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Utility of standing office blood pressure in detecting hypertension in healthy adults
Current guidelines recommend office blood pressures (BP) be taken in a seated position when screening for hypertension (HTN). Seated BP is known to have limited accuracy in detecting high BP, while the utility of standing BP in diagnosing HTN is unknown. We conducted a cross-sectional study to deter...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Nature Publishing Group UK
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511521/ https://www.ncbi.nlm.nih.gov/pubmed/37730821 http://dx.doi.org/10.1038/s41598-023-42297-6 |
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author | Giacona, John M. Kositanurit, Weerapat Wang, Jijia Petric, Ursa B. Khan, Ghazi Pittman, Danielle Williamson, Jon W. Smith, Scott A. Vongpatanasin, Wanpen |
author_facet | Giacona, John M. Kositanurit, Weerapat Wang, Jijia Petric, Ursa B. Khan, Ghazi Pittman, Danielle Williamson, Jon W. Smith, Scott A. Vongpatanasin, Wanpen |
author_sort | Giacona, John M. |
collection | PubMed |
description | Current guidelines recommend office blood pressures (BP) be taken in a seated position when screening for hypertension (HTN). Seated BP is known to have limited accuracy in detecting high BP, while the utility of standing BP in diagnosing HTN is unknown. We conducted a cross-sectional study to determine the incremental value of standing BP in diagnosing HTN. Seated, standing, and 24-h ambulatory BPs (ABPM) were obtained in adults without known cardiovascular disease, HTN, or BP medication use. Presence of HTN was defined by the 2017 ACC/AHA and the 2023 ESH HTN guidelines based on ABPM. Area under the receiver-operating-characteristic curve (AUROC) was used to evaluate the diagnostic accuracy of seated and standing BP. Sensitivity and specificity of standing BP was determined using cut-offs derived from Youden’s Index, while sensitivity and specificity of seated BP was determined using the cut-off of 130/80 mmHg and by 140/90 mmHg. Among 125 participants (mean age 49 ± 17 years; 62% female; 24% Black), 33.6% of them had HTN. Sensitivity and specificity of seated systolic BP (SBP) was 43% and 92%, respectively. Cut-offs selected by Youden’s index for standing SBP/diastolic BP (DBP) were 124/81 mmHg according to the 2017 ACC/AHA HTN guidelines, and 123.5/83.5 mmHg according to the 2023 ESH HTN guidelines. Sensitivity and specificity of standing SBP was 71% and 67%, respectively. The AUROC of standing SBP (0.81 [0.71–0.92]) was significantly higher than seated SBP (0.70 [0.49–0.91]), when HTN was defined as average 24-h SBP ≥ 125 mmHg. Moreover, the addition of standing to seated SBP (0.80 [0.68–0.92]) improved HTN detection when compared to seated SBP. These patterns were consistent for both the 2017 ACC/AHA and the 2023 ESH definitions for HTN. In summary, standing BP, alone or in combination with seated BP, outperformed seated BP alone in diagnosing HTN in adults. |
format | Online Article Text |
id | pubmed-10511521 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-105115212023-09-22 Utility of standing office blood pressure in detecting hypertension in healthy adults Giacona, John M. Kositanurit, Weerapat Wang, Jijia Petric, Ursa B. Khan, Ghazi Pittman, Danielle Williamson, Jon W. Smith, Scott A. Vongpatanasin, Wanpen Sci Rep Article Current guidelines recommend office blood pressures (BP) be taken in a seated position when screening for hypertension (HTN). Seated BP is known to have limited accuracy in detecting high BP, while the utility of standing BP in diagnosing HTN is unknown. We conducted a cross-sectional study to determine the incremental value of standing BP in diagnosing HTN. Seated, standing, and 24-h ambulatory BPs (ABPM) were obtained in adults without known cardiovascular disease, HTN, or BP medication use. Presence of HTN was defined by the 2017 ACC/AHA and the 2023 ESH HTN guidelines based on ABPM. Area under the receiver-operating-characteristic curve (AUROC) was used to evaluate the diagnostic accuracy of seated and standing BP. Sensitivity and specificity of standing BP was determined using cut-offs derived from Youden’s Index, while sensitivity and specificity of seated BP was determined using the cut-off of 130/80 mmHg and by 140/90 mmHg. Among 125 participants (mean age 49 ± 17 years; 62% female; 24% Black), 33.6% of them had HTN. Sensitivity and specificity of seated systolic BP (SBP) was 43% and 92%, respectively. Cut-offs selected by Youden’s index for standing SBP/diastolic BP (DBP) were 124/81 mmHg according to the 2017 ACC/AHA HTN guidelines, and 123.5/83.5 mmHg according to the 2023 ESH HTN guidelines. Sensitivity and specificity of standing SBP was 71% and 67%, respectively. The AUROC of standing SBP (0.81 [0.71–0.92]) was significantly higher than seated SBP (0.70 [0.49–0.91]), when HTN was defined as average 24-h SBP ≥ 125 mmHg. Moreover, the addition of standing to seated SBP (0.80 [0.68–0.92]) improved HTN detection when compared to seated SBP. These patterns were consistent for both the 2017 ACC/AHA and the 2023 ESH definitions for HTN. In summary, standing BP, alone or in combination with seated BP, outperformed seated BP alone in diagnosing HTN in adults. Nature Publishing Group UK 2023-09-20 /pmc/articles/PMC10511521/ /pubmed/37730821 http://dx.doi.org/10.1038/s41598-023-42297-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Giacona, John M. Kositanurit, Weerapat Wang, Jijia Petric, Ursa B. Khan, Ghazi Pittman, Danielle Williamson, Jon W. Smith, Scott A. Vongpatanasin, Wanpen Utility of standing office blood pressure in detecting hypertension in healthy adults |
title | Utility of standing office blood pressure in detecting hypertension in healthy adults |
title_full | Utility of standing office blood pressure in detecting hypertension in healthy adults |
title_fullStr | Utility of standing office blood pressure in detecting hypertension in healthy adults |
title_full_unstemmed | Utility of standing office blood pressure in detecting hypertension in healthy adults |
title_short | Utility of standing office blood pressure in detecting hypertension in healthy adults |
title_sort | utility of standing office blood pressure in detecting hypertension in healthy adults |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511521/ https://www.ncbi.nlm.nih.gov/pubmed/37730821 http://dx.doi.org/10.1038/s41598-023-42297-6 |
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