Clinical and Epidemiological Implications of 24-Hour Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Kenyan Adults: A Population-Based Study

被引:15
作者
Etyang, Anthony O. [1 ,2 ]
Warne, Ben [1 ]
Kapesa, Sailoki [1 ]
Munge, Kenneth [1 ]
Bauni, Evasius [1 ]
Cruickshank, J. Kennedy [3 ]
Smeeth, Liam [2 ]
Scott, J. Anthony G. [1 ,2 ]
机构
[1] KEMRI Wellcome Trust Res Programme, Kilifi, Kenya
[2] London Sch Hyg & Trop Med, London, England
[3] Kings Coll London, London, England
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2016年 / 5卷 / 12期
基金
英国惠康基金;
关键词
ambulatory blood pressure monitoring; diagnostic accuracy; hypertension; masked hypertension; sub-Saharan Africa; white coat hypertension; ARTERIAL STIFFNESS INDEX; SUB-SAHARAN AFRICA; MASKED HYPERTENSION; EUROPEAN-SOCIETY; PREVALENCE; INTERVALS; ACCURACY; DISEASE; BURDEN; HEALTH;
D O I
10.1161/JAHA.116.004797
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 approximate to 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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页数:9
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