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Diagnostic Performance of Unattended Automated Office Blood Pressure Measurement for Hypertension Screening Among
Ruth K Lucinde1, Megan Willkens2, Benson Issarow3
1Department of Epidemiology and Demography KEMRI-Wellcome Trust Research Programme Kilifi Kenya.
Insights
Automated office blood pressure (AOBP) may misdiagnose hypertension in over half of people with HIV (PWH) and people without HIV (PWoH) in sub-Saharan Africa. This screening method lacks sufficient accuracy for effective hypertension diagnosis in these populations.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Hypertension screening in people with HIV (PWH) is crucial but diagnostic performance of automated office blood pressure (AOBP) remains unknown.
- Sub-Saharan Africa faces a high burden of hypertension, necessitating accurate diagnostic tools.
Purpose of the Study:
- To evaluate the diagnostic performance of unattended AOBP in screening for hypertension among PWH compared to people without HIV (PWoH).
- To assess the prevalence of hypertensive diagnostic phenotypes using 24-hour ambulatory blood pressure monitoring (ABPM) as a reference standard.
Main Methods:
- Cross-sectional analysis of baseline data from the Mwanza HIV&CVD cohort study.
- Unattended AOBP and 24-hour ABPM were conducted on PWH and PWoH.
- Diagnostic performance metrics were calculated using average 24-hour BP as the reference standard.
Main Results:
- The study included 959 participants (50.4% PWH). Hypertension prevalence (35.3%) and masked hypertension (25.7% in PWH, 26.7% in PWoH) did not differ by HIV status.
- The sensitivity of unattended AOBP for hypertension was low and similar in both groups (25.7%).
- Isolated nocturnal hypertension was observed in 24.2% of PWH and 21.6% of PWoH.
Conclusions:
- Unattended AOBP alone may lead to misdiagnosis of hypertension in over half of individuals, irrespective of HIV status, in sub-Saharan Africa.
- Current AOBP screening methods are insufficient for accurate hypertension diagnosis in this population.
- Further research into validated hypertension screening tools for PWH is warranted.
Background:
The diagnostic performance of automated office blood pressure (AOBP) in screening for hypertension in people with HIV (PWH) is not known.
Methods:
We conducted a cross-sectional analysis of baseline data from PWH and people without HIV (PWoH) from the Mwanza HIV&CVD cohort study. We conducted unattended AOBP and 24-hour ambulatory BP monitoring as recommended by international guidelines. Using average 24-hour BP as the reference standard, we estimated the prevalence of hypertensive diagnostic phenotypes and calculated measures of diagnostic performance at different diagnostic cutoffs in participants.
Results:
We included 959 participants (50.4% PWH and 49.6% PWoH). Characteristics were similar across participant groups. The median age was 44 years (interquartile range, 38-50 years), and 69.8% were women. Overall prevalence of hypertension, based on average 24-hour ambulatory BP monitoring, was 35.3% using European Society of Hypertension cutoffs and did not differ by HIV infection status. Masked hypertension was present in 25.7% (95% CI, 22.0%-29.8%) of PWH and 26.7% (95% CI, 22.9%-30.8%) of PWoH. The sensitivity of unattended AOBP was 25.7% for PWH (95% CI, 19.3%-33.1%) and 25.7% for PWoH (95% CI, 19.4%-33.0%) with little difference in the area under the receiver-operating curve by HIV infection status. Based on 24-hour BP averages, 24.2% of PWH and 21.6% of PWoH had isolated nocturnal hypertension.
Conclusions:
More than half of individuals with hypertension on ambulatory BP monitoring, irrespective of their HIV infection status, may be misdiagnosed if unattended AOBP alone is used to screen for hypertension in sub-Saharan Africa.
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