The "white coat" effect: False positives and false negatives in the assessment and diagnosis of essential hypertension

Screening for Hypertension in Adults

“…In total, 52 studies reported in 81 articles were included (Figure 2). For all KQs, additional descriptive and outcome data are available in the full report.…”

“…Twenty fair- to good-quality studies (n = 12 614) examined the test accuracy of OBPM for initial screening for hypertension compared with ABPM (eTable 3 in the Supplement). Participants in the studies were primarily recruited from community-based samples. Only 5 were conducted in the US.…”

“…Most other protocol characteristics were sparsely or variably reported. Studies most commonly used an office blood pressure of greater than 140/90 mm Hg or of 140/90 mm Hg or greater as the diagnostic threshold for the index test (17/20 studies) . Several studies additionally reported accuracy for other thresholds, and 2 studies used SBP-alone or DBP-alone thresholds .…”

“…False-positive and false-negative rates likewise ranged widely (false-positive rate range, 0%-30%; false-negative rate range, 8%-100%). A sensitivity analysis adding 2 studies measuring blood pressure at multiple visits rendered the same point estimate but with slightly narrower confidence intervals (sensitivity, 0.53 [95% CI, 0.37-0.68]; specificity, 0.91 [95% CI, 0.85-0.95]).…”

“…Additional results for less commonly reported thresholds are available in the full evidence report . In quantitative analysis of KQ2 (initial screening), only studies measuring OBPM at a single visit were included; 2 additional studies measuring blood pressure at multiple visits were included in a sensitivity analysis . Results for KQ3 (confirmatory measurement) were stratified by the type of confirmatory measure (repeat OBPM, HBPM, self-OBPM, AOBP, and kiosk).…”