African Cardiology Review | 20 February 2018
An Ethnographic Study of Masked Hypertension among Normotensive Professional Drivers in Lagos, Nigeria: Prevalence, Determinants and Socio-occupational Contexts
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Abstract
Masked hypertension, defined by normal clinic blood pressure but elevated out-of-office readings, is a significant cardiovascular risk factor often missed in routine care. Professional drivers in high-stress urban settings like Lagos, Nigeria, may face a high risk due to unique socio-occupational pressures, yet this remains understudied in this population. This study investigated the prevalence and determinants of masked hypertension among normotensive professional drivers in Lagos. It aimed to understand the condition within its specific socio-occupational and cultural contexts. An ethnographic study was conducted using participant observation and in-depth interviews with 42 professional drivers who were normotensive during clinic screening. Ambulatory blood pressure monitoring (ABPM) identified masked hypertension. Fieldwork involved accompanying drivers on routes and engaging with them in their typical work and rest environments. The prevalence of masked hypertension was 31% among the studied drivers. Key determinants included chronic psychosocial stress from traffic congestion, economic pressure to meet daily revenue targets (‘daily dues’), and disrupted sleep patterns. A prominent theme was the normalisation of stress and physical symptoms as an unavoidable part of the occupational identity. Masked hypertension is highly prevalent among ostensibly normotensive professional drivers in Lagos, indicating a hidden cardiovascular disease burden. The condition is deeply embedded in occupational routines and socio-economic realities, making it resistant to conventional clinic-based detection. Routine screening for professional drivers should incorporate ABPM or home blood pressure monitoring. Cardiovascular health programmes must address the structural determinants of stress within the transport sector. Further research should explore targeted interventions within driver unions and parks. masked hypertension, professional drivers, ethnography, ambulatory blood pressure monitoring, Nigeria, occupational health This study provides an in-depth, contextual understanding of masked hypertension within a high-risk, under-researched occupational group in Nigeria, highlighting the critical role of socio-occupational factors and the limitations of clinic-based screening.