| Summary: | Background: As sub Saharan Africa (sSA) goes through demographic and epidemiological transition, accurate data on disease prevalence are required to guide allocation of scarce health resources between declining but still important infectious disease and emerging chronic conditions such as hypertension. We conducted a study to determine the difference in the prevalence of hypertension as diagnosed using standard blood pressure measurement (SBP) compared to 24-hour ambulatory monitoring (ABPM).
Methods: We randomly selected an age-stratified sample of 700 adults (18–90 years) living within the Kilifi Health and Demographic Surveillance System (KHDSS) in Kenya (adult population ∼125,000). All participants underwent SBP by WHO recommended methods (mean of last 2 from 3 sequential readings); those with an average SBP ≥140/90 mmHg underwent ABPM. Prevalence was calculated by applying age specific rates of hypertension to the KHDSS population to determine the total number each method would have detected.
Results: SBP was performed on 671 individuals and ABPM on 138 (21%). Mean±SD age was 52 ±18.5 years, 62% women. Of those who underwent ABPM, 49% were confirmed to have ‘hypertension’. The age-standardized hypertension prevalence in KHDSS was 24.6% (95%CI 24.1–25.1) using SBP and 3.9 (95%CI 3.7–4.1) % using ABPM. Use of SBP would lead to an additional 22,323 adults being referred for treatment in the KHDSS.
Conclusion: Use of ABPM drastically reduced the number of individuals potentially requiring treatment. However, because no randomized intervention trials have yet been done in sSA, whether ABPM or repeated SBP are more appropriate targets of treatment requires more data.
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