International Society Of Hypertension Research Articles

Cardiovascular Risk Profiling Using the Globorisk Calculator among Noncommunicable Disease Patients Attending Primary Health Centers of a Tertiary Care Teaching Hospital in South India: A Cross-Sectional Analytical Study.

Cardiovascular diseases (CVDs) account for over three-quarters of all deaths taking place in developing nations. The present study aims to stratify noncommunicable disease (NCD) patients using the Globorisk chart for predicting their 10-year risk of a major (fatal or nonfatal) CVD event and to estimate the level of agreement between this country-specific chart and the existing World Health Organization (WHO)/International Society of Hypertension (ISH) risk strata. A record-based cross-sectional analytical study was conducted in 2018 among adults attending the NCD clinic of one rural and one urban primary health center in Puducherry. Laboratory and office risk calculators of the Globorisk chart were used to calculate the risk. The median age (interquartile range (IQR)) of the 760 study participants was 58 (50-65) years. When calculated using the Globorisk prediction chart, 22.1% (n = 168) of the participants had a <10% risk for any CVD event in the next 10 years, whereas the same risk was found in 71.1% (n = 540) by using the WHO/ISH risk chart. There was no agreement found between the two risk charts (k = 0.0174; P-value = 0.26). The Globorisk chart was found to identify more patients as belonging to the higher risk category as compared to WHO/ISH charts.

Sex- and Gender-Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines.

Hypertension is the leading modifiable cardiovascular risk factor with recognized sex- and gender-based differences. We assessed the incorporation of sex and gender reporting in the antihypertensive medication literature informing hypertension guidelines. Literature cited in the International Society of Hypertension (2020), European Society of Cardiology/European Society of Hypertension (2018), American College of Cardiology/American Heart Association (2017), Latin American Society of Hypertension (2017), Pan-African Society of Cardiology (2020), and Hypertension Canada (2020) guidelines was systematically reviewed. Observational studies, randomized controlled trials, and systematic reviews involving antihypertensive medications were included. Studies with participants of a single sex, guidelines, and commentaries were excluded. Data on study participation-to-prevalence ratio by sex, analysis of baseline demographics and study outcomes by sex, and stratification of adverse events by sex were extracted. Of 1659 unique citations, 331 studies met inclusion criteria. Of those, 81% reported the sex of participants, and 22% reported a male-to-female participation-to-prevalence ratio of 0.8 to 1.2. Three percent of studies stratified baseline characteristics by sex, and 20% considered sex during analysis through statistical adjustment or stratification. Although 32% of studies reported adverse events, only 0.6% stratified adverse events by sex. Most(58%) studies reporting sex/gender used sex and gender terms interchangeably. Incorporation of sex- and gender-based considerations in study population, analysis, or reporting of results and adverse events is not common in the antihypertensive medication literature informing international hypertension guidelines. Greater attention to sex- and gender-based factors in research is required to optimally inform management of hypertension.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA): Erratum.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA): Erratum.

Evening anti-hypertensive dosing, blood pressure and cardiovascular events in hypertensive: Updated meta-analysis of 41 trials in 65,271 patients

Abstract Introduction In 2022, the International Society of Hypertension and World Hypertension League released a position paper noting that there is limited evidence on the impact of bedtime versus other time dosing of antihypertensives on 24-h BP profile and on cardiovascular morbidity and mortality. Since then, the Treatment In Morning versus Evening (TIME) trial results which enrolled over 20 thousand participants was published. This study aims to update our prior meta-analysis in 2020 (Sunjaya et al. EHJ. Vol. 41:S2) in light of this new results. Purpose In patients with hypertension does evening dosing of anti-hypertensive compared to morning dosing led to better reduction in pressure, blood pressure control and reduced cardiovascular morbidity. Methods A meta-analysis was performed based on randomized controlled trials obtained from Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline and Medline ahead of print published between 2000 and February 2023. Main outcome measures include mean 24 hour systolic and diastolic blood pressure, cardiovascular events as well as prevalence of blood pressure in control. Data synthesis and analysis was done using RevMan 5.3 using a random effects model. Results A total of 41 randomized controlled trials, representing 65,271 patients were included in this meta-analysis. Most studies evaluate the administration of mixed anti-hypertensive with ≥1 medication ingested at bedtime, calcium channel blockers (CCBs) or angiotensin receptor blockers (ARBs) with sample sizes ranging from 30 to 21,104 patients. Evening administration of anti-hypertensive was found to significantly lower 24-hour systolic blood pressure (Mean difference = -1.09, 95% CI -1.97 to -0.20, p = 0.02) and 24-hour diastolic blood pressure (Mean difference = -1.05, 95% CI -1.60 to -0.51, p = 0.0002). Significant reduction in cardiovascular events were found in the evening dosing group (RR = 0.53, 95% CI 0.38 to 0.73, p = 0.0001). Discussion: While evening administration was found to result in significantly lower systolic and diastolic blood pressure, both reductions were found to not be clinically meaningful (At least 5 mmHg for systolic and at least 3 mmHg as per 2022 Hypertension Academic Research Consortium consensus). Few studies have reported the impact on cardiovascular events (7 studies), mostly contributed by one research group (Hermida et al. 4 studies). Sensitivity analyses conducted removing studies conducted by this research group resulted in a non-significant pooled risk being found, though with result from only 3 studies. Conclusion For patients with hypertension, current evidence suggests no significant impact on blood pressure levels. While a reduction in the risk for cardiovascular events was found, this result was strongly contributed by that from one setting. Further studies remain required to answer this important question due to its possible widespread impact on clinical practice.Figure 1MACEFigure 2Systolic Blood Pressure

Estimation of 10-year cardiovascular risk among adult population in western Nepal using nonlaboratory-based WHO/ISH chart, 2023: A cross-sectional study.

Noncommunicable diseases have emerged as a major cause of morbidity and mortality worldwide among which the majority of the deaths are caused by cardiovascular diseases. Estimating the risk of cardiovascular diseases helps eliminate the risk factors and prevent developing cardiovascular diseases in the future. The World Health Organization in association with the International Society of Hypertension has developed risk charts for the estimation of 10-year risk for cardiovascular diseases. This study aimed to estimate 10-year cardiovascular risk in the Nepalese population using nonlaboratory-based charts. A hospital-based cross-sectional study was conducted among 314 adults aged 40-74 years visiting the outpatient departments of Shishuwa Hospital in western Nepal. Systematic random sampling was used to select the participants. Questionnaire-guided short interviews, physical examination, and anthropometric measurements were done. The χ 2 test was used to test the significance and a p < 0.05 was considered statistically significant. As per the risk estimation charts, high cardiovascular risk (20%-30%) was seen in 6.1% of total participants and moderate cardiovascular risk (10%-20%) was found in 29% of participants. The moderate-high risk was significantly higher among male participants compared to females (p < 0.01). Of all the participants, 22.0% were current smokers, 17.2% were alcohol users, 61.1% were hypertensive, and 35.7% were diabetics. Smoking tobacco, alcohol use, and hypertension were significantly more prevalent among the male participants. (p < 0.01) Adults in the 50-59 years age group had a significantly high prevalence of hypertension (p < 0.01), diabetes (p = 0.02), and alcohol abuse (p = 0.01). This study shows high cardiovascular risk among adult population in western Nepal. The 10-year cardiovascular risk score and risk factors were significantly higher among males than females. There seems to be a prompt necessity of health promotion interventions to reduce cardiovascular risk factors and prevent the burden of cardiovascular diseases in Nepal.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA).

Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).

Correlation between Steatosis Degree and Hypertension Degree in Non-Alcoholic Fatty Liver Disease Patients in Indonesia

Non-alcoholic fatty liver disease (NAFLD) has been recognized closely linked to cardiovascular diseases including hypertension. The connection between these conditions can be attributed to lipotoxicity, that induces systemic inflammation by activating the sympathetic nervous system (SNS) and triggers the release of angiotensin II within the renin-angiotensin-aldosterone system (RAAS). This study examined the correlation between degree of steatosis and degree of hypertension in NAFLD patients at Hajj Hospital Jakarta in 2019-2022. A cross-sectional approach was used to analyse the medical record data obtained through consecutive sampling. B-mode abdominal ultrasound examination assessed the degree of steatosis in NAFLD. Blood pressure grading was based on the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines. The data were processed using Somers’d test to define the correlation between steatosis and hypertension.Of 53 NAFLD subjects, 56.6% were female, and mild steatosis was dominant (54.7%). The proportion of hypertension among NAFLD patients was 39.7%, with a higher prevalence of 61.9% among those aged 50 years or older. Majority of patients were grade I hypertension, whereas all subjects with grade II hypertension exhibited severe steatosis. There was correlation between the degree of hypertension and steatosis patients with NAFLD, with a p-value of 0.029 and a weak correlation coefficient (r= 0.251). This study found a correlation between steatosis and degree of hypertension. It was suggested females aged 50 years or older with grade II hypertension should be screened for fatty liver.

Validation of mobile health technology (mhealth tech) for cardiovascular risk detection

BackgroundWireless health monitoring device is handy, reduces measurement time and aids in screening and monitoring especially in resource limited settings and remote areas leading to early diagnosis and treatment. Objective of this study was to validate mobile health technology (mhealth tech) in cardiovascular risk detection and to assess Cardiovascular Disease (CVD) risk based on WHO's International Society of Hypertension (ISH) risk score among the study population. MethodologyA Cross-sectional study was carried out in 172 participants. Vital parameters were measured by wireless health monitoring device and traditional methods. Pulse rate and respiratory rate were calculated manually. SPO2, temperature and blood pressure were measured by pulse oximeter, thermometer and sphygmomanometer respectively. ROC curve and Independent T-test were done. ResultsMean difference in time spent measuring vitals manually by traditional method and by wireless health monitoring device was 239.65 (P=<0.001, 95% CI = 232.91 to 246.38). Area under the Receiver Operating Characteristic (ROC) curve for accuracy in diagnosing tachycardia, tachypnoea, hypoxia, hyperthermia, systolic and diastolic hypertension was 0.866 (95% CI (0.745–0.988); p=<0.001), 0.866 (95% CI (0.686–1); p=<0.001), 0.872 (95% CI (0.617–1); p = 0.011), 0.931 (95% CI (0.797–1); p=<0.001), 0.907 (95% CI (0.782–1); p=<0.001), and 0.854 (95% CI (0.651–1); p = 0.002) respectively. ConclusionWireless health monitoring devices can be used as a screening and monitoring tool. It is convenient, user-friendly and quickly measures vitals, hence can be used in centres with minimal manpower, health camps and mass screening.

The HEARTS partner forum-supporting implementation of HEARTS to treat and control hypertension.

Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs).

Prevalence and Predictors of Hypertension among Company Workers in Rivers State, Nigeria

Background/ObjectiveHypertension, “the silent killer,” is an important preventable cause of premature morbidity and mortality globally. This condition has become a major non-communicable disease threatening sub-Saharan Africa, and its prevalence is rising in middle and low-income countries. This study objective was to determine the prevalence and predictors of hypertension among company workers in Rivers State, NigeriaMethodsThis analytical and cross-sectional study used a multi-stage sampling technique to recruit 296 company workers in Rivers State, Nigeria. A semi-structured questionnaire was used to obtain the respondents’ demographics, lifestyle, and healthcare characteristics. Respondents’ weight and height were measured using standard procedures. Blood pressure was determined by standard practice and criteria as defined by WHO and International Society of Hypertension. Data were analyzed using descriptive statistics, correlation, and logistic regression at p&lt; 0.05 level of significance.Results64.9% of the respondents were married and 59.5% were male. 52.0% drank alcohol, and 7.4% smoked. While 67.2% claimed they were not hypertensive, 22.6% don’t know their blood pressure status, and 58.1% were physically inactive. The prevalence of hypertension was 33.4%, and the prevalence of overweight and obesity was 43.6% and 15.2%, respectively. Predictors of hypertension in the study population were sex (male) (p&lt;0.001), age &gt;40 (p&lt;0.001), alcohol consumption (any) (p&lt;0.05), physical activity (≤rarely) (p&lt;0.001) and BMI (≥25) (p&lt;0.001) of the respondents.ConclusionThere was a high prevalence of hypertension and presence of modifiable cardiovascular disease risk factors among the population. Therefore, both secondary and primary prevention require attention, in the latter case, comprehensive population-wide and workstation interventions, including behavioral change and communication interventions that are context-specific, should be implemented.

HIGH PREVALENCE OF NEW HYPERTENSION AND EARLY VASCULAR AGING: A REPORT FROM MAY MEASUREMENT MONTH 2019 SCREENING PROGRAMME IN BULGARIA

Objective: Hypertension remains a major public health issue with inadequate control worldwide. The May Measurement Month (MMM) initiative by the International Society of Hypertension was implemented in Bulgaria in 2019 aiming to raise hypertension awareness and control. Increased arterial stiffness may indicate high cardiovascular risk, but little is known about its prevalence at the population level. Design and method: Adult volunteers (&gt;18 years) were recruited through opportunistic screening in 21 of 28 administrative areas in the country. Information on medical history and triplicate sitting blood pressure (BP) measurements were obtained using validated automated upperarm devices. Aortic pulse wave velocity (aoPWV) was estimated, using age, systolic BP, and waveform characteristics. Using age-specific percentiles from a nonhypertensive group, we defined healthy (HVA) and early (EVA) vascular aging. Results: A total of 3678 participants were analyzed [mean age 58.8±16.5 years, men 37.2%, 71.2% had BP measurement in the last 12 months]. Mean BP was 135/82 mm Hg. In all, 45.4% of participants had elevated BPs (&gt;140/90 mm Hg), 58.3% out of 1910 participants with known hypertension, and 31.4% out of 1768 participants without known hypertension. In all, 4,67% of participants had aoPWV below 10th reference percentile (HVA), with a negligible proportion above 50 years. In total, 40.5% were above the 90th reference percentile (EVA), with proportions rising from one-quarter in youngest partcipants bellow 50 to one-half in oldest participants. In participants with EVA, BP was elevated during the measurement in 82.6%. Among participants without established HTN, according to European guidelines in 18.4 % BP was elevated, when measured during the campaign. The lowest proportion of newly diagnosed hypertension was found in HVA group – 4.8% and the highest 30% in EVA group. Figure 1 gives information for blood pressure measured according to quintiles of vascular aging groups. Conclusions: The prevalence of hypertension in Bulgaria is high, with considerable potential for improving awareness, treatment, and control. The high prevalence of early vascular aging and higher incidence of newly diagnosed hypertension in this group of patient at early age is alarming.

FRANCE DURING MAY MEASUREMENT MONTH: RESULTS OF HYPERTENSION SCREENING UNDER THE AUSPICES OF THE FRENCH SOCIETY OF HYPERTENSION (SFHTA)

Objective: Launched by the International Society of Hypertension and supported by the World League Against Hypertension, May Measurement Month (MMM) is a worldwide campaign to screen for hypertension. The objective of this study is to identify, valorize, and publicize the data obtained in France and Monaco on the occasion of MMM 2022 under the auspices of the French Society of Hypertension (SFHTA). Design and method: The SFHTA proposed ‘an MMM protocol kit’ adapted in French and declared to the Committee for the Protection of Persons with the support of the French Society of Cardiology. A blood pressure monitor (Omron HEM-FL31/M3 Comfort) was sent to the centers that had requested it. 12 centers participated from June to October. Results: Are summarized in the table. In this population of 1187 subjects, women were in the majority. Eight out of 10 screened subjects measured their BP at least once a year. 34% declared themselves to be hypertensive, and among the treated hypertensives, 56% reported being on monotherapy. 10% of the screened individuals are not vaccinated against COVID. Conclusions: The SFHTA, which is positively involved with European and International bodies to raise awareness of hypertension screening, has encouraged its members to participate collectively. Our MMM data collected remain limited about interpretation in public health and at the level of the French population. Nevertheless, the MMM approach could help alert to the public, health professionals, and government authorities to reduce the burden of hypertension. Thanks to all the teams of each site who participated in this campaign.

Prevalence of Traditional Risk Factors in First-Degree Relatives of Patients With Established Cardiovascular Disease.

World Health Organization (WHO)/International Society of Hypertension (ISH) risk prediction charts are useful for predicting 10-year combined myocardial infarction and stroke risk (fatal and non-fatal). Hence the current study was conducted to assess the 10-year risk of cardiovascular disease among adults in Ahmedabad, India. The primary aim of the study was to assess the cardiovascular risk among first-degree relatives of patients attending the outpatient clinic. Also, to create awareness regarding assessment of cardiovascular risk among the studied group. A cross-sectional study was carried out among 372 first-degree relatives of patients at an out-patient cardiology clinic present in Vadaj, Ahmedabad. The WHO/ISH risk prediction chart for South-East Asia Region D (SEAR D) was used for calculating the 10-year cardiovascular risk. A maximum (80.10%) of the study participants were in the low-risk (<10%) category followed by 8.33% for moderate-risk (10-20%), 7.25% for moderately high-risk (20-30%), 2.42% for high-risk (30-40%) and 1.88% for very high-risk (>40%). WHO/ISH risk prediction charts provide a quick and effective way to assess and categorize the population in a low-resource setting which in turn helps in delivering focused intervention to the high-risk groups.

A Review on Hypertension: Practice and Diagnosis

Among various reasons of raised hypertension, excessive blood pressure is the major one. Hypertension affects over a billion people worldwide, especially the elder people. The International Society of Hypertension (ISH) has extensively developed the practice guidelines to reduce the extent of hypertension caused by high blood pressure (BP) with evidence-based contents for adults, expecting wide range of accessibility and applicability by the physicians from low to high resource settings inclusively. Optimal care defines the evidence-based standard of care while the essential standard refers to the principles of care allowing specification for the deprived settings only. However, the specific portion of this study required to take experts’ opinion when there was a limitation to evidence for undertaking the assessments. This paper evaluates the ways in which we can diagnose hypertension in patients and evaluate the preventive measures and treatment options through lifestyle changes and pharmacological treatments.

Association of abdominal obesity and systolic blood pressure indices with cardiovascular disease risk prediction among community-dwelling older adults

&lt;b&gt;Background:&lt;/b&gt; Excess adiposity is an established risk factor for cardiovascular disease (CVD), therefore the early screening indies with predicted CVD risk is more useful for older adults. The current study evaluated the associations between anthropometric, body composition and dietary indices and elevated 10-year CVD risk in older people.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; This research, which involved 55 to 94-year-olds living in the community. Standard techniques were used to determine anthropometric factors and body composition indicators. The risk prediction chart created by World Health Organization and International Society of Hypertension was used to calculate the CVD risk score. Odds ratio (OR) and 95% confidence interval (CI) were determined.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; CVD risk prediction was positively correlated with the anthropometric and body composition parameters. After controlling for confounding variables, the logistic regression analysis revealed that waist circumference (OR=16.34; 95% CI: 7.22, 36.98; &lt;i&gt;p&lt;/i&gt;&amp;lt;0.001), systolic blood pressure (BP) (OR=9.53; 95% CI: 4.52, 20.07; &lt;i&gt;p&lt;/i&gt;&amp;lt;0.001), and visceral adipose tissue percentage (OR=5.47; 95% CI: 2.98, 10.01; &lt;i&gt;p&lt;/i&gt;&amp;lt;0.001) were correlated with cardiovascular risk prediction.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Abdominal obesity and increase of systolic BP were associated to increased risk for CVD. Additionally, a positive association between the risk factors for CVD (%visceral adipose tissue) and diet (cholesterol consumption) was established.

It is strongly recommended to not conduct, fund, or publish research studies that use spot urine samples with estimating equations to assess individuals' sodium (salt) intake in association with health outcomes: a policy statement of the World Hypertension League, International Society of Hypertension and Resolve to Save Lives.

Spot urine samples with estimating equations have been used to assess individuals' sodium (salt) intake in association with health outcomes. There is large random and systematic error in estimating sodium intake using this method and spurious health outcome associations. Substantial controversy has resulted from false claims the method is valid. Hence, the World Hypertension League, International Society of Hypertension and Resolve to Save Lives, supported by 21 other health organizations, have issued this policy statement that strongly recommends that research using spot urine samples with estimating equations to assess individuals' sodium (salt) intake in association with health outcomes should not be conducted, funded or published. Literature reviews on the health impacts of reducing dietary sodium that include studies that have used spot and short duration timed urine samples with estimating equations need to explicitly acknowledge that the method is not recommended to be used and is associated with spurious health outcome associations.

Stagnating rates of blood pressure control in Australia: insights from opportunistic screening of 10 046 participants of the May Measurement Month campaigns.

Raised blood pressure (BP) remains the single most important modifiable risk factor contributing to cardiovascular and all-cause mortality in Australia and worldwide. May Measurement Month , a global BP measurement and screening campaign initiated by the International Society of Hypertension and carried out in Australia since its inception in 2017, aimed at obtaining standardized BP measurements from members of the community to increase awareness of high BP and its associated risks. Adults participants (≥18 years) were recruited through opportunistic sampling across Australia during the month of May in 2017, 2018 and 2019. Trained volunteers recorded BP readings in a standardized manner and collected data on demographic, lifestyle factors and comorbidities. Hypertension was defined as SBP of at least 140 mmHg, or DBP of at least 90 mmHg, or taking antihypertensive medication. Data were collated centrally and analysis was carried out using regression models to evaluate the associations between BP and participant characteristics. A total of 10 046 participants were screened, of whom 3097 (31.0%) had hypertension, only 48.5% were aware of their condition and 44.4% were taking antihypertensive medication. Of those taking antihypertensive medication, 53.2% were controlled to less than 140/90 mmHg, whereas the remaining 46.8% of participants had BP of at least 140/90 mmHg suggestive of inadequately treated hypertension. Consecutive data obtained over a 3-year period in Australia demonstrated stagnating awareness, treatment and control rates with the latter two being substantially lower than global rates and those in other high-income countries. Concerted efforts from all stakeholders will be required to help overcome the unacceptably poor rates of BP treatment and control in Australia.

RAG-SACA-5: HEALTH SYSTEM STRENGTHENING ACTIVITIES FOR BETTER HYPERTENSION CARE

Raised systolic BP was responsible for 10·4 million deaths and 218 million disability adjusted life years across the globe in 2017. A disease that largely affected high-income countries in the past, has now been shown to affect low-income and middle-income countries disproportionately. Weak health infrastructure, poor access, high illiteracy rates, poverty, high costs of drugs, bad dietary habits and skewed national health priorities have been found to contribute to the poor performance of these countries in the hypertension care cascade. While there are several effective targeted as well as population-level interventions available to choose from, most countries have failed to integrate them effectively into their hypertension control strategies. Health system-strengthening activities such as capacity building, task shifting and appropriate use of digital health technologies can help bridge some of these gaps. Certificate Course in Management of Hypertension (CCMH) is a joint certification program designed and implemented by the Public Health Foundation of India (PHFI) in collaboration with the British &amp; Irish Hypertension Society (BIHS), the International Society of Hypertension (ISH) and the Centre for Chronic Disease Control (CCDC). CCMH is an ten month course with once- a- month contact sessions, being conducted on a designated weekend at regional training centres across India. It is fundamental objective is to enhance the knowledge, skills and core competencies of practicing PCPs in the management of Hypertension and to build their network with other PCPs and existing specialists. A total of over 2000 primary care physicians have been trained in the initiative so far. The course is being adapted in collaboration with the American Heart Association for online education of prescribers as well as non-prescribers. In addition, PHFI has also instituted an innovative assisted telemedicine healthcare delivery model - Digisahayam - which acts as an inter-operable system setting up multiple innovations in digital health technology on a single platform. It works on the model of task sharing and task shifting while embedding electronic health records (EHR), point-of-care diagnostics (13 common lab tests including ECG), in-built clinical decision support system and numerous state-of-the-art digital health technologies. Approximately 16,000 teleconsultations have been conducted in three clinics in India over the span of 18 months.

AW-NI-4: MAY MEASUREMENT MONTH 2021: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS FROM NEPAL

Objective: This study presents the result of May measurement Month 2021 in Nepal, a global initiative of the International Society of Hypertension (ISH) aiming to screen high blood pressure and raise awareness at the population level. Design and Methods: An opportunistic cross-sectional survey of&gt; = 18 years of age was conducted in 15 out of 77 districts from September-December 2021. The trained enumerators administered the structured questionnaire of the ISH adopted into Nepali and took three blood pressure (BP) readings while in a sitting position at 1-minute intervals, using electronic BP machines. Participants were identified with hypertension using the following criteria: 1) mean of the 2nd and 3rd BP readings&gt; = 140/90 mmHg or 2) being on at least one antihypertensive medicine taken for raised BP. Ethical approval was obtained from the Nepal Health Research Council. Results: A total of 5,172 participants were included. The median age was 37.0 (IQR 25–51) years and 49.9 % were female. Self-reported tobacco use, alcohol drinking, diabetes, and history of myocardial infarction (MI) or stroke were reported in 21.7%, 21.9%, 4.1%, and 0.5% of participants, respectively. The mean of 2nd and 3rd BP readings or history of anti-hypertensive medication use were available for 5,167 participants. The mean was 123.9 mmHg ± 10.3 for systolic blood pressure, and 81.2 mmHg ± 9.3 for diastolic blood pressure. 1,066 (20.6%) met the criteria for hypertension, of which 399 (39.5%) were aware and 298 (29.5%) were treated with at least one anti-hypertensive medicine. Of those who were treated, 167 (56.0%) had their BP under control. With the BP threshold of the AHA/ACC guideline (i.e., SBP&gt; = 130 mmHg or DBP&gt; = 80 mmHg), 3,015 (58.9%) were identified with hypertension. Multivariate logistic regression using age, sex, smoking, alcohol use, diabetes, and history of MI or stroke as covariates showed a significant association between hypertension and age (&lt;40: OR = 1.13, 95 CI:1.11–1.15, &gt; = 40: OR = 1.05 95% CI:1.04–1.06), male (OR = 1.57, 95% CI:1.33–1.89), alcohol use (OR = 1.59, 95% CI:1.30–1.93), and diabetes (OR = 2.63, 95% CI:1.93–3.58). Conclusions: MMM 2021 in Nepal found more than half of the adults in communities were undiagnosed and untreated. Community-based campaigns such as MMM are meaningful for countries to collect hypertension cascade data in hard-to-reach areas and identify those at high-risk.

PS-BPP02-5: COMPARISON OF OPPORTUNISTIC VS SURVEY-BASED POPULATION ASSESSMENT OF HYPERTENSION IN 14 COUNTRIES

Objective: We sought to compare the proportion of individuals with hypertension obtained from the large-scale May Measurement Month (MMM) opportunistic screening program with those from the population-based household STEPwise Approach to Non-communicable Risk Factor Surveillance (STEPS) surveys in 14 countries. Design: The MMM program was first implemented in 20117 by the International Society of Hypertension in 92 countries to improve detection and awareness of elevated blood pressure (BP). The STEPS surveys are cross-sectional household surveys developed by the World Health Organization to track non-communicable risk factors in more than 115 countries. Methods: Up to three BP readings were obtained by MMM and STEPS. The average of the second and third BP readings was used to compare the proportion of individuals with hypertension (systolic BP &gt; = 140 mmHg and/or diastolic BP &gt; = 90 or on drug treatment for raised BP) from the MMM 2017–2019 with the prevalence estimates of hypertension from STEPS 2013–2019 by sex and age among adults (&gt; 18 years) across 14 countries (Figure). Countries were selected if data with a maximum 5-year overlap among sources was available and if MMM sample size was &gt; 10,000 observations. Prevalence estimates were paired based on age, sex, and year. Chi-squared tests with alpha of 0.05 were used to test comparisons. Results: In total, 211,852 individuals aged at least 30 years across 14 countries over 3 years (2017–2019) were screened by the MMM program. STEPS surveyed 48,300 adults in 14 countries over 7 years, representing 252,095,678 individuals. Based on MMM, the proportion of females with hypertension across countries (all ages) ranged from 13.2% in United Arab Emirates to 34.9% in Algeria while in males ranged from 45% in Armenia to 22.8% in Ecuador. STEPS hypertension prevalence in females and males, ranged from 41.2% and 42.1%, in Kyrgyzstan to 10.5% and 17.1% in Ecuador, respectively. Countries where prevalence was most similar were Botswana and Kenya. Countries where MMM estimates were higher than STEPS were Mongolia and Malawi. STEPS reported higher estimates than MMM in Kyrgyzstan. Differences on the prevalence of hypertension across surveys showed heterogeneous variation by age, sex, and country (Figure). Conclusion: Hypertension prevalence varies between opportunistically screened MMM and systematically sampled STEPS populations. However, given the high prevalence of hypertension worldwide and the lack of routine health examination surveys in most countries, screening efforts, such as MMM, could be helpful in approximating the population prevalence of hypertension in specific subgroups and to raise hypertension awareness, treatment, and control.