Diagnostic Performance of Unattended Automated Office Blood Pressure Measurement for Hypertension Screening Among People With and Without HIV

Abstract

Background: The diagnostic performance of automated office blood pressure (AOBP) in screening for hypertension in people with HIV (PWH) is not known.

Methods: We conducted a cross-sectional analysis of baseline data from PWH and people without HIV (PWoH) from the Mwanza HIV&CVD cohort study. We conducted unattended AOBP and 24-hour ambulatory BP monitoring as recommended by international guidelines. Using average 24-hour BP as the reference standard, we estimated the prevalence of hypertensive diagnostic phenotypes and calculated measures of diagnostic performance at different diagnostic cutoffs in participants.

Results: We included 959 participants (50.4% PWH and 49.6% PWoH). Characteristics were similar across participant groups. The median age was 44 years (interquartile range, 38-50 years), and 69.8% were women. Overall prevalence of hypertension, based on average 24-hour ambulatory BP monitoring, was 35.3% using European Society of Hypertension cutoffs and did not differ by HIV infection status. Masked hypertension was present in 25.7% (95% CI, 22.0%-29.8%) of PWH and 26.7% (95% CI, 22.9%-30.8%) of PWoH. The sensitivity of unattended AOBP was 25.7% for PWH (95% CI, 19.3%-33.1%) and 25.7% for PWoH (95% CI, 19.4%-33.0%) with little difference in the area under the receiver-operating curve by HIV infection status. Based on 24-hour BP averages, 24.2% of PWH and 21.6% of PWoH had isolated nocturnal hypertension.

Conclusions: More than half of individuals with hypertension on ambulatory BP monitoring, irrespective of their HIV infection status, may be misdiagnosed if unattended AOBP alone is used to screen for hypertension in sub-Saharan Africa.