Ambulatory blood pressure levels in individuals with uncontrolled clinic hypertension across Bangladesh, Pakistan, and Sri Lanka

Anqi Zhu, Truls Ostbye, Aliya Naheed, H. Asita de Silva, Imtiaz Jehan, Mihir Gandhi, Nantu Chakma, Anuradhani Kasturiratne, Zainab Samad, Tazeen Hasan Jafar

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Abstract

Hypertension is a leading risk factor for cardiovascular disease in South Asia. The authors aimed to assess the cross-country differences in 24-h ambulatory, daytime, and nighttime systolic blood pressure (SBP) among rural population with uncontrolled clinic hypertension in Bangladesh, Pakistan, and Sri Lanka. The authors studied patients with uncontrolled clinic hypertension (clinic BP ≥ 140/90 mmHg) who underwent ambulatory blood pressure monitoring (ABPM) during the baseline assessment as part of a community-based trial. The authors compared the distribution of ABPM profiles of patients across the three countries, specifically evaluating ambulatory SBP levels with multivariable models that adjusted for patient characteristics. Among the 382 patients (mean age, 58.3 years; 64.7% women), 56.5% exhibited ambulatory hypertension (24-h ambulatory BP ≥ 130/80 mmHg), with wide variation across countries: 72.6% (Bangladesh), 50.0% (Pakistan), and 51.0% (Sri Lanka; P <.05). Compared to Sri Lanka, adjusted mean 24-h ambulatory, daytime, and nighttime SBP were higher by 12.24 mmHg (95% CI 4.28–20.20), 11.96 mmHg (3.87–20.06), and 12.76 mmHg (4.51–21.01) in Bangladesh, separately. However, no significant differences were observed between Pakistan and Sri Lanka (P >.05). Additionally, clinic SBP was significantly associated with 24-h ambulatory (mean 0.38, 95% CI 0.28–0.47), daytime (0.37, 0.27–0.47), and nighttime SBP (0.40, 0.29–0.50) per 1 mmHg increase. The authors observed substantial cross-country differences in the distribution of ABPM profiles among patients with uncontrolled clinic hypertension in rural South Asia. The authors findings indicated the need to incorporate 24-h BP monitoring to mitigate cardiovascular risk, particularly in Bangladesh.

Original languageEnglish
Number of pages14
JournalJOURNAL OF CLINICAL HYPERTENSION
DOIs
Publication statusE-pub ahead of print - 2024
Publication typeA1 Journal article-refereed

Keywords

  • ambulatory blood pressure monitor
  • South Asia
  • uncontrolled clinic hypertension

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

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