Underdiagnosis Of Hypertension Research Articles

Improving the accuracy of blood pressure measuring devices in Australia: a modelled return on investment study

The VALID BP project was initiated to increase the availability of validated blood pressure measuring devices (BPMDs). The goal is to eliminate non validated BPMDs and minimise over- and underdiagnosis of hypertension caused by inaccurate readings. This study was undertaken to assess the potential return on investment in the VALID BP project. The Framework to Assess the Impact of Translational Health Research was applied to the VALID BP project. This paper focuses on the implementation of the cost benefit analysis aspect of this framework to monetise past research investment and model future research costs, implementation costs, and benefits. Analysis was based on reasoned assumptions about potential impacts from availability and use of validated BPMDs (assuming an end goal of 100% validated BPMDs available in Australia by 2028) and improved skills leading to more accurate BP measurement. After 5 years, with 20% attribution of benefits, there is a potential $1.14–$1.30 return for every dollar spent if the proportion of validated BPMDs and staff trained in proper BP measurement technique increased from 20% to 60%. After eight years (2020–2028) and assuming universal validation and training coverage, the returns would be between $2.70 and $3.20 per dollar spent (not including cost of side effects of unnecessary medication or downstream patient impacts from unmanaged hypertension). This modelled economic analysis indicates there will be positive downstream economic benefits if the availability of validated BPMDs is increased. The findings support ongoing efforts toward a universal regulatory framework for BPMDs and can be considered within more detailed future economic analyses.

Urbanization and Inequality in Hypertension Diagnosis and Medication in Indonesia

Urbanization has been progressing quickly in Indonesia and the consequences on health and health inequities are still not well understood. In this paper, we present new empirical evidence on the differences in the utilization of health care services between rural and urban areas as well as for the respective health inequities. Exploiting the rich data set of the Indonesian Family Life Survey, this paper measures the socioeconomic inequality of health care utilization for the case of the diagnosis of hypertension and its medication. In the Indonesian Family Life Survey, about 45% of all respondents over the age of 39 were found to suffer from hypertension (average systolic blood pressure higher than 140). However, more than half of the people with hypertension have never been diagnosed by a health care professional, and only a small fraction of the people suffering from hypertension are taking medicine for it. Our analysis further shows that diagnosis and medication rates are significantly higher in urban areas than in rural areas, implying that urban areas offer better access to health care services and medicines. Calculating concentration indices, we find that under-diagnosis of hypertension is more prevalent among the poor and this health inequality is more pronounced in rural areas. For the case of medication, we are unable to detect strong evidence of inequality either in rural or urban areas, as most Indonesians with hypertension do not take medicine irrespective of their socioeconomic status. Finally, decomposition analysis shows that the inequality in education, living standards, sanitary conditions, and the possession of vehicle and home appliances can explain a large fraction of the inequality of diagnosis and medication.

A Comparison of Casual In-Clinic Blood Pressure Measurements to Standardized Guideline-Concordant Measurements in Severely Obese Individuals.

Background/Objectives. The objective of this study was to compare casual BP taken in a bariatric clinic to standardized guideline-concordant BP. Subjects/Methods. A cross sectional analysis was performed using baseline data from a weight management trial. Patients were recruited from a Canadian bariatric care program. Standardized BP was performed using a Watch BP oscillometric device. Casual in-clinic BP single readings, taken using a Welch Allyn oscillometric device, were chart-abstracted. Paired t-tests, Bland-Altman plots, and Pearson's correlations were used for analysis. Results. Data from 134 patients were analyzed. Mean age was 41.5 ± 8.9 y, mean BMI was 46.8 ± 6.5 kg/m2, and 40 (30%) had prior hypertension. Mean casual in-clinic BP was 128.8 ± 14.1/81.6 ± 9.9 mmHg and mean standardized BP was 133.2 ± 15.0/82.0 ± 10.3 mmHg (difference of −4.3 ± 12.0 for systolic (p < 0.0001) and −0.4 ± 10.0 mmHg for diastolic BP (p = 0.6)). Pearson's coefficients were 0.66 (p < 0.0001) for SBP and 0.50 (p < 0.0001) for DBP. 28.4% of casual versus 26.9% of standardized measurements were ≥140/90 mmHg (p < 0.0001). Conclusion. In this bariatric clinic, casual BP was unexpectedly lower than standardized BP. This could potentially lead to the underdiagnosis of hypertension.

Hypertension in South African adults

To evaluate the age-specific, sex-specific, and race-specific prevalence of hypertension among South African adults using a nationally representative dataset. Data from the 59 227 adults (ages 18 and older) who participated in the 2010 South African General Household Survey (GHS) were analyzed using age-adjusted logistic regression models and direct age standardization. The weighted prevalence of self-reported diagnosis of hypertension by a health professional was 10.4%. The prevalence of hypertension increased significantly with age for both men and women. For black African, coloured, and Indian/Asian populations, the prevalence of hypertension in women was about twice the prevalence for men, with the gap narrowing for older adults. For white South Africans, the age-standardized rates were not significantly different by sex. The highest age-standardized diagnosed hypertension rates were for coloured women and black African women; the lowest age-standardized rates were for black African men and Indian/Asian men. In total, 94% of those reporting a diagnosis of hypertension reported taking antihypertensive medications. There is a significant burden from hypertension in South Africa, especially as the under-diagnosis of hypertension may mean that the GHS underestimates the true rate of high blood pressure in the population.

Underdiagnosis of Hypertension in Children and Adolescents

Underdiagnosis of Hypertension in Children and Adolescents

Underdiagnosis of Hypertension in Children and Adolescents

Pediatric hypertension is increasing in prevalence with the pediatric obesity epidemic. Diagnosis of hypertension in children is complicated because normal and abnormal blood pressure values vary with age, sex, and height and are therefore difficult to remember. To determine the frequency of undiagnosed hypertension and prehypertension and to identify patient factors associated with this underdiagnosis. A cohort study of 14,187 children and adolescents aged 3 to 18 years who were observed at least 3 times for well-child care between June 1999 and September 2006 in the outpatient clinics in a large academic urban medical system in northeast Ohio. For children and adolescents who met criteria for hypertension or prehypertension at 3 or more well-child care visits, the proportion with a hypertension-related International Classification of Diseases, Ninth Revision code in the diagnoses list, problem list, or past medical history list of any visit was determined. Proportion of children and adolescents with 3 or more elevated age-adjusted and height-adjusted blood pressure measurements at well-child care visits and with a diagnosis of hypertension or prehypertension documented in the electronic medical record. Multivariate logistic regression identified patient factors associated with a correct diagnosis. Of 507 children and adolescents (3.6%) who had hypertension, 131 (26%) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record. Patient factors that increased the adjusted odds of a correct diagnosis were a 1-year increase in age over age 3 (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.16), number of elevated blood pressure readings beyond 3 (OR, 1.77; 95% CI, 1.21-2.57), increase of 1% in height-for-age percentile (OR, 1.02; 95% CI, 1.01-1.03), having an obesity-related diagnosis (OR, 2.61; 95% CI, 1.49-4.55), and number of blood pressure readings in the stage 2 hypertension range (OR, 1.68; 95% CI, 1.29-2.19). Of 485 children and adolescents (3.4%) who had prehypertension, 55 (11%) had an appropriate diagnosis documented in the electronic medical record. Patient factors that increased the adjusted odds of being diagnosed with prehypertension included a 1-year increase in age over age 3 (OR, 1.21; 95% CI, 1.09-1.34) and number of elevated blood pressure readings beyond 3 (OR, 3.07; 95% CI, 2.20-4.28). Hypertension and prehypertension were frequently undiagnosed in this pediatric population. Patient age, height, obesity-related diagnoses, and magnitude and frequency of abnormal blood pressure readings all increased the odds of diagnosis.

Under- treatment and under diagnosis of hypertension: a serious problem in the United Arab Emirates

BackgroundHypertension, notably untreated or uncontrolled, is a major risk factor for cardiovascular diseases (CVD) morbidity and mortality. In countries in transition, little is known about the epidemiology of hypertension, and its biochemical correlates. This study was carried out in Al Ain, United Arab Emirates, to characterize self-reported (SR) normotensives and hypertensives in terms of actual hypertension status, demographic variables, CVD risk factors, treatment, and sequalae.MethodsA sample, stratified by SR hypertensive status, of 349 SR hypertensives (Mean age ± SD; 50.8 ± 9.2 yrs; Male: 226) and 640 SR normotensives (42.9 ± 9.3 yrs, Male: 444) among nationals and expatriates was used. Hypertensives and normotensive subjects were recruited from various outpatient clinics and government organizations in Al-Ain city, United Arab Emirates (UAE) respectively. Anthropometric and demographic variables were measured by conventional methods.ResultsBoth under-diagnosis of hypertension (33%) and under-treatment (76%) were common. Characteristics of undiagnosed hypertensives were intermediate between normotensives and SR hypertensives. Under-diagnosis of hypertension was more common among foreigners than among nationals. Risk factors for CVD were more prevalent among SR hypertensives. Obesity, lack of exercise and smoking were found as major risk factors for CVD among hypertensives in this population.ConclusionHypertension, even severe, is commonly under-diagnosed and under-treated in the UAE. Preventive strategies, better diagnosis and proper treatment compliance should be emphasized to reduce incidence of CVD in this population.

Cuff bladder width and blood pressure measurement in children and adolescents

To estimate the independent contribution of the blood pressure cuff bladder width: mid-upper arm circumference (CW:AC) ratio to the variability in systolic blood pressure (SBP), diastolic blood pressure phase 4 (DBP4) and diastolic blood pressure phase 5 (DBP5) in children and adolescents, and its impact upon the estimate of prevalence of high blood pressure derived at screening. Use of cuffs with a CW:AC ratio below 40% causes overestimation of the true blood pressure level. With higher CW:AC ratios the level is underestimated. National recommendations for adults state that the CW:AC ratio is optimal at approximately 40%, but no consistent recommendations exist for children. We measured SBP and diastolic blood pressure phases 4 and 5 in 811 boys and 771 girls aged 10-17 years (93% participation rate). In each subject the blood pressure was measured with a cuff conforming to the 40% rule (recommended cuff), with one smaller (mean decrease in the CW:AC ratio:7.4%), and with one larger (mean increase in the CW:AC ratio:10.2%). Cuffs were used in random order. Smaller cuffs gave significantly higher blood pressure readings. With the larger cuff there were significant mean decreases. The differences were independent of the blood pressure level obtained with the recommended cuff. The impact upon the estimate of the prevalence of high blood pressure was substantial. Selection of the proper cuff size is important for children and adolescents, in order to avoid both over- and underdiagnosis of hypertension.