HOME BLOOD PRESURE MEASUREMENT IN RURAL SUB-SAHARAN AFRICA

Objective: Self-home blood pressure (BP) measurement has been reported to be superior to office BP measurements (attended or unattended) in diagnosing hypertension. However, it is not readily available in rural sub-Saharan Africa (SSA) due to the cost of the measurement devices and the literacy it requires to correctly measure and record BP. Consequently, the diagnostic performance of self-home BP measurement in rural sub-Saharan Africa remains unclear. Trained community health workers (CHWs) with home BP measurement devices may improve the availability and use of these devices by providing and training community members to use them Design and method: We are conducting a cross-sectional study to determine the diagnostic performance of self-home BP measurement in identifying individuals with hypertension in rural Kenya and The Gambia. A random age-stratified random sample of 1250 participants aged 30 years and above from the Kilifi Health and Demographic Surveillance System and the Kiang West Demographic Surveillance System are being enrolled into the study. Trained CHWs avail the measurement devices to enrolled participants and train them to measure and record their BP for seven consecutive days. Primary data of BP measurements are then downloaded from the measurement devices. Additionally, participants undergo ambulatory BP monitoring (reference standard). Results: Recruitment is ongoing. We have enrolled and completed BP measurements for 154 participants, all from the Kenya study site (12% of the total sample). Of these 106 (69%) are female with an average age of 57 years (standard deviation 15 years). Based on home and ambulatory BP respectively, 49 (32%) and 66 (43%) of included participants are hypertensive. Of the included participants, 26 (17%) have masked hypertension and were not detected by home BP while 9(6%) are normotensive but considered hypertensive based on home BP. The preliminary sensitivity and specificity of self-home BP measurement is 0.61 (0.49, 0.72) and 0.90 (0.81, 0.95) respectively while its diagnostic odds ratio (DOR) is 13.5 (likelihood ratio positive 5.93 (3.10, 11.34)). Further analyses will be conducted when recruitment is complete. Conclusions: Self-home BP measurement has modest diagnostic utility in the general population in rural SSA.