Misclassification of Hypertension Status According to Office Blood Pressure vs 24-Hour Ambulatory Blood Pressure Monitoring
Bibliographic record
Abstract
Background: Ambulatory blood pressure monitoring (ABPM) is the gold standard for establishing the diagnosis of hypertension yet remains underused in Canada. There remains a scarcity of Canadian data surrounding how commonly misclassification of hypertension phenotypes occurs without regular use of ABPM. Methods: This cross-sectional study included 964 consecutive adult patients referred to the Ottawa Hospital Hypertension Clinic who underwent same-day ABPM and automated office-based blood pressure measurement (AOBPM) between 2019 and 2023. The proportion of hypertension status misclassification was determined by comparing ABPM and AOBPM values. White coat hypertension (if on no antihypertensive medication) or white coat effect (if on antihypertensive medication) was defined as AOBPM ≥140/90 mm Hg but mean 24-hour ABPM <130/80 mm Hg. Masked hypertension (if on no antihypertensive medication) or masked uncontrolled hypertension (if on antihypertensive medication) was defined as AOBPM <140/90 mm Hg but mean 24-hour ABPM ≥130/80 mm Hg. Results: The mean (SD) age was 60 (16) years, and 46% of the patients were female. Among 296 patients with normotension or controlled hypertension based on ABPM, 146 (49%) met criteria for white coat hypertension (n = 21) or white coat effect (n = 125). Among 668 patients with uncontrolled hypertension based on ABPM, 364 (54%) met criteria for masked hypertension (n = 65) or masked uncontrolled hypertension (n = 299). Conclusions: The hypertension status of approximately 50% of patients was misclassified by AOBPM vs ABPM. Broader use of ABPM in Canada will improve hypertension awareness, treatment, and control rates.
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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 | 0.005 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 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".