May Measurement Month Research Articles

Risk factors for cardiometabolic multimorbidity: an analysis of 4 million participants from May Measurement Month 2017-2019

Abstract Background Cardiometabolic multimorbidity (CMM), defined as the presence of two or more cardiometabolic conditions, presents a significant global challenge due to aging populations and a growing prevalence of cardiometabolic diseases. However, evidence regarding the risk factors for CMM is scarce, particularly in low- and middle-income countries. May Measurement Month (MMM) is the largest annual global campaign collecting data on blood pressure (BP) and cardiometabolic diseases. Purpose To determine the proportion of hypertension in people with CMM and risk factors associated with CMM, from the three MMM campaigns in 2017-2019. Methods A total of 3 397 746 participants (≥18 years) were included, arising from 103 countries. CMM was defined as having two or more of three cardiometabolic diseases: myocardial infarction, stroke, and diabetes. Hypertension was defined as 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. A multivariable logistic mixed effects regression model was used to examine associations between CMM and potential risk factors, including age, sex, BMI category, smoking status, and alcohol consumption in the model, with random effects for country. Results Amongst all participants, 316 940 (9.3%), 62 731 (1.8%), and 28 491 (0.8%) had one, two or three cardiometabolic conditions, respectively, and 91 222 (2.7%) had CMM. The proportion with hypertension increased with an increasing number of cardiometabolic conditions: 29.6% in those with none, and 63.0%, 68.6% and 71.2% in those with one, two, or three conditions, respectively. In a fully adjusted model, females had 16% (OR = 1.16, 95% CI: 1.12-1.20, p-value <0.001) higher odds of having CMM than males (Figure). Increasing age was associated with higher odds of having CMM, the highest risk being found in participants ≥70 years. Participants who were underweight, overweight, or obese, were more likely to have CMM than those with a healthy weight. Of the risk factors studied, current smoking was associated with the highest odds for CMM, (OR = 12.8, 95% CI: 12.62-13.04, p-value<0.001) compared with not smoking. Participants consuming alcohol at least once per week had 74% lower odds (OR = 0.26, 95% CI: 0.25-0.27, p-value <0.001) of having CMM compared with those who never or rarely consumed alcohol (Figure 1). Conclusions The risk of CMM increases with female sex, older age, abnormal weight, and smoking. Additionally, CMM is associated with a higher likelihood of having hypertension. Efforts targeting high-risk populations with modifiable CMM related-risk factors are crucial for prevention of CMM.Figure 1.Risk factors for CMM

Regional variation of age-related blood pressure trajectories and their association with blood pressure control rates, disability-adjusted life years and death

Abstract Background/Introduction While the relationship between blood pressure (BP) changes and increasing age is well described, age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. Purpose The dataset of the May Measurement Month (MMM) international campaigns enables a unique investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcomes. Method Global BP data from more than 4,5 million adult (≥18 years) screenees obtained during the cross-sectional MMM campaigns in 2017, 2018, 2019, and 2021 were used for analysis. Average BP and slopes of BP changes across age groups were calculated within regional, socio-economic and sex strata. BP slopes of individuals between 30 and 70 years of age were derived from adjusted linear regression models, along with baseline BP estimates at young age. These BP slopes were correlated in regression models adjusted for baseline BP at young age with country-specific all-cause rates of DALYs (Disability-Adjusted Life Years), death (both from Global Burden of Disease Study 2019), life expectancy (World Bank data SP.DYN.LE00.IN 2019) and BP control rates (NCD Risk Factor Collaboration). Results Age-related BP changes differed distinctly across global geographic regions, income levels, and between sexes. The steepest increase in BP with age was observed in populations from Africa and Europe, whereas a more gradual rise in BP with increasing age was seen in South-East Asian populations. Women had lower BP levels than men at younger ages (twenties and thirties), but subsequently experienced a more pronounced age-related BP increase resulting in diminishing sex differences across older age groups. Geographically divergent age-related BP trajectories were significantly associated with major national public health indicators. Globally, the steeper the age-related BP slope, the stronger the association with poor BP control (β = -0.46 [95% CI: -0.74; -0.19], p=0.001), increased DALY’s (β = 66155.68 [95% CI: 44847.0; 87464.36], p<0.001) and death rates. (β = 1017.3 [95% CI: 351.72; 1682.89], p=0.003). Conclusion Age-related BP trajectories vary considerably across global populations and contribute considerably to the variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of lifestyle and other factors contributing to adverse BP trajectories to improve health outcomes.Average blood pressure by ageAssiciations with public health metrics

May Measurement Month 2020: An Analysis of Blood Pressure Screening Results From China.

We reported the blood pressure data obtained in the May Measurement Month (MMM) China project in 2020 during the COVID-19 control period. The study participants were adults (≥ 18 years), ideally in whom blood pressure had not been measured in the previous year. Blood pressure was measured three times consecutively with a 1-min interval in the sitting position, using a validated automated BP monitor (Omron HEM-7081IT), and transmitted to a central database via a smartphone app. The measurement was performed at 136 sites across 29 China provinces. The 100 728 participants had a mean (±SD) age of 45.6 (±18.3) years and included 56 097 (55.7%) women. The mean systolic/diastolic blood pressure was 120.0/76.9mm Hg. The proportion of hypertension was 28.9% (n = 29 135), and the awareness, treatment, and control rates of hypertension were 45.3% (n=13 212), 39.7% (n= 1573), and 24.4% (n=7101), respectively. After adjustment for age, gender, and use of antihypertensive medication, systolic/diastolic BP were significantly higher with cigarette smoking (n=8070, +0.5/+1.0mm Hg, p < 0.05), mild (n=4369, +1.2/+1.3mm Hg, p<0.001) and moderate or heavy alcohol drinking (n=3871, +0.4/+0.7mm Hg, p<0.05), and overweight (+1.8/+1.4mm Hg, p<0.001) and obesity (+2.3/+1.5mm Hg, p<0.001). In conclusion, our study provided unique blood pressure data during the COVID-19 period, and suggested that hypertension management might have been even more challenging when the medical professionals had to shift their focus on other urgencies.

P079 HOME BLOOD PRESSURE SCREENING IN MAY MEASUREMENT MONTH 2022 USING THE ZOE HEALTH STUDY APP

Background and Objective: May Measurement Month (MMM) is a global blood pressure (BP) screening campaign with aims to raise awareness of raised BP. In 2022, MMM incorporated home BP measurements from UK users of the ZOE Health Study app. We compare rates of hypertension prevalence, treatment, and control amongst ZOE app users with other European non-ZOE MMM participants. Methods: Adult (≥18 years) UK ZOE app users were invited to participate in MMM in 2022. ZOE participants were advised on taking three home BP measurements and non-ZOE participants had three standardised seated BP measurements in a range of facilities outside the home. All participants completed a questionnaire including demographics and antihypertensive medication use. Hypertension was defined using thresholds for clinic BP (≥140/90 mmHg) for non-ZOE participants and thresholds for home BP (≥135/85 mmHg) for ZOE participants, based on the mean of the second and third measurements, and/or taking antihypertensive medication. Awareness was defined as having a previous diagnosis of hypertension or treatment with antihypertensive medication. Results: A total of 50,200 ZOE participants were screened in MMM22, of whom 94.0% were over 50 years of age and 65.8% were female. 24,967 (49.7%) were hypertensive, of whom 19,356 (77.5%) were aware, and 18,195 (72.9%) were taking antihypertensive medication, and 11,454 (45.9%) were controlled to &lt;135/85 mmHg. Compared to the other 64,256 MMM22 European participants (mean age 53.6 [SD 16.8] years, 58.7% female), ZOE participants had slightly higher rates of hypertension (49.7% vs 48.9%), and greater proportions of ZOE hypertensive participants were aware (77.5% vs 70.8%), treated (72.9% vs 63.3%), and controlled to &lt;135/85 in ZOE participants and &lt;140/90 mmHg in non-ZOE participants (45.9% vs 30.9%) (p&lt;0.001 for all). Conclusions: In this large UK sample of ZOE users with hypertension, a higher proportion were aware, treated and controlled than amongst other European MMM screenees with hypertension. These digitally-enabled ZOE users apparently have greater access or engagement with effective BP management strategies.

O02 SIMULTANEOUS BLOOD PRESSURE AND ATRIAL FIBRILLATION SCREENING IN MAY MEASUREMENT MONTH 2022

Background and objective: May Measurement Month (MMM) is a global campaign aiming to raise awareness of raised blood pressure (BP). In 2022, concurrent screening for BP and atrial fibrillation (AF) was conducted in ten countries, given that hypertension and AF are both major treatable risk factors for stroke. Here, we evaluate AF prevalence and treatment by BP status among opportunistic samples of adults. Methods: In MMM, adults (≥18 years) undergo opportunistic BP screening. In ten participating countries, concurrent AF screening was carried out using OMRON Complete or M7 devices, in addition to three standardized, sitting BP measurements. ‘Known’ AF was defined as having had a previous diagnosis of either AF or irregular heartbeat, or taking oral anticoagulants. To risk-stratify those with AF, we calculated the CHA2DS2-VASc score. Hypertension was defined as a BP ≥140 and/or ≥90 mmHg (average of the second and third readings) and/or taking BP-lowering medication. Results: 80,751 adults (mean age 50.1 years; 58.2% female) underwent BP and AF screening. AF was detected in 1,526 (1.9%), of whom 1,014 (66.4%) had ‘known’ AF. Of those with ‘known’ AF, 214 (21.1%) were taking anticoagulants and 644 (63.5%) were taking neither anticoagulants nor aspirin. AF was detected more commonly among those aged ≥60 than &lt;60 (3.2% vs 1.2%: p&lt;0.001). Hypertension was detected more commonly among those with than without AF (63.6% vs 45.2%; age-sex-adjusted p&lt;0.001). There was a graded association in anticoagulant and aspirin treatment rates according to CHA2DS2-VASc score in participants with ‘known’ AF (Table). Amongst participants with ‘known’ AF, anticoagulant usage was reported by 35.7% of those with a class 1 indication for anticoagulation according to CHA2DS2-VASc score. Conclusions Opportunistic AF screening in the MMM 2022 campaign detected AF in 3.2% of participants aged ≥60, and hypertension was more common in those with AF. Over one third of detected cases were not ‘known’ cases. Only 35.7% of ‘known’ cases with a class 1 indication for anticoagulants were treated.

P217 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY IN RELATION TO AGE AND SEX

Background and Objective: Within-visit blood pressure variability (BPV) is predictive of cardiovascular events independent of mean blood pressure (BP) levels and may serve as marker of cardiovascular aging. This study aimed to explore changes in BPV by age, and sex in May Measurement Month (MMM) 2019 survey participants. Methods: Adults (≥18 years) were surveyed opportunistically from 92 countries and up to three standardized seated BP readings were recorded. This analysis included all participants who were not taking BP-lowering medication and with complete data on age, sex, and three valid BP recordings. Three indices of BPV were compared: the standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM). A linear regression model was created for each index. Models were adjusted for mean BP, age, sex, and an interaction between age and sex. Age and mean BP were each included as natural cubic splines with 11 and 5 knots, respectively, to allow for flexibility with modelling relationships. Results: Data from 842,356 participants were included. The mean age was 42.9 (SD 15.9) years and 51.5% were female. Patterns of BPV from 18-90 years and by sex were consistent across BPV indices. Systolic BPV was higher in female than male participants between the ages of 30 and 80. In female participants, systolic BPV declined with age from 18-25, after which systolic BPV increased with age. In male participants, systolic BPV declined with age from 18-45, after which systolic BPV increased with age. Diastolic BPV was highest at the youngest and oldest ages, and lowest between 45 and 55 in both sexes. Conclusions: There was a highly consistent pattern amongst three commonly used indices of BPV in their relationships with age and sex. The BPV of screened adults was lower in males than females and varied non-linearly with age, with markedly higher BPV at younger and older ages, with distinct patterns of variation observed between systolic and diastolic BPV.

P142 ADHERENCE TO PHYSICAL ACTIVITY GUIDELINES IN MAY MEASUREMENT MONTH 2021 AND 2022 PARTICIPANTS

Background and Objective: Physical activity (PA) lowers blood pressure (BP) and improves other cardiovascular risk factors, but many adults fail to achieve recommended PA levels. We aimed to evaluate adherence to the World Health Organisation's (WHO) PA guidelines and associations with BP treatment and control rates amongst adults screened in May Measurement Month (MMM) 2021 and 2022. Methods: Adults (≥18 years) were surveyed opportunistically from 74 countries. Each participant had three seated BP readings, using multiple imputation for any missing values. Participants who self-reported (yes/no) adherence to the WHO PA guidelines (75 minutes of vigorous exercise or 150 minutes of moderate exercise per week) were included. Hypertension was defined as a BP ≥140/90mmHg and/or taking BP-lowering medication. Results: Of 1,357,575 participants screened, 1,098,038 (80.9%) provided information on PA adherence. The mean (standard deviation) age was 46.8 (16.8) years and 52.9% were female. 333,214 (30.3%) participants adhered to PA guidelines. Of 394,444 (35.9%) participants with hypertension, PA adherence was higher in the 211,900 (53.7%) treated with BP-lowering medication (33.2% vs 27.4%, p&lt;0.0001) than those untreated. Amongst treated hypertensives, adherence was higher in those with controlled BP (Table) and increased with age (p&lt;0.0001). Of participants not taking BP-lowering medication, higher adherence was reported by the 703,594 (79.4%) normotensive participants (p&lt;0.0001) and adherence was highest in the 18–29 age group. The absolute rates of PA adherence were 40.3%, 37.3% and 36.2% in those with a history of diabetes, stroke and myocardial infarction, respectively, compared to 29.7, 30.3, 30.2% in those without these respective conditions (all p&lt;0.0001). Conclusions: Only 30% of MMM 2021 and 2022 participants worldwide adhered to WHO PA guidelines. Compared with untreated hypertensive participants, adherence was higher amongst those taking BP-lowering medication. PA adherence was significantly higher in those with diabetes. Those adhering to PA guidelines were more likely to have BP &lt;140/90 mmHg, regardless of taking BP-lowering medication, emphasising the importance of PA for BP control.

P207 MAY MEASURE MONTH 2022 AND 2019: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS PRE COVID-19 AND POST COVID-19 FROM ULAANBAATAR, MONGOLIA

Background: Mongolia has experienced high mortality rates from ischaemic heart disease and haemorrhagic stroke, with hypertension as a major risk factor. Two separate hypertension screening campaigns were conducted: the May Measurement Month (MMM) campaign in May 2019 and a follow-up campaign after the COVID-19 pandemic between July and September 2022. Methods: The 2019 MMM campaign involved screening at 80 sites, primarily workplaces, using trained health volunteers. Blood pressure was measured using clinically verified digital devices. In contrast, the 2022 campaign was conducted at five primary healthcare centers in Ulaanbaatar, with participants voluntarily attending the screening, where blood pressure was measured over three sessions. Results: In 2019, 6522 individuals were screened, with a hypertension prevalence of 32.5%, where 62.2% were aware of their condition and 50.1% were on medication. The control rate among those treated was 27.1%. In 2022, 1774 individuals were screened, showing a higher prevalence of 56.1%, with 95.4% awareness and 52.7% receiving treatment. The control rate for treated individuals was significantly higher at 48.5%. Conclusion: Both campaigns highlight the critical public health issue of hypertension in Mongolia. The increase in hypertension awareness and control rates in 2022 may be due to smaller sample size and participants are already patients who came to visit primary healthcare centers.However, the persistent high prevalence of hypertension underscores the need for continued prioritization and enhanced strategies in hypertension management.

O06 HYPERTENSION CONTROL AND COMORBIDITIES: INSIGHTS FROM THE MAY MEASUREMENT MONTH CAMPAIGN, 2017-2019

Background and Objective: Hypertension frequently coexists with other chronic conditions and cardiometabolic risk factors. The identification of comorbidities is key in the management of hypertensive patients. May Measurement Month (MMM) is a global initiative aimed at enhancing the detection and awareness of hypertension. This study analyzes data from MMM collected between 2017 and 2019 to evaluate hypertension control among adults aged 18 years and the frequency of comorbidities. Methods: Three sitting blood pressure (BP) readings, anthropometric measurements, and self-reported history of diabetes, myocardial infarction and stroke were collected. Missing BP readings were inputted using multiple imputation based on available BP measurements and sociodemographic variables. Hypertension was defined as an average systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. Hypertension treatment was defined as current medication use; control was defined as BP &lt;140/90 mmHg. Results: Among 2,907,848 participants from 95 countries, 34.2% had hypertension, and 12.1% had a history of at least one other chronic condition. Specifically, 8.3% self-reported type 2 diabetes, 4.5% had experienced myocardial infarction, and 2.9% had a history of stroke. Some individuals had multiple comorbidities at the time of the screening: 6% had both myocardial infarction and type 2 diabetes, 8% had myocardial infarction and stroke, 2% had stroke and type 2 diabetes, and 8% had all three comorbidities. Among those with hypertension, 58.9% were on medication and 24.0% had at least one additional comorbidity, specifically, 15.8% reported type 2 diabetes, 8.8% had experienced myocardial infarction, and 5.5% had a history of stroke. Of those with hypertension on medication, 43.1% were controlled. Among treated individuals, hypertension control rates were higher in individuals with comorbidities (50% vs 30%). Conversely, individuals without comorbidities had poorer hypertension control. Conclusions: The data suggest a high prevalence of comorbidities within the screened population and among individuals diagnosed with hypertension. Additionally, individuals without comorbidities exhibited suboptimal hypertension management.

P218 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY AND ITS RELATIONSHIP WITH HYPERTENSION AND COMORBIDITIES

Background and Objective: Within-visit blood pressure variability (BPV) is a predictor of cardiovascular events, independent of mean blood pressure (BP) levels. This study explored the associations of BPV with hypertension status and comorbidities in May Measurement Month (MMM) 2019 global survey participants. Methods: Adults (≥18 years) were surveyed via convenience sampling from 92 countries in May 2019. Each participant had up to three standardized seated BP readings. Participants with incomplete data on age or sex, or any missing BP readings were excluded. Hypertension was defined as having a BP ≥140 and/or 90 mmHg or being treated with BP-lowering medication. Participants were stratified into three groups: normotensive, untreated hypertensives, treated hypertensives, and normotensives. BPV was calculated as the variation independent of the mean (VIM) of the three BP readings. Associations between BPV and each of three conditions (previous stroke, previous myocardial infarction, or diabetes) were modelled using linear regression. Each model was adjusted for mean BP, age, sex, and an interaction term between age and sex. Results: Data from 1,128,889 participants were included. The mean age was 45.2 (SD 16.6) years and 51.4% were female. A third (33.6%) of participants were hypertensive, of whom 200,370 (53.2%) were treated. Of non-hypertensive and untreated hypertensive participants, those with a history of stroke, myocardial infarction, or diabetes had lower BPV relative to those without a history of these conditions (Figure). A stronger association was observed for diabetes within untreated hypertensive than non-hypertensive participants. However, amongst treated hypertensive participants, differences in BPV between those with comorbid conditions and those without were smaller than in the other two groups. Conclusions: Contrary to expectation, BPV was significantly lower in those with diabetes, or a history of stroke or myocardial infarction, amongst both untreated hypertensives and normotensives. However, among treated hypertensives, BPV was similar between those with or without each comorbidity, suggesting a modifying effect of BP-lowering medication.

May Measurement Month 2021: an analysis of blood pressure screening results from Venezuela.

Cardiovascular diseases continue to be the main cause of death in Venezuela, and hypertension is the principal risk factor. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. May Measurement Month 2021 included 46 732 participants with a mean age of 56.4 years (SD 14.4), 57.9% of whom were female. The percentage with hypertension was 60.3% (57.9% of females and 63.7% of males), 82.3% (84.8% of females and 79.2% of males) were aware, and 80.2% were taking antihypertensive medication. Of those on antihypertensive medication, 44.2% (41.2% of females and 48.2% of males) were not controlled [blood pressure (BP) ≥ 140/≥90 mmHg], with 61.3% receiving one drug, 30.0% two drugs, and 8.7% three or more drugs. 87.5% of those on treatment reported taking it regularly. Conditions associated with higher BP levels include fewer years of education, having a previous diagnosis of hypertension, and women who were hypertensive during a previous pregnancy. Physical activity and pregnancy were conditions associated with lower BP levels. A previous positive COVID-19 test was reported in 11.1%, and one or more COVID-19 vaccinations reported in 22.7% of participants. Of those on antihypertensive medication, 78.8% reported their treatment was not affected by COVID-19. Results are consistent with previous MMM campaigns and indicate that the screening campaign is feasible and useful to identify hypertension even in exceptional conditions such as the COVID-19 pandemic.

May Measurement Month 2021: an analysis of blood pressure screening results from Thailand.

Blood pressure (BP) measurement is the mainstay for diagnosing and treating hypertension. Blood pressure screening in the May Measurement Month (MMM) project is helpful for the early detection of hypertension, which is usually asymptomatic. This study aimed to investigate the epidemiology of hypertension from data in the MMM21 project in Thailand. A cross-sectional study was conducted according to the MMM clinical study protocol for MMM21 in all regions of Thailand from August to November 2021. We included adults aged ≥18 years. Baseline characteristics, history of hypertension diagnosis, and treatment were collected through the questionnaires followed by three standardized BP measurements, 1 min apart. We included 10 940 participants with a mean age of 41.3 (SD ± 13.5) years. Only 6% never had their BP measured before. Of all participants, 30.2% had hypertension, and among this hypertensive population, 50.3% were aware, and 46.2% were taking antihypertensive medications. Of participants with hypertension, 31.6% had controlled BP (<140/90 mmHg), and BP control was 68.5% among those taking antihypertensive medication. The proportion of participants who had diabetes, were on aspirin, and were on statin were 6, 7.2, and 11.4%, respectively. Almost all participants (93.7%) had received at least one COVID-19 vaccination, and 8.0% reported a previous COVID-19 positive test. Most of the participants (97.4%) received hypertension care at no cost. Hypertension awareness and overall BP control rate were relatively low, while most subjects had previously had their BP checked. The widespread use of BP measurement may improve the diagnosis and treatment of hypertension to improve the care of those with hypertension in Thailand.

May Measurement Month 2021: an analysis of blood pressure screening campaign results from India.

Raised blood pressure (BP) is the leading preventable risk factor for cardiovascular diseases that makes a major impact on early mortality and morbidity. Recognizing hypertension in the community, educating people about routine BP monitoring, and improving medication compliance are all important steps in detecting, controlling, and managing hypertension. During the course of 5 months, members of the Indian Society of Hypertension organized unique medical indoor and outdoor camps at 100 screening locations around India for the May Measurement Month (MMM) 2021 study. At every location, BP was measured three times, and a questionnaire was completed. Participants known to have hypertension before the study whether taking or not taking treatment were not included (not a normal pre-requisite for exclusion in MMM). The analysis included 15 045 participants in total. After calculating the average of the second and third BP measurements, 16.4% of participants were found to have hypertension based on ≥140/90 mmHg thresholds (2461 out of 15 045). 14.0% of females and 16.4% of males had hypertension. 16.4% of participants had undiagnosed hypertension and were not receiving treatment. The MMM screening campaign has the potential for identifying large numbers of people with undiagnosed hypertension and raising awareness of the importance of raised BP among the general public, medical professionals, policymakers, the government, and the media. Future BP screening campaigns should be larger in scope and involve follow-ups with past participants.

May Measurement Month 2021: an analysis of blood pressure screening results from a suburban community in the Democratic Republic of the Congo.

Hypertension remains the most powerful contributor to the global morbidity and mortality. May Measurement Month (MMM), a worldwide screening campaign initiated by the International Society of Hypertension (ISH), is organized annually to increase awareness of high blood pressure (BP). We screened 20 913 adult (≥18 years) residents of suburb hamlets of Mbujimayi (mean age 35.1 ± 15.1 years; Black ethnicity: 98.8%; women: 29.6%; diabetes: 1.6%; alcohol drinkers: 16.8% and smokers: 6.7%, previous myocardial infarction: 1.4%; stroke: 0.8%; taking aspirin: 3.2%; taking statins: 1.9%). Three sitting BP readings were taken, and hypertension was defined as a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Half of the participants had never had their BP checked, whilst 4.2% of respondents had participated in the MMM19 campaign. 0.9% and 1.7% reported COVID-19 vaccination and positive test, respectively. After multiple imputation of missing BP readings, 14.0% of respondents had hypertension of which 35.8% were aware, 28.0% were on antihypertensive medication and 14.1% had controlled BP. Of those on antihypertensive medication, 40.4% were on monotherapy, 37.2% adhered to taking their medication regularly, and 50.4% had controlled BP (<140/90 mmHg). In regression analyses adjusted for age, sex, and antihypertensive treatment, smoking was associated with lower systolic BP, having more years of education was associated with higher systolic and diastolic BP, and physical activity was associated with lower systolic and diastolic BP. This campaign contributes somewhat to reducing the 'black hole' on the prevalence of hypertension in DRC pending systematic countrywide BP screening.

May Measurement Month 2021: an analysis of blood pressure screening results from Uganda.

High blood pressure (BP) is the leading cause of cardiovascular disease in Uganda accounting for more than 50% of cardiovascular related deaths each year. In Uganda, more than 25% of adults have high BP with lack of awareness being the main barrier to achieving satisfactory control rates. May measurement month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of BP screening programmes. A cross-sectional survey of voluntary screenees aged 18 years and above was carried out between May and September 2021. Screening was carried out in two outpatient departments of two referral hospitals within the capital city, Kampala. BP measurements, the definition of hypertension and statistical analysis followed the standard MMM protocol. A total of 1671 people were screened and included in analysis. After multiple imputation, 1018 (60.9%) had hypertension. Of all 1018 participants with hypertension, 765 (75.1%) were aware and 750 (69.3%) were on antihypertensive medicine. Of the participants on antihypertensive medicine, 248 (35.2%) had controlled BP (<140/90 mmHg). Previous history of stroke and taking alcohol 1-6 times per week were significantly associated with higher diastolic BP. The MMM21 Uganda campaign highlights the importance of measuring BP as it generates real-time data on untreated and inadequately treated hypertension. This should motivate government and policy makers to promote routine local screening for BP.

May Measurement Month 2021: an analysis of blood pressure screening results from Hungary.

Elevated blood pressure (BP) is the most important risk factor for cardiovascular diseases (CVDs), which are still the leading cause of mortality in Hungary. Therefore, screening programmes identifying subjects with hypertension have an important role in CVD prevention. In 2017, the International Society of Hypertension initiated May Measurement Month (MMM) aimed at raising awareness of elevated BP. Hungary joined the MMM campaigns in 2017, 2019, and 2021, and a summary of the results from 2021 is presented here. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in September 2021. Measurement of BP, the definition of hypertension, and statistical analysis followed the standard MMM protocol. In Hungary, 30 sites were set up in primary and secondary care facilities, in pharmacies, and in malls. Both cities and villages were involved in all regions. A total of 1414 individuals were screened, and 558 subjects (39.5%) had hypertension. Out of 1065 participants not on antihypertensive medication, 209 (19.6%) had elevated BP. Among treated individuals (n = 349), 206 (59.0%) had controlled BP (<140/90 mmHg). Almost 40% of the participants had hypertension. Among untreated participants, one in five had elevated BP, while among patients on antihypertensive medication, 41% had uncontrolled BP. These results confirm the importance of screening of hypertension in untreated individuals and that efforts are required to adequately control BP in treated hypertensive patients.

May Measurement Month 2021: an analysis of blood pressure screening results from Kazakhstan.

The May Measurement Month (MMM) screening campaign initiated by the International Society of Hypertension aimed to assess the prevalence of hypertension and associated risk factors to increase and improve population awareness of raised blood pressure (BP) and methods of prevention. The MMM is a cross-sectional survey of adults aged 18 years and over of both sexes who gave informed consent to participate in the survey and to have their BP measured. Kazakhstan participated in the campaign for the first time in 2021. Blood pressure was measured three times on a single occasion, and data on cardiovascular risk factors were collected. A total of 1763 respondents from 4 regions participated in the screening. The mean age was 41 ± 14.4 years; 31.5% of all participants were found to have hypertension, of whom 41.8% were aware, 34.0% on treatment, and only 15.8% controlled (<140/90 mmHg). Significant differences in these rates were found between age and sex groups. The screening campaign confirms low levels of awareness of hypertension and associated risk factors in the population in Kazakhstan and the need for annual screening and implementation of national hypertension control programmes.

May Measurement Month 2021: an analysis of blood pressure screening results from Albania.

This article describes the May Measurement Month (MMM) 2021 campaign, which was the fourth time this annual hypertension screening campaign was conducted in Albania, a Mediterranean country in southeastern Europe. The MMM21 was conducted during the period of 28 September-30 November 2021, in 32 sites across several districts of Albania. Overall, 11 788 participants aged ≥18 years were included (63% women), with a mean age of 49.7 ± 14.9 years. Blood pressure (BP) was measured three times with Omron sphygmomanometers (model M3, Omron Healthcare, Kyoto, Japan), which are automatic upper arm BP monitors. Hypertension was defined as SBP ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg (based on the mean of the second and third recordings for SBP and DBP, respectively) or on antihypertensive medication. Self-reported data included pre-existing conditions, physical activity, smoking, alcohol consumption, COVID-19 testing, and use of contraception in women. Overall, 47.3% of screened participants had hypertension. Of those with hypertension, 70.1% were aware of their condition and 67.0% were on antihypertensive medication. About half (49.3%) of participants on antihypertensive medication had controlled BP (<140/90 mmHg). On average, BP was higher in those on antihypertensive medication and with increasing alcohol intake but lower in those with a history of stroke and those with higher levels of physical activity, previous positive COVID-19 test, and contraception use in women. In Albania, the MMM campaign continues to contribute to the early detection of hypertension among adults. Hence, it constitutes a valuable opportunistic screening instrument among other routine tools applied in the general Albanian population.

May Measurement Month 2021: an analysis of blood pressure screening results from Malawi.

May Measurement Month (MMM) is a global initiative aiming at raising awareness and screening people for blood pressure (BP) for free. Malawi started participating in 2017 due to our membership with the International Society of Hypertension, and this was done mainly to raise awareness of high BP, which could be of benefit to the population. An opportunistic cross-sectional survey of participants aged 18 years and above was carried out from May to September 2021 in Blantyre and Lilongwe. All BP measurements, definition of hypertension, and statistical analysis followed the standard MMM protocol. A total of 7074 participants took part with 4348 (61.5%) being male and 2726 (38.5%) female. A total of 1525 (21.6%) participants were found to have hypertension. Of these, 84 (5.5%) were aware that they had the condition, and 81 (5.3%) of those with hypertension were on antihypertensive treatment. Of those on antihypertensive treatment, 61 (76.5%) had controlled BP. The screenings were done in just two districts and a few locations, which therefore are not representative of the whole country. This shows there is a significant need to expand screening opportunities within Malawi for early detection of hypertension to have a greater impact on the country as far as the fight against hypertension is concerned.

May Measurement Month 2021: an analysis of blood pressure screening results from Kenya.

Hypertension is a major contributor to premature death and disability globally. The age-standardized prevalence of hypertension among adults aged 30-79 years is among the highest at 36%. Despite the availability of cost-effective interventions, awareness, treatment, and control rates remain low. To tackle this and raise awareness, the May Measurement Month (MMM) campaign was initiated by the International Society of Hypertension in 2017. This paper summarizes results from the 2021 MMM campaign. Screening was conducted in 22 sites across 7 counties. We aimed to take three blood pressure (BP) readings and corresponding heart rate measurements as per the standardized protocol. Where this was not achievable, at least one reading was taken. Other variables recorded included demographic data, risk factors, comorbidities, and history of COVID-19 infection. A total of 9738 individuals were screened, of whom 57% were female. After multiple imputations, 28.2% were hypertensive, of whom 45.9% were aware and 42.0% were on treatment. Of those on treatment, 50.3% were controlled, translating to control among only 21.1% of the total hypertensive population. Previous COVID-19 vaccinations were associated with lower systolic BP (SBP) and diastolic BP (DBP). Individuals who consumed alcohol one to three times a month had lower diastolic BP after adjustment for age, sex, and anti-hypertensive treatment. Among women, the use of hormonal contraceptives was associated with lower SBP and DBP after adjustment for age, sex, and anti-hypertensive treatment. Hypertension awareness, treatment, and control rates remain low, though trends from previous MMM campaigns in Kenya suggest steady improvement. The associations between COVID-19 vaccination and contraceptive use with lower BP warrant further investigation. Programmes such as MMM provide much needed data to track the progress towards reducing the burden of hypertension.