May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Abstract

Aims: Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries.

Methods and results: Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension.

Conclusion: May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk.

Keywords: Blood pressure; Control; Global; Hypertension; Screening; Treatment.

Figure 1

Proportions of hypertensives not on medication, on medication and controlled, on medication and uncontrolled, by country income strata.

Figure 2

Change in blood pressure with age and sex, excluding those on antihypertensive medication, from linear mixed model after imputation. Note: shaded areas represent 95% confidence intervals.

Figure 3

Change in mean systolic and diastolic blood pressure compared to baseline group, for co-morbidities, adjusted for age, sex, and use of antihypertensive medication, from linear mixed models. Note: Error bars represent 95% confidence intervals.

Figure 4

Change in mean systolic and diastolic blood pressure compared to baseline group, for other participant factors, adjusted for age, sex, and use of anti-hypertensive medication (pregnancy adjusted for age and medication alone), from linear mixed models. Note: Error bars represent 95% confidence intervals.

Figure 5

Change in mean systolic and diastolic blood pressure compared to baseline group, for body mass index category, adjusted for age, sex, and use of antihypertensive medication, from linear mixed models. Note: Error bars represent 95% confidence intervals. Body Mass Index categories: underweight: <18.5 kg/m²; healthy weight: 18.5–24.9 kg/m²; overweight: 25.0–29.9 kg/m²; obese: ≥30.0 kg/m².

Figure 6

Change in mean systolic and diastolic blood pressure compared to baseline group, for heart rate category, adjusted for age, sex, and use of anti-hypertensive medication, from linear mixed models. Note: Error bars represent 95% confidence intervals.