Abstract
Background: Hypertension (HTN) is a major risk factor for cardiovascular diseases (CVD). The World Health Organization recommends opportunistic screening, defined as measuring blood pressure (BP) during routine healthcare visits even for unrelated reasons. However, implementation of this approach remains suboptimal, and the impact of extending such screening is unknown. Objective: To estimate the impact of extending opportunistic HTN screening in public healthcare facilities in Bangladesh from 20% to 80% of eligible adults on CVD outcomes. Methods: Using a two-stage modelling framework, we estimated the impact of extending opportunistic screening from 20% (current) to 80%(goal) among adults (age > 25) without HTN treatment. First, we simulated the intervention effect on systolic BP (SBP), using a microsimulation model. Next, we incorporated the SBP effect in a state-transition model to estimate the 10-year impact on incident CVD events and deaths, assuming SBP effects were maintained over 10 years. Key model inputs were derived from clinical trials, the 2018 WHO STEPS survey, and the 2019 Global Burden of Disease Study. Results: Extended screening was estimated to increase HTN treatment coverage and prevent incident CVD events in the model population ( Figure ). Extending opportunistic screening from 20% to 80% could increase the number of people screened from 149,925 to 599,685/million (Panel A), and an additional 15,417/million more persons will be diagnosed and started on treatment (an increase from 16,857 to 32,274/million). Over 10 years, the extended screening could avert ~1,900 incident CVD events and ~340 averted CVD deaths, per 1 million eligible population (Panel B). Conclusions: Extending opportunistic HTN screening with subsequent treatment could substantially reduce CVD burden among adults with untreated HTN in Bangladesh. Understanding the costs related to screening and treatment requires further investigation.