University of Oxford|June 2018 | Reducing the need for 24-hour blood pressure monitors in general practice
A new prediction tool that uses a simple computer algorithm is able to identify patients with hypertension in 97 per cent of cases. The tool has been developed by researchers at Oxford and Birmingham Universities using data from 2000 patients in order to understand the difference between blood pressure readings taken in clinic and 24-hour blood pressure readings. From these data they developed an algorithm that is able to predict an individual’s blood pressure. The tool may help to halve the number of patients required to wear the 24-hour blood pressure monitors for hypertension to be confirmed.
Ninety-seven per cent of the time the algorithm was able to determine if the patient had normal blood pressure, high blood pressure or needed further investigation.
(Source: University of Oxford).
The predictive tool is available free here
A paper based on this research has now been published in the BMJ
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 and had a sensitivity of 97% and specificity of 76% for hypertension. The AUROC was 0.86. Use of triaging, rather than uniform referral for ABPM in routine practice, would have resulted in 435 patients being referred for ABPM and the remainder managed on the basis of their clinic measurements. Of these, 69 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.
Full reference: 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: observational cohort study |
The paper can be read in full at the BMJ