Influence of ethnicity on acceptability of method of blood pressure monitoring: a cross-sectional study in primary care.
BACKGROUND
Ambulatory and/or home monitoring are recommended in the UK and the US for the diagnosis of hypertension but little is known about their acceptability.


OBJECTIVE
To determine the acceptability of different methods of measuring blood pressure to people from different minority ethnic groups.


METHODS
Cross-sectional study with focus groups in primary care in the West Midlands.


METHODS
People of different ethnicities with and without hypertension were assessed for acceptability of clinic, home, and ambulatory blood pressure measurement using completion rate, questionnaire, and focus groups.


RESULTS
A total of 770 participants were included, who were white British (n = 300), South Asian (n = 241), and African Caribbean (n = 229). White British participants had significantly higher successful completion rates across all monitoring modalities compared with the other ethnic groups, especially for ambulatory monitoring: white British (n = 277, 92% [95% confidence interval [CI] = 89% to 95%]) versus South Asian (n = 171, 71% [95% CI = 65% to 76%], P<0.001) and African Caribbean (n = 188, 82% [95% CI = 77% to 87%], P<0.001), respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared with white British participants. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least acceptable without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input.


CONCLUSIONS
Reduced acceptability and completion rates among minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring. Selection of method of blood pressure monitoring should take into account clinical need, patient preference, and potential cultural barriers to monitoring.
Sally
S
Wood
Sheila M
SM
Greenfield
M
M
Sayeed Haque
Una
U
Martin
Paramjit S
PS
Gill
Jonathan
J
Mant
Mohammed A
MA
Mohammed
Gurdip
G
Heer
Amanpreet
A
Johal
Ramandeep
R
Kaur
Claire
C
Schwartz
Richard J
RJ
McManus
D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000523:psychology; D003430:Cross-Sectional Studies; D004739:England; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D010346:Patient Care Management; D011320:Primary Health Care
D000959:Antihypertensive Agents
blood pressure monitoring; ethnicity; hypertension; patient satisfaction; primary care