TY - JOUR
T1 - Clinical and Epidemiological Implications of 24‐Hour Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Kenyan Adults
T2 - A Population‐Based Study
AU - Etyang, Anthony O.
AU - Warne, Ben
AU - Kapesa, Sailoki
AU - Munge, Kenneth
AU - Bauni, Evasius
AU - Cruickshank, J. Kennedy
AU - Smeeth, Liam
AU - Scott, J. Anthony G.
PY - 2016/12/15
Y1 - 2016/12/15
N2 - 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.
AB - 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.
U2 - 10.1161/JAHA.116.004797
DO - 10.1161/JAHA.116.004797
M3 - Article
SN - 2047-9980
VL - 5
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e004797
ER -