PP.32.23
Bibliographic record
Abstract
Objective: Accurate blood pressure (BP) measurement is critical to properly identify and manage individuals with hypertension. For 2015 the Canadian Hypertension Education Program (CHEP) subcommittee on BP measurement and diagnosis conducted an in-depth review of the literature to determine the best current evidence-based practice for establishing a diagnosis of hypertension.Design and method: Systematic literature searches from 2009 to 2014 were performed by a Cochrane Collaboration librarian in MEDLINE/PubMed. Members of the subcommittee reviewed the abstracts and selected the most relevant papers to be reviewed in depth. The results were presented to the CHEP Central Review Committee for a second review. Finally the recommendations, along with the supporting evidence, were presented to the full membership of the CHEP Recommendations Task Force for debate and voting. Results: Our literature review identified two major deficiencies in the current Canadian diagnostic process. 1. The auscultatory measurements performed in routine clinical settings have serious limitations in accuracy that have not been overcome despite great efforts to educate healthcare professionals over several years. Alternatives to auscultatory measurements should be used. 2. Patients with white coat hypertension must be identified earlier in the process and in a systematic manner rather than on an ad-hoc or voluntary basis so they are not unnecessarily treated with anti-hypertensive medications. Based on these critically important considerations, a revised algorithm for the diagnosis of hypertension was introduced. (Figure 1) Conclusions: The main take-home messages for the revised algorithm are: 1. For office BP measurement (OBPM) we strongly encourage the use of validated electronic digital oscillometric devices in place of auscultatory BP measurement. 2. When OBPM is elevated, out-of-office BP measurements should be performed to confirm the diagnosis of hypertension and rule out white coat hypertension. This should be done prior to the second visit. 3. For out-of-office measurement Ambulatory BP Measurement (ABPM) is the preferred method. If ABPM is not available or not tolerated by the patient, a diagnostic home BP measurement series (HBPM) should be performed. 4. If the out-of-office measurement is normal the patient should be diagnosed with white coat hypertension and pharmacologic treatment is not indicated.
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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 | 0.003 | 0.008 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.004 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.463 | 0.366 |
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".