The potential for overdiagnosis and underdiagnosis because of blood pressure variability: a comparison of the 2017 ACC/AHA, 2018 ESC/ESH and 2019 NICE hypertension guidelines

The potential for overdiagnosis and underdiagnosis because of blood pressure variability: a comparison of the 2017 ACC/AHA, 2018 ESC/ESH and 2019 NICE hypertension guidelines.

Full text not available from this repository.
Item Type: Article
Status: Published
Official URL: https://doi.org/10.1097/HJH.0000000000002614
Journal or Publication Title: Journal of Hypertension
Volume: 39
Number: 2
Page Range: pp. 236-242
Date: 2020
Divisions: Molecular Cardiology
Depositing User: General Admin
Identification Number: 10.1097/HJH.0000000000002614
ISSN: 0263-6352
Date Deposited: 10 Jun 2021 06:06
Abstract:

Objective: To estimate the extent that BP measurement variability may drive over- and underdiagnosis of 'hypertension' when measurements are made according to current guidelines.

Methods: Using data from the National Health and Nutrition Examination Survey and empirical estimates of within-person variability, we simulated annual SBP measurement sets for 1 000 000 patients over 5 years. For each measurement set, we used an average of multiple readings, as recommended by guidelines.

Results: The mean true SBP for the simulated population was 118.8 mmHg with a standard deviation of 17.5 mmHg. The proportion overdiagnosed with 'hypertension' after five sets of office or nonoffice measurements using the 2017 American College of Cardiology guideline was 3-5% for people with a true SBP less than 120 mmHg, and 65-72% for people with a true SBP 120-130 mmHg. These proportions were less than 1% and 14-33% using the 2018 European Society of Hypertension and 2019 National Institute for Health and Care Excellence guidelines (true SBP <120 and 120-130 mmHg, respectively). The proportion underdiagnosed with 'hypertension' was less than 3% for people with true SBP at least 140 mmHg after one set of office or nonoffice measurements using the 2017 American College of Cardiology guideline, and less than 18% using the other two guidelines.

Conclusion: More people are at risk of overdiagnosis under the 2017 American College of Cardiology guideline than the other two guidelines, even if nonoffice measurements are used. Making clinical decisions about cardiovascular prediction based primarily on absolute risk, minimizes the impact of blood pressure variability on overdiagnosis.

Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.

Creators:
Creators
Email
Bell, Katy
UNSPECIFIED
Doust, Jenny
UNSPECIFIED
McGeechan, Kevin
UNSPECIFIED
Horvath, Andrea Rita
UNSPECIFIED
Barratt, Alexandra
UNSPECIFIED
Hayen, Andrew
UNSPECIFIED
Semsarian, Christopher
UNSPECIFIED
Irwig, Les
UNSPECIFIED
Last Modified: 10 Jun 2021 06:06
URI: https://eprints.centenary.org.au/id/eprint/1031

Actions (login required)

View Item View Item