Impact of one or two visits strategy on hypertension burden estimation in HYDY, a population-based cross-sectional study: implications for healthcare resource allocation decision making

Modesti, Pietro Amedeo; Rapi, Stefano; Bamoshmoosh, Mohamed; Baldereschi, Marzia; Massetti, Luciano; Padeletti, Luigi; Gensini, Gian Franco; Zhao, Dong; Al-Hidabi, Dawood Abdulmalek Yahya; Goshae, Husni Al

doi:10.1136/bmjopen-2012-001062

Cited by 30 publications

(48 citation statements)

References 21 publications

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“…25 Hypertension rates were 35% lower at the second visit compared with the first. Furthermore, those who would have been treated for hypertension based on their first visit recordings, but not their second, were found to have a lower cardiovascular disease risk score.…”

Section: Discussionmentioning

confidence: 92%

Ambulatory Blood Pressure Monitoring to Assess the White‐Coat Effect in an Elderly East African Population

Ivy

Tam

Dewhurst

et al. 2015

J of Clinical Hypertension

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5The authors hypothesized that published hypertension rates in Tanzania were influenced by the physiological response of individuals to blood pressure (BP) testing, known as the white-coat effect (WCE). To test this, a representative sample of 79 participants from a baseline cohort of 2322 people aged 70 years and older were followed to assess BP using conventional BP measurement (CBPM) and ambulatory BP monitoring (ABPM). There was a significant difference between daytime ABPM and CBPM for both systolic BP (mean difference 29.7 mm Hg) and diastolic BP (mean difference 7.4 mm Hg). Rates of hypertension were significantly lower when measured by 24-hour ABPM (55.7%) than by CBPM (78.4%). The WCE was observed in 54 participants (68.4%). The WCE was responsible for an increase in recorded BP. Accurate identification of individuals in need of antihypertensive medication is important if resources are to be used efficiently, especially in resource-poor settings. J Clin Hypertens (Greenwich). 2015;17:389-394. ª 2015 Wiley Periodicals, Inc.Globally, hypertension is a major cause of disability and early mortality.1-3 Previous reports of the prevalence of hypertension in sub-Saharan Africa (SSA) have indicated it to be at least as common as in many highincome regions.4,5 A recent study by members of our team revealed the prevalence of hypertension to be 69.9% in persons aged 70 years and older in rural Tanzania.6 Furthermore, few of those who had hypertension had been previously diagnosed, and effective hypertension control was rare.In most previously published studies of hypertension in SSA, conventional blood pressure measurement (CBPM) has been used to assess blood pressure (BP). However, the white-coat effect (WCE), first observed by Mancia and colleagues in 1983, 8 can lead to falsely elevated recorded BP values and mistaken diagnoses of hypertension, known as white-coat hypertension (WCH).9 WCH is thought to be present in 15% to 30% of people diagnosed with hypertension based on CBPM. 10The use of ambulatory BP monitoring (ABPM) can overcome many of the problems of CBPM. ABPM readings are normally taken over a 24-hour period, with the participant wearing a cuff and data recorded digitally. The use of ABPM is recommended by the National Institute for Health and Clinical Excellence in the United Kingdom for anyone with a CBPM ≥140/90 mm Hg. 11South African hypertension guidelines have been developed and recommend the use of ABPM in some situations.12 However, the impracticalities and cost of regular ABPM in resource-poor settings is acknowledged.Previous studies using ABPM to assess populations from SSA are few. Millen and colleagues 13 used ABPM to assess the relationship between BP, salt intake, and insulin resistance in a cohort of 331 patients from South Africa. In 2014, Polonia and colleagues 14 published a study comparing ABPM findings in untreated hypertensives living in Mozambique and Europe. Those in Mozambique were found to have higher BP, with a notably lower nighttime fall, than patients in Europe. Howev...

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Section: Discussionmentioning

confidence: 92%

Ambulatory Blood Pressure Monitoring to Assess the White‐Coat Effect in an Elderly East African Population

Ivy

Tam

Dewhurst

et al. 2015

J of Clinical Hypertension

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“…13 Furthermore, the possibility to focus antihypertensive treatment on high-risk subjects might thus have potential implications for health-care resource allocation in low-resource settings. 14 …”

Section: Introductionmentioning

confidence: 99%

Relationship between hypertension, diabetes and proteinuria in rural and urban households in Yemen

et al. 2013

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Little information is available on the meanings of proteinuria in low-resource settings. A population-based, cross-sectional survey was performed in Yemen on 10 242 subjects aged 15–69 years, stratified by age, gender and urban/rural residency. Hypertension is defined as systolic blood pressure (BP) of ⩾140 mm Hg and/or diastolic BP of ⩾90 mm Hg, and/or self-reported use of antihypertensive drugs; diabetes is diagnosed as fasting glucose of ⩾126 mg dl−1 or self-reported use of hypoglycaemic medications; proteinuria is defined as ⩾+1 at dipstick urinalysis. Odds ratios (ORs) for associations were determined by multivariable logistic regression models. Prevalence (weighted to the Yemen population aged 15–69 years) of hypertension, diabetes and proteinuria were 7.5, 3.7 and 5.1% in urban, and 7.8, 2.6 and 7.3% in rural locations, respectively. Proteinuria and hypertension were more prevalent among rural dwellers (adjusted ORs 1.56; 95% confidence limit (Cl) 1.31–1.86, and 1.23; 1.08–1.41, respectively), diabetes being less prevalent in rural areas (0.70; 0.58–0.85). Differently from hypertension and diabetes, proteinuria was inversely related with age. Most importantly, 4.6 and 6.1% of urban and rural dwellers, respectively, had proteinuria in the absence of hypertension and diabetes. The approach of considering kidney damage as a consequence of hypertension and diabetes might limit the effectiveness of prevention strategies in low-income countries.

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“…The importance of conducting an epidemiological study throughout a whole year, or at least to declare the exact timing of the study in the final report, is indeed not always given due importance. A recent large epidemiological survey aimed at assessing hypertension burden at the population level, BP is the main factor guiding cardiovascular (CV) risk stratification, including the measurement of temperature as one of the parameters investigated 5. In the Hypertension and Diabetes in Yemen (HYDY) study, an increase of 1°C in air temperature reduced hypertension with an OR of 0.98 (95% confidence limits: 0.96–0.99) at logistic regression analyses adjusted for age, gender, education and average air temperature at the two survey visits 5…”

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confidence: 99%

“…As a consequence, at the patient level, only a low value in winter can thus be considered a low ‘yearly’ value, whereas a low value in summer does not mean a low value in winter. At the population level, seasonal differences may be important because CV risk estimation plays a key role in the efficient allocation of resources 5. This aspect is especially important for low-income countries, but any speculation is limited by the small number of studies carried out in the Southern Hemisphere, and by the absence of studies investigating populations from Asia, Africa and South America 6…”

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confidence: 99%

The hazard of rounding Cape Horn: is it changing?

Modesti

2014

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…he who goes the oftenest round Cape Horn goes the most circumspectly.Herman Melville, "White-Jacket", 1850Notwithstanding the range of strategies to help one cope with the cold weather, most countries experience mortalities in excess of 5-30% in winter, brought on mainly by cerebrovascular events. 1 This variability is mainly attributed to the population being able to keep themselves warm, both indoors and outdoors, necessitated by the mean cold temperature. Policies and measures to increase efficient use of energy indoors, coupled with advice to citizens suggesting to wear adequate warm protective clothing and to keep themselves active when out in the open, have been thus promoted. The elderly are aware of the risks, and traditionally perceive winter as a rounding of Cape Horn.Consequently, the result of exposure to acute cold may trigger vasoconstriction, with a rise in blood pressure (BP), and myocardial ischaemia in patients with coronary artery disease. This acute response is considered in all guidelines on BP measurement which recommend the importance of standardised room temperature when assessing BP values. However, a negative relationship between outdoor temperature and BP values was consistently observed even when measurements were taken in comfortably warm rooms. 2 In the French Three-City study 3 that prospectively investigated 8801 participants over the age of 65 years, average systolic BP was 5 mm Hg higher in winter than in summer. This variation was independent of anthropometric data and baseline BP values, but rather related to the subjects' age. Variations in BP were greater in subjects 80 years of age or older, than in younger participants. In the reanalysis of data collected in the World Health Organization Monica Project (monitoring trends and determinants in cardiovascular disease) risk factors surveys, 4 including 25 populations in 16 countries (115 434 participants aged 35-64 years) the effect of outdoor temperature remained after controlling for indoor temperature, as a 1°C increase in outdoor temperature reducing BP values by 0.14 mm Hg (95% Cl −0.23 to −0.05, adjusted for indoor temperature). Conversely, the effects of the winter season disappeared after controlling for outdoor temperature, suggesting that a major component of the seasonal change in BP was the direct result of temperature. 4 As physicians, we often have to deal with the effects of temperature in treating hypertensive patients even during summer, when we encounter the potential implications of falls or acute renal failure caused by a marked reduction in BP especially in the elderly. As a consequence, (although not considered in hypertension guidelines) physicians often resort to seasonal adaptation of antihypertensive drugs in their clinical practice.The influence of temperature, or at least seasonality, is conversely less considered in epidemiological studies investigating the burden of risk factors in populations. The importance of conducting an epidemiological study throughout a whole year, or at least to declare the...

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Impact of one or two visits strategy on hypertension burden estimation in HYDY, a population-based cross-sectional study: implications for healthcare resource allocation decision making

Cited by 30 publications

References 21 publications

Ambulatory Blood Pressure Monitoring to Assess the White‐Coat Effect in an Elderly East African Population

Ambulatory Blood Pressure Monitoring to Assess the White‐Coat Effect in an Elderly East African Population

Relationship between hypertension, diabetes and proteinuria in rural and urban households in Yemen

The hazard of rounding Cape Horn: is it changing?

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