IMPACT OF AMERICAN VS CANADIAN STYLE BLOOD PRESSURE MEASUREMENT ON BLOOD PRESSURE CLASSIFICATION ACCORDING TO THE 2017 ACC/AHA TASK FORCE HYPERTENSION GUIDELINES
Bibliographic record
Abstract
Objective: Due to the new ACC/AHA task force hypertension guidelines (ACC/AHA), concerns have been raised that the lower cut-off values of blood pressure (BP) categories will lead to a relevant increase of hypertension prevalence. However, not only the cut-off values were changed, but also office blood pressure measurement (BPM) technique was redefined. Our aim was to study the differences in systolic BP classification based on BPM techniques recommended by the American and Canadian guidelines (CHEP). Design and method: In this cross-sectional, single-centre trial, 1000 adult subjects were recruited. After five minutes of rest, four sequential standard office BPM were performed at two-minute intervals in a quiet room and in sitting position. Based on the ACC/AHA, we calculated the mean of the first and second systolic BPM (sBPM). Based on the CHEP, we calculated the mean of the second and third sBPM. A systolic BP (sBP) < 120 mmHg was regarded as normal, 120–129 mmHg as elevated and >129 as hypertensive, as per ACC/AHA definition. BP differences were calculated using a related-samples Wilcoxon Signed Rank Test. Results: Complete measurements were available in 805 subjects. 195 patients were excluded due to incomplete measurements. Median sBP was 126 (114.5–138) mmHg in ACC/AHA technique and 123 (112.5–135) mmHg in CHEP technique (p-value < 0.005), with 199 (24.7%) subjects showing a higher BP value with CHEP technique and 580 (72.0%) subjects with the ACC/AHA technique. 26 subjects had the same sBP with both techniques (Figure 1). Applying both BPM techniques during one BPM session, lead to disagreement regarding sBP classification in 20% of cases. Comparing CHEP and AHA/ACC technique 344 (43%) vs. 297 (37%) subjects were classified as normal BP, 194 (24%) vs. 188 (23%) as elevated BP and 267 (33%) vs. 320 (40%) as hypertensive BP (Figure 2).Conclusions: There are significant differences in sBP values and classification depending on the guideline regarding BPM technique applied. 20% of hypertensive patients based on ACC/AHA would be reclassified to a lower BP category by applying CHEP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.028 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".