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Comparison of community and clinic-based blood pressure measurements: A cross-sectional study from Haiti
Caleigh E Smith1, Miranda Metz1, Jean Lookens Pierre2
1Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America.
Insights
Community blood pressure (BP) screening accurately identifies hypertension (HTN) in low-income settings. This study found community BP measurements are feasible and comparable to clinic readings for assessing cardiovascular disease risk.
Area of Science:
- Cardiovascular Disease Epidemiology
- Public Health Interventions
- Health Disparities
Background:
- Hypertension (HTN) is a primary modifiable risk factor for cardiovascular disease (CVD) in low and middle-income countries.
- Accessible blood pressure (BP) measurement is crucial for identifying at-risk individuals.
- Community-based screening programs offer a convenient approach in resource-limited settings.
Purpose of the Study:
- To compare community and clinic blood pressure (BP) measurements in the Haiti CVD Cohort Study.
- To assess the concordance between community and clinic BP measurements for hypertension (HTN) detection.
- To identify factors associated with agreement or disagreement in BP measurements across settings.
Main Methods:
- Multistage random sampling recruited 2,123 participants from March 2019 to August 2021.
- Hypertension (HTN) defined using WHO guidelines (SBP ≥ 140mmHg or DBP ≥ 90mmHg, or antihypertensive use).
- Multivariable Poisson regressions analyzed factors associated with measurement concordance/discordance.
Main Results:
- Community BP screening identified 36% of participants with HTN, versus 30% with clinic BP.
- High correlation observed between clinic and community SBP (0.78) and DBP (0.77).
- Majority showed concordant results (59% normotension, 26% HTN); 10% had isolated elevated community BP.
Conclusions:
- Community BP measurements are a feasible and accurate method for hypertension screening.
- This approach can enhance HTN detection and prevalence estimation in vulnerable populations facing clinic access barriers.
- Community screening supports public health efforts to manage cardiovascular disease risk factors globally.
Abstract:
Hypertension (HTN) is the leading modifiable cardiovascular disease (CVD) risk factor in low and middle-income countries, and accurate and accessible blood pressure (BP) measurement is essential for identifying persons at risk. Given the convenience and increased use of community BP screening programs in low-income settings, we compared community and clinic BP measurements for participants in the Haiti CVD Cohort Study to determine the concordance of these two measurements. Participants were recruited using multistage random sampling from March 2019 to August 2021. HTN was defined as systolic BP (SBP) ≥ 140mmHg, diastolic BP (DBP) ≥ 90mmHg or taking antihypertensives according to WHO guidelines. Factors associated with concordance versus discordance of community and clinic BP measurements were assessed with multivariable Poisson regressions. Among 2,123 participants, median age was 41 years and 62% were female. Pearson correlation coefficients for clinic versus community SBP and DBP were 0.78 and 0.77, respectively. Using community BP measurements, 36% of participants screened positive for HTN compared with 30% using clinic BPs. The majority of participants had concordant measurements of normotension (59%) or HTN (26%) across both settings, with 4% having isolated elevated clinic BP (≥140/90 in clinic with normal community BP) and 10% with isolated elevated community BP (≥140/90 in community with normal clinic BP). These results underscore community BP measurements as a feasible and accurate way to increase HTN screening and estimate HTN prevalence for vulnerable populations with barriers to clinic access.
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