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

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.

Keywords: South Asia; ambulatory blood pressure monitor; uncontrolled clinic hypertension.

FIGURE 1

Comparison of ambulatory systolic blood pressure levels and the proportion of individuals with ambulatory hypertension in patients with uncontrolled clinic hypertension across rural Bangladesh, Pakistan, and Sri Lanka. (A) Violin plot comparing the distribution of 24‐h ambulatory, daytime, and nighttime SBP levels in patients with uncontrolled clinic hypertension across the three countries. (B) Bar plot comparing the proportions of patients having ambulatory hypertension (defined as 24‐h ambulatory SBP/DBP ≥ 130/80 mmHg) across the three countries. The black dots represented the mean and the error bars represented 95% confidence interval (CI). Pairwise comparison was conducted using the t‐test, with Sri Lanka serving as the reference group. ns ≥ 0.05, ^* p < .05, ^** p < .001.