{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:33:12Z","timestamp":1769128392127,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T00:00:00Z","timestamp":1630627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014989","name":"Chan Zuckerberg Initiative","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014989","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Standard triplicate blood pressure (BP) measurements pose time barriers to hypertension screening, especially in resource\u2010limited settings. We assessed the implications of simplified approaches using fewer measurements with adults (\u226518\u00a0years old) not using anti\u2010hypertensive medications from the US National Health and Nutrition Examination Survey 1999\u20102016 (<jats:italic>n<\/jats:italic>\u00a0=\u00a030\u00a0614), and two datasets from May Measurement Month 2017\u20102018 (<jats:italic>n<\/jats:italic>\u00a0=\u00a014\u00a0795 for Nepal and <jats:italic>n<\/jats:italic>\u00a0=\u00a06\u00a0771 for India). We evaluated the proportion of misclassification of hypertension when employing the following simplified approaches: using only 1st BP, only 2nd BP, 2nd if 1st BP in a given range (otherwise using 1st), and average of 1st and 2nd BP. Hypertension was defined as average of 2nd and 3rd systolic BP \u2265140 and\/or diastolic BP \u226590\u00a0mm\u00a0Hg. Using only the 1st BP, the proportion of missed hypertension ranged from 8.2%\u201312.1% and overidentified hypertension from 4.3%\u20139.1%. Using only 2nd BP reduced the misclassification considerably (corresponding estimates, 4.9%\u20136.4% for missed hypertension and 2.0%\u20134.4% for overidentified hypertension) but needed 2nd BP in all participants. Using 2nd BP if 1st BP \u2265130\/80 demonstrated similar estimates of missed hypertension (3.8%\u20138.1%) and overidentified hypertension (2.0%\u20133.9%), but only required a 2nd BP in 33.8%\u201359.8% of participants. In conclusion, a simplified approach utilizing 1st BP supplemented by 2nd BP in some individuals has low misclassification rates and requires approximately half of the total number of measurements compared to the standard approach, and thus can facilitate screening in resource\u2010constrained settings.<\/jats:p>","DOI":"10.1111\/jch.14299","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T11:37:51Z","timestamp":1630669071000},"page":"1865-1871","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Simplified hypertension screening approaches with low misclassification and high efficiency in the United States, Nepal, and India"],"prefix":"10.1111","volume":"23","author":[{"given":"Olive","family":"Tang","sequence":"first","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-4103","authenticated-orcid":false,"given":"Minghao","family":"Kou","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8907-4898","authenticated-orcid":false,"given":"Yifei","family":"Lu","sequence":"additional","affiliation":[{"name":"University of North Carolina  Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"3rd","given":"Edgar R.","family":"Miller","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1315-6747","authenticated-orcid":false,"given":"Tammy","family":"Brady","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl","family":"Dennison\u2010Himmelfarb","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arun","family":"More","sequence":"additional","affiliation":[{"name":"Rural Health Progress Trust  Osmanabad India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1501-2990","authenticated-orcid":false,"given":"Dinesh","family":"Neupane","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"},{"name":"Nepal Development Society  Bharatpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Appel","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7179-718X","authenticated-orcid":false,"given":"Kunihiro","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32279-7"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.018912"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.184182"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2015.04.006"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31134-5"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30259-6"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz300"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.14874"},{"key":"e_1_2_10_10_1","unstructured":"WHO Steps Surveillance Manual.2017;https:\/\/www.who.int\/ncds\/surveillance\/steps\/STEPS_Manual.pdf. 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