Sudharsanan N, et al. Health Aff (Millwood). 2020 Jan;39(1):124-132.
Home-based screening for hypertension has the prospective to result wide enhancements in blood pressure control in large population of South Africa and other low- and middle-income countries. First, hypertension screening is a moderately simple and low-cost procedure. Second, home-based screening may show higher population coverage than health facility based screening by including people who are unlikely to seek preventive care or care for illnesses perceived as minor at health facilities. The real-world effect of home-based hypertension screening on two-year change in blood pressure was evaluated in a nationally representative cohort of South African adults. Thus, Sudharsanan N et al., conducted a study to recognize efficacious ways to decrease elevating levels of cardiovascular disorder in South Africa and other low- and middle-income countries.
The Data of the National Income Dynamics Study were used from the 2008, 2010–11, 2012, 2014–15, and 2017 waves. Approximately 28,000 people were analysed from 7,300 households over South Africa in a nationally representative longitudinal examination. In all, 7,305 of 10,642 households participated in the baseline survey. Particularly, field workers gathered two blood pressure measurements of each adult member of the household with an Omron digital blood pressure monitor and readings were entered on a health information sheet. The field worker should have checked a box that read (in the participant’s native language): “Your blood pressure readings are higher than normal, if either of the two readings had a systolic blood pressure of 140 mmHg or more or a diastolic blood pressure of 90 mmHg or more. The primary outcome was among-wave changes in blood pressure. The average of the two blood pressure measurements was used i.e. recorded in each wave of the data. The analytic samples comprised of individuals whose blood pressure was within the windows around cutoffs in the overall samples which were used to outline the intervention and control groups. These windows augment both above and below the cutoffs and the evaluation is conducted in this range. In men, there was little discontinuity at the cutoff for systolic blood pressure (Figure 1).
Figure 1: Two-year change in systolic blood pressure among South African adults ages 30 and older, by sex and baseline systolic BP, 2008–17
In contrast, for women, there was proof of a downward jump at the cutoff, which recommended that the interference had an effect on their systolic blood pressure change above time. The interference showed reduction by 4.7 mmHg in a systolic blood pressure for women (95% CI: -12.6, -2.1; p = 0:006). However, there was no evidence of the interference that decreased diastolic blood pressure for women or either blood pressure consequence for men. The effect of the interference on systolic blood pressure was more articulated in adults ages 30-45 as compared to older age groups. For men ages 30-45, the interference showed a decrease in systolic blood pressure of 7.0 mmHg (p = 0:022) as compared to men of other age groups with basically null effects. Similarly, for women of ages 30-45, the interference showed significant reduction in systolic blood pressure by 9.1 mmHg.
Thus, it was concluded that in low- and middle-income countries, home-based hypertension screening may be an important strategy for decreasing elevated blood pressure. But, further work is required to assure the maximum extent and effect of such strategies.
CI: Confidence Interval
