Development and Internal Validation of a Multivariable Clinical Risk Score for Adult Hypertension among Non-Pregnant Women: A Biomarker Analysis of the 2024/25 EDHS from Ethiopia

High blood pressure is a silent force that quietly damages the heart, kidneys, and brain, often without causing any noticeable symptoms until it is too late. In many parts of the world, especially in low-income regions, the tools needed to detect this condition are often missing. Standard medical tests usually require drawing blood to check cholesterol or sugar levels, but in rural clinics across Ethiopia, such laboratories simply do not exist. Without these tests, doctors cannot easily use the complex risk charts developed in wealthier nations to guess who is in danger. This leaves millions of women vulnerable, unaware that their blood pressure is rising until they suffer a stroke or heart failure. The challenge for health workers in these settings is to find a way to identify the most at-risk individuals using only the information they can gather right in front of them: a person's age, their weight, where they live, and their family history.

A team of researchers from Teda Health Science College and Wollo University in Ethiopia set out to solve this specific problem. They analyzed data from a massive national survey of over 12,000 non-pregnant women, looking for patterns that could predict high blood pressure without needing a single drop of blood. By examining the records of these women, they discovered that seven specific factors were strongly linked to the condition. These factors included a woman's age, her body mass index, whether she lived in a city or the countryside, her household wealth, whether she used tobacco, and how many children she had given birth to. Using these six pieces of information, the team built a simple scoring system. They assigned points to different levels of each factor, creating a tool that anyone could use with a pencil and paper to calculate a risk score.

The researchers tested this new tool on a separate group of women to see if it would work in the real world. The results were striking. The score proved to be highly accurate at distinguishing between women who had high blood pressure and those who did not. When the researchers looked at the women who scored highest on the list, they found that nearly half of them actually had hypertension. In contrast, the women with the lowest scores had a very low chance of having the condition. This means the tool can act as a filter, helping health workers decide who needs immediate medical attention and who can wait for a routine check-up. The study confirmed that this method works well even without laboratory equipment, offering a practical way to screen large populations in places where advanced technology is unavailable.

The implications of this work are significant for the daily practice of medicine in Ethiopia. Health Extension Workers, who are the primary link between the health system and rural communities, can now use this simple point system during home visits or community gatherings. Instead of trying to measure the blood pressure of every single woman—a task that would require thousands of expensive, often broken machines—they can first calculate the risk score. Those who score high can be prioritized for a proper diagnosis and treatment, while those with low scores can be reassured and monitored later. This approach allows the limited medical resources to be focused exactly where they are needed most. The study did not claim to cure hypertension or to work perfectly in every country, but it provided a validated, reliable method for identifying risk in a population that has long been overlooked by standard medical guidelines. By turning complex medical data into a simple list of questions, the researchers have given local health workers a powerful new way to protect the women in their communities.