The Diagnostic Accuracy of Using Borderline High Office Blood Pressure Thresholds to Diagnose Masked Hypertension According to the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline

BACKGROUND: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline recommends ambulatory BP monitoring (ABPM) for diagnosing masked hypertension among adults not taking antihypertensive medication with borderline office BP (i.e., office systolic BP [SBP] 120 to < 130 mm Hg or diastolic BP [DBP] 75 to < 80 mm Hg). METHODS: Using data from the Improving the Detection of Hypertension Study, sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios for a positive and negative test of having borderline office BP (i.e., office SBP 120 to < 130 mm Hg or DBP 75 to < 80 mm Hg) for diagnosing masked hypertension (i.e., mean awake SBP ≥ 130 mm Hg or mean awake DBP ≥ 80 mm Hg) were determined among 263 participants who had a mean office SBP < 130 mm Hg and mean DBP < 80 mm Hg. Likelihood ratios for a positive test > 10, 5–10, and < 5 were considered strong, moderate, and weak, respectively. Likelihood ratios for a negative test < 0.1, 0.1–0.2, and > 0.2 were considered strong, moderate, and weak, respectively. RESULTS: Among the 263 participants, mean ± SD age was 39.2 ± 12.8 years, 62.4% were female, 38.4% had borderline office BP, and 26.2% had masked hypertension. SN, SP, PPV, and NPV were 0.754, 0.747, 0.515, and 0.895, respectively. The likelihood ratios for a positive and negative test were 2.984 (weak) and 0.330 (weak), respectively. CONCLUSIONS: The use of borderline office BP thresholds recommended in the 2017 ACC/AHA BP guideline did not sufficiently rule in or rule out masked hypertension.