THE DIAGNOSTIC THRESHOLD OF 2017 ACC/AHA HYPERTENSION GUIDELINES INCREASES WHITE-COAT HYPERTENSION

Abstract

Objective: We compared the diagnostic office blood pressure (OBP) threshold of 2017 American College of Cardiology and the American Heart Association hypertension (ACC/AHA) guidelines (> = 130/80 mmHg) to that of European Society of Hypertension (ESH) guidelines (> = 140/90 mmHg) using ABP based diagnosis of each guidelines as a reference. Design and method: Among individuals (n = 319) who had high blood pressure (BP, > = 140/90 mmHg) measured by physicians at the outpatient clinic and did not take antihypertensive drugs, 263 patients (mean age, 51.6 ± 9.6 years; 125 men) with valid 24-hour ABP measurements were analyzed. Research grade OBP was measured three times for each occasion during three-days visit with attendance of study nurses using a validated oscillometric device (WatchBP Home, Microlife, Taiwan) after 5 minutes of seated rest and at 1-minute intervals. Results: The prevalence of hypertension by OBP was increased to 93.9 % (n = 247) based on 130/80 mmHg from 65.4 % (n = 172) based on 140/90 mmHg. The mean difference of systolic and diastolic BP between OBP and daytime ABP were 3.9 ± 11.0 mmHg and −0.4 ± 8.6 mmHg, respectively. When diagnosis of hypertension was based on daytime ABP diagnostic threshold of each guidelines, the sensitivity, specificity, positive and negative predictive value of ESH guidelines were 78.4, 71.0, 88.4 and 53.8 %. Those of ACC/AHA guidelines were 98.2, 28.6, 87.8, and 75.0 %. The diagnostic agreement (kappa) of ESH and ACC/AHA guidelines between OBP and daytime ABP were 0.448 and 0.357, respectively. The prevalence of white-coat hypertension based on daytime ABP in normotensive individuals was 29.0% (20/69) by ESH guidelines and 71.4% (30/42) by AHA guidelines (p = 0.001). Among 86 individuals with systolic OBP 130 – 139 mmHg, 37 (43.0 %) had white-coat hypertension. Among 86 individuals with diastolic OBP 80 – 89 mmHg, 18 (20.9%) had white-coat hypertension. Conclusions: The diagnostic threshold of OBP and ABP by new ACC/AHA guidelines shows poor diagnostic agreement and increases the frequency of white-coat hypertension, which may lead to over-treatment of hypertension.