PS-P04-9: PULSE PRESSURE AND MEAN ARTERIAL PRESSURE IN HYPERTENSIVES WITH MULTI-MORBIDITY: AN ANALYSIS USING GLOBAL DATA FROM MAY MEASUREMENT MONTH (MMM)

Abstract

Background: The increasing prevalence of people living with multimorbidity is an increasing challenge for health systems. Mean arterial pressure (MAP) serves as the steady component in a patient's arteries during one cardiac cycle while pulse pressure (PP) is recognized as the pulsatile component. Along with systolic blood pressure (BP) and diastolic BP, both MAP and PP are established risk factors for the development of major adverse cardiovascular events. The knowledge of how PP and MAP vary among hypertensives according to the presence of one or more long-term conditions (LTCs) is limited. May Measurement Month (MMM) is the largest contemporary global BP screening campaign designed to raise awareness of high BP. Purpose: To identify the association between BP parameters and number of LTCs (diabetes, myocardial infarction and stroke) in participants with hypertension. Design and methods: MMM is an opportunistic cross-sectional survey with over 4.8 million volunteers aged over 18 years recruited between 2017–2019, and 2021 in 106 countries. Three sitting BP readings were taken for each participant on a single occasion, with data on demographics, lifestyle, hypertension and LTCs collected. Hypertension was defined as systolic BP greater than 140mmHg and/or diastolic BP greater than 90mmHg (average of the second and third readings) and/or taking antihypertensive medication(s). Mixed-effects linear regression models were applied to compare the BP parameters with different numbers of LTCs, assuming random intercepts for country to account for clustering. Multivariable models were adjusted for age and sex (with an interaction term), medication use, current smoking and alcohol consumption. Findings: We analysed data from 1,107,432 individuals with hypertension, recorded data on LTCs and with all three BP readings. Overall, 860,376 (77.7%) had no LTCs, 188,306 (17.0%) had one, 40,592 (3.7%) had two, and 18,158 (1.6%) had three LTCs. After adjustment for potential confounders, the average PP of hypertensives without LTCs was 52.9mmHg. Compared to those with no LTCs, the PPs were significantly higher at 54.4mmHg, 54.9mmHg, and 53.6mmHg, in hypertensives with one, two or three LTCs, respectively (all p < 0.001). A strong inverse relationship was seen between MAP and numbers of LTCs, with mean MAPs of 104.1mmHg, 103.8mmHg, and 101.5mmHg in those with one, two or three LTCs respectively, compared to participants without (104.4 mmHg) (all p < 0.001). Conclusion: Our study highlights that the presence of one or more LTCs is associated with higher PP and lower MAP. These differences in PP and particularly reduced MAP may have implications for optimal BP management in people with multimorbidity.