Simplified hypertension screening methods across 60 countries: An observational study.
<h4>Background</h4>Simplified blood pressure (BP) screening approaches have been proposed. However, evidence is limited to a few countries and has not documented the cardiovascular risk amongst missed hypertension cases, limiting the uptake of these simplified approaches. We quantified t...
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Public Library of Science (PLoS)
2022-04-01
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| Series: | PLoS Medicine |
| Online Access: | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1003975&type=printable |
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| author | Rodrigo M Carrillo-Larco Wilmer Cristobal Guzman-Vilca Dinesh Neupane |
| author_facet | Rodrigo M Carrillo-Larco Wilmer Cristobal Guzman-Vilca Dinesh Neupane |
| author_sort | Rodrigo M Carrillo-Larco |
| collection | DOAJ |
| description | <h4>Background</h4>Simplified blood pressure (BP) screening approaches have been proposed. However, evidence is limited to a few countries and has not documented the cardiovascular risk amongst missed hypertension cases, limiting the uptake of these simplified approaches. We quantified the proportion of missed, over-diagnosed, and consistently identified hypertension cases and the 10-year cardiovascular risk in these groups.<h4>Methods and findings</h4>We used 60 WHO STEPS surveys (cross-sectional and nationally representative; n = 145,174) conducted in 60 countries in 6 world regions between 2004 and 2019. Nine simplified approaches were compared against the standard (average of the last 2 of 3 BP measurements). The 10-year cardiovascular risk was computed with the 2019 World Health Organization Cardiovascular Risk Charts. We used t tests to compare the cardiovascular risk between the missed and over-diagnosed cases and the consistent hypertension cases. We used Poisson multilevel regressions to identify risk factors for missed cases (adjusted for age, sex, body mass index, and 10-year cardiovascular risk). Across all countries, compared to the standard approach, the simplified approach that missed the fewest cases was using the second BP reading if the first BP reading was 130-145/80-95 mm Hg (5.62%); using only the second BP reading missed 5.82%. The simplified approach with the smallest over-diagnosis proportion was using the second BP reading if the first BP measurement was ≥140/90 mm Hg (3.03%). In many countries, cardiovascular risk was not significantly different between the missed and consistent hypertension groups, yet the mean was slightly lower amongst missed cases. Cardiovascular risk was positively associated with missed hypertension depending on the simplified approach. The main limitation of the work is the cross-sectional design.<h4>Conclusions</h4>Simplified BP screening approaches seem to have low misdiagnosis rates, and cardiovascular risk could be lower amongst missed cases than amongst consistent hypertension cases. Simplified BP screening approaches could be included in large screening programmes and busy clinics. |
| format | Article |
| id | doaj-art-c8632e6a37d54062b594cefe00927548 |
| institution | Kabale University |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2022-04-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-c8632e6a37d54062b594cefe009275482025-08-20T03:46:25ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762022-04-01194e100397510.1371/journal.pmed.1003975Simplified hypertension screening methods across 60 countries: An observational study.Rodrigo M Carrillo-LarcoWilmer Cristobal Guzman-VilcaDinesh Neupane<h4>Background</h4>Simplified blood pressure (BP) screening approaches have been proposed. However, evidence is limited to a few countries and has not documented the cardiovascular risk amongst missed hypertension cases, limiting the uptake of these simplified approaches. We quantified the proportion of missed, over-diagnosed, and consistently identified hypertension cases and the 10-year cardiovascular risk in these groups.<h4>Methods and findings</h4>We used 60 WHO STEPS surveys (cross-sectional and nationally representative; n = 145,174) conducted in 60 countries in 6 world regions between 2004 and 2019. Nine simplified approaches were compared against the standard (average of the last 2 of 3 BP measurements). The 10-year cardiovascular risk was computed with the 2019 World Health Organization Cardiovascular Risk Charts. We used t tests to compare the cardiovascular risk between the missed and over-diagnosed cases and the consistent hypertension cases. We used Poisson multilevel regressions to identify risk factors for missed cases (adjusted for age, sex, body mass index, and 10-year cardiovascular risk). Across all countries, compared to the standard approach, the simplified approach that missed the fewest cases was using the second BP reading if the first BP reading was 130-145/80-95 mm Hg (5.62%); using only the second BP reading missed 5.82%. The simplified approach with the smallest over-diagnosis proportion was using the second BP reading if the first BP measurement was ≥140/90 mm Hg (3.03%). In many countries, cardiovascular risk was not significantly different between the missed and consistent hypertension groups, yet the mean was slightly lower amongst missed cases. Cardiovascular risk was positively associated with missed hypertension depending on the simplified approach. The main limitation of the work is the cross-sectional design.<h4>Conclusions</h4>Simplified BP screening approaches seem to have low misdiagnosis rates, and cardiovascular risk could be lower amongst missed cases than amongst consistent hypertension cases. Simplified BP screening approaches could be included in large screening programmes and busy clinics.https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1003975&type=printable |
| spellingShingle | Rodrigo M Carrillo-Larco Wilmer Cristobal Guzman-Vilca Dinesh Neupane Simplified hypertension screening methods across 60 countries: An observational study. PLoS Medicine |
| title | Simplified hypertension screening methods across 60 countries: An observational study. |
| title_full | Simplified hypertension screening methods across 60 countries: An observational study. |
| title_fullStr | Simplified hypertension screening methods across 60 countries: An observational study. |
| title_full_unstemmed | Simplified hypertension screening methods across 60 countries: An observational study. |
| title_short | Simplified hypertension screening methods across 60 countries: An observational study. |
| title_sort | simplified hypertension screening methods across 60 countries an observational study |
| url | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1003975&type=printable |
| work_keys_str_mv | AT rodrigomcarrillolarco simplifiedhypertensionscreeningmethodsacross60countriesanobservationalstudy AT wilmercristobalguzmanvilca simplifiedhypertensionscreeningmethodsacross60countriesanobservationalstudy AT dineshneupane simplifiedhypertensionscreeningmethodsacross60countriesanobservationalstudy |