The effect of population-based blood pressure screening on long-term cardiometabolic morbidity and mortality in Germany: A regression discontinuity analysis
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Published on: January 8, 2020
Sara Pedron1,2,3, Michael Hanselmann1, Jacob Burns1,4,5
1Professorship of Public Health & Prevention, Technical University of Munich, Munich, Germany.
Insights
A population-based blood pressure screening and information treatment did not reduce cardiovascular disease mortality or morbidity. Further research with larger datasets is needed to confirm these findings on hypertension management.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Epidemiology
Background:
- Hypertension is a major global risk factor for cardiovascular morbidity and mortality.
- Early detection and treatment are crucial but often inadequate.
- Simple, effective interventions are needed to improve hypertension management.
Purpose of the Study:
- To investigate the impact of population-based blood pressure screening and subsequent low-threshold information treatment on long-term cardiovascular disease (CVD) morbidity and mortality.
- To assess the effect on intermediate outcomes like hypertension awareness, blood pressure, and behavior.
Main Methods:
- Utilized a regression discontinuity design on pooled data from the KORA study (1984-1996, N=14,592).
- Examined CVD mortality and morbidity over 16.9 years following screening and information treatment.
- Assessed intermediate outcomes after 7 years.
Main Results:
- No significant effect of the screening and information treatment on CVD mortality (HR=1.172) or long-term CVD events (HR=1.022).
- Intermediate outcomes, including hypertension awareness, were also unaffected.
- Results require cautious interpretation due to potential lack of statistical power.
Conclusions:
- The study found no evidence that the assessed blood pressure screening and information intervention impacts blood pressure, health behavior, or long-term CVD outcomes.
- Larger datasets are recommended for future studies to detect potential intervention effects.
- Shorter follow-up periods for intermediate outcomes are suggested to capture short-, medium-, and long-term effects.
Background:
Hypertension represents one of the major risk factors for cardiovascular morbidity and mortality globally. Early detection and treatment of this condition is vital to prevent complications. However, hypertension often goes undetected, and even if detected, not every patient receives adequate treatment. Identifying simple and effective interventions is therefore crucial to fight this problem and allow more patients to receive the treatment they need. Therefore, we aim at investigating the impact of a population-based blood pressure (BP) screening and the subsequent "low-threshold" information treatment on long-term cardiovascular disease (CVD) morbidity and mortality.
Methods And Findings:
We examined the impact of a BP screening embedded in a population-based cohort study in Germany and subsequent personalized "light touch" information treatment, including a hypertension diagnosis and a recommendation to seek medical attention. We pooled four waves of the KORA study, carried out between 1984 and 1996 (N = 14,592). Using a sharp multivariate regression discontinuity (RD) design, we estimated the impact of the information treatment on CVD mortality and morbidity over 16.9 years. Additionally, we investigated potential intermediate outcomes, such as hypertension awareness, BP, and behavior after 7 years. No evidence of effect of BP screening was observed on CVD mortality (hazard ratio (HR) = 1.172 [95% confidence interval (CI): 0.725, 1.896]) or on any (fatal or nonfatal) long-term CVD event (HR = 1.022 [0.636, 1.641]) for individuals just above (versus below) the threshold for hypertension. Stratification for previous self-reported diagnosis of hypertension at baseline did not reveal any differential effect. The intermediate outcomes, including awareness of hypertension, were also unaffected by the information treatment. However, these results should be interpreted with caution since the analysis might not be sufficiently powered to detect a potential intervention effect.
Conclusions:
The study does not provide evidence of an effect of the assessed BP screening and subsequent information treatment on BP, health behavior, or long-term CVD mortality and morbidity. Future studies should consider larger datasets to detect possible effects and a shorter follow-up for the intermediate outcomes (i.e., BP and behavior) to detect short-, medium-, and long-term effects of the intervention along the causal pathway.
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