A pioneering global initiative by the International Society of Hypertension (ISH) to screen the blood pressure of as many people globally as possible managed to screen just over 1.5 million people across countries of all incomes in 2018, discovering that 1 in 3 had hypertension.
Furthermore, only a small proportion (1 in 3) of those found to have hypertension had their condition under control, either because they were unaware, not on treatment, or both – or, their treatment was not working well enough.
According to the most recent Global Burden of Disease study (2017), raised blood pressure is the biggest contributor to disease and mortality worldwide, with 10.4 million raised blood pressure related deaths in 2017.
To help tackle this burden and address the lack of priority given to blood pressure monitoring and control in most countries of the world, the ISH decided to take action, using a global network of volunteers to measure the blood pressure of as many people as possible during the month of May. The project, called ‘May Measurement Month’, began in 2017 and is now in its third year.
A nurse takes a patient’s blood pressure at the East Arkansas Family Health Center in Lepanto
“The simplest way to save lives is to increase awareness and get people’s blood pressure checked,” explains Professor Neil Poulter, Chief Investigator for MMM, Immediate Past-President of ISH, Professor of preventive cardiovascular medicine and Director of the Imperial Clinical Trials Unit at Imperial College London, UK.
In 2017, some 1.2 million people in 80 countries were screened. Now, the results of MMM for 2018 are available, and the initiative has grown to 89 countries and 1.5 million people screened. These latest results for 2018 are being published in the European Heart Journal as part of World Hypertension Day.
Furthermore, right now and throughout the month of May many events are currently ongoing for MMM 2019, which aims to further increase numbers screened.
MMM is run mostly by a network of volunteer staff, working for free, who set up screening sites in a wide range of locations including hospitals, primary care clinics, indoor and outdoor public places, places of worship, pharmacies, and workplaces. The campaign was promoted internationally by the ISH and locally through television, radio, the media, and social media. Wherever possible, endorsements from sporting, political, and national celebrities were also used. Staff were asked to take three sitting readings of blood pressure for each person screened, with the average of the second and third readings used as the result.
These new data from 2018 showed that 502 079 (33.4%) out of 1 504 963 participants were found to have hypertension (see table 4 full paper, link below). Of these, 298 940 (59.5%) were aware of their condition and 277 794 (55.3%) were on treatment. Of those on treatment, 166 580 (60.0%) were controlled and hence only 33.2% of all those with hypertension were controlled. A total of 111 214 (40%) of people were taking blood pressure treatments but still had uncontrolled blood pressure. Furthermore, one in six (15%) of those screened overall (224 285) had hypertension and were not on any form of treatment.
In all cases where hypertension was detected, the person was offered diet and lifestyle advice to help lower their blood pressure and ways to seek treatment if required. While the effects of this advice could not be measured in the 2018 study, there are plans to evaluate this for MMM 2019 which is ongoing.
Other interesting findings include that less than half (43%) of people screened had had their blood pressure checked in the last 12 months. There were also stark regional differences in the results. The Americas and Europe had the highest rates of hypertension detected (40.4% and 41.6% respectively), while sub-Saharan Africa had the lowest (24.8%). The Americas (76.7%) and Europe (71.0%) also had the highest proportion of people with hypertension aware of their condition, while North Africa and the Middle East had the lowest (35.7%). The Americas was also the region with the highest proportion of cases of controlled hypertension (43.0%) while sub-Saharan Africa was the lowest (15%).
Systolic and diastolic BPs were lower when measured on the left compared to the right arm, and in pregnant women compared to women who were not pregnant. Higher BPs were seen in alcohol drinkers, increasing proportionally with the amount of alcohol consumed, and slightly higher BPs were seen in those who were fasting at the time of their blood pressure measurement (more than 100,000 participants were fasting during Ramadan in May 2018). BPs also increased across the range of body-mass index from underweight to obese. Compared to hospital- or clinic-based measurements, BPs measured in pharmacies were significantly lower, while those taken in the workplace were significantly higher. Systolic BPs were highest on Saturday and lowest on Tuesday.
MMM 2018 was achieved at a central cost of US$0.14 per participant and US$0.65 per identified case of untreated, or treated but uncontrolled hypertension, although most costs were offset by having volunteer investigators, donated BP measurement devices and locally raised funds. The authors say: “Without the generosity of the organizations and people involved, this global mass screening would not have been possible.”
They add: “May Measurement Month 2018 confirms that mass screening of blood pressure is feasible around the world at a relatively low cost to raise awareness of blood pressure in large numbers of people. Although the ultimate aim of the MMM campaign is to use the data to influence health policy on blood pressure screening and management where it is needed most, meanwhile, it provides stand-alone benefits likely to reduce the health burden due to raised blood pressure.”
Professor Poulter concludes: “It is urgent that we act to address the enormous burden that hypertension is placing on every country in the world. As long as we have sufficient support, we will continue to grow MMM on an annual basis, making May the month the world checks its blood pressure. Whilst we do this, the ISH is also calling upon policy influencers around the globe to recognize the need for better availability of screening as a direct way to reduce the huge burden raised blood presents for global health.”