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 Modesti, Stefano Rapi, Mohamed Bamoshmoosh, Marzia Baldereschi, Luciano Massetti, Luigi Padeletti, Gian Franco Gensini, Dong Zhao, Dawood Al-Hidabi, Husni Al Goshae

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere001062
JournalBMJ Open
Volume2
Issue number4
DOIs
Publication statusPublished - 2012

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Resource Allocation
Yemen
Decision Making
Cross-Sectional Studies
Reading
Blood Pressure
Hypertension
Delivery of Health Care
Population
Proteinuria
House Calls
Developed Countries
Antihypertensive Agents
Developing Countries
Blood Glucose
Economics
Outcome Assessment (Health Care)
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)

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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. / Modesti, Pietro Amedeo; Rapi, Stefano; Bamoshmoosh, Mohamed; Baldereschi, Marzia; Massetti, Luciano; Padeletti, Luigi; Gensini, Gian Franco; Zhao, Dong; Al-Hidabi, Dawood; Al Goshae, Husni.

In: BMJ Open, Vol. 2, No. 4, e001062, 2012.

Research output: Contribution to journalArticle

Modesti, PA, Rapi, S, Bamoshmoosh, M, Baldereschi, M, Massetti, L, Padeletti, L, Gensini, GF, Zhao, D, Al-Hidabi, D & Al Goshae, H 2012, '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', BMJ Open, vol. 2, no. 4, e001062. https://doi.org/10.1136/bmjopen-2012-001062
Modesti, Pietro Amedeo ; Rapi, Stefano ; Bamoshmoosh, Mohamed ; Baldereschi, Marzia ; Massetti, Luciano ; Padeletti, Luigi ; Gensini, Gian Franco ; Zhao, Dong ; Al-Hidabi, Dawood ; Al Goshae, Husni. / 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. In: BMJ Open. 2012 ; Vol. 2, No. 4.
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abstract = "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.",
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AU - Modesti, Pietro Amedeo

AU - Rapi, Stefano

AU - Bamoshmoosh, Mohamed

AU - Baldereschi, Marzia

AU - Massetti, Luciano

AU - Padeletti, Luigi

AU - Gensini, Gian Franco

AU - Zhao, Dong

AU - Al-Hidabi, Dawood

AU - Al Goshae, Husni

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N2 - 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.

AB - 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.

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