Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance

The validity of a mass blood pressure screening program carried out on Dallas high school students who were followed for at least 3 years is reported. Blood pressure results on initial screening in the tenth grade were related to outcome blood pressure status. The frequency of initial blood pressure elevation (systolic and/or diastolic pressure above the 95th percentile) was 10%, whereas the prevalence of sustained elevation in the tenth grade was less than 2%. The initial screening correctly identified 72% of those who had sustained elevations on all three tenth grade examinations (sensitivity), and correctly identified 91% of those who did not have sustained elevations (specificity). However, the predictive value of an initial positive screening result was low, at only 17% (152/900). The high proportion of false-positive results represents a significant cost to any blood pressure screening program, both in economic terms and in its potential for creating anxiety among families with children having only transiently elevated blood pressure. Because the costs are high and the yield from mass screening of children low, case finding of childhood hypertension should remain the responsibility of the physician who sees children in the clinical setting.

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The outcome of two-step blood pressure screening in dental healthcare

Scandinavian Journal of Public Health ◽

10.1177/1403494818759840 ◽

2018 ◽

Vol 46 (6) ◽

pp. 623-629

Author(s):

Helen Andersson ◽

Lennart Hedström ◽

Stefan Bergman ◽

Håkan Bergh

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Cardiovascular Mortality ◽

European Society ◽

Risk Estimation ◽

Screening Method ◽

Newly Diagnosed ◽

Step Method ◽

Number Needed To Screen ◽

Blood Pressure Screening

Aim: The purpose of this study was to evaluate a two-step screening method for hypertension in dentistry regarding the number needed to screen (NNS) and positive predictive value (PPV) and to risk-classify those with newly diagnosed hypertension. Methods: In connection with their regular dental care check-up, 2025 subjects aged 40–75 years were screened for high blood pressure. Via a health questionnaire, data were collected concerning risk factors. Blood pressure was screened comprehensively in two steps, which included screening in a dental clinic and home measurements for one week. Recently discovered hypertensive participants were assessed for 10-year risk of cardiovascular mortality according to the guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). Results: A total of 170 new hypertensive participants were found (NNS = 12; 95% confidence interval (CI): 11–13). The method yielded a PPV of 0.73 (95% CI: 0.68–0.78) and eliminated 84.8% of the false-positive participants. The results also showed that based on ESH/ESC risk estimation, 76.5% of those newly diagnosed hypertensive participants had a moderate or high risk of cardiovascular mortality within 10 years. Conclusions: The study shows that a two-step method for blood pressure screening in a dental setting including home measurement resulted in a high PPV and eliminated most of those with a false high blood pressure reading. The findings also show that two-step screening for hypertension is feasible in a larger population with more screening providers involved.

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An experiment in common sense: Education at blood pressure screening

Patient Education and Counseling ◽

10.1016/0738-3991(89)90007-4 ◽

1989 ◽

Vol 14 (1) ◽

pp. 53-67 ◽

Cited By ~ 10

Author(s):

Linda J. Baumann ◽

Rick S. Zimmerman ◽

Howard Leventhal

Keyword(s):

Blood Pressure ◽

Common Sense ◽

Blood Pressure Screening

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Linkage to primary care after home-based blood pressure screening in rural KwaZulu-Natal, South Africa: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023369 ◽

2018 ◽

Vol 8 (12) ◽

pp. e023369 ◽

Cited By ~ 2

Author(s):

Mark J Siedner ◽

Kathy Baisley ◽

Joanna Orne-Gliemann ◽

Deenan Pillay ◽

Olivier Koole ◽

...

Keyword(s):

South Africa ◽

Blood Pressure ◽

Linkage To Care ◽

Sampling Weights ◽

Rural South ◽

Home Based ◽

Kwazulu Natal ◽

Blood Pressure Screening ◽

The Impact ◽

Rural South Africa

ObjectivesThe expanding burden of non-communicable diseases (NCDs) globally will require novel public health strategies. Community-based screening has been promoted to augment efficiency of diagnostic services, but few data are available on the downstream impact of such programmes. We sought to assess the impact of a home-based blood pressure screening programme on linkage to hypertension care in rural South Africa.SettingWe conducted home-based blood pressure screening withinin a population cohort in rural KwaZulu-Natal, using the WHO Stepwise Approach to Surveillance (STEPS) protocol.ParticipantsIndividuals meeting criteria for raised blood pressure (≥140 systolic or ≥90 diastolic averaged over two readings) were referred to local health clinics and included in this analysis. We defined linkage to care based on self-report of presentation to clinic for hypertension during the next 2 years of cohort observation. We estimated the population proportion of successful linkage to care with inverse probability sampling weights, and fit multivariable logistic regression models to identify predictors of linkage following a positive hypertension screen.ResultsOf 11 694 individuals screened, 14.6% (n=1706) were newly diagnosed with elevated pressure. 26.9% (95% CI 24.5% to 29.4%) of those sought hypertension care in the following 2 years, and 38.1% (95% CI 35.6% to 40.7%) did so within 5 years. Women (adjusted OR (aOR) 2.41, 95% CI 1.68 to 3.45), those of older age (aOR 11.49, 95% CI 5.87 to 22.46, for 45–59 years vs <30) and those unemployed (aOR 1.71, 95% CI 1.10 to 2.65) were more likely to have linked to care.ConclusionsLinkage to care after home-based identification of elevated blood pressure was rare in rural South Africa, particularly among younger individuals, men and the employed. Improved understanding of barriers and facilitators to NCD care is needed to enhance the effectiveness of blood pressure screening in the region.

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