Abstract P192: Implications of a Simplified Hypertension Screening Approach for Low-and Middle-Income Countries

Abstract

Background: In low- and middle- income settings, standardized protocols that require triplicate blood pressure (BP) readings pose substantial logistical barriers to hypertension (HTN) screening. We assessed algorithms using fewer measurements. Methods: We evaluated the efficiency, % HTN missed and % misdiagnosed as HTN associated with algorithms based on the 1st and/or 2nd measurements. For reference, we defined HTN as recommended by the WHO, i.e. average of 2nd and 3rd BP ≥ 140/90. We focused on 11,999 and 7,382 adults without anti-HTN medication use in Nepal and India, respectively, from May Measurement Month 2017-2018 and contrasted them with 21,751 from the US National Health and Nutrition Examination Survey 1999-2014. Results: The prevalence of HTN was 18.8% in Nepal, 27.0% in India, and 10.2% in the US. Using only the 1st BP, 7.8%, 11.7%, and 10.1% of cases would be missed in each country respectively. The % of misdiagnosed HTN would be 9.9%, 9.4%, and 4.2%, respectively. Using a 2nd BP among those with a 1 st BP ≥ 135/85 (“Two-Step Simple”) missed fewer cases (4.7%, 9.4%, and 7.7%), and misdiagnosed fewer people (2.8%, 3.5%, and 1.6%). Under this approach, 36.3%, 44.1%, and 18.7% would receive a 2 nd BP reading. Alternative, more complex, algorithms were able to further minimize misclassification and improve efficiency ( Table ). Conclusions: Using screening data from Nepal, India, and the US, we found several algorithms based on <3 BP readings had low misclassification rates. These algorithms reduce the total number of measurements by more than half from the standard triplicate protocol and appear to be practical for large-scale screening in resource-constrained settings.