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Engström et al. BMC Public Health 2011, 11:194 http://www.biomedcentral.com/1471-2458/11/194

RESEARCH ARTICLE

Open Access

Efficacy of screening for high blood pressure in dental health care
Sevek Engström1,2,3*, Christian Berne4, Lars Gahnberg5 and Kurt Svärdsudd1
Abstract
Background: There is consensus on the importance of early detection and treatment of high blood pressure. Dentalcare is one of few medical services to which a considerable proportion of the general population comes for regular check-ups. We tested the effects of blood pressure screening in dental care centres with subsequent workup of subjects screening positive in primary health care (PHCC). Methods: Altogether 1,149 subjects 40-65 years old or 20-39 years old with body mass index >25, and with nopreviously known hypertension, who came for a dental examination had their blood pressure measured with an Omron M4® automatic blood pressure reading device. Subjects with systolic blood pressure readings above 160 mmHg or diastolic above 90 mmHg were referred to their PHCC for a check up. Outcome data were obtained by scrutiny of PHCC and hospital patient records for hypertension diagnoses during thethree years following screening. Results: 237 (20.6%) subjects screened positive. Of these, 230 (97.1%) came to their PHCC within the 3-year followup period, as compared with 695 (76.2%) of those who screened negative (p < 0.0001). Of those who screened positive, 76 (32.1%) received a diagnosis of hypertension, as compared with 26 (2.9%) of those who screened negative. Sensitivity was 79.1%,specificity 84.8% and positive predictive value 30.1%. The number of subjects needed to screen to find one case of hypertension was 18. Conclusions: Co-operation between dental and primary care for blood pressure screening and work-up appears to be an effective way of detecting previously unknown hypertension.

Background Hypertension is a global health problem. It has been estimated that approximately1.8 million (27%) adults in Sweden may have high blood pressure, according to the World Health Organization criteria [1]. The consequences of non-treated high blood pressure are well known and include increased risk of developing heart disease, stroke, kidney disease and retinopathy [2]. There is a general consensus that the best way to avoid such problems is early detection and treatment of thehigh blood pressure, before organ damage has occurred. Many subjects with hypertension are unaware of their condition. Most incidents of hypertension are detected at primary health care, usually en passant when patients

* Correspondence: sevek.engstrom@pubcare.uu.se 1 Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, Uppsala,Sweden Full list of author information is available at the end of the article

seek care for other conditions, a kind of non-systematic opportunistic screening. In industrialised countries, dental care is usually the only public health care organisation to which healthy people come for regular checkups, usually at least once every second year [3,4]. Patients only come to almost all other healthcare organizations for consultations when they are ill or have a health complaint. Thus the dental service might be one of the most suitable health care organisations for systematic opportunistic screening of healthy subjects as well as for subjects with dental disease. However, one prerequisite for success is a multidisciplinary approach with cooperation between the dental services and primaryhealth care services for clinical work-ups of subjects screening positive [4]. The aim of this cooperative project between the dental and primary healthcare service was to test the efficacy of blood pressure screening in the dental service with subsequent workup in primary care.

© 2011 Engström et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the...
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