Objectives To evaluate diagnostic equity, feasibility and acceptability of a remote photoplethysmography-based blood pressure screening application among adults with darker skin tones in Nigeria. Design Prospective observational multisite field evaluation.
Setting Three hospitals in Kebbi State, Nigeria. Participants Adults with Fitzpatrick skin types V - VI.
Outcome measures Feasibility, agreement, diagnostic accuracy, acceptability, and equity relevant factors including facial tribal markings and internet bandwidth, using automated cuff measurements as the reference standard and a 140 over 90 mm Hg hypertension threshold. Results Among 306 enrolled participants, 249 (81.4%) produced usable readings.
Agreement was poor (systolic mean absolute error (MAE) 15.4 mm Hg, root mean square error (RMSE) 19.9; diastolic MAE 10.9 mm Hg, RMSE 13.6). Sensitivity for threshold-based systolic and diastolic blood pressure classification was very low (systolic 0.04; diastolic 0.10), with systolic sensitivity 0.00 in Fitzpatrick type VI.
Specificity was high (systolic 0.99; diastolic 0.89). Lower internet bandwidth correlated with reading failure (r = - 0.69 to - 0.51).
BMJ Open published a clinical update in Research Highlights on 22 Jun 2026.
The item focuses on Skin tone and diagnostic equity in contactless blood pressure screening: a prospective observational field evaluation of remote photoplethysmography in Nigeria.
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