**Question:** If the American Heart Association lowered the cut-off threshold for hypertension, which of the following effects would that have on the following properties of blood pressure assessment as a screening test?

A. Increased sensitivity
B. Decreased specificity
C. Increased positive predictive value
D. Increased negative predictive value

**Correct Answer:** .

**Core Concept:** Blood pressure screening

Hypertension is a significant risk factor for cardiovascular events and is defined as a blood pressure reading of ≥140/90 mmHg. The American Heart Association (AHA) sets these thresholds for hypertension classification. Blood pressure screening, using a screening test, aims to accurately identify individuals with hypertension.

**Why the Correct Answer is Right:**

If the AHA lowers the cut-off threshold for hypertension, the properties of blood pressure assessment as a screening test will change. Lowering the threshold increases the number of individuals classified as having hypertension. As a result, the screening test will have:

1. **Increased sensitivity:** A higher proportion of individuals with hypertension will be correctly identified, which is essential for early intervention and prevention of complications.
2. **Decreased specificity:** A higher proportion of individuals without hypertension will be classified as having hypertension, leading to more false positives and unnecessary investigations and treatments.

**Why Each Wrong Option is Incorrect:**

3. **Increased positive predictive value:** This property measures the probability that an individual with a positive screening test result actually has the condition. Lowering the threshold would not significantly affect the positive predictive value, as it depends more on the prevalence of hypertension in the population being screened.
4. **Increased negative predictive value:** This property measures the probability that an individual with a negative screening test result does not have the condition. Again, lowering the threshold would not significantly affect the negative predictive value due to its dependence on the prevalence of hypertension in the population.

**Clinical Pearl:**

When assessing the effectiveness of a screening test, consider the balance between sensitivity and specificity. Lowering the cut-off threshold improves sensitivity but reduces specificity, potentially leading to overdiagnosis and unnecessary treatments. In practice, the optimal screening test should aim for a balance between both properties.