May Measurement Month Research Articles

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.

HYPERTENSION SCREENING CAMPAIGN: THE STRENGTH OF A CITY NETWORK INVOLVING THE HOSPITAL AT MAY MEASUREMENT MONTH 2022

Objective: The World Hypertension League (WHL) created the World Hypertension Day on May 17. This day gave way to the campaign called MMM (May Measurement Month), which each year raises awareness against hypertension. The objective of this study is to disseminate the data obtained from a sample of adults screened in Bobigny, France. Design and method: Following the MMM protocol adapted in France by the French Society of Hypertension (SFHTA), numerous volunteers from the network of territorial professional health communities (CPST) (physicians, nurses, pharmacists, dieticians, psychologists, social workers, and patients’ association) and in association with the hospital, carried out a screening campaign in a prefab adapted for this action. In addition and organized upstream, the CPTS and the city of Bobigny were able to offer self-measurement devices. Results: The general anonymous data of this population of 270 subjects (including 146 F) are summarized in the table. All participants reported having had at least one BP measurement within the last year. Of the 58% of participants reported as hypertensive, 37.3% were unaware of their antihypertensive treatment. CVD history was: diabetes (n = 101), myocardial infarction and hypertension pregnancy disorders (n = 25 each one), and stroke (n = 13). Conclusions: The organization of an MMM-type screening campaign by a CPTS and under the aegis of a ‘neighborhood”-attending attending physician seems to promote the participation of a population. A wide dissemination of information prior to such a campaign by a city-hospital network must be encouraged, as well as succeeding in obtaining the participation of health professionals.

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 (>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 (>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.

EFFECT OF EXPOSURE TO AMBIENT PM2.5 ON BLOOD PRESSURE AND HYPERTENSION AMONG PARTICIPANTS OF THE GLOBALLY CONDUCTED MAY MEASUREMENT MONTH 2018-2019

Objective: Low-middle-income countries (LMICs) face most of the burden of air pollution and increasing incidence and mortality from increased blood pressure (BP) and hypertension. Yet, there is a paucity of studies linking air pollution and BP conducted in LMICs. We aim to extend the spatial coverage of the evidence using data from countries with different income and air pollution levels. We investigated the effect of exposure to short and long-term ambient PM2.5 on BP and prevalent hypertension in 125,198 participants from 29 countries during May Measurement Month (MMM) BP screening campaigns in 2018 and 2019. Design and method: We conducted a cross-sectional study using satellite-derived data on monthly average PM2.5 and assigned exposure (averaged for 1month, 3months, 6 months, and 1 year) to participants for the month in which BP measurement was recorded based on the coordinates of the MMM screening site. We used generalized additive models with penalized splines for BP and generalized linear models for prevalent hypertension, accounting for potential confounders and country-level clustering effects. Results: Short and long-term exposure to ambient PM2.5 was associated with increased SBP and DBP at an individual level but not at the country level. We found the relationship non-linear, with significantly higher effects beyond 70ug/m3. An interquartile range increase (17.6ug/m3) in annual PM2.5 was associated with a higher prevalence of hypertension with an odds ratio of 1.12 [95% CI: 1.09, 1.15]. Stratified analysis showed that individuals with high BMI and those with hypertension, particularly among those untreated and participants with comorbidities, were more susceptible to the effect of air pollution on BP. Conclusions: More high-quality data are required to evaluate individual air pollution exposure (using robust and granular data) with cardiovascular risk factors such as BP and major adverse cardiovascular events. Meanwhile, health policies promoting air pollution reduction are needed, particularly for those at the highest 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 > = 140 mmHg and/or diastolic BP > = 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 (> 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 > 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.

PS-P04-1: RISK FACTOR PROFILE AND LACK OF TREATMENT INTENSIFICATION AS A MAIN FACTOR OF INCREASED STROKE MORTALITY IN BULGARIA

Objective: Bulgaria is one of the leading countries in terms of premature mortality due to stroke with 6406,4 years of life lost per 100000 (95% CI 5211,7 to 7763,4) according to the data from Global Burden of Disease for 2019. In the same year The May Measurement Month (MMM) initiative was implemented in the country aiming to raise hypertension awareness and control. The aim of the study was to identify whether national-level MMM hypertension parameters are associated with national stroke mortality statistics. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from 3678 participants during MMM2019 campaign. National stroke mortality statistics and Socio-Demographic Index (SDI) were extracted from the Global Burden of Disease (GBD) study 2019. Hypertension was defined as a raised BP (systolic BP > 140 mmHg or diastolic BP > 90 mmHg based on the mean of the second and third readings), or on antihypertensive medication. Logistic and linear regression were applied, respectively, to the association between hypertension and stroke and between national-level GBD stroke mortality with MMM proportions with raised, treated and uncontrolled BP. Results: Overall we notice a relatively high proportion of participants with a previous stroke 237 (6.4%). Stroke survivors were older (69 vs 58,1, p < 0.001), with higher levels of systolic BP (139,4 vs 134,9 mmHg), but lower diastolic BP (80,2 vs 82,5 mmHg) and significantly more frequent concomitant coronary and peripheral arterial diseases, diabetes or heart failure (p < 0.001 for all). The proportion with previous atrial fibrillation was also higher among previous stroke patients 13,9 vs 5,6%. Stroke mortality increased, on average, by 680 per 100,000 per 1% increase in the proportion of individuals with raised BP (p = 0.006) and by 909 per 100,000 per 1% increase in proportion with treated but uncontrolled BP (p = 0.012). The corresponding years of life lost due to ischemic stroke were 736 (p = 0.015) and 172 per 100000 (p = 0.0005) due to hemorrhagic stroke per 1% increase in proportion with suboptimally treated BP. Conclusions: There was a significant association between national stroke mortality from GBD and the proportions of participants with raised BP and of hypertensives treated but uncontrolled in MMM. This suggests that despite lacking a population-based design, estimates from MMM broadly reflect rates of downstream mortality and that opportunistic screening can be an effective means not only of screening for hypertension, but of improving control of the patients already treated. The data presented gives rational for using estimates to inform policy and to start national campaign in order to change the existing tendencies.

PS-P03-4: LOW LEVELS OF HYPERTENSION AWARENESS AND HIGH PROPORTIONS OF UNCONTROLLED BLOOD PRESSURE IN THE UNITED KINGDOM AND IRELAND

Objective: Globally, it is estimated that 10.4 million people die each year due to raised blood pressure (BP). Unfortunately, at least 40% of those with high BP globally are unaware of their condition. In the most recent UK and Ireland community-based data, 66.5% of people were unaware of their high BP(1). The UK and Ireland have taken part in the global May Measurement Month (MMM) campaign, in a bid to increase awareness of BP and to evidence the proportion of those in the community with undiagnosed high BP. The aim of this study was to investigate the large and combined 2017, 2018 and 2019 MMM dataset, to evidence the proportion of people with raised BP, undiagnosed hypertension and levels of hypertension not treated to target in the UK and Ireland. Design and method: As part of the MMM protocol, community-based opportunistic BP screening sites were set up across the UK and Ireland in places of worship, supermarkets, pharmacies, GP surgeries, workplaces, gyms and other public spaces in 2017, 2018 and 2019. A questionnaire recording medical history, lifestyle and demographics was used to collate participant information. BP was measured three times and the average of 2nd and 3rd readings used for analyses. Multiple imputations were performed to impute the mean BP, where data were missing. The term Hypertension was used for those with systolic BP >/ = 140 or diastolic BP >/ = 90 mmHg, or the participant was on BP medication. Controlled BP was considered as < 140 and < 90 mmHg. Results: Data on 22,910 individuals were analysed as part of the combined MMM dataset. Mean age of participants was 52 ± 18 years, with 60% reporting as female gender. See Table 1 below for the proportion of those considered hypertensive, levels of awareness and the proportion of hypertensives treated to target. Conclusion: In the largest community-based BP dataset to date in the UK and Ireland, our data highlight the concerning levels of people with high BP unaware of their condition and poor levels of controlled BP in hypertensive patients. Better community based and primary care screening initiatives are required to improve awareness and early identification of those at high risk of cardiovascular disease. REFERENCES: (1) McDonnell BJ, Rees E, Cockcroft JR, et al. May Measurement Month 2019: an analysis of blood pressure screening results from the UK and the Republic of Ireland. Eur Heart J Suppl. 2021 May;23 Suppl_B. 147–150.

S-34-4: HYPERTENSION AND SOME RELATED RISK FACTORS FROM MAY MEASUREMENT MONTH SCREENING PROGRAMME IN VIETNAM FROM 2017 TO 2019

Aim: The May Measurement Month (MMM) programme is a global cross-sectional blood pressure (BP) screening programme. Here we present the combined data for the years 2017, 2018 and 2019 from Vietnam. Study methods: BP was measured at various screening sites, according to MMM standard protocol and hypertension was diagnosed if the BP was equal or over 140/90 mmHg or if the individual was already on antihypertensive medication. Results: A total of 44,786 individuals (mean age 47.70 ± 17.65 years, range 18 to 89 years; 58,8 % female) were screened over the 3 year period. The mean of the last two BP readings was 121.60 ± 18.64 mmHg; 13,972 (31,2%) readings were in the hypertensive range; 20,033 (44,7%) were in prehypertension; 5,910 (57,7%) were undiagnosed hypertension. A further 5,576 individuals were on antihypertensive medications but only 2,578 (46,2%) patients on BP controlled, 8.1% of those with previous myocardial infarction, 2.2% of those with previous stroke and 11.7% of the diabetic patients. SBP and DBP correlated with body mass index (BMI) (r = 0,228 and r = 0,235, p < 0,01) and age [OR, 95% CI: 3.22 (3.22–4,52)], with a large proportion of individuals having overweight/obese [OR, 95% CI: 2.70 (2.56–2.85)]. Conclusion: Community screening MMM programmes help identify the prevalence of hypertension especially also help to identify those at high cardiometabolic risk. More emphasis should be given to monitoring those in high cardiometabolic risk categories and older age groups./.

S-21-2: MAY MEASUREMENT MONTH IN NEPAL: FIVE-YEAR COMPARISON OF BLOOD PRESSURE SCREENING RESULTS IN 2017 - 2021

Objective: Nepal has been participating in the May Measurement Month (MMM) aiming to raise hypertension awareness and improve health seeking behavior to control high blood pressure in communities and present data for policymakers. This study compares the results from 2017 to 2021. Design and Methods: Opportunistic cross-sectional surveys to measure the proportion of hypertension, its awareness, treatment, control, and risk factors among> = 18 years of age annually from 2017 to 2021 in Nepal. Although MMM was not executed globally due to the COVID-19 pandemic in 2020, it was conducted in Nepal by following safety measures. We administered the structured questionnaire and took three BP readings while sitting at 1-minutes intervals. Measures of association were calculated using the logistic regression model adjusting for age and sex. The same definition of hypertension (a mean of 2nd and 3rd BP reading> = 140/90 mmHg, or participants were treated with medicines for known hypertension) was applied for all years. Results: The summary characteristics from 2017 to 2021 are presented in Table 1. Baseline characteristics were similar for all five studies except for low tobacco use in 2017. The proportion of hypertension ranges from 20.6% to 31.3% (24.4% in 2017, 27.8% in 2018, 27.5% in 2019, 31.3% in 2020, and 20.6% in 2021). Awareness, treatment, and control were also similar across five years, ranging from 39.5% to 49.9%, 29.5% to 39.1%, and 46.0% to 56.0% respectively. Smoking, alcohol use, body mass index> = 25, diabetes, and history of myocardial infarction (MI) or stroke were associated with hypertension after adjusting for age and sex across multiple studies. Conclusions: A five-year comparison of the MMM study in Nepal showed that hypertension awareness, treatment, and control have been suboptimal, suggesting an urgent need to implement a nationwide prevention and control program together with a national screening program.

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

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.

PS-BPP02-8: BRIDGING THE GAPS IN HYPERTENSION CARE IN NIGERIA: END-LINE EVALUATION OF COMMUNITY ACTION AGAINST NON-COMMUNICABLE DISEASES (COMAAND) PROJECT

Title: Bridging the Gaps in Hypertension care in Nigeria: End-line Evaluation of COMmunity Action Against Non-communicable Diseases (COMAAND) Project Objective: Non-Communicable Diseases (NCDs) have become a global public health burden leading to at least 70% of deaths globally. Cardiovascular Diseases (CVDs) are the primary drivers of this epidemic, and hypertension is the leading determinant of CVD mortality. We implemented an innovative community-based strategy focused on early detection and timely management of hypertension in three communities in Anambra state, Nigeria entitled COMmunity Action Against Non-communicable Diseases (COMAAND). We conducted a baseline study to establish hypertension's prevalence, awareness, treatment, and control in implementing communities. In this study, we set out to assess the same metrics we evaluated at baseline, and also compared them with the findings at baseline to establish the impact made by the project. Design and Methods: We conducted a cross-sectional survey (at baseline and end-line) using an adapted version of the May Measurement Month (MMM) questionnaire. Blood pressure was measured following the 2018 ESC/ ESC Guideline for treatment of arterial hypertension, and anthropometry was taken in line with the Diet Anthropometry and Physical Activity (DAPA) measurement toolkits of the National institute for health research, Medical Research Council (MRC) the UK. Hypertension was defined as blood pressure (BP) > = 140/90 mmHg, and/or self-reported treatment of hypertension with antihypertensive medication in the last 2 weeks. Awareness of hypertension was defined as a self-report of any previous diagnosis of hypertension by a healthcare professional. Treatment of hypertension was self-reported use of prescription medication for management of hypertension during the previous 2 weeks. Control of hypertension is a pharmacological treatment of hypertension associated with an average BP < 140/90 mmHg Results: 360 participants were sampled across three participating communities, and are averagely 47 years old (there was no significant difference in the age of participants at end-line vs baseline. Body mass index and systolic BP reduced significantly at the end-line compared to baseline (23.8 kg/m2 vs 26.2 kg/m2, 130.1 mmHg vs 135.0 mmHg) respectively, as well as habits such as cigarette smoking and alcohol intake reduced at end-line compare to baseline (5.3% vs 26.6%, and 40.3% vs 62.1%) respectively. Hypertension prevalence reduced by 17.3%, Awareness increased by 36.8%, treatment increased by 111.1%, and control decreased by 18.6% at the end-line compared to baseline. Conclusion: COMAAND project has helped in bridging the gaps in hypertension care, especially in increasing awareness, and improving uptake of treatment.

PS-P04-7: ALERTING REACTION OF BLOOD PRESSURE AND AGE: MAY MEASUREMENT MONTH 2019

Objective: The extent of the alerting reaction on systolic blood pressure (BP) measurements has been shown to be related to age and the magnitude of the first reading, with implications for the monitoring and diagnosis of hypertension. We investigated the effects of age on the direction and magnitude of change in both systolic and diastolic BP from the first to subsequent readings, using data from the May Measurement Month (MMM) global BP screening campaign in 2019. Design and method: We examined the relationship between the value of the first reading (BP1) and the change in BP from BP1 to the average (BPA) of the second (BP2) and third readings (BP3) taken at 1 minute intervals in participants with three BP readings. Mixed effects regression models were fit, stratified by age, and using random intercept for country of screening site to account for clustering. This approach was repeated for diastolic and systolic BP. Results: Of the 1,133,008 participants with three BP readings, 58.7% had a decrease in systolic and 54.2% a decrease in diastolic BP from BP1 to BPA. Above an age dependent threshold value in BP1, a higher BP1 was associated with a greater decrease from BP1 to BPA. Older participants on average exhibited relatively smaller changes in systolic BP from systolic BP1 to systolic BP2 for equivalent values of systolic BP1 than younger age groups (Fig.1A). The average difference between diastolic BP1 and diastolic BPA showed a “U shaped” interaction with age such that the largest difference was observed in the youngest and oldest age groups and the smallest difference in those aged 40 to 49 and 50 to 59 years (Fig.1B). These patterns of BPV across values of BP1 and age persisted when the models were adjusted for antihypertensive medication or sex, or if the difference in BP from BP1 to BP2 or BP3 were used as the outcome. Conclusions: Age had a significant and differential modifying effect on the fall in systolic and diastolic BP from first to subsequent readings taken on a single occasion. These results could reflect age related variation in homeostatic capabilities to regulate BP following an initial stress response or differential sizes of alerting response by age. This highlights the importance of taking multiple BP readings when assessing BP, particularly in younger individuals, to avoid overestimation and overdiagnosis.

PS-P04-8: COMPARISON OF INDICES OF WITHIN-VISIT BLOOD PRESSURE VARIABILITY IN MAY MEASUREMENT MONTH 2019

Objective: There is a lack of consensus on the optimal mathematical indices for quantifying blood pressure variability (BPV). We sought to compare four established indices of BPV across six age strata among the substantial international population screened during May Measurement Month (MMM) 2019. Design and method: Within visit BPV of readings taken at 1 minute intervals was calculated for each of the 1,133,008 participants with three readings on a single occasion. Indices of BPV were the standard deviation (SD), absolute difference in BP from the first to the second reading (AR), coefficient of variation (CV), and variation independent of the mean (VIM). Mixed effects regression models were fit with a random intercept for country of screening site to account for clustering. Three models were created for each systolic (sbp) and diastolic (dbp) BPV metric: (1) unadjusted, (2) adjusted for average BP, and (3) adjusted for average BP, sex, and use of antihypertensive medication (multifactor). Results: Unadjusted models of sbpSD and sbpAR showed increased BPV with age from 40 to 49 years onwards. In average BP and multifactor adjusted models of all indices and unadjusted models of sbpVIM and sbpCV, systolic BPV decreased with age from 18 to 49 years but was similar across the remaining age categories (Fig.1A). Diastolic BPV displayed a “U shaped” association with age such that it was lowest in the 40 to 49 year group and relatively higher in the youngest and oldest age categories (Fig.1B). Adjustment for average BP significantly altered coefficient estimates for SD and AR (Fig.1). Compared to unadjusted models, adjustment for average BP modestly affected effect estimates for sbpCV, dbpCV, sbpVIM, and dbpVIM (Fig.1). Compared to models only adjusted for average BP, multifactor adjusted models resulted in increases in the relative differences in systolic within visit BPV across age categories but estimates for diastolic BPV across age categories were slightly attenuated on multifactor adjustment. Conclusions: Unlike AR and SD, CV and VIM were largely independent of average BP levels. Unlike VIM, to calculate CV for an individual solely requires parameters derived from their own BP readings. Models of CV produced similar outputs those produced by models of VIM, which suggests CV may have utility in clinical practice settings as an index of within visit BPV that is relatively independent of average BP while simple to calculate. The relative clinical utility and prognostic implications of these metrics of BPV remain to be assessed.

S-05-4: ENVIRONMENTAL POLLUTANTS AND BLOOD PRESSURE

Pollution via air, land and water was estimated to cause over nine million deaths globally in 2019. The vast majority of these deaths and associated economic losses occur in LMICs. It is estimated that almost seven million of these annual deaths are due to air pollution, which is increasing, due to an increase in outdoor sources whilst there has been a global decrease in household air pollution since 2000. Of deaths caused by air pollution, it is estimated that approximately half are caused by cardiovascular disease (CVD) with about one third due to coronary heart disease and one fifth due to stroke. One of the mechanisms whereby air pollution impacts adversely on CVD health is via raised blood pressure (BP). Lead pollution which is thought to cause almost one million deaths per year globally is also linked to increased BP levels and thereby to adverse CV outcomes. This presentation will focus on air pollution and BP, since air pollution from combined indoor and outdoor sources is the major contributor to pollution-induced mortality. Air pollution is cause by a mixture of particles or particulate matter (PM) and gaseous compounds which consist of nitrogen oxides. The PM which consists of solid and liquid particles is classified by its aerodynamic diameter across a wide range and those with a diameter < 2.5pm (PM2.5) are commonly used to evaluate this form of pollution. Short and longer-term exposures to elevated outdoor PM2.5 have been shown to be associated with higher BP and incident and prevalent hypertension. The mechanisms involved are thought to include damage to the vascular endothelium, via inflammatory and pro-oxidative reactions. Few high-quality data linking different parameters of air pollution and effects on BP are available from around the world, particularly those areas worst affected by pollution. Using the May Measurement Month (MMM) database, associations between BP and pollution are under investigation in retrospective and prospective studies. In the retrospective studies data collected on the bespoke MMM app from 29 countries in MMM18 and MMM19 allow linkage between longitudinal and latitudinal coordinates of where BP was screened and PM2.5 pollution, based on data collected from ground monitors, satellite observations, meteorological data and land use. In prospective studies from MMM21 data arising from 12 cities in the Philippines, Vietnam, Thailand and Indonesia, BP results and PM2.5 levels are in progress using linear mixed models to evaluate cross-sectional associations at the individual and screen-site levels.

May Measurement Month 2017: an analysis of blood pressure screening results from Mauritius.

Hypertension is a growing burden worldwide. According to the World Health Organization, ∼1.13 billion people worldwide suffer from hypertension. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programmes worldwide. We provide the results of the 2017 MMM (MMM17) edition in Mauritius. This cross-sectional survey of participants aged 18 years and over was carried out in May 2017. Hypertension was defined as systolic BP of at least 140 mmHg or diastolic BP of at least 90mmHg or in those on antihypertensive medication. Blood pressure measurement and statistical analysis followed the standard MMM protocol. The screening was conducted by the Non-Communicable Diseases and Health Promotion Unit, which is under the aegis of the Ministry of Health and Wellness, mainly in workplaces and community centres, in both rural and urban areas across Mauritius. Of the 2302 individuals screened, after multiple imputations, 375 (16.3%) had untreated hypertension. May Measurement Month 2017 was the very first BP screening campaign initiated in Mauritius. These results suggest that MMM17 was useful in the identification of potential patients with raised BP.

May Measurement Month 2017-2019: an analysis of blood pressure screening results from Guatemala.

In 2018, the Ministry of Public Health and Social Assistance of Guatemala published the last update of the prevalence of noncommunicable diseases (NCDs), and as in other low-income countries, the prevalence of NCD morbidity and mortality had risen. The prevalence of hypertension in Guatemala has been reported in a range from 18.7 to 22.7% which could be underestimated, because the country does not have an adequate statistical surveillance system. May Measurement Month (MMM) 2017, 2018, and 2019 in Guatemala was an opportunistic survey, which followed the methodology previously published. Blood pressure (BP) measurements were carried out in various locations, mainly hospitals and clinics (48.9%) or pharmacies (34.2%) in Guatemala City. In all patients, three BP measurements were taken after 5 min of rest and sitting in the correct recommended position. The mean of the second and third BP measurements was used for the analyses. Multiple imputation was used to impute the missing readings, based on the global MMM data. After multiple imputation, of all 3265 participants, 43.4% had hypertension. Of all participants with hypertension, 74.7% were aware of their diagnosis, 69.2% were on antihypertensive medication, and 63.1% had controlled BP (<140/90 mmHg). Of all those with hypertension, 43.6% had controlled BP. MMM is the largest hypertension survey ever carried out globally. The MMM results from Guatemala reported here provide complementary and strong data on the impact of hypertension in the country and help to make hypertension visible as a priority health problem, which requires urgent solutions.

May Measurement Month 2018: an analysis of blood pressure screening results from Pakistan.

The May Measurement Month (MMM) screening campaigns comprise an opportunistic assessment of the arterial blood pressure (BP) of Pakistani adults (≥18 years old) and evaluate the level of awareness and spectrum of the problem of hypertension and the associated risk factors. The prospective study was carried out in May 2018 in multiple medical screening camps at hospitals, pharmacies, and public areas with the help of local health care workers under ethical guidelines. The volunteers took BP measurements using OMRON digital BP devices, in a seated position, and three successive readings were noted after 5 min rest. The mean values of the second and third readings were attained. Data were analysed centrally by the MMM project management team and multiple imputations were performed, where BP readings were missing. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or in those taking antihypertensive medication. This study included 25 076 participants, of whom 14 726 (58.7%) were hypertensive. Among all hypertensives, only 11 681 were aware of their hypertension status. After imputation, age and gender standardization, mean systolic and diastolic BP were 129.8 mmHg and 82.9 mmHg, respectively. MMM17 data revealed that 55.2% of those screened were hypertensive in Pakistan, while in 2018 the proportion rose slightly to 58.7%. The prevalence of hypertension among those screened for MMM in Pakistan was high in both years. Although most patients with hypertension were treated, the majority remained uncontrolled. Further efforts to improve awareness and control are needed.

May Measurement Month 2017-19: an analysis of blood pressure screening results from Paraguay.

The aim of this study was to highlight the importance of measuring blood pressure (BP) and to identify and reduce the BPs of those people who require intervention to lower their BP according to current guidelines. A total of 7782 individuals aged ≥18 years were recruited during the 3 years of the May Measurement Month (MMM) campaign (2017: 1196, 2018: 2285, 2019: 4301). Recruitment was through opportunistic sampling at a variety of screening sites distributed throughout the country. Each participant underwent a pre-specified questionnaire with questions on risk factors concluding with three BP measurements at 1 min intervals and measurement of weight and height. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or those receiving antihypertensive therapy. Of all 7782 participants, 3323 had hypertension (42.7%) of whom 61.8% were aware and 50.4% were not receiving antihypertensive medication. Of those treated (49.6%), 43.8% had controlled BP (<140/90 mmHg). Among all hypertensive patients (with and without medication), 21.7% had controlled BP. In relation to previous surveys carried out in the country, awareness of hypertension increased two-fold, with no change in the proportion of hypertensive patients on treatment and the proportion of hypertensive patients with controlled BP which remained low.

May Measurement Month 2017-2019: results from Switzerland.

May Measurement Month (MMM) is an international screening campaign for arterial hypertension initiated by the International Society of Hypertension and endorsed by the World Hypertension League. Its aim is to raise the awareness of elevated blood pressure (BP) in the population worldwide. The goal of the present analyses is to assess the results obtained during three years of this campaign in Switzerland. Swiss data from MMM17 to MMM19 campaigns were used. BP and a questionnaire for basic demographic and clinical information were recorded for each participant. BP measurements and definition of arterial hypertension followed the standard MMM protocol. To assess BP control, European Society of Hypertension 2018 thresholds of <140/90 mmHg were used. Overall, 3635 participants had their BP measured, including 2423 women (66.7%) and 1212 (33.3%) men. More than half of the data came from pharmacies during MMM18 and MMM 19 campaigns. The difference in BP between pharmacies and other screenings sites was small. Overall, prevalence and awareness rates were 32.7% and 72.3%, respectively. Of those on medication, 60.9% were controlled, and of all hypertensive patients, 39.4% had controlled BP. In Switzerland, the prevalence of hypertension based on a 3-year awareness campaign was similar to previous epidemiological data within the country. One third of the population screened had hypertension, two thirds were aware of it, and less than half had controlled BP.

May Measurement Month 2018-2019: an analysis of blood pressure screening results from Austria.

Arterial hypertension is a global burden leading to over 10.8 million deaths per year worldwide. May Measurement Month (MMM) is a global project initiated by the International Society of Hypertension to raise the awareness of high blood pressure (BP) in the population. Following the MMM protocol 2508 participants ≥18 years had their BP measured in Austria in MMM18 and MMM19. Of those screened, 54.6% were found to be hypertensive, defined as a BP ≥140/90 mmHg and/or being on treatment for hypertension. Among those individuals with hypertension, 56.1% were on medication but only 42.0% of those treated had controlled BP (<140/90 mmHg). Lower BPs were found in those with previous myocardial infarction (MI), probably explained by a medical monitoring system of patients with MI in Austria. Those with hypertension were referred for further medical investigations and were provided lifestyle advice. Among a high number of individuals receiving antihypertensive treatment, BP is still not controlled. Further screening and monitoring of therapeutic effects is urgently required.