Ethnic Disparities in Hypertension Among Women in the May Measurement Month Global Campaigns 2021-2023

Objective: Hypertension is the leading risk factor for cardiovascular disease globally. The May Measurement Month (MMM) initiative promotes blood pressure (BP) screening to raise awareness. Epidemiological data on hypertension prevalence, awareness, treatment, and control among Black women in Sub-Saharan African (SSA) are relatively sparse – this study aimed to investigate this population compared with other ethnic groups participating in the MMM 2021, 2022, and 2023 campaigns. Design and method: Adults (>=18 years) had opportunistic BP screening using a standardised protocol. Three seated BP measurements were taken, along with a questionnaire collecting information on demographics and comorbidities. Females who reported Black SSA (n=91,916), East and Southeast Asian (ESA) (n=347,718), South Asian (n=73,779), or White European (n=82,071) ethnicity were included in analysis. Hypertension was defined as systolic BP >=140mmHg or diastolic BP >=90 mmHg, or taking BP-lowering medication. Results: In total, 595,484 participants from 62 countries were included (mean age: 46.4±16.4 years). Black SSA women were the youngest (41.7 years) and exhibited the highest age-standardised mean systolic (125.4 mmHg) and diastolic (79.9 mmHg) BP. Hypertension prevalence was highest in Black SSA women (39.7%) and lowest in ESA women (25.2%). Among hypertensive participants, awareness and treatment rates were lowest amongst ESA women (37.3% and 35.7%, respectively), while control rates among treated hypertensives (BP <140/90 mmHg) were lowest among Black SSA women (54.1%). Of those who were untreated, combined systolic-diastolic hypertension (systolic BP >=140 mmHg and diastolic BP >= 90mmHg) was the most common phenotype in Black SSA (41.3%) and White (36.3%) women, whilst isolated diastolic hypertension (systolic BP <140 mmHg and diastolic BP >=90 mmHg) predominated in ESA women (37.5%), and isolated systolic hypertension (systolic BP >=140 mmHg and diastolic BP <90 mmHg) predominated in South Asian women (36.9%). Conclusions: Black SSA women demonstrate a particularly high burden of hypertension and poorer BP control. Together with lower rates of hypertension awareness and treatment found in East and Southeast Asian women, these findings suggest a need for culturally tailored screening, education, and health system interventions to improve early detection and effective management in these populations.