Ab1281 usage of Proof-Bp to Predict Hypertension in Mexican-Mestizo Rheumatic Patients

Abstract

Background: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 c-statistic (AUC) of 0.86 in non-rheumatic subjects (2). This model has not been explored in rheumatic patients.Objectives:To evaluate the diagnostic performance of the PROOF-BP algorithm for the prediction of HTN in subjects with/without rheumatic diseases.Methods: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 (<130/80 mmHg), medium (130/80-145/90 mmHg) and high risk (>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.Results: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.Abstract USAGE Table 1Clinical characteristics.Number of patients, n (%)N= 217Female188 (86.6)Hypertension51 (23.5)T2DM24 (11.1)Dyslipidemia68 (31.3)Active smoking13 (6.0)No rheumatic disease65 (30.0)RA78 (35.9)SLE6 (2.8)Sjögren syndrome5 (2.3)OA29 (13.4)Other34 (15.6)PROOF-BP class:Low risk133 (61.3)Medium risk71 (33.6)High risk11 (5.1)New diagnosis of hypertension14 (38.9)Abstract USAGE Table 2Diagnostic performances.Sensitivity(%)Specificity(%)PPV(%)NVP(%)Low risk1005558100High risk29958068PPV: Positive predictive value; NPV: Negative predictive value.Conclusion: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 ...