Clinical and epidemiological implications of 24-hour ambulatory blood pressure monitoring for the diagnosis of hypertension in kenyan adults: A population-based study

Background-the clinical and epidemiological implications of using ambulatory blood pressure monitoring (abpm) for the diagnosis of hypertension have not been studied at a population level in sub-saharan africa. we examined the impact of abpm use among kenyan adults. methods and results-we performed a nested case-control study of diagnostic accuracy. we selected an age-stratified random sample of 1248 adults from the list of residents of the kilifi health and demographic surveillance system in kenya. all participants underwent a screening blood pressure (bp) measurement. all those with screening bp =140/90 mm hg and a random subset of those with screening bp < 140/90 mm hg were invited to undergo abpm. based on the 2 tests,participants were categorized as sustained hypertensive,masked hypertensive,white coat hypertensive,or normotensive. analyses were weighted by the probability of undergoing abpm. screening bp ≥ 140/90 mm hg was present in 359 of 986 participants,translating to a crude population prevalence of 23.1% (95% ci 16.5-31.5%). age standardized prevalence of screening bp ≥ 140/90 mm hg was 26.5% (95% ci 19.3-35.6%). on abpm,186 of 415 participants were confirmed to be hypertensive,with crude prevalence of 15.6% (95% ci 9.4-23.1%) and age-standardized prevalence of 17.1% (95% ci 11.0-24.4%). age-standardized prevalence of masked and white coat hypertension were 7.6% (95% ci 2.8-13.7%) and 3.8% (95% ci 1.7-6.1%),respectively. the sensitivity and specificity of screening bp measurements were 80% (95% ci 73-86%) and 84% (95% ci 79-88%),respectively. bp indices and validity measures showed strong age-related trends. conclusions-screening bp measurement significantly overestimated hypertension prevalence while failing to identify ≈50% of true hypertension diagnosed by abpm. our findings suggest significant clinical and epidemiological benefits of abpm use for diagnosing hypertension in kenyan adults. © 2016 the authors.