Key result
Screening blood pressure measurement overestimated hypertension prevalence (23.1% vs 15.6%) and had a sensitivity of 80% and specificity of 84% compared to 24-hour ambulatory monitoring.
Why the study?
Does 24-hour ambulatory blood pressure monitoring improve the diagnostic accuracy of hypertension compared to screening blood pressure measurement in Kenyan adults?
Case-Control (n=1,248)
No
Does 24-hour ambulatory blood pressure monitoring improve the diagnostic accuracy of hypertension compared to screening blood pressure measurement in Kenyan adults?
Effect estimate: Sensitivity 80%, Specificity 84% (95% CI 73-86% (sensitivity), 79-88% (specificity))
In Kenyan adults, screening blood pressure significantly overestimates hypertension prevalence and misses masked hypertension, highlighting the clinical and epidemiological value of ABPM in this population.
Screening BP may overestimate hypertension in Kenyan adults; leaves open ABPM's diagnostic role pending prospective validation.
BACKGROUND: The clinical and epidemiological implications of using ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension have not been studied at a population level in sub-Saharan Africa. We examined the impact of ABPM use among Kenyan adults. METHODS AND RESULTS: We performed a nested case-control study of diagnostic accuracy. We selected an age-stratified random sample of 1248 adults from the list of residents of the Kilifi Health and Demographic Surveillance System in Kenya. All participants underwent a screening blood pressure (BP) measurement. All those with screening BP ≥140/90 mm Hg and a random subset of those with screening BP <140/90 mm Hg were invited to undergo ABPM. Based on the 2 tests, participants were categorized as sustained hypertensive, masked hypertensive, "white coat" hypertensive, or normotensive. Analyses were weighted by the probability of undergoing ABPM. Screening BP ≥140/90 mm Hg was present in 359 of 986 participants, translating to a crude population prevalence of 23.1% (95% CI 16.5-31.5%). Age standardized prevalence of screening BP ≥140/90 mm Hg was 26.5% (95% CI 19.3-35.6%). On ABPM, 186 of 415 participants were confirmed to be hypertensive, with crude prevalence of 15.6% (95% CI 9.4-23.1%) and age-standardized prevalence of 17.1% (95% CI 11.0-24.4%). Age-standardized prevalence of masked and white coat hypertension were 7.6% (95% CI 2.8-13.7%) and 3.8% (95% CI 1.7-6.1%), respectively. The sensitivity and specificity of screening BP measurements were 80% (95% CI 73-86%) and 84% (95% CI 79-88%), respectively. BP indices and validity measures showed strong age-related trends. CONCLUSIONS: Screening BP measurement significantly overestimated hypertension prevalence while failing to identify ≈50% of true hypertension diagnosed by ABPM. Our findings suggest significant clinical and epidemiological benefits of ABPM use for diagnosing hypertension in Kenyan adults.
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Etyang et al. (2016) conducted a case-control in Hypertension (n=1,248). 24-hour ambulatory blood pressure monitoring (ABPM) vs. Screening blood pressure measurement was evaluated on Diagnostic accuracy (sensitivity and specificity) of screening blood pressure measurements (Sensitivity 80%, Specificity 84%, 95% CI 73-86% (sensitivity), 79-88% (specificity)). Screening blood pressure measurement overestimated hypertension prevalence (23.1% vs 15.6%) and had a sensitivity of 80% and specificity of 84% compared to 24-hour ambulatory monitoring.
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