A simple score to screen for isolated ambulatory hypertension in older adults. Development and validation

Abstract Introduction and objectives Masked or isolated ambulatory hypertension (IAH), a poor-prognosis condition, can be diagnosed with ambulatory blood pressure monitoring (ABPM), but ABPM is not available in many clinical practices. We developed and validated a score to screen for IAH among older adults, where limited information is available. Methods A total of 645 community-dwelling adults ≥ 65 years from the Seniors-ENRICA-2 cohort (derivation sample) and 327 from the Seniors-ENRICA-1 cohort (external-validation sample), with untreated casual BP  Results Participants’ mean age was 70.8 years (46.7% men); 19.7% had IAH. Allocated score-points were: male sex (1 point), age ≥ 80 (2 points), body-mass index (2 points if 25–29; 3 if ≥30 kg/m2), the first BP measurement (2 points if ≥140/90 mmHg), and the mean of the second and third BP (2 points if 120–129/80–84; 4 if 130–139/85–89). Probabilities of having IAH for scores of 6, 7, 8, 9, or ≥10 points were 25%, 35%, 47%, 59%, and 72%, respectively. Area-under-the-ROC curve was 0.80 for the derivation and 0.73 for the validation-sample. Two subjects at high risk of IAH (>8 points) and 3 at middle risk (≥6) needed to undergo ABPM to detect 1 IAH case. Conclusions A simple score with 4 routine variables performed well identifying IAH in older adults. For high scores, using ABPM for diagnosing IAH was very size-efficient.