Awareness, Treatment, and Control of Hypertension Using Opportunistic Screening Programs: Evidence From the May Measurement Month Campaign, 2017-2019

Objective: To evaluate adult (>18 years) hypertension awareness, treatment, control, and comorbidities using three years of May Measurement Month (MMM) data (2017-2019). Design and method: Up to three sitting blood pressure (BP) readings as well as lifestyle and comorbidity data (self-reported diabetes, myocardial infarction, stroke and overweight/obesity) were collected from participants. Missing BP readings were imputed through multiple imputation, leveraging available BP measurements and sociodemographic variables. Hypertension was defined using the average of the second and third BP readings (systolic BP >140 mmHg and/or diastolic BP >90 mmHg or taking antihypertensive medication). For those with hypertension, hypertension awareness was defined as self-report of previous diagnosis or current medication use, while control was defined as BP <140/90 mmHg among people on medication. Logistic regression models were used to analyze lifestyle factors and main comorbidities associated with hypertension awareness, treatment and control. Results: Among 2,907,848 participants from 95 countries, 34.2% had hypertension. Among those with hypertension, 60.1% were aware, 57.0% were medicated, 32.0% were controlled and 22.8% had at least one additional chronic condition. Of those with hypertension who were on medication, 57.0% were controlled. Europe had the highest proportion of individuals with hypertension while Sub-Saharan Africa had the lowest awareness, treatment and control rates (Figure 1). Hypertension treatment and control were higher in individuals with comorbidities (Figure 2-3). Adjusting for age, sex and survey year, those with comorbidities were more likely to be aware of their hypertension while participants from low-income countries and smokers were less likely to be aware. Individuals from low-income countries and smokers were less likely to receive treatment, while those with comorbidities were more likely to get treated. Middle-income individuals were more likely to receive treatment but less likely to be controlled than high-income individuals (Figure 3). Conclusions: MMM provides a means of measuring hypertension, awareness, treatment, and control rates, particularly in resource-limited countries. Data suggests heterogeneity in awareness, treatment and control and poorer hypertension management in individuals without comorbidities, informing global strategies for improved hypertension prevention, detection and management.