{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:03:36Z","timestamp":1792109016475,"version":"4.4.0"},"reference-count":26,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203921\/Z\/16\/Z"],"award-info":[{"award-number":["203921\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013373","name":"NIHR Oxford Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013373","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,25]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypertension is the leading risk factor for death globally. Undiagnosed hypertension is common, but the incidence in hospitalised patients is unclear. There are calls for universal facility-based screening for hypertension among all attending patients. The hospital inpatient setting, where blood pressure (BP) is measured routinely and repeatedly, presents an ideal opportunity. However, international hypertension guidelines do not include inpatient BP thresholds for diagnostic or treatment purposes. We investigated the performance of current UK community BP thresholds for diagnosing hypertension in the hospital setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Investigate the diagnostic performance of the current UK ambulatory BP diagnostic thresholds for systolic and diastolic hypertension in the hospital setting against the reference test of community-based ambulatory BP monitoring (ABPM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A prospective diagnostic accuracy study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hospital inpatients admitted to three UK centres were approached. Follow-up ABPM was delivered in the community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Eligible patients were aged between 18 and 80 years, with no prior diagnosis of, or prescription for hypertension, and whose mean cumulative daytime BP was 120 mm Hg to 179\u2009mm Hg systolic and \u2264109\u2009mm Hg diastolic from the 24th hour of their hospital admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants received 24-hour ABPM 4\u201326 weeks post-discharge, as the reference test for hypertension, with UK diagnostic thresholds of an average daytime BP of \u2265135\u2009mm Hg systolic and \u226585\u2009mm Hg diastolic applied. Participants found to be severely hypertensive at the ABPM fitting appointment were also considered reference-test positive but did not proceed with ABPM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The diagnostic performance of a mean daytime in-hospital BP of \u2265135\u2009mm Hg systolic or \u226585\u2009mm Hg diastolic (index test) for the prediction of hypertension diagnosed on ABPM (reference test) was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as primary outcome measures. Additionally, we explored the accuracy of a range of alternative in-hospital systolic and diastolic BP thresholds against the same reference test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>351 participants were enrolled and 206 completed the study protocol. The average age of the 206 participants was 53 years, 55% were male, and 91 (44%) had daytime community hypertension on ABPM reference testing. Of 107 participants with raised in-hospital daytime BP, 59 (55%) had daytime community hypertension. When assessing the performance of the index test for detecting daytime community hypertension, sensitivity was 65% (59\/91, 54% to 75%) and specificity was 58% (67\/115, 49% to 67%). The PPV was 55% (59\/107, 45% to 65%) and NPV was 68% (67\/99, 58% to 77%), respectively. A further 45\/206 participants (23%) had night-time community hypertension when assessed using European diagnostic thresholds for nocturnal hypertension (120\u2009mm Hg systolic or 70\u2009mm Hg diastolic), while 25\/107 of those with raised in-hospital daytime BP (23%) had night-time community hypertension. When assessing the performance of the index test for detecting either day or night-time community hypertension, sensitivity was 62% (84\/135, 53% to 70%) and specificity was 68% (48\/71, 55% to 78%). The PPV was 79% (84\/107, 70% to 86%) and NPV was 48% (48\/99, 38% to 59%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Undiagnosed hypertension is common in hospitalised patients, particularly those with raised in-hospital BP. While in-hospital BP alone is an imperfect predictor and should not be used as a stand-alone diagnostic test, this could serve as a trigger for further assessment of BP in the community after discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      The study protocol was registered with the ISCTRN Registry (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN80586284\">ISRCTN80586284<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107038","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T16:30:36Z","timestamp":1768840236000},"page":"e107038","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Screening for hypertension in the inpatient environment (SHINE): a prospective diagnostic accuracy study among adult hospital patients"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"isrctn80586284","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn80586284","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn80586284","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5009-4899","authenticated-orcid":false,"given":"Laura Catherine","family":"Armitage","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9164-8659","authenticated-orcid":false,"given":"Cristian","family":"Roman","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9524-9502","authenticated-orcid":false,"given":"Beth K","family":"Lawson","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"Department of Engineering, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Mahdi","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, Oxford, UK"},{"name":"Oxford Internet Institute, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0348-5480","authenticated-orcid":false,"given":"Christopher","family":"Biggs","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9094-1733","authenticated-orcid":false,"given":"Louise","family":"Young","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"Gastroenterology Clinical Trials Facility, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1353-690X","authenticated-orcid":false,"given":"Holly","family":"Edmundson","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9928-8934","authenticated-orcid":false,"given":"Thomas","family":"Fanshawe","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0118-1646","authenticated-orcid":false,"given":"Lionel","family":"Tarassenko","sequence":"additional","affiliation":[{"name":"Engineering Science, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-4402","authenticated-orcid":false,"given":"Andrew","family":"Farmer","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1023-3927","authenticated-orcid":false,"given":"Peter J","family":"Watkinson","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"2026011908302659000_16.1.e107038.1","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/jch.12372","article-title":"High Blood Pressure: Why Prevention and Control Are Urgent and Important\u2014A 2014 Fact Sheet From the World Hypertension League and the International Society of Hypertension","volume":"16","author":"Campbell","year":"2014","journal-title":"J Clin Hyperten"},{"key":"2026011908302659000_16.1.e107038.2","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1016\/S0140-6736(25)00561-6","article-title":"Improved hypertension care requires measurement and management in health facilities, not mass screening","volume":"405","author":"Frieden","year":"2025","journal-title":"Lancet"},{"key":"2026011908302659000_16.1.e107038.3","first-page":"521","article-title":"Patterns of care for hypertension among hospitalized patients","volume":"97","author":"Shankar","year":"1982","journal-title":"Public Health Rep"},{"key":"2026011908302659000_16.1.e107038.4","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1097\/00005650-198708000-00005","article-title":"Hospitalization as an Opportunity to Improve Hypertension Recognition and Control","volume":"25","author":"Greenland","year":"1987","journal-title":"Med Care"},{"key":"2026011908302659000_16.1.e107038.5","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1093\/ajh\/hpab070","article-title":"Estimated Prevalence of Hypertension and Undiagnosed Hypertension in a Large Inpatient Population: A Cross-sectional Observational Study","volume":"34","author":"Mahdi","year":"2021","journal-title":"Am J Hypertens"},{"key":"2026011908302659000_16.1.e107038.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2006.09.007"},{"key":"2026011908302659000_16.1.e107038.7","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/MBP.0b013e328332fd40","article-title":"Evaluation, management, and referral of elderly emergency department patients with elevated blood pressure","volume":"14","author":"Baumann","year":"2009","journal-title":"Blood Press Monit"},{"key":"2026011908302659000_16.1.e107038.8","doi-asserted-by":"publisher","DOI":"10.1197\/j.aem.2007.05.016"},{"key":"2026011908302659000_16.1.e107038.9","unstructured":"NHS England . Health Survey for England, 2022 Part 2. Hypertension. 2024."},{"key":"2026011908302659000_16.1.e107038.10","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2003.151"},{"key":"2026011908302659000_16.1.e107038.11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jen.2009.11.017","article-title":"Barriers to screening and intervention for ED patients at risk for undiagnosed or uncontrolled hypertension","volume":"37","author":"Tanabe","year":"2011","journal-title":"J Emerg Nurs"},{"key":"2026011908302659000_16.1.e107038.12","first-page":"52","article-title":"White coat hypertension: relevance to clinical and emergency medical services personnel","volume":"9","author":"Khan","year":"2007","journal-title":"MedGenMed"},{"key":"2026011908302659000_16.1.e107038.13","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1111\/jch.13643","article-title":"Screening for hypertension using emergency department blood pressure measurements can identify patients with undiagnosed hypertension: A systematic review with meta\u2010analysis","volume":"21","author":"Armitage","year":"2019","journal-title":"J Clin Hyperten"},{"key":"2026011908302659000_16.1.e107038.14","unstructured":"National Institute for Health and Care Excellence . Hypertension in Adults: Diagnosis and Management. NG 136. 2019."},{"key":"2026011908302659000_16.1.e107038.15","first-page":"1953","article-title":"2018 ESC\/ESH Guidelines for the management of arterial hypertension","volume":"36","author":"Williams","year":"2018","journal-title":"J Hypertens (Los Angel)"},{"key":"2026011908302659000_16.1.e107038.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.006"},{"key":"2026011908302659000_16.1.e107038.17","unstructured":"Brandon S . Special Report: Observations and Vital Signs. 2019."},{"key":"2026011908302659000_16.1.e107038.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012799","article-title":"STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration","volume":"6","author":"Cohen","year":"2016","journal-title":"BMJ Open"},{"key":"2026011908302659000_16.1.e107038.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033792","article-title":"Screening for Hypertension in the INpatient Environment(SHINE): a protocol for a prospective study of diagnostic accuracy among adult hospital patients","volume":"9","author":"Armitage","year":"2019","journal-title":"BMJ Open"},{"key":"2026011908302659000_16.1.e107038.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2026011908302659000_16.1.e107038.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026011908302659000_16.1.e107038.22","doi-asserted-by":"crossref","DOI":"10.12688\/wellcomeopenres.17537.3","article-title":"Ambulatory blood pressure monitoring using telemedicine: proof-of-concept cohort and failure modes and effects analyses","volume":"7","author":"Armitage","year":"2022","journal-title":"Wellcome Open Res"},{"key":"2026011908302659000_16.1.e107038.23","unstructured":"British and Irish Hypertension Society . Standard Operating Procedure for Ambulatory Blood Pressure Monitoring (ABPM), 2011. Available: https:\/\/bihsoc.org\/resources\/bp-measurement\/abpm\/"},{"key":"2026011908302659000_16.1.e107038.24","unstructured":"Posit team . R Studio: Integrated Development Environment for R. 2022."},{"key":"2026011908302659000_16.1.e107038.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5877(00)00115-X"},{"key":"2026011908302659000_16.1.e107038.26","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1001\/jamainternmed.2020.7501","article-title":"Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions","volume":"181","author":"Rastogi","year":"2021","journal-title":"JAMA Intern Med"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107038","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T16:30:39Z","timestamp":1768840239000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107038"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,19]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjopen-2025-107038"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107038","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}