Prevalence of hypertension and blood pressure control using ambulatory blood pressure monitoring (ABPM) criteria. The Colombian GLADIATOR ABPM registry.
A Sotomayor, M C Bejarano, D Vargas, M J Reyes, A Coca, C E Vesga-ReyesAbstract
Background
Hypertension (HT) remains the leading modifiable risk factor for cardiovascular disease. The ACC/AHA guidelines maintain lower blood pressure (BP) thresholds for HT diagnosis and control status compared to the ESC/ESH based frameworks.
Objective
This study aimed to evaluate differences in HT prevalence and BP control classification according to current international guidelines using ambulatory blood pressure monitoring (ABPM).
Methods
We conducted a retrospective, cross-sectional study using data from an institutional ABPM registry, including 10,713 recordings. BP classification for diagnosis and HT control was determined according to ACC/AHA and ESC/ESH criteria. Agreement was assessed using weighted Cohen’s kappa coefficient with Fleiss-Cohen quadratic weighing for diagnostic classification and unweighted Cohen’s Kappa coefficient for control status. Subgroup analyses were interpreted according to Landis and Koch.
Results
Among recordings performed for hypertension diagnosis (n = 3716), prevalence of HT was higher using ACC/AHA criteria compared with ESC/ESH (82.9% vs 57.4%), with 25.3% of recordings classified as elevated BP under ESC/ESH reclassified as HT under ACC/AHA. Among recordings performed for control evaluation (n = 3352) controlled BP was identified in 58.8% under ESC/ESH compared to 15.2% under ACC/AHA, representing a 43.6 percentage point difference. Overall, the diagnostic agreement between frameworks was moderate, whereas concordance for BP control was slightly fair.
Conclusion
Guideline selection substantially influences hypertension prevalence and BP control classification using ABPM, with major potential implications for clinical decision-making and population level surveillance.ClasificationHeat map