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Impact of Hypertension Screening on Early Detection of Hypertension among Adults in Nigeria

Abstract

Hypertension is a major public health challenge and an important risk factor for cardiovascular diseases, stroke, kidney disease, and other serious health complications. The condition may remain asymptomatic for prolonged periods, making regular blood pressure screening essential for identifying individuals with elevated blood pressure before complications develop. Hypertension screening involves the systematic measurement and assessment of blood pressure among individuals who may not yet have a confirmed diagnosis, with the aim of identifying those who require further clinical evaluation. Early detection enables timely confirmation, counselling, lifestyle modification, treatment where indicated, and continued monitoring, thereby providing an opportunity to reduce the risk of hypertension-related complications. In Nigeria, the burden of hypertension among adults remains a significant concern, while many individuals may be unaware of their blood pressure status. Barriers to early detection include limited awareness, inadequate routine screening, financial constraints, poor access to healthcare facilities, long distances to health facilities, low perceived risk among apparently healthy individuals, and insufficient opportunities for preventive health services. Community and facility-based hypertension screening may therefore provide an important means of identifying previously undiagnosed cases and increasing awareness of blood pressure status. Against this background, this study investigates the impact of hypertension screening on the early detection of hypertension among adults in Nigeria. The study is anchored on the Health Belief Model (HBM), Andersen's Behavioral Model of Health Services Use, and the Preventive Health Model. The Health Belief Model explains participation in preventive health services through perceptions of susceptibility, severity, benefits, barriers, and cues to action. Andersen's Behavioral Model emphasizes the role of predisposing, enabling, and need-related factors in healthcare utilization, including access to preventive screening services. The Preventive Health Model provides a framework for understanding how individual perceptions, social influences, and perceived health risks affect participation in preventive health behaviours such as routine blood pressure screening. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how hypertension screening may contribute to the early detection of hypertension among adults in Nigeria. The study adopts a quantitative cross-sectional research design. Primary data will be collected from adults aged 18 years and above in selected communities and healthcare facilities in Nigeria using a structured interviewer-administered questionnaire and standardized blood pressure measurement procedures. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible adult participants. Hypertension screening will be assessed based on participants' exposure to blood pressure screening services, frequency of screening, location of screening, access to screening opportunities, and previous awareness of their blood pressure status. Early detection of hypertension will be assessed based on newly identified elevated blood pressure among participants without a previous diagnosis and subsequent referral for confirmatory assessment. Blood pressure will be measured using validated equipment and appropriate standardized procedures, with repeated measurements where necessary. Descriptive statistics will be used to summarize participants' sociodemographic characteristics, screening history, and blood pressure status. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic regression analysis, will be employed to determine the impact of hypertension screening on early detection. Appropriate diagnostic tests will also be conducted to assess multicollinearity, model specification, goodness of fit, and the robustness of the findings. The study anticipates that hypertension screening will have a significant positive impact on the early detection of hypertension among adults in Nigeria. Individuals who participate in regular blood pressure screening are expected to have a greater likelihood of knowing their blood pressure status and identifying elevated blood pressure before the development of obvious symptoms or complications. Screening may also increase awareness of cardiovascular risk and encourage individuals with elevated readings to seek confirmatory assessment and appropriate medical care. Community-based screening programmes may be particularly useful in reaching adults who have limited contact with formal healthcare facilities. However, the identification of elevated blood pressure through screening does not necessarily guarantee subsequent diagnosis and treatment. Factors such as access to healthcare facilities, affordability of services, availability of healthcare professionals, follow-up systems, health literacy, and individuals' willingness to seek care may influence the transition from screening to confirmed diagnosis and treatment. Consequently, effective hypertension detection requires screening to be linked with appropriate referral, confirmation, counselling, treatment, and follow-up services. This study is expected to make significant contributions to the literature on hypertension prevention, cardiovascular health, preventive healthcare, and public health in Nigeria by providing empirical evidence on the relationship between hypertension screening and early detection among adults. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, primary healthcare facilities, hospitals, community health workers, public health practitioners, development partners, and policymakers regarding the importance of systematic blood pressure screening. The study will also provide evidence-based recommendations for expanding community and facility-based hypertension screening, improving public awareness of the importance of routine blood pressure checks, strengthening referral and follow-up systems, increasing access to affordable screening services, and integrating hypertension screening into existing primary healthcare and community health programmes to promote earlier detection and management of hypertension in Nigeria.

Keywords: Hypertension screening, early detection, hypertension, blood pressure, adults, cardiovascular health, preventive healthcare, primary healthcare, public health, Nigeria.