What does this research mean for the field?

Attended and unattended automated blood pressure measurements conducted by community health workers have comparable diagnostic accuracy, offering high specificity but low sensitivity for hypertension screening compared to 24-hour ambulatory monitoring. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 5, 2026BMC MedicineOpen Access

Diagnostic accuracy of attended versus unattended automated blood pressure measurements compared to ambulatory blood pressure monitoring conducted by community health workers in rural sub-Saharan Africa

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=1220). Intervention: Attended and unattended automated home blood pressure measurements vs. 24-hour ambulatory blood pressure monitoring (ABPM). Primary outcome: Diagnostic accuracy (Area under the receiver operating characteristic curve).

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Key result

Attended and unattended home BP measurements show comparable diagnostic accuracy but low sensitivity versus 24-hour ABPM.

n=1,220

Why the study?

Community health workers increasingly screen for hypertension in rural sub-Saharan Africa, but the diagnostic accuracy of attended versus unattended automated blood pressure measurement at home had not been compared.

Does attended versus unattended automated blood pressure measurement by community health workers have comparable diagnostic accuracy to 24-hour ambulatory blood pressure monitoring in rural sub-Saharan African adults?

Population

1220 individuals aged >= 30 years in Kenya and The Gambia

Comparison

Attended vs unattended automated blood pressure vs 24-hour ABPM

Design

Cross-sectional, population-based diagnostic accuracy study

Authors

RLRuth LucindeKenya Medical Research Institute MJModou JobeMRC Unit the Gambia APAlexander D. PerkinsLondon School of Hygiene & Tropical Medicine

Discussion

Member takes

Implication

Attended and unattended measurements show comparable accuracy with high specificity but low sensitivity; supports equivalence but leaves open screening utility pending prospective validation.

Key Points

To compare the diagnostic accuracy of attended versus unattended automated blood pressure measurements conducted by community health workers in participants' homes against 24-hour ambulatory blood pressure monitoring.
Conducted a cross-sectional, population-based diagnostic accuracy study across two health and demographic surveillance systems in Kenya and The Gambia, enrolling an age-stratified sample of individuals aged ≥ 30 years (N=1220).
Compared community health worker-led attended and unattended automated home blood pressure measurements against reference 24-hour ambulatory blood pressure monitoring using European Society of Hypertension cutoffs.
In Kenya, age-standardized sensitivity was 59.5% (95% CI 52.1, 66.9) for attended and 56.1% (95% CI 48.4, 63.8) for unattended measurements; in The Gambia, sensitivity was 42.2% (95% CI 34.9, 49.5) and 42.2% (95% CI 35.2, 49.2), respectively.
Age-standardized specificity was 92.5% (95% CI 90.2, 94.7) for attended and 92.6% (95% CI 90.2, 95.0) for unattended measurements in Kenya, and 93.2% (95% CI 90.6, 95.9) and 93.3% (95% CI 90.8, 95.9) in The Gambia.
The area under the receiver operating characteristic curve was 0.76 (95% CI 0.72, 0.80) for attended and 0.74 (95% CI 0.70, 0.78) for unattended in Kenya, compared to 0.68 (95% CI 0.64, 0.72) and 0.68 (95% CI 0.64, 0.71) in The Gambia.

Study Design

Type

Cross-Sectional (n=1,220)

Blinding

Index and reference tests blinded to each other

Randomization

Randomly assigned order of BP measurements

Multicenter

Yes

Structured PICO

Population

1,220 adults aged 30 years and older from rural communities in Kenya and The Gambia underwent attended and unattended automated home blood pressure measurements to evaluate diagnostic accuracy.

Exposure

Attended and unattended automated blood pressure measurements conducted by community health workers at participants' homes (AHBP).

Comparator

24-hour ambulatory blood pressure monitoring (ABPM) conducted by community health workers.

Outcome

Diagnostic accuracy (sensitivity, specificity, predictive values, and area under receiver operating characteristic curve) using European Society of Hypertension cutoffs.surrogate

Attended and unattended automated blood pressure measurements by community health workers have comparable diagnostic accuracy with high specificity but low sensitivity compared to 24-hour ambulatory monitoring, suggesting they are useful for initial screening but require confirmatory testing.

Limitations

Cross-sectional design precludes assessment of the relationship between measurement accuracy and long-term clinical outcomes.
BP measurement protocol used the average of all three measurements rather than the final two, differing slightly from ESH recommendations.
Potential measurement variability due to differences in CHW characteristics, participant behavior, or environmental conditions.
Did not implement guideline-recommended confirmatory diagnostic procedures such as bilateral arm measurements.
24-hour ABPM has poor reproducibility and a single recording may not fully capture an individual's usual BP profile.
Results from two sites in East and West Africa may not be generalizable to all sub-Saharan Africa settings.
Cross-sectional design precludes assessment of long-term clinical outcomes
BP measurement protocol differed slightly from ESH recommendations (average of 3 instead of final 2)
Measurement variability due to community setting
Lack of guideline-recommended confirmatory diagnostic procedures
24-hour ABPM has poor reproducibility
Results may not be generalizable to all sub-Saharan African settings

Cite This Study

Lucinde et al. (2026) conducted a cross-sectional in Hypertension (n=1,220). Attended and unattended automated home blood pressure measurements vs. 24-hour ambulatory blood pressure monitoring (ABPM) was evaluated on Diagnostic accuracy (Area under the receiver operating characteristic curve). Attended and unattended automated home blood pressure measurements conducted by community health workers had comparable diagnostic accuracy (AUC 0.76 vs 0.74 in Kenya; 0.68 vs 0.68 in The Gambia) but low sensitivity compared to 24-hour ABPM.

synapsesocial.com/papers/6a9bd48c6b95aff0620ec550 https://doi.org/10.1186/s12916-026-05198-9

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Implication

Attended and unattended measurements show comparable accuracy with high specificity but low sensitivity; supports equivalence but leaves open screening utility pending prospective validation.