title: Do community based self-reading sphygmomanometers improve detection of hypertension? A feasibility study.
abstract: BACKGROUND
  Hypertension is a major risk factor for stroke and ischaemic heart disease. Most hypertension is detected opportunistically by general practitioners. Those who rarely use medical services are less likely to have their blood pressure (BP) measured. We hypothesized that open access self-reading BP measurement would detect previously unrecognized hypertension.
  
  
  METHODS
  Self-reading sphygmomanometers were placed at 13 public sites in Exeter, Devon, United Kingdom. Machine use was determined by users completing a proforma and by direct observation of sites. Users whose BP reading was above an action level of 135/85 mmHg were asked to attend their general practice. General practitioner records were reviewed 6 months after machine use to identify diagnoses of hypertension. A random sample of users was interviewed, and local general practices were asked about effects on their workload.
  
  
  RESULTS
  A total of 758 first time users completed a proforma fully, although direct observations suggested total use was much higher. Of the total, 221 (29.2 per cent) readings were above the action level. Eleven new hypertensives were found, 1.4 per cent (95 per cent confidence interval (CI 0.7-2.5) of the total users. User acceptability was high. All general practice replies were supportive.
  
  
  CONCLUSIONS
  Open access sphygmomanometry for detection of hypertension is feasible. This scheme led to the diagnosis of hypertension in 1.4 per cent of users, and allowed many people to measure their BP in a way convenient to them. Before recommending wider implementation we suggest a study examining if our results are transferable to other settings, and if this approach reduces inequalities and is cost-effective.
authors.affiliation: Division of Primary Care, University of Bristol, Cotham House, Bristol B56 6JL. w.t.hamilton@btopenworld.com
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
authors.forename: Alison
authors.initials: A
authors.lastname: Round
authors.forename: Rebecca
authors.initials: R
authors.lastname: Goodchild
authors.forename: Cindy
authors.initials: C
authors.lastname: Baker
mesh_terms: D000328:Adult; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D004739:England; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D011634:Public Health; D012648:Self Care / Q000706:statistics & numerical data*; D019722:Sphygmomanometers / Q000706:statistics & numerical data* / Q000600:supply & distribution; D016526:Workload