Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Catherine Yeckel

Second Advisor

Rosana Gonzalez-Colaso


Hypertension is one of the most common medical conditions, affecting nearly one-third of Americans.1 Chronic high blood pressure is the cause of numerous cardiovascular diseases which cost the United States over $100 billion annually.1 The American College of Cardiology and American Heart Association have recently challenged the previous definition of hypertension by suggesting those with a blood pressure of ≥130/80 mmHg now have the disease.2 This new threshold would classify nearly 50% of Americans as hypertensive.2 Establishing a diagnosis of hypertension can be difficult and resource intensive requiring patients to have serial recordings over 24-hours. Until recently there has been no reliable strategy for indexing the 24-hour ambulatory blood pressure in the clinic. This thesis used the Proof-BP algorithm along with traditional Clinic BP measurements to analyze MI, stroke, and CHF prevalence in hypertensive NHANES participants. Additionally, the sensitivity, specificity, and predictive values of Proof-BP and Clinic BP were calculated. Based on the findings of this study, Proof-BP may be advantageous at assessing cardiovascular prevalence in certain groups. Due to its high specificity and negative predictive value, Proof-BP provides a reliable method of ruling out cardiovascular disease in healthy populations. Importantly, Proof-BP allows for detection of white coat hypertension and masked hypertension, both of which are impossible to detect from a single blood pressure measurement.


This is an Open Access Thesis.

Open Access

This Article is Open Access