Screening for Hypertension in Asymptomatic Individuals in Nepal: An Expert Consensus Statement

Hypertension affects a substantial proportion of the general population in Nepal with prevalence ranging from 20 to 30 percent. Early diagnosis and treatment are essential for undiagnosed hypertension and is possible through hypertension screening. The aim of this paper is to provide unified consensus recommendations for the effective screening of hypertension in Nepal. In two National Advisory expert consensus meetings, a total of 42 experts participated, discussed and voted on the key statements for formulating the consensus. Each key statement was scored on a Likert scale ranging from 1 to 9 and a mean score was calculated. The consensus statement was accepted if the mean score was seven or more with the voting of more than two-thirds of the experts. The main consensus recommendations are the following. First, screening for hypertension should start among adults from 18 years of age. Second, effective screening of hypertension can aid in the early diagnosis, control, and improve the cardiovascular disease outcomes. Third, in asymptomatic adults, re-screening is necessary every 3 to 6 months and every 3 to 5 years for initial blood pressure levels of 130-139/80-89 mmHg and <130/85 mmHg, respectively. Fourth, hypertension screening is cost-effective in a resource-limited setting. The use of consensus recommendations will help in a unified community screening of hypertension among the asymptomatic adult population of Nepal. Screening of hypertension should be promoted by all the stakeholders in healthcare services.  

[1]  H. Sachdev,et al.  Prevalence of and Factors Associated With High Blood Pressure Among Adolescents in India , 2022, JAMA network open.

[2]  Okan Akacı,et al.  The Prevalence of Post-COVID-19 Hypertension in Children , 2022, Clinical pediatrics.

[3]  M. Kruk,et al.  COVID-19 and resilience of healthcare systems in ten countries , 2022, Nature medicine.

[4]  D. Arabiat,et al.  Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries. , 2022, Journal of pediatric nursing.

[5]  M. Dhimal,et al.  Hypertension screening, awareness, treatment, and control: a study of their prevalence and associated factors in a nationally representative sample from Nepal , 2022, Global health action.

[6]  M. Akpek Does COVID-19 Cause Hypertension? , 2021, Angiology.

[7]  M. Dhimal,et al.  Prevalence of non-communicable diseases risk factors and their determinants: Results from STEPS survey 2019, Nepal , 2021, PloS one.

[8]  B. Koirala,et al.  May Measurement Month 2019: an analysis of blood pressure screening results from Nepal , 2021, European heart journal supplements : journal of the European Society of Cardiology.

[9]  N. Patel,et al.  Prevalence, awareness, risk factors and control of hypertension in Nepal from 2000 to 2020: A systematic review and meta-analysis , 2021, Public health in practice.

[10]  A. Schutte,et al.  How to check whether a blood pressure monitor has been properly validated for accuracy , 2020, Journal of clinical hypertension.

[11]  Dorairaj Prabhakaran,et al.  2020 International Society of Hypertension Global Hypertension Practice Guidelines. , 2020, Hypertension.

[12]  Siddharth N. Shah,et al.  Screening for Hypertension in Asymptomatic Individuals in India: An Expert Consensus Statement. , 2020, The Journal of the Association of Physicians of India.

[13]  D. Spiegelman,et al.  Cardiovascular disease trends in Nepal – An analysis of global burden of disease data 2017 , 2020, International journal of cardiology. Heart & vasculature.

[14]  A. Murphy,et al.  Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal , 2019, BMC Health Services Research.

[15]  S. Bajracharya,et al.  Hypertension and its Determinants Among School Going Adolescents: A Cross Sectional Study in Nepal , 2019, Journal of Nepal Paediatric Society.

[16]  Y. Hao,et al.  Prevalence of hypertension and prehypertension in Nepal: a systematic review and meta-analysis , 2019, Global Health Research and Policy.

[17]  Vlad Radoias,et al.  Screening, diagnosis, and long-term health outcomes in developing countries—The case of hypertension , 2018, PloS one.

[18]  W. Spiering,et al.  [2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)]. , 2018, Giornale italiano di cardiologia.

[19]  Alan Murray,et al.  A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement. , 2018, Journal of hypertension.

[20]  E. Schiffrin,et al.  The New ACC/AHA Hypertension Guidelines for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. , 2018, American journal of hypertension.

[21]  K. Agrawal Screening of hypertension among rural community of Nepal , 2017 .

[22]  A. Davis,et al.  Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. , 2017, JAMA.

[23]  J. Lindholt,et al.  Population screening and intervention for vascular disease in Danish men (VIVA): a randomised controlled trial , 2017, The Lancet.

[24]  S. Balsari,et al.  A retrospective analysis of hypertension screening at a mass gathering in India: implications for non-communicable disease control strategies , 2017, Journal of Human Hypertension.

[25]  P. Sever Will the recent hypertension trials change the guidelines? , 2017, Journal of the renin-angiotensin-aldosterone system : JRAAS.

[26]  K. Kario,et al.  Progression from prehypertension to hypertension and risk of cardiovascular disease , 2016, Journal of epidemiology.

[27]  I. Rudan Setting health research priorities using the CHNRI method: IV. Key conceptual advances , 2016, Journal of global health.

[28]  D. Wangchuk,et al.  Is diabetes and hypertension screening worthwhile in resource-limited settings? An economic evaluation based on a pilot of a Package of Essential Non-communicable disease interventions in Bhutan. , 2015, Health policy and planning.

[29]  Sachiyo Yoshida,et al.  Approaches, tools and methods used for setting priorities in health research in the 21st century , 2015, Journal of global health.

[30]  Tej K. Khalsa,et al.  Resources for Blood Pressure Screening Programs in Low Resource Settings: A Guide From the World Hypertension League , 2015, Journal of clinical hypertension.

[31]  S. Fleming,et al.  Self-Screening and Non-Physician Screening for Hypertension in Communities: A Systematic Review , 2015, American journal of hypertension.

[32]  Christopher I Amos,et al.  Community-wide cardiovascular disease prevention programs and health outcomes in a rural county, 1970-2010. , 2015, JAMA.

[33]  Jackson T. Wright,et al.  2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). , 2014, JAMA.

[34]  M. Lamsal,et al.  Hypertension among Young Adults in the Shopping Malls of Kathmandu , 2013 .

[35]  S. Adhikari,et al.  Demographics and diagnoses at rural health camps in Nepal: cross-sectional study. , 2012, Family practice.

[36]  D. Panagiotakos,et al.  Exercise Capacity and Progression From Prehypertension to Hypertension , 2012, Hypertension.

[37]  Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP) , 2011, BMJ : British Medical Journal.

[38]  R. Cooper,et al.  Progression from prehypertension to hypertension in a Jamaican cohort: incident hypertension and its predictors. , 2010, The West Indian medical journal.

[39]  M. Dogan,et al.  The incidence of asymptomatic hypertension in school children. , 2010, Journal of Nippon Medical School = Nippon Ika Daigaku zasshi.

[40]  Karl Claxton,et al.  Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations. , 2009, Health policy.

[41]  Stephen D. Persell,et al.  Increased blood pressure in the emergency department: pain, anxiety, or undiagnosed hypertension? , 2008, Annals of emergency medicine.

[42]  A. Rigaud,et al.  Hypertension in older adults. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[43]  R. D'Agostino,et al.  Secular trends in long-term sustained hypertension, long-term treatment, and cardiovascular mortality. The Framingham Heart Study 1950 to 1990. , 1996, Circulation.

[44]  R. Glynn,et al.  Evidence for a positive linear relation between blood pressure and mortality in elderly people , 1995, The Lancet.

[45]  C. Escobar Cervantes,et al.  [A randomized trial of intensive versus standard blood pressure control]. , 2016, Semergen.

[46]  Screening for High Blood Pressure in Adults: Recommendation Statement. , 2016, American family physician.

[47]  N. Wong,et al.  Prehypertension: a meta-analysis of the epidemiology, risk factors, and predictors of progression. , 2011, Texas Heart Institute journal.