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Original article
DOI: 10.1016/j.rccl.2021.07.003
Available online 3 August 2021
A simple score to screen for isolated ambulatory hypertension in older adults. Development and validation
Una escala sencilla para identificar la hipertensión ambulatoria aislada en adultos mayores. Desarrollo y validación
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Ana Hernández-Aceitunoa,b,c, Mercedes Sánchez-Martíneza,b,d, Esther López-Garcíaa,b,e, Pilar Guallar-Castillóna,e, Juan J. Cruza, Rosario Ortoláa, Auxiliadora Graciania,b, Esther García-Esquinasa,e, Juan García-Puiga,f, Fernando Rodríguez-Artalejoa,b,e, José R. Banegasa,b,d,
Corresponding author
joseramon.banegas@uam.es

Corresponding author.
a Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
b Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
c Departmento de Medicina Preventiva, Complejo Hospitalario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
d Facultad de Ciencias y Artes, Departamento de Ciencias de la Salud, Universidad Católica «Santa Teresa de Jesús», Ávila, Spain
e IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
f Division de Medicina Interna, Hospital Universitario Quirón, Madrid, Spain
Received 26 June 2021. Accepted 08 July 2021
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Table 1. Characteristics of the participants, according to cohort and blood pressure status.
Table 2. Factors associated with isolated ambulatory hypertension based on multiple logistic regression modeling, in normotensive adults aged 65 and over.
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Abstract
Introduction and objectives

Masked or isolated ambulatory hypertension (IAH), a poor-prognosis condition, can be diagnosed with ambulatory blood pressure monitoring (ABPM), but ABPM is not available in many clinical practices. We developed and validated a score to screen for IAH among older adults, where limited information is available.

Methods

A total of 645 community-dwelling adults65 years from the Seniors-ENRICA-2 cohort (derivation sample) and 327 from the Seniors-ENRICA-1 cohort (external-validation sample), with untreated casual BP<140/90mmHg (mean of the last 2 of 3 BP) were examined. Probabilities of having IAH (mean 24-h ambulatory BP130/80mmHg) were calculated with a multivariable model (with sex, age, and clinical variables). Beta coefficients were used to allocate points to each variable in an IAH score (range, 0–12).

Results

Participants’ mean age was 70.8 years (46.7% men); 19.7% had IAH. Allocated score-points were: male sex (1 point), age80 (2 points), body-mass index (2 points if 25–29; 3 if ≥30kg/m2), the first BP measurement (2 points if ≥140/90mmHg), and the mean of the second and third BP (2 points if 120–129/80–84; 4 if 130–139/85–89). Probabilities of having IAH for scores of 6, 7, 8, 9, or ≥10 points were 25%, 35%, 47%, 59%, and 72%, respectively. Area-under-the-ROC curve was 0.80 for the derivation and 0.73 for the validation-sample. Two subjects at high risk of IAH (>8 points) and 3 at middle risk (≥6) needed to undergo ABPM to detect 1 IAH case.

Conclusions

A simple score with 4 routine variables performed well identifying IAH in older adults. For high scores, using ABPM for diagnosing IAH was very size-efficient.

Keywords:
Hypertension
Ambulatory blood pressure monitoring
Masked hypertension
Prediction
Elderly
Abbreviations:
MH
IAH
BP
ABPM
NND
Resumen
Introducción y objetivos

La hipertensión enmascarada o ambulatoria aislada (HAA) se puede diagnosticar con monitorización ambulatoria de presión arterial (MAPA), pero no está disponible en muchas clínicas. Desarrollamos una puntuación sencilla para detectar HAA en adultos mayores donde la información es limitada.

Métodos

Se examinó a 645 adultos65 años de la cohorte poblacional Seniors-ENRICA-2 (muestra de derivación) y 365 de la cohorte Seniors-ENRICA-1 (validación externa), con presión arterial (PA) casual no tratada<140/90mmHg (media de las últimas 2 de 3 mediciones). Se calcularon las probabilidades de tener HAA (PA media de 24h130/80) con un modelo multivariable, cuyos coeficientes beta se usaron para asignar puntos a cada variable en una escala de puntuación (rango, 0-12).

Resultados

Muestra con edad media de 70,8 años (46,7% varones); 19,7% tenían HAA. Los puntos asignados fueron: varón (1 punto), edad80 (2 puntos), índice de masa corporal (2 puntos si 25-29; 3 si30kg/m2), primera medición de PA (2 puntos si140/90mmHg), media de segunda y tercera PA (2 puntos si 120-129/80-84; 4 si 130-139/85-89). Las probabilidades de tener HAA para puntuaciones de 6, 7, 8, 9 o ≥10 puntos fueron 25, 35, 47, 59 y 72%, respectivamente. El área bajo la curva ROC fue 0,80 para la muestra de derivación y 0,73 para la de validación. Para detectar un aso de HAA se necesitaría examinar con MAPA a 2 personas con alto riesgo (>8 puntos).

Conclusiones

Una puntuación simple con 4 variables rutinarias tuvo buen rendimiento para identificar HAA en adultos mayores. Para puntuaciones altas, usar MAPA para diagnosticar HAA resultó muy eficiente clínicamente.

Palabras clave:
Hipertensión
Monitorización ambulatoria de la presión arterial
Hipertensión enmascarada
Predicción
Personas mayores

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