Impact of one or two visits strategy on hypertension burden estimation in HYDY, a population-based cross-sectional study: implications for healthcare resource allocation decision making
- Pietro Amedeo Modesti1–3,
- Stefano Rapi2,
- Mohamed Bamoshmoosh4,
- Marzia Baldereschi5,
- Luciano Massetti5,
- Luigi Padeletti1,
- Gian Franco Gensini1–3,
- Dong Zhao6,
- Dawood Al-Hidabi4,
- Husni Al Goshae4
- 1Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
- 2Department of Laboratory, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- 3Centro di S.Maria degli Ulivi, Fondazione Don Carlo Gnocchi, Florence, Italy
- 4Department of Cardiology, University of Science and Technology, Science and Technology University Hospital, Sana'a, Yemen
- 5Istituto di Biometeorologia, Italian National Research Council, Florence, Italy
- 6Department of Epidemiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Correspondence to Dr Pietro Amedeo Modesti;
- Received 22 February 2012
- Accepted 29 June 2012
- Published 8 August 2012
Context The prevalence of hypertension in developing countries is coming closer to values found in developed countries. However, surveys usually rely on readings taken at a single visit, the option to implement the diagnosis on readings taken at multiple visits, being limited by costs.
Objective To estimate more accurately the magnitude and extent of the resource that should be allocated to the prevention of hypertension.
Design Population-based cross-sectional survey with triplicate blood pressure (BP) readings taken on two separate home-visits.
Setting Rural and urban locations in three areas of Yemen (capital, inland and coast).
Participants A nationally representative sample of the Yemen population aged 15–69 years (5063 men and 5179 women), with an overall response rate of 92% in urban and 94% in rural locations.
Main outcome measure Hypertension diagnosed as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or self-reported use of antihypertensive drugs.
Results Hypertension prevalence (age-standardised to the WHO world population 2001) based on fulfilling the same criteria on both visits (11.3%; 95% Cl 10.7% to 11.9%), was 35% lower than estimation based on the first visit (17.3%; 16.5% to 18.0%). Advanced age, blood glucose ≥7 mmol/l or proteinuria ≥1+ at dipstick test at visit one were significant predictors of confirmation at visit 2. The 959 participants found to be hypertensive at visit 1 or at visit 2 only and thus excluded from the final diagnosis had a rate of proteinuria (5.0%; 3.8% to 6.5%) comparable to rates of the general population (6.1%; 5.6% to 6.6%), and of subjects normotensive at both visits (5.6%; 5.1% to 6.2%). Only 1.9% of Yemen population classified at high or very high cardiovascular (CV) risk at visit 1 moved to average, low or moderate CV risk categories after two visits.
Conclusions Hypertension prevalence based on readings obtained after two visits is 35% lower than estimation based on the first visit, subjects were excluded from final diagnosis belonging to low CV risk classes.
- Preventive Medicine
- Public Health
- Internal Medicine
- Diabetes & endocrinology
- Internal Medicine
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