AB1281 USAGE OF PROOF-BP TO PREDICT HYPERTENSION IN MEXICAN-MESTIZO RHEUMATIC PATIENTS
Authors: Dionicio Ángel Galarza-Delgado, José Ramón Azpiri-López, Iris Jazmin Colunga-Pedraza, Carolina Marlene Martínez-Flores, Karla Paola Cuéllar-Calderón, Ileana Cecilia Reynosa-Silva, Marielva Castro-González, Raymundo Pineda
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Subjects with rheumatic diseases have an increased risk of cardiovascular morbimortality. Hypertension (HTN) is a key modifiable risk factor for cardiovascular events (1). A recently published and validated prediction model (Predicting Out-of-Office Blood Pressure, PROOF-BP) has been proposed as a tool to improve diagnosis of HTN, and detection of out-of-office HTN in subjects with a previous diagnosis, with a <i>c</i>-statistic (AUC) of 0.86 in non-rheumatic subjects (2). This model has not been explored in rheumatic patients. <h3>Objectives:</h3> To evaluate the diagnostic performance of the PROOF-BP algorithm for the prediction of HTN in subjects with/without rheumatic diseases. <h3>Methods:</h3> A cross-sectional, observational trial was designed. Subjects were recruited at a rheumatology outpatient clinic in northeastern Mexico. Subjects with/without rheumatologic conditions were recruited. Complete clinical history with somatometry of each subject was registered. BP was measured by a physician 3 times to each participant using current recommendations, with an OMRON HEM-7121 BP monitor. Calculations using the PROOF-BP online site were done, and risk categories were assigned to each subject using their predicted out-of-office BP: low (&lt;130/80 mmHg), medium (130/80-145/90 mmHg) and high risk (&gt;145/90 mmHg). Subjects in the medium and high risk strata were then asked to return for further evaluation and additional BP measurement, to define each diagnosis of HTN. We used frequencies (%) and median (q25-q75) for descriptive analysis. Diagnostic accuracy of each category was determined using 2 x 2 tables. <h3>Results:</h3> A total of 217 subjects were included. Baseline characteristics are shown in Table 1. The most frequent rheumatic disease was RA (n=78, 35.9%). Using PROOF-BP, 84 (38.7%) subjects were stratified as medium or high risk. Of these, only 36 (42.8%) returned for evaluation. A final diagnosis of HTN was attained in 14 (38.8%) of those who returned. Diagnostic performances of the low and high risk categories are shown in Table 2. In 21 (67.7%) cases of the medium risk category the diagnosis of HTN was finally discarded, and in the remaining 10 (32.2%) diagnosis of HTN was finally ascertained. The high risk category had a specificity of 95% and a PPV of 80% for the diagnosis of HTN. <h3>Conclusion:</h3> In a cohort of Mexican-mestizo subjects with rheumatic diseases, 38.7% were classified as medium or high-risk for HTN. Only 42.8% of patients that required further evaluation followed medical recommendations. More than 30% of patients in the medium-risk category had a final diagnosis of HTN. Using the PROOF-BP algorithm, none of the patients in the low-risk stratum had a final diagnosis of HTN (sensitivity= 100%); the high-risk category had a high specificity (95%) for the diagnosis of HTN. <h3>References</h3> [1] Lewington S, et al. Lancet. 2002;360:1903–1913. [2] Sheppard JP, et al. Hypertension. 2016;67:941–950. <h3>Disclosure of Interests:</h3> None declared