Figure 1
Hypertension diagnostic algorithm.
Table 1
Standardized protocol for blood pressure measurement.
| 1. Prior to measurement, patient should have an empty bladder and not have smoked, drunk coffee, or exercised for 30 minutes |
| 2. Patient sitting and relaxed for at least 5 minutes prior to the measurement |
| 3. Cuff is placed on bare skin on the middle of the arm and maintained at the level of the heart during the measurement |
| 4. During and between measurements: neither patient nor evaluator talks; back is supported; feet are maintained on the ground; legs are not crossed |
Table 2
Weighting scheme for kappa analysis of CHW-physician agreement.
| CHW ASSESSMENT | PHYSICIAN ASSESSMENT | ||
|---|---|---|---|
| NO | POSSIBLE | YES | |
| No | 1 | 1/3 | 0 |
| Possible | 1/3 | 1 | 2/3 |
| Yes | 0 | 2/3 | 1 |
Figure 2
Participant flow diagram and final diagnoses.
Table 3
Demographic characteristics of study subjects by hypertension classification at primary screening.
| ALL SUBJECTS | NO HTN* | POSSIBLE HTN | CONFIRMED HTN | P OVERALL | |
|---|---|---|---|---|---|
| N = 359 | N = 302 | N = 13 | N = 44 | ||
| Age, years (SD) | 45.9 (16.1) | 43.9 (15.8) | 58.8 (14.3) | 55.3 (13.1) | <0.001 |
| Sex, n (%): | 0.071 | ||||
| Female | 298 (83.0%) | 255 (84.4%) | 8 (61.5%) | 35 (79.5%) | |
| Male | 61 (17.0%) | 47 (15.6%) | 5 (38.5%) | 9 (20.5%) | |
| Physician measured SBP, mmHg (SD) | 116 (18.5) | 111 (11.9) | 149 (11.6) | 144 (22.7) | <0.001 |
| CHW measured SBP, mmHg (SD) | 114 (19.1) | 109 (13.1) | 144 (11.3) | 140 (25.6) | <0.001 |
| Physician measured DBP, mmHg (SD) | 73.8 (9.74) | 71.4 (7.52) | 84.0 (8.65) | 86.8 (11.4) | <0.001 |
| CHW measured DBP, mmHg (SD) | 73.8 (10.1) | 71.9 (8.44) | 82.2 (9.01) | 84.0 (13.2) | <0.001 |
| Body mass index, kg/m2 (SD)† | 29.2 (5.55) | 29.1 (5.52) | 31.0 (9.08) | 29.1 (4.37) | 0.489 |
| History of diabetes, n (%): | 43 (12.0%) | 25 (8.28%) | 5 (38.5%) | 13 (29.5%) | <0.001 |
| Number of days per week with physical activity (SD) | 4.42 (3.07) | 4.46 (3.05) | 3.38 (3.28) | 4.41 (3.13) | 0.464 |
[i] *Patient categorization (no HTN, possible HTN, confirmed HTN) reported based physician categorization.
†BMI, history of diabetes, and physical activity days reported for physician assessment.
Table 4
Cross tabulation of CHW and physician hypertension assessment at primary screening visit.
| CHW ASSESSMENT | PHYSICIAN ASSESSMENT | |||
|---|---|---|---|---|
| NO | POSSIBLE | YES | TOTAL | |
| No | 292 | 1 | 7 | 300 |
| Possible | 6 | 9 | 4 | 19 |
| Yes | 4 | 3 | 33 | 40 |
| Total | 302 | 13 | 44 | 359 |
[i] Note: Bolded numbers in represent cases of complete agreement between physician and CHW.
Table 5
Cross tabulation of CHW and physician hypertension assessment at secondary screening visit.
| CHW ASSESSMENT | PHYSICIAN ASSESSMENT | ||
|---|---|---|---|
| NO | YES | TOTAL | |
| No | 0 | 2 | 2 |
| Yes | 2 | 7 | 9 |
| Total | 2 | 9 | 11 |
[i] Note: Bolded numbers in represent cases with agreement between physician and CHW.
Table 6
Cross tabulation of overall CHW and physician hypertension assessment.
| CHW ASSESSMENT | PHYSICIAN ASSESSMENT | |||
|---|---|---|---|---|
| NO | POSSIBLE | YES | TOTAL | |
| No | 292 | 0 | 9 | 301 |
| Possible | 6 | 1 | 4 | 11 |
| Yes | 6 | 1 | 40 | 47 |
| Total | 304 | 2 | 53 | 359 |
[i] Note: Bolded numbers in represent cases of complete agreement between physician and CHW.
Figure 3
Bland-Altman plot for systolic blood pressure (mmHg) measurements.
Figure 4
Bland-Altman plot for BMI (kg/m2) measurements.
Table 7
CHW and physician agreement on patient characteristics (binary variables).
| PHYSICIAN IDENTIFIED POSITIVE | OVERALL AGREEMENT | KAPPA | MCC | SENSITIVITY | SPECIFICITY | PPV | NPV | |
|---|---|---|---|---|---|---|---|---|
| Coronary Artery Disease (CAD) | 1 (0.28%) | 96.94% | –0.01 | –0.01 | 0.00 | 1.00 | 0.00 | 0.97 |
| Heart Failure | 5 (1.39%) | 98.05% | –0.01 | –0.01 | 0.00 | 0.99 | 0.00 | 0.99 |
| Diabetes | 43 (11.98%) | 98.61% | 0.93 | 0.93 | 0.95 | 0.99 | 0.93 | 0.99 |
| Stroke | 8 (2.23%) | 96.94% | 0.51 | 0.53 | 0.40 | 0.99 | 0.75 | 0.97 |
| Hyperlipidemia | 30 (8.36%) | 94.15% | 0.57 | 0.58 | 0.70 | 0.96 | 0.53 | 0.98 |
| Chronic Kidney Disease (CKD) | 9 (2.51%) | 94.99% | 0.33 | 0.36 | 0.26 | 0.99 | 0.56 | 0.96 |
| Hypertension | 93 (25.91%) | 89.14% | 0.71 | 0.71 | 0.81 | 0.92 | 0.75 | 0.94 |
| Taking Antihypertensive Medication | 26 (7.24%) | 98.33% | 0.87 | 0.87 | 0.92 | 0.99 | 0.85 | 0.99 |
| Smokes | 12 (3.34%) | 99.72% | 0.96 | 0.96 | 1.00 | 1.00 | 0.92 | 1.00 |
| Drinks Alcohol (30 Days) | 27 (7.52%) | 98.05% | 0.86 | 0.86 | 0.88 | 0.99 | 0.85 | 0.99 |
Table 8
CHW and physician agreement on patient characteristics (continuous and categorical variables).
| KAPPA | |
|---|---|
| Stove Type | 0.58 |
| Cooking Location | 0.48 |
| Low Activity (7 days)* | 0.24 |
| High Activity (7 Days)* | 0.25 |
[i] Note:
*Weighted Kappa reported for continuous variables.
Table 9
CHW and physician agreement on patient characteristics (continuous and categorical variables).
| TYPICAL # CIGARETTES/DAY | # ALCOHOLIC DRINKS LAST 30 DAYS | |
|---|---|---|
| Subset | 0.4 | 0.63 | 0.21 | –0.04 |
| All participants (N = 359) | 0.7 | 0.86 | 0.66 | 0.73 |
[i] Note:
Kappa reported as: “Unweighted Kappa | Weighted Kappa”.
Subset of smokers N = 12Subset of alcohol drinkers N = 30.
Table 10
CHW and physician agreement on antihypertensive medication use.
| MEDICATION NAMES | DAILY DOSAGE (MG) | |
|---|---|---|
| All Subjects (N = 1077) | 0.82 | 0.72 |
| Subjects with at least one medication listed; 3 medications (N = 84) | 0.76 | 0.64 |
| Subjects with at least one medication listed (N = 36) | 0.57 | 0.44 |
[i] Note:
Subjects with at least one medication listed (N = 84) includes 3 observations per patient.
Subjects with at least one medication listed (N = 36) includes only observations with a medication listed.