article · BMC Cardiovascular Disorders
Standard office blood pressure readings often fail to capture the full picture of abnormal blood pressure patterns, especially in sub-Saharan Africa where ambulatory blood pressure monitoring is not widely used. A cross-sectional community study of 348 adults in Ido-Ekiti, Nigeria, evaluated 24-hour ambulatory monitoring alongside routine office measurements. Researchers identified sustained hypertension in 36.9 percent of participants, white-coat hypertension in 17.8 percent, masked hypertension in 5.0 percent, and true normotension in 40.3 percent. Additionally, circadian issues were common, with nocturnal hypertension recorded in 56.8 percent and morning hypertension in 40.6 percent of subjects. Age was the most consistent factor linked to these variations, showing sharp increases in sustained and nocturnal hypertension over time. Women also experienced higher rates of morning hypertension and lower rates of true normal blood pressure than men.
Relying purely on single clinic visits can cause healthcare providers to miss hidden, nighttime, or early-morning spikes in blood pressure. This evidence demonstrates that substantial numbers of individuals in semi-urban African settings experience these unmonitored cardiovascular patterns, indicating that wider adoption of ambulatory monitoring could significantly improve diagnosis and treatment.
The findings support the clinical adoption of ambulatory blood pressure monitoring devices and diagnostic workflows by healthcare providers in regional African health systems. As this is observational, community-based health research, it does not detail a proprietary product or service, but it establishes a clinical rationale for deploying affordable ambulatory monitoring technologies in semi-urban primary care settings.
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Office blood pressure (BP) measurement alone may underestimate the true burden of abnormal BP regulation, particularly in sub-Saharan Africa, where ambulatory blood pressure monitoring (ABPM) remains underutilised. This study characterised the distribution and sociodemographic factors of ABPM-derived hypertension phenotypes in a semi-urban Nigerian population. This community-based cross-sectional study enrolled 348 adults in Ido-Ekiti, Nigeria, who underwent 24-hour ABPM alongside standardised office BP measurement. Phenotypes (white-coat, masked, sustained hypertension, and true normotension) and circadian abnormalities (nocturnal and morning hypertension) were classified using 2024 European Society of Hypertension thresholds. Associations with sociodemographic and lifestyle factors were assessed using chi-square tests and multivariable logistic regression. Sustained hypertension was present in 36.9% of participants, white-coat hypertension in 17.8%, masked hypertension in 5.0%, and true normotension in 40.3%. Nocturnal hypertension (56.8%) and morning hypertension (40.6%) were highly prevalent. Age showed the strongest and most consistent gradient across nearly all phenotypes (all P < 0.001), with sustained and nocturnal hypertension rising sharply and true normotension declining with advancing age. Female participants had significantly higher morning hypertension (46.4% vs. 33.3%, P = 0.013) and lower true normotension (29.6% vs. 41.0%, P = 0.025) than males. Monthly income showed phenotype-specific, non-uniform associations with sustained, morning, nocturnal hypertension, and true normotension, while showing no association with white-coat hypertension. ABPM revealed a substantial burden of abnormal BP patterns, particularly sustained, nocturnal and morning hypertension, with pronounced age-related variation. These findings support wider ABPM adoption in African clinical practice, while socioeconomic and behavioural associations should be regarded as hypothesis-generating rather than causal.
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DOI: 10.1186/s12872-026-06517-x
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