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OPEN Machine learning evaluation of a

hypertension screening program
in a university workforce over five
years
Olumide Adeleke1,2, Segun Adebayo3, Halleluyah Aworinde4, Oludamola Adeleke1,
Abidemi Emmanuel Adeniyi4 & Oluwasegun Julius Aroba5,6
The global prevalence of hypertension continues excessively elevated, especially among low- and
middle-income nations. Workplaces provide tremendous opportunities as a unique, easily accessible
and practical avenue for early diagnosis and treatment of hypertension among the workforce class. The
evaluation of such a Workplace Screening Strategy can give insight into its possible effects. Innovative
machine learning approaches like k-means clustering are underutilized for such assessments. We
set out to use this technology to analyze the results of our university’s yearly health checkup of
the employees for hypertension. An anonymized dataset including the demographics and blood
pressure monitoring information gathered from workers in various departments/units of a learning
organization. The overall amount of samples or data values is 1, 723, and the supplied dataset
includes six attributes, such as year group (2018, 2019, 2021, 2022), Department/Unit (academic and
non-academic), and gender (male and female), with the intended output being the blood pressure
status (low, normal, and high). The dataset was analyzed using machine learning approaches. In this
longitudinal study, it was discovered that the average age for the workforce is 42. Similarly, it was
revealed that hypertension was common among employees over the age of 40, regardless of gender
or occupational type (academic or nonacademic). The data also found that there was a consistent
drop in the prevalence of hypertension from 2018 to 2022. According to the study findings, the use of
machine learning algorithms for periodic evaluations of workplace health status monitoring initiatives
(particularly for hypertension) is feasible, realistic, and sustainable in diagnosing and controlling
hypertension among those in the workforce.

Keywords Machine learning, Artificial Intelligence, Hypertension/diagnosis, Hypertension/prevention &

control, Screening programmes, Occupational health, Medical records systems, workplace

Hypertension, simply known as elevated blood pressure, is the number one risk factor for death globally,
significantly increasing the risk of developing cardiovascular, brain, and kidney diseases1. Globally, 1.28 billion
people between the ages of 30 and 79 were reported to have hypertension in 2019. Two-thirds of these adults
reside in low- and middle-income nations2. Regrettably, the WHO African Region has the highest prevalence
of hypertension (27%) while the WHO Americas Region has the lowest prevalence of hypertension (18%)2.
Sadly, an estimated 46% of persons with hypertension are ignorant of their disease and only 21% of persons with
hypertension have it under control3. Screening programmes for hypertension could help to reduce morbidity
and mortality associated with the condition in adults4.
Employee’s health status is of great importance to the stability and development of any institution and the
society at large. However, it has been reported that the cardiovascular health status of the occupational population
worldwide is not optimal5. Fortunately, workplace health programmes such as employee’s periodic screening

1Directorate of Health Services, Bowen University, Iwo, Nigeria. 2College of Health Sciences, Bowen University, Iwo,

Nigeria. 3College of Agriculture, Engineering and Science, Bowen University, Iwo, Nigeria. 4College of Computing
and Communication Studies, Bowen University, Iwo, Nigeria. 5Honorary Research Associate, Department of
Operations and Quality Management, Durban University of Technology, Durban, South Africa. 6Centre for Ecological
Intelligence, Faculty of Engineering and the Build Environment (FEBE), Electrical and Electronic Engineering
Science, University of Johannesburg, Auckland Park Campus, Auckland Park, P.O. Box 524, Johannesburg 2006,
South Africa. email: olumide.adeleke@bowen.edu.ng; jaroba@uj.ac.za

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have been shown to protect the individual employee’s overall health6, improve his/her productivity7, lower the
overall medical costs7, and reduce disease prevalence in general8,9. Occupational screening of employees at work
is an effective approach of identifying undiagnosed hypertensive people10.
Artificial intelligence (AI) has been used in many areas of healthcare services, including medical imaging
and diagnostics, pandemic management, virtual patient care, promoting medication and vaccine innovation,
lowering the administrative burden on medical staff, tracking patient adherence to treatment regimens,
conducting gait analyses for technology-assisted rehabilitation, and increasing patient engagement11. AI has also
been used in some published research to diagnose12,13 and to forecast the prevalence of hypertension14,15 in the
general population. However, machine learning approaches such as k-means clustering are underutilized in the
context of workplace screening. Leveraging machine learning in workplace offers a promising opportunity for
advanced data analysis techniques to enhance health assessments in the workplace.
K-Means Clustering is a machine-learning technique capable of providing useful insight into the behavior
and patterns of data16. It has been applied in diverse areas in medical science such as cancerous cell detection,
segmentation of brain images, skin treatment, intrathoracic airway trees, and abnormality detection of heart
ventricles17,18. Analysis of workplace and occupational screenings, where patient data may be complex,
multidimensional, and subject to variable degrees of uncertainty, is particularly well-suited for k-Means
clustering. In this study, we applied the k-Means Clustering algorithm to analyze health medical records from
the university workforce19.

Methodology
Study site and participants
This retrospective study was carried out between December 17, 2018, and December 20, 2022, at the Bowen
University Hospital located in the urban setting of Iwo (population range of 250,000-499,999 inhabitants), Osun
State in southwestern Nigeria. Bowen University, founded by the Nigerian Baptist Convention in 2001, is one of
the oldest private coeducational institutions of higher education in Nigeria. This retrospective study included
1723 rows of datasets from the workforce at Bowen University across different academic and non-academic units
of the university.

Dataset acquisition
The dataset was collated from staff in different units of an academic institution for a period of four years (2018,
2019, 2021 and 2022). The blood pressure measurements used in this screening programme were taken by nurses
and community health extension workers trained in manual blood pressure measurement, including proper
body positioning during measurement. BPs were measured manually using a stethoscope and the appropriate
sized brachial pressure cuff with a sphygmomanometer. The participants did not smoke or ingest caffeine or
other stimulants or food in the 30 min before the measurements, which were taken after at least 5 min of rest in
a quiet and calm environment Two BP readings were taken on both arms of employees in a sitting position and
at 2-minute intervals. If the first two readings differ by more than 10mmHg, additional readings were obtained
in line with American Heart Association (AHA) recommendations20–22.
Equipment was inspected on a routine basis to ensure accuracy. Employees with measurements outside of
the recommended range during the screening programme were advised to follow up with medical doctors at the
Bowen University Hospital. High blood pressure (hypertension) at the time of screening is defined as a systolic
blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher National Heart, Lung,
and Blood Institute23. We then anonymized these data from the university’s yearly health checkup to ensure
privacy while providing valuable insights into the prevalence of hypertension among different demographic
groups.

Data preprocessing
The dataset needs to be pre-processed before model training because each input sample contains different
features with missing and inconsistent values. Most of the missing data in the dataset are measured values
from staff, therefore, the study employed data-cleaning techniques. This entails locating and fixing mistakes
or discrepancies in the data, including duplicates, outliers, and missing numbers24,25. The data cleaning was
accomplished with a variety of methods, including imputation, removal, and transformation.

Data correlation
Data mining task play an important role in discovering patterns in data. This study employed feature correlation
and k-means clustering to find relevant and non-redundant features in the data. Pearson correlation coefficient
was employed to understand the linear relationships between variables. The Pearson Correlation Coefficient
between two variables X and Y is computed as:
COV (X, Y )
ρ (X,Y ) = (1)
σ Xσ Y

Where cov is the covariance, σ X is the standard deviation of variable X andσY is the standard deviation of variable
Y.

Data clustering
K-means clustering algorithms30 are used to discover the structure of data and form the cluster. This is achieved
by dividing the dataset into clusters according to data similarity. The technique involves initially selecting ‘k’
features randomly from original dataset D, as initial cluster centres. Based upon the distance between the features

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and cluster mean, the most similar object is assigned to the cluster. New mean value is then calculated for each
cluster. The latter step is repeated until there is no redistribution of features in any cluster.

Ethical consideration
This study was conducted using de-identified data obtained from the health medical record unit of the University
Hospital. Ethical approval was sought and obtained from the Directorate of Research and Strategic Partnerships
of the University.

Results
Initial dataset exploration
The dataset contains both sociodemographic and medical records. The data set is summarized in Table 1 based
on different features. The dataset contains seven features which are stated as year, age, systolic and diastolic
values, blood pressure status, department or unit, and gender. There are 1723 rows in the dataset and the mean
age is 42.64 years old, mean systolic and diastolic measurement are 120.91 and 78.4 respectively.
The dataset contains bio and blood pressure measurements values obtained from staff of different
departments/Unit in an academic institution. The total number of samples or data points are 1, 723 in which the
input dataset contains six features, including year category (2018, 2019, 2021,2022), Department/Unit (academic
and non-academic), gender (male and female), while the target output is the blood pressure status (low, normal
and high) respectively.
The number of individuals with normal blood pressure is higher than low or high blood pressure as shown in
Fig. 1. The mean for systolic blood pressure value is about 124. Insight from Fig. 1a and b show that high blood
pressure is prevalent among staff above the age of 40 irrespective of their gender or category (academic or non-
academic).
Figure 2 shows the relationship plots of the dataset variables. The graphs revealed that there has been a relative
decline in high blood pressure between 2018 and 2022. As against 29% high blood pressure in 2018, there has
been a relatively significant fall to 18% in 2022 which accounts for 11% improvement in healthcare of individual
staff by reason of blood pressure. Conversely, there seems to be a slight rise (3%) in low blood pressure from 2%
in 2018 to 5% in 2022; this may be another trend to really pay attention to and the attendant contributive factors.
From the age-range variable, high blood pressure is prevalent among the age range 60–69 with 49% prevalent
rate while the age group 20–29 has the lowest rate of 8%. In terms of low blood pressure, the age group 20–29 has
the highest rate of 7% while the age group 40–49 has the lowest rate in low blood pressure of 1%.
For the staff category, the difference in high blood pressure rate is not so significant as there is only a difference
of 1% between academic and non academic staff. Non academic staff members have a high blood pressure rate of
25% while the academic category of staff has 24%.

Features correlation
After looking at the trends for the main variables in the previous section, the study considered the potential
correlations between various variables. Figure 3 shows the Pearson Correlation matrix with significant values
obtained from the dataset. Significant values have been identified as values with a 95% confidence and different
from zero29. However, studies have shown that variable correlation can be full of noise or misrepresentation. To
prevent such in our results, the study performed t-test30 and the result is presented in Fig. 4. This shows that there
is a strong correlation between systolic and age as well as diastolic and age.

Insight through unsupervised learning: clustering

The application of the k-means algorithm as depicted in Fig. 5 shows a clustering of the workforce based on three
major parameters: systolic, diastolic, and age. While Fig. 6 shows the clustering in three dimensions.

Discussion
This study highlights the promising potential of leveraging machine learning techniques in workplace screening
programmes for hypertension among university workforces. In this retrospective analysis of our university

Statistic Year Age Systolic_Blood_Press Diatolic_Blood_Press Blood_Press_Status Dept_Unit Gender Category

count 1723 1723 1723 1723 1723 1723 1723 1723
unique NaN NaN NaN NaN 3 239 2 2
top NaN NaN NaN NaN Normal Registry M Non-academic
freq NaN NaN NaN NaN 1237 288 891 1172
mean 2019 42.6 120.9 78.4 NaN NaN NaN NaN
std 1.3 9.7 18.6 23.1 NaN NaN NaN NaN
min 2018 17 80 10 NaN NaN NaN NaN
25% 2018 35 110 70 NaN NaN NaN NaN
50% 2019 42 120 80 NaN NaN NaN NaN
75% 2019 50 130 80 NaN NaN NaN NaN
max 2022 76 230 910 NaN NaN NaN NaN

Table 1. Summarized dataset.

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Fig. 1. Blood status against age across different (a) years, (b) gender, (c) category.

workforce health records using k-Means Clustering, we observed that the mean age for this working class was
observed to be 42 years old. Similarly, we discovered that hypertension was prevalent among members of staff
above the age of 40 irrespective of their gender or professional category (academic or non-academic). The
analysis also revealed that there was a steady decline in the prevalence of hypertension from 2018 to 2022. We
particularly found using k-Means Clustering relevant and appropriate for this analysis.
The average age for the working population in this analysis was observed to be 42 years. Evidence on the
benefits of screening programmes for hypertension in adults in this age bracket is well-established. The United
State Preventive Services Task Force (USPSTF) strongly recommends screening for high blood pressure in adults
aged 18 years or older21. Similarly, the Canadian Task Force on Preventive Health Care continues to recommend
screening for hypertension in adults aged 18 years and older without previously diagnosed hypertension28.
Similar recommendations were made by the World Health Organisation and the International Society of
Hypertension28. This makes the workplace an ideal setting for hypertension screening programmes and other
health promotion interventions. It provides a convenient and accessible platform to reach many people who
constitute a stable population and it may promote sustained positive peer support30–32.
Furthermore, we discovered that the prevalence of hypertension among members of staff increases with age
and that hypertension prevalence is particularly high above the age of 40. This is not unusual because it is well-
established in the literature that age is a predisposing factor for the development of primary hypertension33. A
similar finding has been reported in another Nigerian study where age was found to be a risk factor for the high
prevalence of hypertension among the urban population in Nigeria34,35. Given the earlier reported mean age of
40 for this working class, there is adequate evidence for the screening of employees for hypertension.
This analysis revealed that there was a steady decline in the prevalence of hypertension from 2018 to 2022
which implies that the screening programme helps to identify and better control blood pressure over the
subsequent years. The reason for this is not far-fetched as this annual screening programme, carried out on
staff members in the university community, serves as a regular sensitization mechanism put in place by the
University, contributing to timely identification of undiagnosed hypertension and appropriate treatment of
hypertension among the employees which promotes better blood pressure control. Similar benefits have earlier
been attributed to workplace health promotion programmes8,9,36.
The consistent drop in the prevalence of hypertension from 2018 to 2022 observed in this study lays credence
to the usefulness of k-Means Clustering for analysis of healthcare data from medical records. The relevance and

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Fig. 2. Relationship plots of the variables in the dataset: (a) Distribution of blood pressure status in function
of year; (b) Distribution of blood pressure status in function of Age-group; (c) Distribution of blood pressure
status in function of categories.

reliability of k-Means Clustering for diagnosing hypertension has been earlier documented in literature. Tsoi et
al. have shown that, among a number of Deep Learning and Machine Learning algorithms, K-means clustering
produced the most consistent and dependable results for diagnosing hypertension37.
Limitations.
The study’s retrospective design nature limits the ability to establish causality between workplace interventions
and changes in hypertension prevalence. However, the study’s longitudinal nature, spanning from 2018 to 2022,
allows for the observation of trends over time, revealing a consistent drop in the prevalence of hypertension. Due
to COVID-19 pandemic lockdown in Nigeria, the annual screening programme could not be conducted in 2020.
Hence, there was no dataset on hypertension among the employees in 2020. Furthermore, since the employer
bears the health care costs of the screening of the workforce in the setting of this study, there is a need for caution
in the generalizability of the findings of this analysis to a very different context. Although the study was carried
out in a single institution - limiting the generalizability of the findings to other settings or populations, the study
includes a sizable dataset with 1,723 samples, increasing the reliability of the findings.

Conclusion
We have shown with the use of machine learning techniques that a periodic workplace screening programme
for hypertension is an effective, feasible, and sustainable strategy to diagnose and control hypertension among
the working class. Workplace is as an idea setting for early detection and treatment of hypertension among the
working class. Although the study demonstrates the feasibility of using machine learning for health assessments
- illustrating the potential for advanced data analysis techniques to enhance health assessments in the workplace,
it does not address the cost-effectiveness or practical implementation challenges of integrating these technologies
into routine workplace health monitoring. Therefore, further research is needed to evaluate the barriers and
facilitators of implementations of similar workplace health promotion programmes in the appropriate way.

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Fig. 3. Pearson Correlation Matrix of the Variables in the dataset.

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Fig. 4. Pearson Correlation Matrix of the Variables in the dataset with non-significant values and the upper
triangular filtered out.

Fig. 5. Clustering based on (a) blood pressure status (systolic) and age; (b) blood pressure status (diastolic)
and age.

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Fig. 6. Clustering in 3D.

Data availability
The datasets generated and/or analyzed during the current study are not publicly available because it involve
data obtained from human participants. Dr. Olumide Adeleke should be contacted at (olumide.adeleke@bowen.
edu.ng) for the dataset in this studyThe link to the data set https://data.mendeley.com/datasets/7d3kjdwn5d/1.

Received: 15 July 2024; Accepted: 25 September 2024

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Author contributions
Olumide Adeleke came up with the concept, methdology and Segun adebayo and Halleluyah worked on the
modelling, Oludamola adeleke worked on the literature, Abidemi worked on Introduction, Oluwasegun Aroba
worked on the abstract, summary, proof reading.The datasets generated and/or analyzed during the current
study are not publicly available because it involve data obtained from human participants. Dr. Olumide Adeleke
should be contacted at (olumide.adeleke@bowen.edu.ng) for the dataset in this study.

Declarations

Competing interests
The authors declare no competing interests.

Consent for publication

All the authors consent to submit and publish this research in the scientific report.

Ethical approval and consent to Participate

The ethical clearance is attached to this submission. We confirm that all methods were carried out in
accordance with relevant guidelines and regulations.

Informed consent
All informed consent was obtained from all subjects and/or their legal guardian(s).

Additional information
Supplementary Information The online version contains supplementary material available at ​h​t​t​p​s​:​/​/​d​o​i.​ ​o​r​g​/​1​
0​.​1​03​ ​8​/​s​4​1​5​9​8​-0​ ​2​4​-​7​4​3​6​0​-​1​​​​.​ ​​
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Scientific Reports | (2024) 14:30255 | https://doi.org/10.1038/s41598-024-74360-1 10