S-53-4: HYPERTENSION AND ITS ASSOCIATIONS WITH MULTIMORBIDITY: AN ANALYSIS OF 4 MILLION PARTICIPANTS FROM MAY MEASUREMENT MONTH 2017–2019

Abstract

Objective: Hypertension is a leading cause of global morbidity and mortality and is a principal risk factor for cardiometabolic multimorbidity. Evidence regarding the prevalence of hypertension, hypertension treatment and blood pressure (BP) control is scarce in people with cardiometabolic long-term conditions (LTCs). May Measurement Month is the largest annual, global BP screening campaign providing one of the largest datasets on BP and cardiometabolic status. This study explores the association between cardiometabolic LTCs and hypertension, hypertension treatment, BP control, and mean BP. Design and methods: A total of 3,397,746 participants (≧18 years) from the three MMM campaigns in 2017–2019 arising from 103 countries were included. Data on three LTCs were collected: diabetes, myocardial infarction and stroke. Participants were subdivided based on number of LTCs. Hypertension was defined as having a systolic BP≧140mmHg and/or diastolic BP≧90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. Multiple imputation was used to estimate BP readings if any readings were missing. Controlled hypertension was defined as a BP< 140/90mmHg on treatment. Results: Amongst all participants, 316940 (9.3%), 62731 (1.8%), and 28491 (0.8%) reported having one, two or three LTCs, respectively. There was a graded effect of increasing number of LTCs on rates of hypertension: 29.6% in those with no LTCs, and 63.0%, 68.6% and 71.2% in those with one, two or three LTCs, respectively. A similar graded effect was seen for the percentage of hypertensive participants on antihypertensive medication: 44.0% in those with no LTCs, and 79.6%, 87.1% and 89.8% in those with one, two or three LTCs, respectively. Despite higher treatment rates, BP control rates (<140/90mmHg) were similar in those with no LTCs, one or two LTCs (57.6%, 56.4% and 56.0%, respectively) but higher in those with three LTCs (67.9%). This was reflected in the average BPs of participants on treatment, with similar average BPs in those with no LTCs, one, or two LTCs (134/82mmHg, 135/81mmHg and 135/81mmHg, respectively) compared with lower BP (129/78mmHg) in those with three LTCs. Conclusions: With an increasing number of cardiometabolic LTCs, there was a graded increase in the likelihood of having hypertension, and amongst hypertensives, of being treated. Control rates were similar in those with two or fewer LTCs but higher in those with three LTCs, although BP control was suboptimal in all groups. Focused efforts in the higher-risk population with cardiometabolic LTCs are needed to reduce the global burden of hypertension.