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Office blood pressure threshold of 130/80 mmHg better predicts uncontrolled out-of-office blood pressure in apparent treatment-resistant hypertension

Authors
 Chan Joo Lee  ;  Jeong-Ha Ha  ;  Jang Young Kim  ;  In-Cheol Kim  ;  Sung Kee Ryu  ;  Moo-Yong Rhee  ;  Ju-Hee Lee  ;  Jung-Hee Lee  ;  Hae-Young Lee  ;  Sang-Hyun Ihm  ;  Joong Wha Chung  ;  Jung Hyun Choi  ;  Jinho Shin  ;  Sungha Park  ;  Kazuomi Kario 
Citation
 JOURNAL OF CLINICAL HYPERTENSION, Vol.23(3) : 595-605, 2021-03 
Journal Title
JOURNAL OF CLINICAL HYPERTENSION
ISSN
 1524-6175 
Issue Date
2021-03
MeSH
Antihypertensive Agents / pharmacology ; Antihypertensive Agents / therapeutic use ; Blood Pressure ; Blood Pressure Determination ; Blood Pressure Monitoring, Ambulatory ; Humans ; Hypertension* / diagnosis ; Hypertension* / drug therapy ; Hypertension* / epidemiology ; Republic of Korea / epidemiology
Keywords
office blood pressure ; out-of-office blood pressure ; resistant hypertension
Abstract
The objective of this study was to compare the diagnostic accuracy of office blood pressure (BP) threshold of 140/90 and 130/80 mmHg for correctly identifying uncontrolled out-of-office BP in apparent treatment-resistant hypertension (aTRH). We analyzed 468 subjects from a prospectively enrolled cohort of patients with resistant hypertension in South Korea (clinicaltrials.gov: NCT03540992). Resistant hypertension was defined as office BP ≥ 130/80 mmHg with three different classes of antihypertensive medications including thiazide-type/like diuretics, or treated hypertension with four or more different classes of antihypertensive medications. We conducted different types of BP measurements including office BP, automated office BP (AOBP), home BP, and ambulatory BP. We defined uncontrolled out-of-office BP as daytime BP ≥ 135/85 mmHg and/or home BP ≥ 135/85 mmHg. Among subjects with office BP < 140/90 mmHg and subjects with office BP < 130/80 mmHg, 66% and 55% had uncontrolled out-of-office BP, respectively. The prevalence of controlled and masked uncontrolled hypertension was lower, and the prevalence of white-coat and sustained uncontrolled hypertension was higher, with a threshold of 130/80 mmHg than of 140/90 mmHg, for both office BP and AOBP. The office BP threshold of 130/80 mmHg was better able to diagnose uncontrolled out-of-office BP than 140/90 mmHg, and the net reclassification improvement (NRI) was 0.255. The AOBP threshold of 130/80 mmHg also revealed better diagnostic accuracy than 140/90 mmHg, with NRI of 0.543. The office BP threshold of 130/80 mmHg showed better than 140/90 mmHg in terms of the correspondence to out-of-office BP in subjects with aTRH.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/jch.14113
DOI
10.1111/jch.14113
Appears in Collections:
6. Others (기타) > Dept. of Health Promotion (건강의학과) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Lee, Chan Joo(이찬주) ORCID logo https://orcid.org/0000-0002-8756-409X
Ha, Jeong-Ha(하정하)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184385
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