Ambulatory and Unattended, Automated Office Blood Pressure in People With and Without HIV in Tanzania: A Cohort Study of Repeatability and Regression to the Mean
6 affiliations
- 1Weill Cornell Medicine
- 2KEMRI‐Wellcome Trust Research Programme
- 3University of Colorado School of Medicine, CU Anschutz
- 4National Institute of Medical Research
- 5London School of Hygiene and Tropical Medicine, London, Greater London, UK
- 6Weill Cornell Medical College
Abstract
Sub‐Saharan Africa (sSA) bears a high burden of hypertension and HIV, yet blood pressure measurement often relies on single‐day, conventional office readings, prone to measurement error. We assessed the short‐term repeatability of unattended, automated office BP (uAOBP) and ambulatory blood pressure monitoring (ABPM), and whether reproducibility differs by HIV status in Tanzania. We analyzed data from the Mwanza HIV&CVD cohort study, using measurements from enrollment and 1‐month later. Bland‐Altman plots visualized mean differences and limits of agreement. Reproducibility of hypertension classification was calculated using Cohen's kappa, with differences by HIV status evaluated using large‐sample variance. Of 999 participants enrolled, 750 (384 people with HIV (PWH) and 366 people without HIV (PWoH)) had valid ABPM measurements at both timepoints. The mean difference in systolic blood pressure was significant for uAOBP (−1.02 mmHg; 95% CI −1.76, −0.27) but not 24 h ABPM (−0.46; −1.02, 0.10), with similar results for diastolic blood pressure. Bland‐Altman plots showed narrower limits of agreement for ABPM. Kappa statistics were 0.45 (0.33, 0.56) for uAOBP and 0.56 (0.50, 0.62) for 24 h ABPM. Regression dilution ratios were 0.77 and 0.82 for systolic and diastolic uAOBP and 0.73 and 0.77 for ABPM. Reproducibility did not differ by HIV status. ABPM and uAOBP demonstrated high short‐term reproducibility, with ABPM showing greater stability for hypertension classification. Reproducibility did not differ by HIV status, supporting the use of both approaches in sub‐Saharan Africa.
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BibTeX
@article{willkens2026ambulatory,
title = {{Ambulatory and Unattended, Automated Office Blood Pressure in People With and Without HIV in Tanzania: A Cohort Study of Repeatability and Regression to the Mean}},
author = {Megan Willkens and Ruth Lucinde and Cody Cichowitz and Anthony Etyang and Godfrey Kisigo and Grace Ruselu and Bernard Desderius and Lily D. Yan and Ana C. Krieger and Richard B. Devereux and Philip Ayieko and Saidi Kapiga and Robert N. Peck and Myung Hee Lee},
journal = {Journal of clinical hypertension (Greenwich, Conn.)},
year = {2026},
month = oct,
doi = {10.1111/jch.70373},
url = {https://europepmc.org/article/PMC/PMC13658356},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Ambulatory and Unattended, Automated Office Blood Pressure in People With and Without HIV in Tanzania: A Cohort Study of Repeatability and Regression to the Mean
AU - Megan Willkens
AU - Ruth Lucinde
AU - Cody Cichowitz
AU - Anthony Etyang
AU - Godfrey Kisigo
AU - Grace Ruselu
AU - Bernard Desderius
AU - Lily D. Yan
AU - Ana C. Krieger
AU - Richard B. Devereux
AU - Philip Ayieko
AU - Saidi Kapiga
AU - Robert N. Peck
AU - Myung Hee Lee
PY - 2026
DA - 2026/10/01
JO - Journal of clinical hypertension (Greenwich, Conn.)
DO - 10.1111/jch.70373
UR - https://europepmc.org/article/PMC/PMC13658356
AB - Sub‐Saharan Africa (sSA) bears a high burden of hypertension and HIV, yet blood pressure measurement often relies on single‐day, conventional office readings, prone to measurement error. We assessed the short‐term repeatability of unattended, automated office BP (uAOBP) and ambulatory blood pressure monitoring (ABPM), and whether reproducibility differs by HIV status in Tanzania. We analyzed data from the Mwanza HIV&CVD cohort study, using measurements from enrollment and 1‐month later. Bland‐Altman plots visualized mean differences and limits of agreement. Reproducibility of hypertension classification was calculated using Cohen's kappa, with differences by HIV status evaluated using large‐sample variance. Of 999 participants enrolled, 750 (384 people with HIV (PWH) and 366 people without HIV (PWoH)) had valid ABPM measurements at both timepoints. The mean difference in systolic blood pressure was significant for uAOBP (−1.02 mmHg; 95% CI −1.76, −0.27) but not 24 h ABPM (−0.46; −1.02, 0.10), with similar results for diastolic blood pressure. Bland‐Altman plots showed narrower limits of agreement for ABPM. Kappa statistics were 0.45 (0.33, 0.56) for uAOBP and 0.56 (0.50, 0.62) for 24 h ABPM. Regression dilution ratios were 0.77 and 0.82 for systolic and diastolic uAOBP and 0.73 and 0.77 for ABPM. Reproducibility did not differ by HIV status. ABPM and uAOBP demonstrated high short‐term reproducibility, with ABPM showing greater stability for hypertension classification. Reproducibility did not differ by HIV status, supporting the use of both approaches in sub‐Saharan Africa.
SN - 1524-6175
SN - 1751-7176
ER -