Simplified Blood Pressure Approaches May Be Appropriate for Population Screening

NEW YORK (Reuters Health) – Simplified blood pressure (BP) screening approaches vary from country to country but are generally reliable and may be suitable for large screening programs, researchers suggest.

“The evidence suggests low misdiagnosis rates using a simplified approach in comparison to the standard protocol (average of the last two measurements),” Dr. Rodrigo Carrillo-Larco of Imperial College London, UK, told Reuters Health by email. “Simplified approaches could save time and lead to more people being screened for hypertension. Our results open the possibility of using a simplified approach at the global level.”

“A simplified approach could be used for large screening programs, population-based surveys, and busy clinics,” he added. “It may be too early to apply the simplified approaches for initiating treatment or for monitoring patients with hypertension.”

As reported in PLOS Medicine, Dr. Carrillo-Larco and colleagues analyzed data from WHO STEPS surveys, which included more than 145,000 people in 60 countries in six world regions between 2004 and 2019.

The team compared the use of nine simplified approaches against the standard, computing the number of cases that would be missed or overdiagnosed with each approach.

Across all countries, the simplified approach that missed the fewest cases was using the second BP reading if the first BP reading was 130-145/80-95 mm Hg (5.62%). By contrast, using only the second BP reading missed 5.80%.

The simplified approach with the smallest overdiagnosis proportion was using the second BP reading if the first BP measurement was 140/90 mm Hg or greater (3.03%)

In many countries, cardiovascular risk was not significantly different between the missed and consistent hypertension groups, yet the mean was slightly lower among missed cases.

Cardiovascular risk was positively associated with missed hypertension depending on which simplified approach was used, and where.

The authors conclude, “Simplified BP screening approaches seem to have low misdiagnosis rates, and cardiovascular risk could be lower amongst missed cases than amongst consistent hypertension cases… Countries should identify the best simplified screening approach according to the local blood pressure distribution, hypertension epidemiology, and available resources for massive blood pressure screening programmes targeting the general population.”

Dr. Renee Bullock-Palmer, Director of the Women’s Heart Center and Non-Invasive Cardiac Imaging at Deborah Heart and Lung Center in Brown Mills, New Jersey agrees that a simplified approach should be implemented clinically. “Generally, when I see patients in my clinic if the initial blood pressure is elevated I usually re-measure it before making any clinical decisions.”

“However,” she added, “it is very important to recognize ‘masked’ hypertension and ‘white coat’ hypertension, and the latest hypertension guideline encourages the use of ambulatory blood pressure monitoring to assess the patient’s blood pressure control outside of the clinic visits.”

SOURCE: PLOS Medicine, online April 1, 2022.

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