Predicting Out-of-Office Blood Pressure in a diverse US population.
Bellows BK., Xu J., Sheppard JP., Schwartz JE., Shimbo D., Muntner P., McManus RJ., Moran AE., Bryant KB., Cohen LP., Bress AP., King JB., Shikany JM., Green BB., Yano Y., Clark Iii D., Zhang Y.
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 UK 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 four 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 ≥130 mmHg and diastolic BP ≥80 mmHg. 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 curve (95% CI) for hypertensive out-of-office systolic BP was 0.81 (0.79-0.82) and diastolic BP was 0.76 (0.74-0.78) for PROOF-BP. For PROOF-BP-US, the area under the receiver-operator characteristic curve for hypertensive out-of-office systolic BP was 0.82 (0.81-0.83) and for diastolic BP 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 mmHg for PROOF-BP and 125-134/75-84 mmHg for PROOF-BP-US. The 2017 American College of Cardiology/American Heart Association BP guideline (referral range 130-159/80-99 mmHg) would refer 93.1% of adults not taking antihypertensive medications with office BP ≥130/80 mmHg 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.