bp_stages: Blood Pressure Stage Classification

In johnschwenck/bp: Blood Pressure Analysis in R

Blood Pressure Stage Classification

Description

Adds BP_CLASS, SBP_Category, and DBP_Category columns to supplied dataframe.

Usage

bp_stages(
  data,
  sbp,
  dbp,
  bp_type = c("hbpm", "abpm", "ap"),
  inc_low = TRUE,
  inc_crisis = TRUE,
  data_screen = TRUE,
  SUL = 240,
  SLL = 50,
  DUL = 140,
  DLL = 40,
  adj_sbp_dbp = TRUE,
  guidelines = c("Lee_2020", "AHA", "Custom"),
  bp_cutoffs = list(c(100, 120, 130, 140, 180), c(60, 80, 80, 90, 120))
)

Arguments

data	User-supplied dataset containing blood pressure data. Must contain data for Systolic blood pressure and Diastolic blood pressure at a minimum.
sbp	Required column name (character string) corresponding to Systolic Blood Pressure (mmHg)
dbp	Required column name (character string) corresponding to Diastolic Blood Pressure (mmHg)
bp_type	Required argument specifying which of the three BP data types ("HBPM", "ABPM", or "AP") the input data is. Default bp_type set to "HBPM". This argument determines which processing steps are necessary to yield sensible output. HBPM - Home Blood Pressure Monitor | ABPM - Ambulatory Blood Pressure | AP - Arterial Pressure NOTE: bp_type impacts blood pressure staging in bp_stages if guidelines = "AHA", for which the cutoffs for each blood pressure stage are automatically adjusted according to bp_type.
inc_low	Optional logical argument dictating whether or not to include the "Low" category for BP classification column (and the supplementary SBP/DBP Category columns). Default set to TRUE.
inc_crisis	Optional logical argument dictating whether or not to include the "Crisis" category for BP classification column (and the supplementary SBP/DBP Category columns). Default set to TRUE.
data_screen	Optional logical argument; default set to TRUE. Screens for extreme values in the data for both SBP and DBP according to Omboni, et al (1995) paper - Calculation of Trough:Peak Ratio of Antihypertensive Treatment from Ambulatory Blood Pressure: Methodological Aspects
SUL	Systolic Upper Limit (SUL). If data_screen = TRUE, then SUL sets the upper limit by which to exclude any SBP values that exceed this threshold. The default is set to 240 per Omboni, et al (1995) paper - Calculation of Trough:Peak Ratio of Antihypertensive Treatment from Ambulatory Blood Pressure: Methodological Aspects
SLL	Systolic Lower Limit (SLL). If data_screen = TRUE, then SLL sets the lower limit by which to exclude any SBP values that fall below this threshold. The default is set to 50 per Omboni, et al (1995) paper - Calculation of Trough:Peak Ratio of Antihypertensive Treatment from Ambulatory Blood Pressure: Methodological Aspects
DUL	Diastolic Upper Limit (DUL). If data_screen = TRUE, then DUL sets the upper limit by which to exclude any DBP values that exceed this threshold. The default is set to 140 per Omboni, et al (1995) paper - Calculation of Trough:Peak Ratio of Antihypertensive Treatment from Ambulatory Blood Pressure: Methodological Aspects
DLL	Diastolic Lower Limit (DLL). If data_screen = TRUE, then DLL sets the lower limit by which to exclude any DBP values that fall below this threshold. The default is set to 40 per Omboni, et al (1995) paper - Calculation of Trough:Peak Ratio of Antihypertensive Treatment from Ambulatory Blood Pressure: Methodological Aspects
adj_sbp_dbp	Logical indicator to dictate whether or not to run helper functions that adjust / process SBP & DBP columns in supplied data set. Default set to: adj_sbp_dbp = TRUE
guidelines	A string designation for the guidelines to follow when mapping BP readings to a respective BP stage. guidelines can take on either "Lee_2020" corresponding to staging in Lee et al (2020), "AHA" corresponding to guidelines by the American Heart Association, see e.g. Muntner et al (2019), or "Custom" based on user-defined cutoffs in bp_cutoffs. By default, AHA guidelines adjust bp_cutoffs depending on the BP type.
bp_cutoffs	A list containing two vectors corresponding to SBP and DBP cutoffs, respectively. Each vector contains 5 values. The SBP vector (100, 120, 130, 140, 180) corresponds to the upper limits for the following stages: Low (0-100), Normal (100-120), Elevated (120-130), Stage 1 Hypertension (130-140), Stage 2 Hypertension (140-180). When utilizing Lee et al (2020) guidelines, additional stages are included: Isolated Systolic Hypertension for Stage 1 (ISH - S1) (130-140), Isolated Diastolic Hypertension for Stage 1 (IDH - S1) (0-130), ISH - S2 (140-180), and IDH - S2 (0-140). The DBP vector (60, 80, 80, 90, 120) corresponds to the upper limits for the following stages: Low (0-60), Normal (60-80), Elevated (0-80), Stage 1 Hypertension (80-90), Stage 2 Hypertension (90-120). The upper limit of the "Elevated" category repeats in the DBP vector and matches that of Normal. This because according to most guidelines, there is no distinction between DBP cutoffs for Normal and Elevated - these stages are discerned by SBP, not DBP. When utilizing Lee et al (2020) guidelines, additional stages are included: Isolated Diastolic Hypertension for Stage 1 (ISH - S1) (0-80), Isolated Diastolic Hypertension for Stage 1 (IDH - S1) (80-90), ISH - S2 (0-90), and IDH - S2 (90-120). Any SBP reading below 100 or DBP reading below 60 is considered Hypotension ("Low"). Any SBP reading above 180 or DBP reading above 120 is considered a Crisis. When guidelines = "AHA", the cutoffs are automatically adjusted to match BP type without user input, For bp_type = "hbpm", SBP = (100, 120, 130, 135, 160), DBP = (60, 80, 80, 85, 110). Forbp_type = "abpm", SBP = (100, 115, 125, 130, 160), DBP = (60, 75, 75, 80, 105). An adjustment of default cutoffs by the user These choices can be overwritten by directly changing bp_cutoffs, in which case the guidelines are ignored and automatically treated as "Custom". If inc_low = FALSE, although an upper limit value is still required in the SBP vector, the "Low" stage will be omitted in the final output. Similarly, if inc_crisis = FALSE, then the "Crisis" category will be omitted from the final output.

Details

Supplied dataframe must adhere to the unified format using the process_data function.

Value

A dataframe with additional columns corresponding to the stages of blood pressure and the supplementary SBP / DBP categories

References

Lee H, Yano Y, Cho SMJ, Park JH, Park S, Lloyd-Jones DM, et al. Cardiovascular risk of isolated systolic or diastolic hypertension in young adults. Circulation. 2020;141(22):1778–1786. doi: 0.1161/CIRCULATIONAHA.119.044838

Muntner, P., Carey, R. M., Jamerson, K., Wright Jr, J. T., & Whelton, P. K. (2019). Rationale for ambulatory and home blood pressure monitoring thresholds in the 2017 American College of Cardiology/American Heart Association Guideline. Hypertension, 73(1), 33-38. doi: 10.1161/HYPERTENSIONAHA.118.11946

Examples

# Load bp_hypnos
data(bp_hypnos)

bp_stages(bp_hypnos, sbp = "syst", dbp = "diast")


# Load bp_jhs data
data(bp_jhs)

bp_stages(bp_jhs, sbp = "sys.mmhg.", dbp = "dias.mmhg.")

johnschwenck/bp documentation built on Aug. 18, 2022, 11:30 a.m.