LAUSR

Objectives: Previous studies have examined the relevance of hypertension (HTN) screening in walk-in clinics. To our best knowledge, there is no valid algorithm available on how to integrate HTN screening in this context. The aimed of the study was to assess the predictive value (PV) of diagnostic strategies including the addition of automated office blood pressure (AOBP) measurement for patients with elevated routine office blood pressure (OBP) measurement. Methods: Included participants were adults with non-emergent medical conditions and an initial walk in clinic OBP between 140/90 and 180/110 mm Hg. AOBP (BpTru™) was performed with patients unattended. Twenty-four hour ABPM (Spacelabs 90227™) with a threshold of 130/80 mm Hg was the reference for predictive value calculations. Results: Fifty participants (80% undiagnosed HTN, mean age 51,9 years, 54 % men) were included in the study. Average BP results were the following: OBP 147/90 mm Hg, AOBP 133/85 mm Hg and 24-hour ABPM 125/76 mm Hg. AOBP measurements over diagnostic thresholds occurred in 32 subjects and were confirmed by ABPM in 20 participants, leading to a 62,5 %positive PV (95 % CI 51.5% - 72.3%). Measurements under AOBP thresholds occurred in 18 subjects and were confirmed by ABPM in 15 participants, leading to a negative PV of 83,5 % (95% CI 62.3% - 93.8%). Pain was not associated with ABPM-confirmed HTN (p = 0,31). Conclusion: In a walk-in clinic, adding AOBP improves the diagnostic performance of OBP. Twenty-four hour ABPM remains the gold standard and is still needed to confirm the diagnosis after AOBP ≥ 135/85 mm Hg. After high OBP, the addition of AOBP, is a pertinent addition to HTN-screening procedures in walk-in clinics.