensive patients (40% males, mean age 59.1 ± 14.4 years) who underwent office and home BP monitoring. We compared the sensitivity, specificity, area under curve (AUC), and positive (PPV) and negative (NPV) predictive values of several ΔBP cutoffs to detect WUCH and MUCH. The 15/9 mmHg cutoff, which reflects a 1.0 standard deviation of the ΔBP, showed the best AUC (0.783, 95% CI = 0.772-0.794) for the detection of WUCH, particularly in individuals with office grade 1 hypertension (AUC = 0.811, 95% CI = 0.793-0.829). The -1/-1 mmHg cutoff, which considers all individuals who had lower systolic or diastolic BP levels in the office than at home, had the highest AUC (0.822, 95% CI = 0.808-0.836) for the detection of MUCH. Both cutoff values also had the best performances for identifying all patients with higher and lower office-than-home BP grades. In conclusion, the 15/9 and -1/-1 mmHg cutoffs showed the best performance for the detection of treated hypertensive patients with WUCH and MUCH, respectively, and therefore might be markers of significant white-coat and masked effects and could be useful for identifying preferential targets for more routine home BP measures. |
doi_str_mv | 10.1038/s41440-019-0298-3 |
format | article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2251122836</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2306482805</sourcerecordid><originalsourceid>FETCH-LOGICAL-c353t-a73446f7cb040cb9ef31d11773598faf505f7769dfe77dcefeb6e765b0c640613</originalsourceid><addsrcrecordid>eNpdkU1v1TAQRS0Eoq-FH9ANssSmG5cZ27GTJVT9kiqxgbXlOOPXtEkc7ESUf0-qV5BgNYt77tVIh7FThHMEVX8qGrUGAdgIkE0t1Cu2Q6VroSXq12wHDRrRGGWO2HEpDwCyrhp8y44USqMkwo49fRlS6vicqZQ1Ew_rkmIsPKbMf973C4mQ_ML91PHRl0fqOMVIYSm8n7jng8974nOa18EvfZr4OnWU96mf9vw-jcTbf-fHNPVLylv8jr2Jfij0_uWesO9Xl98ubsTd1-vbi893IqhKLcJbpbWJNrSgIbQNRYUdorWqauroYwVVtNY0XSRru0CRWkPWVC0Eo8GgOmFnh905px8rlcWNfQk0DH6itBYnZYUoZa3Mhn78D31Ia56275xUYHQta6g2Cg9UyKmUTNHNuR99_uUQ3LMWd9DiNi3uWYtTW-fDy_LajtT9bfzxoH4DRnmJnA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2306482805</pqid></control><display><type>article</type><title>Blood pressure cutoffs for white-coat and masked effects in a large population undergoing home blood pressure monitoring</title><source>Nexis UK</source><source>Springer Link</source><creator>Feitosa, Audes D M ; Mota-Gomes, Marco A ; Barroso, Weimar S ; Miranda, Roberto D ; Barbosa, Eduardo C D ; Pedrosa, Rodrigo P ; Oliveira, Paula C ; Feitosa, Camila L D M ; Brandão, Andréa A ; Lima-Filho, José L ; Sposito, Andrei C ; Coca, Antonio ; Nadruz, Wilson</creator><creatorcontrib>Feitosa, Audes D M ; Mota-Gomes, Marco A ; Barroso, Weimar S ; Miranda, Roberto D ; Barbosa, Eduardo C D ; Pedrosa, Rodrigo P ; Oliveira, Paula C ; Feitosa, Camila L D M ; Brandão, Andréa A ; Lima-Filho, José L ; Sposito, Andrei C ; Coca, Antonio ; Nadruz, Wilson</creatorcontrib><description>The values used to define the presence of white-coat or masked blood pressure (BP) effects are arbitrary. The aim of this study was to investigate the accuracy of several cutoff points based on the difference between office and home BP (ΔBP) values to detect white-coat uncontrolled (WUCH) and masked uncontrolled (MUCH) hypertension, which are phenotypes with adverse prognoses, in a large cohort of treated hypertensive patients. This multicenter cross-sectional study included 6,049 treated hypertensive patients (40% males, mean age 59.1 ± 14.4 years) who underwent office and home BP monitoring. We compared the sensitivity, specificity, area under curve (AUC), and positive (PPV) and negative (NPV) predictive values of several ΔBP cutoffs to detect WUCH and MUCH. The 15/9 mmHg cutoff, which reflects a 1.0 standard deviation of the ΔBP, showed the best AUC (0.783, 95% CI = 0.772-0.794) for the detection of WUCH, particularly in individuals with office grade 1 hypertension (AUC = 0.811, 95% CI = 0.793-0.829). The -1/-1 mmHg cutoff, which considers all individuals who had lower systolic or diastolic BP levels in the office than at home, had the highest AUC (0.822, 95% CI = 0.808-0.836) for the detection of MUCH. Both cutoff values also had the best performances for identifying all patients with higher and lower office-than-home BP grades. In conclusion, the 15/9 and -1/-1 mmHg cutoffs showed the best performance for the detection of treated hypertensive patients with WUCH and MUCH, respectively, and therefore might be markers of significant white-coat and masked effects and could be useful for identifying preferential targets for more routine home BP measures.</description><identifier>ISSN: 0916-9636</identifier><identifier>EISSN: 1348-4214</identifier><identifier>DOI: 10.1038/s41440-019-0298-3</identifier><identifier>PMID: 31263210</identifier><language>eng</language><publisher>England: Nature Publishing Group</publisher><subject>Aged ; Blood pressure ; Blood Pressure Monitoring, Ambulatory - standards ; Cross-Sectional Studies ; Fear & phobias ; Female ; Humans ; Hypertension ; Male ; Masked Hypertension - diagnosis ; Middle Aged ; Monitoring systems ; Pressure measurement ; White Coat Hypertension - diagnosis</subject><ispartof>Hypertension research, 2019-11, Vol.42 (11), p.1816-1823</ispartof><rights>Copyright Nature Publishing Group Nov 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-a73446f7cb040cb9ef31d11773598faf505f7769dfe77dcefeb6e765b0c640613</citedby><cites>FETCH-LOGICAL-c353t-a73446f7cb040cb9ef31d11773598faf505f7769dfe77dcefeb6e765b0c640613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31263210$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feitosa, Audes D M</creatorcontrib><creatorcontrib>Mota-Gomes, Marco A</creatorcontrib><creatorcontrib>Barroso, Weimar S</creatorcontrib><creatorcontrib>Miranda, Roberto D</creatorcontrib><creatorcontrib>Barbosa, Eduardo C D</creatorcontrib><creatorcontrib>Pedrosa, Rodrigo P</creatorcontrib><creatorcontrib>Oliveira, Paula C</creatorcontrib><creatorcontrib>Feitosa, Camila L D M</creatorcontrib><creatorcontrib>Brandão, Andréa A</creatorcontrib><creatorcontrib>Lima-Filho, José L</creatorcontrib><creatorcontrib>Sposito, Andrei C</creatorcontrib><creatorcontrib>Coca, Antonio</creatorcontrib><creatorcontrib>Nadruz, Wilson</creatorcontrib><title>Blood pressure cutoffs for white-coat and masked effects in a large population undergoing home blood pressure monitoring</title><title>Hypertension research</title><addtitle>Hypertens Res</addtitle><description>The values used to define the presence of white-coat or masked blood pressure (BP) effects are arbitrary. The aim of this study was to investigate the accuracy of several cutoff points based on the difference between office and home BP (ΔBP) values to detect white-coat uncontrolled (WUCH) and masked uncontrolled (MUCH) hypertension, which are phenotypes with adverse prognoses, in a large cohort of treated hypertensive patients. This multicenter cross-sectional study included 6,049 treated hypertensive patients (40% males, mean age 59.1 ± 14.4 years) who underwent office and home BP monitoring. We compared the sensitivity, specificity, area under curve (AUC), and positive (PPV) and negative (NPV) predictive values of several ΔBP cutoffs to detect WUCH and MUCH. The 15/9 mmHg cutoff, which reflects a 1.0 standard deviation of the ΔBP, showed the best AUC (0.783, 95% CI = 0.772-0.794) for the detection of WUCH, particularly in individuals with office grade 1 hypertension (AUC = 0.811, 95% CI = 0.793-0.829). The -1/-1 mmHg cutoff, which considers all individuals who had lower systolic or diastolic BP levels in the office than at home, had the highest AUC (0.822, 95% CI = 0.808-0.836) for the detection of MUCH. Both cutoff values also had the best performances for identifying all patients with higher and lower office-than-home BP grades. In conclusion, the 15/9 and -1/-1 mmHg cutoffs showed the best performance for the detection of treated hypertensive patients with WUCH and MUCH, respectively, and therefore might be markers of significant white-coat and masked effects and could be useful for identifying preferential targets for more routine home BP measures.</description><subject>Aged</subject><subject>Blood pressure</subject><subject>Blood Pressure Monitoring, Ambulatory - standards</subject><subject>Cross-Sectional Studies</subject><subject>Fear & phobias</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Male</subject><subject>Masked Hypertension - diagnosis</subject><subject>Middle Aged</subject><subject>Monitoring systems</subject><subject>Pressure measurement</subject><subject>White Coat Hypertension - diagnosis</subject><issn>0916-9636</issn><issn>1348-4214</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNpdkU1v1TAQRS0Eoq-FH9ANssSmG5cZ27GTJVT9kiqxgbXlOOPXtEkc7ESUf0-qV5BgNYt77tVIh7FThHMEVX8qGrUGAdgIkE0t1Cu2Q6VroSXq12wHDRrRGGWO2HEpDwCyrhp8y44USqMkwo49fRlS6vicqZQ1Ew_rkmIsPKbMf973C4mQ_ML91PHRl0fqOMVIYSm8n7jng8974nOa18EvfZr4OnWU96mf9vw-jcTbf-fHNPVLylv8jr2Jfij0_uWesO9Xl98ubsTd1-vbi893IqhKLcJbpbWJNrSgIbQNRYUdorWqauroYwVVtNY0XSRru0CRWkPWVC0Eo8GgOmFnh905px8rlcWNfQk0DH6itBYnZYUoZa3Mhn78D31Ia56275xUYHQta6g2Cg9UyKmUTNHNuR99_uUQ3LMWd9DiNi3uWYtTW-fDy_LajtT9bfzxoH4DRnmJnA</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Feitosa, Audes D M</creator><creator>Mota-Gomes, Marco A</creator><creator>Barroso, Weimar S</creator><creator>Miranda, Roberto D</creator><creator>Barbosa, Eduardo C D</creator><creator>Pedrosa, Rodrigo P</creator><creator>Oliveira, Paula C</creator><creator>Feitosa, Camila L D M</creator><creator>Brandão, Andréa A</creator><creator>Lima-Filho, José L</creator><creator>Sposito, Andrei C</creator><creator>Coca, Antonio</creator><creator>Nadruz, Wilson</creator><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20191101</creationdate><title>Blood pressure cutoffs for white-coat and masked effects in a large population undergoing home blood pressure monitoring</title><author>Feitosa, Audes D M ; Mota-Gomes, Marco A ; Barroso, Weimar S ; Miranda, Roberto D ; Barbosa, Eduardo C D ; Pedrosa, Rodrigo P ; Oliveira, Paula C ; Feitosa, Camila L D M ; Brandão, Andréa A ; Lima-Filho, José L ; Sposito, Andrei C ; Coca, Antonio ; Nadruz, Wilson</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-a73446f7cb040cb9ef31d11773598faf505f7769dfe77dcefeb6e765b0c640613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Blood pressure</topic><topic>Blood Pressure Monitoring, Ambulatory - standards</topic><topic>Cross-Sectional Studies</topic><topic>Fear & phobias</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Male</topic><topic>Masked Hypertension - diagnosis</topic><topic>Middle Aged</topic><topic>Monitoring systems</topic><topic>Pressure measurement</topic><topic>White Coat Hypertension - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feitosa, Audes D M</creatorcontrib><creatorcontrib>Mota-Gomes, Marco A</creatorcontrib><creatorcontrib>Barroso, Weimar S</creatorcontrib><creatorcontrib>Miranda, Roberto D</creatorcontrib><creatorcontrib>Barbosa, Eduardo C D</creatorcontrib><creatorcontrib>Pedrosa, Rodrigo P</creatorcontrib><creatorcontrib>Oliveira, Paula C</creatorcontrib><creatorcontrib>Feitosa, Camila L D M</creatorcontrib><creatorcontrib>Brandão, Andréa A</creatorcontrib><creatorcontrib>Lima-Filho, José L</creatorcontrib><creatorcontrib>Sposito, Andrei C</creatorcontrib><creatorcontrib>Coca, Antonio</creatorcontrib><creatorcontrib>Nadruz, Wilson</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Hypertension research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feitosa, Audes D M</au><au>Mota-Gomes, Marco A</au><au>Barroso, Weimar S</au><au>Miranda, Roberto D</au><au>Barbosa, Eduardo C D</au><au>Pedrosa, Rodrigo P</au><au>Oliveira, Paula C</au><au>Feitosa, Camila L D M</au><au>Brandão, Andréa A</au><au>Lima-Filho, José L</au><au>Sposito, Andrei C</au><au>Coca, Antonio</au><au>Nadruz, Wilson</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood pressure cutoffs for white-coat and masked effects in a large population undergoing home blood pressure monitoring</atitle><jtitle>Hypertension research</jtitle><addtitle>Hypertens Res</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>42</volume><issue>11</issue><spage>1816</spage><epage>1823</epage><pages>1816-1823</pages><issn>0916-9636</issn><eissn>1348-4214</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>The values used to define the presence of white-coat or masked blood pressure (BP) effects are arbitrary. The aim of this study was to investigate the accuracy of several cutoff points based on the difference between office and home BP (ΔBP) values to detect white-coat uncontrolled (WUCH) and masked uncontrolled (MUCH) hypertension, which are phenotypes with adverse prognoses, in a large cohort of treated hypertensive patients. This multicenter cross-sectional study included 6,049 treated hypertensive patients (40% males, mean age 59.1 ± 14.4 years) who underwent office and home BP monitoring. We compared the sensitivity, specificity, area under curve (AUC), and positive (PPV) and negative (NPV) predictive values of several ΔBP cutoffs to detect WUCH and MUCH. The 15/9 mmHg cutoff, which reflects a 1.0 standard deviation of the ΔBP, showed the best AUC (0.783, 95% CI = 0.772-0.794) for the detection of WUCH, particularly in individuals with office grade 1 hypertension (AUC = 0.811, 95% CI = 0.793-0.829). The -1/-1 mmHg cutoff, which considers all individuals who had lower systolic or diastolic BP levels in the office than at home, had the highest AUC (0.822, 95% CI = 0.808-0.836) for the detection of MUCH. Both cutoff values also had the best performances for identifying all patients with higher and lower office-than-home BP grades. In conclusion, the 15/9 and -1/-1 mmHg cutoffs showed the best performance for the detection of treated hypertensive patients with WUCH and MUCH, respectively, and therefore might be markers of significant white-coat and masked effects and could be useful for identifying preferential targets for more routine home BP measures.</abstract><cop>England</cop><pub>Nature Publishing Group</pub><pmid>31263210</pmid><doi>10.1038/s41440-019-0298-3</doi><tpages>8</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0916-9636 |
ispartof | Hypertension research, 2019-11, Vol.42 (11), p.1816-1823 |
issn | 0916-9636 1348-4214 |
language | eng |
recordid | cdi_proquest_miscellaneous_2251122836 |
source | Nexis UK; Springer Link |
subjects | Aged Blood pressure Blood Pressure Monitoring, Ambulatory - standards Cross-Sectional Studies Fear & phobias Female Humans Hypertension Male Masked Hypertension - diagnosis Middle Aged Monitoring systems Pressure measurement White Coat Hypertension - diagnosis |
title | Blood pressure cutoffs for white-coat and masked effects in a large population undergoing home blood pressure monitoring |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-22T00%3A24%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Blood%20pressure%20cutoffs%20for%20white-coat%20and%20masked%20effects%20in%20a%20large%20population%20undergoing%20home%20blood%20pressure%20monitoring&rft.jtitle=Hypertension%20research&rft.au=Feitosa,%20Audes%20D%20M&rft.date=2019-11-01&rft.volume=42&rft.issue=11&rft.spage=1816&rft.epage=1823&rft.pages=1816-1823&rft.issn=0916-9636&rft.eissn=1348-4214&rft_id=info:doi/10.1038/s41440-019-0298-3&rft_dat=%3Cproquest_cross%3E2306482805%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c353t-a73446f7cb040cb9ef31d11773598faf505f7769dfe77dcefeb6e765b0c640613%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2306482805&rft_id=info:pmid/31263210&rfr_iscdi=true |