Acceptance of ambulatory blood pressure monitoring in a semi-rural population in South Africa.

Farisai Chiwanza,Yoland Irwin,Ros Dowse

doi:10.4102/hsag.v25i0.1336

Abstract

BackgroundAmbulatory blood pressure monitoring is a valuable tool that helps in providing an insight into the diagnosis and management of hypertension; however, no evidence exists of its acceptance in the diverse South African population.AimWe assessed the acceptance of an ambulatory blood pressure monitor in patients attending public sector primary health care (PHC) clinics.SettingFive PHC clinics in the Makana subdistrict in the Eastern Cape.MethodA cross-sectional study was conducted with 70 hypertensive patients. Eligible patients were between 40 and 75 years old, taking either enalapril and hydrochlorothiazide or enalapril, hydrochlorothiazide and amlodipine. Socio-demographic, clinical and acceptance data were collected. The monitor cuff remained in place for 24 h. Acceptance was assessed after the monitor was removed. An overall acceptance score was generated to classify acceptance as either good or poor.ResultsThe mean years of schooling was 5.9 years, with 22 reporting no school attendance. Generally, acceptance was good, with 70% of the population rating the technique as ‘acceptable’ (acceptance score of > 23/30). Most participants reported minimal discomfort with only 13.3% reporting that it hindered normal daily activities. Night readings interrupted sleep in 43%, with extreme sleep disturbance (≥ 3 awakenings) reported in just over half the patients. Increased years of schooling was the only variable associated with acceptance score (r = −0.243, p = 0.042).ConclusionAmbulatory blood pressure monitoring was generally well-accepted, with few adverse effects being reported. Use of this technique at PHC facilities could reduce the incidence of misdiagnosis and uncontrolled hypertension.

Highlights

South Africa faces multiple health challenges, characterised by a quadruple burden of diseases with the burden fast shifting towards chronic non-communicable diseases (NCDS) (Bygbjerg 2012)
Participants reported that the Ambulatory blood pressure monitoring (ABPM) process, which included interacting with the researcher, improved their insight into hypertension and motivated adherence to treatment, in spite of some of the discomforts experienced
We found no significant associations between ABPM acceptance and gender, age, height, weight, BMI, arm circumference, office blood pressure (BP), 24-h ABPM profile or adverse effects or inconveniences of wearing the monitor

Summary

Introduction

South Africa faces multiple health challenges, characterised by a quadruple burden of diseases with the burden fast shifting towards chronic non-communicable diseases (NCDS) (Bygbjerg 2012). Hypertension is a major contributor to cardiovascular complications in South Africa. The South African Health Review 2018 reported a national prevalence of 28.2% (both sexes) for these complications, and the numbers continue to rise with the increase in the prevalence of the condition in younger patient groups over the years (Gray & Vawda 2018). In response to the rapidly escalating epidemic, South Africa identified hypertension as a priority disease, which is one of the most commonly treated conditions at primary health care (PHC) facilities (Day et al 2014; National Department of Health 1998). In spite of the implementation of national clinical guidelines for the diagnosis and management of hypertension at the PHC level, the condition continues to be under-diagnosed, resulting in a number of patients remaining untreated (Addo, Smeeth & Leon 2007). Ambulatory blood pressure monitoring is a valuable tool that helps in providing an insight into the diagnosis and management of hypertension; no evidence exists of its acceptance in the diverse South African population

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