A Study of Risk Factors and Development of a Screening Tool for High-Normal Blood Pressure among Adults Aged 30 Years and Over in Primary Health Care, Health Region 7
Keywords:
Risk Factors, Screening Tool Development, High-Normal Blood Pressure, Health Region 7Abstract
This study aimed to investigate risk factors for high-normal blood pressure and to develop a screening tool for high-normal blood pressure (defined as systolic blood pressure (SBP) 130 mmHg and/or diastolic blood pressure (DBP)
85 mmHg) for use in primary health care settings in Health Region 7. A cross-sectional analytic study was conducted from January to July 2022. The sample consisted of 7,141 adults aged 30 years and older residing in Health Region 7. The participants were selected according to the inclusion criteria from four subdistricts in four target provinces. Data were collected by village health volunteers (VHVs) using a questionnaire consisting of two parts: 1) general information and health status, and 2) health behaviors. Data were analyzed using descriptive statistics. Factors associated with high-normal blood pressure were analyzed using crude odds ratios (OR) and adjusted odds ratios (AOR). The performance of the screening tool was evaluated using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC), as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The results showed that the prevalence of high-normal blood pressure was 34.5%, with most participants aged 35–59 years (52.6%). Sex, age, body mass index (BMI), abdominal obesity, diabetes mellitus, a family history of hypertension, alcohol consumption, and consumption of high-fat beverages were significantly associated with high-normal blood pressure (p < 0.05). The screening tool revealed an area under the ROC curve (AUC) of 0.632, indicating poor discriminative ability. At a cutoff score of
7, the sensitivity was 75.0% (95%CI: 73.2–76.7), indicating acceptable performance for initial screening, while the specificity was 43.0% (95%CI: 41.5–44.4), indicating relatively poor discriminative performance. The PPV, NPV, and overall accuracy were 40.9%, 76.6%, and 54.0%, respectively. This screening tool could be further developed as a self-screening tool or a screening tool in the primary health care services system. The screening criteria could be expanded to include individuals aged 30 years and older by applying cutoff scores of
6 for those aged 30–34 years,
7 for those aged 35–59 years, and
10 for those aged 60 years and older.
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