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Screening for Hypertension in the INpatient Environment(SHINE): a protocol for a prospective study of diagnostic accuracy among adult hospital patients
  1. Laura C Armitage1,
  2. Adam Mahdi2,
  3. Beth K Lawson1,
  4. Cristian Roman2,
  5. Thomas Fanshawe1,
  6. Lionel Tarassenko2,
  7. Andrew J Farmer1,
  8. Peter J Watkinson3
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
  3. 3 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Laura C Armitage; laura.armitage{at}


Introduction A significant percentage of patients admitted to hospital have undiagnosed hypertension. However, present hypertension guidelines in the UK, Europe and USA do not define a blood pressure threshold at which hospital inpatients should be considered at risk of hypertension, outside of the emergency setting. The objective of this study is to identify the optimal in-hospital mean blood pressure threshold, above which patients should receive postdischarge blood pressure assessment in the community.

Methods and analysis Screening for Hypertension in the INpatient Environment is a prospective diagnostic accuracy study. Patients admitted to hospital whose mean average daytime blood pressure after 24 hours or longer meets the study eligibility threshold for mean daytime blood pressure (≥120/70 mm Hg) and who have no prior diagnosis of, or medication for hypertension will be eligible. At 8 weeks postdischarge, recruited participants will wear an ambulatory blood pressure monitor for 24 hours. Mean daytime ambulatory blood pressure will be calculated to assess for the presence or absence of hypertension. Diagnostic performance of in-hospital blood pressure will be assessed by constructing receiver operator characteristic curves from participants’ in-hospital mean systolic and mean diastolic blood pressure (index test) versus diagnosis of hypertension determined by mean daytime ambulatory blood pressure (reference test).

Ethics and dissemination Ethical approval has been provided by the National Health Service Health Research Authority South Central—Oxford B Research Ethics Committee (19/SC/0026). Findings will be disseminated through national and international conferences, peer-reviewed journals and social media.

  • hypertension
  • public health
  • general medicine (see internal medicine)

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  • Contributors PJW is the principal investigator. LCA, PJW, AJF, AM, CR and LT made substantial contributions to the conception and design of the project. BKL has contributed substantially to protocol development. TF provided advice on statistical methodology. All authors contributed to and revised the final manuscript.

  • Funding This study is funded by the National Institute for Health (NIHR) Oxford Biomedical Research Centre (BRC) Technology and Digital Health theme. The sponsor is the University of Oxford. AJF is an NIHR Senior Investigator. The sponsor has provided ethical and legal guidance in study conduction.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Neither the funder nor sponsor have had or will have, any role in study design, collection, management, analysis, interpretation of data or writing of the report.

  • Competing interests PJW and LT are the Chief Medical Officer and R&D Director for Sensyne Health and hold share options in the company. Their University departments receive research funding from Sensyne Health.

  • Patient consent for publication Not required.

  • Ethics approval This study (Protocol V.1.7) has been given ethical approval from the NHS Health Research Authority South Central—Oxford B Research Ethics Committee (19/SC/0026).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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