Efficacy and safety of a novel low-dose triple single-pill combination of telmisartan, amlodipine and indapamide, compared with dual combinations for treatment of hypertension: a randomised, double-blind, active-controlled, international clinical trial.

BACKGROUND: Single-pill combinations (SPCs) of three low-dose antihypertensive drugs can improve hypertension control but are not widely available. A key issue for any combination product is the contribution of each component to efficacy and tolerability. This trial compared a new triple SPC called GMRx2, containing telmisartan, amlodipine, and indapamide, with dual combinations of components for efficacy and safety. METHODS: In this international, randomised, double-blind, active-controlled trial, we enrolled adults with hypertension receiving between zero and three antihypertensive drugs, with a screening systolic blood pressure (SBP) ranging from 140-179 mm Hg (on no drugs) to 110-150 mm Hg (on three drugs). Participants were recruited from Australia, the Czech Republic, New Zealand, Poland, Sri Lanka, the UK, and the USA. In a 4-week active run-in, existing medications were switched to GMRx2 half dose (telmisartan 20 mg, amlodipine 2·5 mg, and indapamide 1·25 mg). Participants were then randomly allocated (2:1:1:1) to continued GMRx2 half dose or to each possible dual combination of components at half doses (telmisartan 20 mg with amlodipine 2·5 mg, telmisartan 20 mg with indapamide 1·25 mg, or amlodipine 2·5 mg with indapamide 1·25 mg). At week 6, doses were doubled in all groups, unless there was a clinical contraindication. The primary efficacy outcome was mean change in home SBP from baseline to week 12, and the primary safety outcome was withdrawal of treatment due to an adverse event from baseline to week 12. Secondary efficacy outcomes included differences in clinic and home blood pressure levels and control rates. This study is registered with ClinicalTrials.gov, NCT04518293, and is completed. FINDINGS: The trial was conducted between July 9, 2021 and Sept 1, 2023. We randomly allocated 1385 participants to four groups: 551 to GMRx2, 276 to telmisartan-indapamide, 282 to telmisartan-amlodipine, and 276 to amlodipine-indapamide groups. The mean age was 59 years (SD 11), 712 (51%) participants self-reported as female and 673 (48·6%) male, and the mean clinic blood pressure at the screening visit was 142/85 mm Hg when taking an average of 1·6 blood pressure medications. Following the run-in on GMRx2 half dose, the mean clinic blood pressure level at randomisation was 133/81 mm Hg and the mean home blood pressure level was 129/78 mm Hg. At week 12, the mean home SBP was 126 mm Hg in the GMRx2 group, which was lower than for each of the dual combinations: -2·5 (95% CI -3·7 to -1·3, p<0·0001) versus telmisartan-indapamide, -5·4 (-6·8 to -4·1, p<0·0001) versus telmisartan-amlodipine, and -4·4 (-5·8 to -3·1, p<0·0001) versus amlodipine-indapamide. For the same comparisons, differences in clinic blood pressure at week 12 were 4·3/3·5 mm Hg, 5·6/3·7 mm Hg, and 6·3/4·5 mm Hg (all p<0·001). Clinic blood pressure control rate below 140/90 mm Hg at week 12 was superior with GMRx2 (74%) to with each dual combination (range 53-61%). Withdrawal of treatment due to adverse events occurred in 11 (2%) participants in the GMRx2 group, four (1%) in telmisartan-indapamide, three (1%) in telmisartan-amlodipine, and four (1%) in amlodipine-indapamide, with none of the differences being statistically significant. INTERPRETATION: A novel low-dose SPC product of telmisartan, amlodipine, and indapamide provided clinically meaningful improvements in blood pressure reduction compared with dual combinations and was well tolerated. This SPC provides a new therapeutic option for the management of hypertension and its use could result in a substantial improvement in blood pressure control in clinical practice. FUNDING: George Medicines.

Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial.

BACKGROUND AND AIMS: Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment. METHODS: Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes. RESULTS: Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10-1.17], P < .001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18-1.26), P < .001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72-0.93), P = .003], total CV events [HR 0.93 (95% CI 0.88-0.98), P = .008], total coronary events [HR 0.92 (95% CI 0.86-0.99), P = .024], and atrial fibrillation [HR 0.91 (95% CI 0.83-0.99), P = .030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82-1.01), P = .073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality. CONCLUSIONS: Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period.

Lipids and apolipoproteins and the risk of vascular disease and mortality outcomes in women and men with type 2 diabetes in the ADVANCE study.

AIM: Whether apolipoproteins (apolipoprotein A1, apolipoprotein B, apolipoprotein B/apolipoprotein A1 [ApoB/ApoA1] ratio) or very-low-density lipoprotein (VLDL) cholesterol are better risk predictors than established lipid risk markers, and whether there are sex differences, is uncertain, both in general populations and in patients with diabetes. The aim of this study was to assess the association between established risk markers, apolipoproteins and the risk of macro- and microvascular disease and death in a large study of women and men with diabetes and to assess the potential sex differences in the associations. MATERIALS AND METHODS: Established lipid risk markers were studied in 11 140 individuals with type 2 diabetes from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial, and apolipoproteins (A1, B, ApoB/ApoA1 ratio) and VLDL cholesterol from nuclear magnetic resonance (NMR) lipid analyses in biobanked samples from 3586 individuals included in the ADVANCE case-cohort study (ADVANCE CC). Primary outcomes were major macro- and microvascular events and death. Cox proportional hazards models adjusted for confounders were used to quantify the associations (hazard ratio [HR] and 95% confidence intervals [CIs]) between established lipid risk markers and apolipoproteins with study outcomes. To address potential effect modification by sex, we investigated the association between the lipid risk markers and outcomes in subgroup analyses by sex. RESULTS: There was a lower risk of macrovascular complications for high-density lipoprotein (HDL) cholesterol (HR [95%CI] 0.88 [0.82-0.95]), a higher risk for total cholesterol (1.10 [1.04-1.17]), low-density lipoprotein (LDL) cholesterol (1.15 [1.08-1.22]), non-HDL cholesterol (1.13 [1.07-1.20]) and the total cholesterol/HDL ratio (1.20 [1.14-1.27]) but no significant associations with triglycerides from ADVANCE. There was a higher risk of macrovascular complications for the ApoB/ApoA1 ratio (1.13 [1.03-1.24]) from the ADVANCE CC. Only the ApoB/ApoA1 ratio (1.19 [1.06-1.34]), but none of the established lipid risk markers, was associated with a higher risk of microvascular complications. There were no statistically significant sex differences for any of the established lipid risk markers or apolipoproteins with any outcome. Using C-statistics and net reclassification improvement (NRI) did not detect significant improvement in predicting all outcomes by adding lipids or apolipoproteins to the models with confounding factors only. CONCLUSIONS/INTERPRETATION: All established lipid risk markers, except triglycerides, were predictors of macrovascular complications, but not microvascular complications, in patients with type 2 diabetes. The ApoB/ApoA1 ratio was associated with major macro- and microvascular complications, but there was no evidence that apolipoproteins are better than established lipid risk markers in predicting cardiovascular complications in patients with type 2 diabetes.

May Measurement Month 2021: an analysis of blood pressure screening results from Zimbabwe.

The May Measurement Month 2021 campaign in Zimbabwe was aimed at assessing the frequency of hypertension and improving awareness among the population of the sequelae of elevated blood pressure (BP). Participants aged 18 years and above were recruited at outdoor booths to fill out a questionnaire and provide three BP measurements with 1-min intervals. Of the 2094 participants, over one-third (37.3%) were hypertensive, half of hypertensives (49.7%) were aware they had elevated pressure, and less than half (45.0%) of the hypertensive patients were on antihypertensive medications. Increasing age was directly proportional to hypertension with a large leap from 9.5 to 27.7% between the 18-29 and 30-39 age groups. Hypertension remains a major public health challenge in Zimbabwe. Improving access to preventive health screening services as well as treatment facilities is essential to early detect and control hypertension.

May Measurement Month 2021: an analysis of blood pressure screening results from Thailand.

Blood pressure (BP) measurement is the mainstay for diagnosing and treating hypertension. Blood pressure screening in the May Measurement Month (MMM) project is helpful for the early detection of hypertension, which is usually asymptomatic. This study aimed to investigate the epidemiology of hypertension from data in the MMM21 project in Thailand. A cross-sectional study was conducted according to the MMM clinical study protocol for MMM21 in all regions of Thailand from August to November 2021. We included adults aged ≥18 years. Baseline characteristics, history of hypertension diagnosis, and treatment were collected through the questionnaires followed by three standardized BP measurements, 1 min apart. We included 10 940 participants with a mean age of 41.3 (SD ± 13.5) years. Only 6% never had their BP measured before. Of all participants, 30.2% had hypertension, and among this hypertensive population, 50.3% were aware, and 46.2% were taking antihypertensive medications. Of participants with hypertension, 31.6% had controlled BP (<140/90 mmHg), and BP control was 68.5% among those taking antihypertensive medication. The proportion of participants who had diabetes, were on aspirin, and were on statin were 6, 7.2, and 11.4%, respectively. Almost all participants (93.7%) had received at least one COVID-19 vaccination, and 8.0% reported a previous COVID-19 positive test. Most of the participants (97.4%) received hypertension care at no cost. Hypertension awareness and overall BP control rate were relatively low, while most subjects had previously had their BP checked. The widespread use of BP measurement may improve the diagnosis and treatment of hypertension to improve the care of those with hypertension in Thailand.

May Measurement Month 2021: an analysis of blood pressure screening results from Malawi.

May Measurement Month (MMM) is a global initiative aiming at raising awareness and screening people for blood pressure (BP) for free. Malawi started participating in 2017 due to our membership with the International Society of Hypertension, and this was done mainly to raise awareness of high BP, which could be of benefit to the population. An opportunistic cross-sectional survey of participants aged 18 years and above was carried out from May to September 2021 in Blantyre and Lilongwe. All BP measurements, definition of hypertension, and statistical analysis followed the standard MMM protocol. A total of 7074 participants took part with 4348 (61.5%) being male and 2726 (38.5%) female. A total of 1525 (21.6%) participants were found to have hypertension. Of these, 84 (5.5%) were aware that they had the condition, and 81 (5.3%) of those with hypertension were on antihypertensive treatment. Of those on antihypertensive treatment, 61 (76.5%) had controlled BP. The screenings were done in just two districts and a few locations, which therefore are not representative of the whole country. This shows there is a significant need to expand screening opportunities within Malawi for early detection of hypertension to have a greater impact on the country as far as the fight against hypertension is concerned.

May Measurement Month 2021: an analysis of blood pressure screening results from Pakistan.

A worldwide screening initiative called May Measurement Month is held every year with the goal of raising both public and individual awareness of checking blood pressure (BP) and its control. A total of 11 366 volunteer adults (≥18 years) were screened in Pakistan. The mean age of the study population was 47.1 ± 13.2 years and 83.8% were male. Of the 6615 (58.2%) participants with hypertension, 69.1% were aware and 4233(64.0%) were on antihypertensive medication. Of all participants on antihypertensive medication, 41.9% had controlled BP (140/90 mmHg). Of participants with hypertension, only 26.8% had controlled BP. Of the 7133 participants not on antihypertensive medication, 2382 (33.4%) were found to be hypertensive. In Pakistan, the proportion of hypertension and uncontrolled BP remains high, suggesting a widespread lack of adopting healthy lifestyle choices, sufficient healthcare facilities, awareness of checking their BP, and also inadequate management of hypertension.

May Measurement Month 2021: an analysis of blood pressure screening results from Paraguay.

The aim of this study was to highlight the importance of measuring blood pressure (BP) to identify new, known, and treated individuals with hypertension and to raise awareness in the general population about the importance of good BP control. In Paraguay, 3663 individuals aged ≥18 years of both sexes were recruited from May to November 2021 as part of the May Measurement Month (MMM) campaign, which was initiated by the International Society of Hypertension in 2017. Volunteers of 18 regional health teams applied the questionnaire provided by the MMM 2021 organization throughout the country. Due to COVID-19 constraints, the majority of the questionnaires (52.2%) were administered in health centres of the Ministry of Health and concluded with three BP and pulse readings using OMRON-automated BP measurement devices. Hypertension was defined as a systolic BP ≥ 140 mmHg or as a diastolic BP ≥ 90 mmHg or taking antihypertensive medication. We found that 57.4% of screenees were hypertensive and 72.9% of these (82.3% of women and 59.4% of men) had known hypertension. Of patients with hypertension, 70.1% were on antihypertensive medication, and 40.9% had controlled BP (<140/90 mmHg). Among hypertensives detected, 79.7% of women were on antihypertensive medication and 44.1% had controlled BP, while 56.4% of men were on treatment and 34.3% had controlled BP. In summary, we found high levels of hypertension with high rates of awareness and treatment particularly among women, although control rates were low particularly among men. This may be because most screening was conducted predominately in hospital settings.

May Measurement Month 2021: an analysis of blood pressure screening results from Nepal.

Despite the well-recognized importance of prevention and early treatment of hypertension, the majority of adults in Nepal are not aware of their high blood pressure (BP) and are left untreated. In this paper, we report the result of the May Measure Month 2021 campaign in Nepal: a nationwide community-based hypertension screening campaign. An opportunistic cross-sectional survey was conducted in 15 districts between September 2021 and December 2021. An individual was included if aged 18 years or more and provided informed consent. Structured questionnaires were administered, and BP was measured three times in a sitting position by trained volunteers. A total of 5172 participants were included. The median age (interquartile range) was 37 (25-51), and 49.9% were female. The mean (SD) of the systolic and diastolic BP was 123.9 (14.9) and 80.2 (9.3) mmHg, respectively. A total of 1066 participants (20.6%) were identified as hypertensive (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or on antihypertensive medication), of whom 399 (39.5%) and 298 (29.5%) were aware of their BP status and treated with at least one antihypertensive medicine, respectively. Blood pressure control (<140/90 mmHg) was achieved in 15.6% of all hypertensives and in 56.0% of treated individuals. Multivariate logistic regression showed an association between hypertension and the following variables: every 1-year increase of age [odds ratio (OR) = 1.13 (1.11-1.15) if age < 40 and OR = 1.05 (1.04-1.06) if age ≥ 40], male [OR = 1.57 (1.33-1.89)], regular alcohol use [OR = 1.59 (1.30-1.93)], and diabetes [OR = 2.63 (1.93-3.58)]. Hypertension awareness, treatment, and control were suboptimal in Nepal. This study supports a strong need to scale up community-based hypertension programmes in Nepal and raises the possibility of task sharing with community health workers.

May Measurement Month 2021: an analysis of blood pressure screening results from Kenya.

Hypertension is a major contributor to premature death and disability globally. The age-standardized prevalence of hypertension among adults aged 30-79 years is among the highest at 36%. Despite the availability of cost-effective interventions, awareness, treatment, and control rates remain low. To tackle this and raise awareness, the May Measurement Month (MMM) campaign was initiated by the International Society of Hypertension in 2017. This paper summarizes results from the 2021 MMM campaign. Screening was conducted in 22 sites across 7 counties. We aimed to take three blood pressure (BP) readings and corresponding heart rate measurements as per the standardized protocol. Where this was not achievable, at least one reading was taken. Other variables recorded included demographic data, risk factors, comorbidities, and history of COVID-19 infection. A total of 9738 individuals were screened, of whom 57% were female. After multiple imputations, 28.2% were hypertensive, of whom 45.9% were aware and 42.0% were on treatment. Of those on treatment, 50.3% were controlled, translating to control among only 21.1% of the total hypertensive population. Previous COVID-19 vaccinations were associated with lower systolic BP (SBP) and diastolic BP (DBP). Individuals who consumed alcohol one to three times a month had lower diastolic BP after adjustment for age, sex, and anti-hypertensive treatment. Among women, the use of hormonal contraceptives was associated with lower SBP and DBP after adjustment for age, sex, and anti-hypertensive treatment. Hypertension awareness, treatment, and control rates remain low, though trends from previous MMM campaigns in Kenya suggest steady improvement. The associations between COVID-19 vaccination and contraceptive use with lower BP warrant further investigation. Programmes such as MMM provide much needed data to track the progress towards reducing the burden of hypertension.

May Measurement Month 2021: an analysis of blood pressure screening results from Australia.

May Measurement Month (MMM) is a global and national blood pressure (BP) screening campaign initiated by the International Society of Hypertension to improve awareness of BP worldwide. This study reports on the findings of the MMM21 campaign in Australia. Adult participants (≥18 years) were screened through opportunistic sampling across Australia between 1 May and 30 November 2021. Trained volunteers recorded standardized BP measurements from community volunteer participants along with demographic data, lifestyle factors, comorbidities, and history of COVID-19 infection and vaccination. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg and/or taking antihypertensive medication. Data were collated and analysed centrally using the current MMM protocol and presented after the imputation of missing BP readings. A total of 1307 participants were screened in 2021, comprising 652 (49.9%) females and 654 (50.0%) males with a mean age of 48 years (SD 20.1). Of all 1307 participants, 524 (40.1%) had hypertension. Of participants with hypertension, 65.4% were aware and 59.3% were on antihypertensive medication. Of 311 participants on antihypertensive medication, 54.7% had controlled BP. Of all 524 participants with hypertension, 32.5% had controlled BP. The current 2021 data may indicate some progress in creating BP awareness; however, consecutive Australian data obtained since 2017 demonstrated stagnating treatment, and control rates compared with global rates and those in other high-income countries. Concerted efforts from all stakeholders will be required to further improve BP awareness, treatment, and control rates in Australia.

May Measurement Month 2021: an analysis of blood pressure screening results from Kazakhstan.

The May Measurement Month (MMM) screening campaign initiated by the International Society of Hypertension aimed to assess the prevalence of hypertension and associated risk factors to increase and improve population awareness of raised blood pressure (BP) and methods of prevention. The MMM is a cross-sectional survey of adults aged 18 years and over of both sexes who gave informed consent to participate in the survey and to have their BP measured. Kazakhstan participated in the campaign for the first time in 2021. Blood pressure was measured three times on a single occasion, and data on cardiovascular risk factors were collected. A total of 1763 respondents from 4 regions participated in the screening. The mean age was 41 ± 14.4 years; 31.5% of all participants were found to have hypertension, of whom 41.8% were aware, 34.0% on treatment, and only 15.8% controlled (<140/90 mmHg). Significant differences in these rates were found between age and sex groups. The screening campaign confirms low levels of awareness of hypertension and associated risk factors in the population in Kazakhstan and the need for annual screening and implementation of national hypertension control programmes.

May Measurement Month 2021: an analysis of blood pressure screening results from Armenia.

Elevated blood pressure (BP) is a growing burden worldwide and is the leading cause of mortality and disability-adjusted life years all over the world. May Measurement Month (MMM) is a global initiative aimed to increase awareness of high BP initiated by the International Society of Hypertension, to identify individuals in need of improved hypertension care, and to improve BP screening worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in accordance with standard MMM protocol in 2021. The study was conducted in public areas, both indoor and outdoor, as well as in primary and secondary healthcare centres. A total of 5777 individuals (mean age 51.8 ± 16.1 years, 49.8% female) were screened. After imputation, 45.7% participants had hypertension and 43.7% of them were aware of their high BP. Of 2640 participants with hypertension, 887 (33.6%) were on antihypertensive treatment, of whom 32.4% were on single medication, 29.7% on two medications, and 37.9% on three or more. Only 42.2% of those on medication had controlled BP (<140/90 mmHg), whereas of the participants with hypertension overall, 14.2% had controlled BP. We found that the prevalence of inadequately treated hypertension remains high in Armenia and may represent a vital contributor to the growing burden of non-communicable diseases.

May Measurement Month 2021: an analysis of blood pressure screening results from Bulgaria.

Cardiovascular disease is not only the leading cause of mortality in Bulgaria, but the associated mortality rate is twice the European Union average, so screening programmes that identify subjects with elevated blood pressure (BP) are of utmost importance. May Measurement Month (MMM) is an annual global initiative that began in 2017 that aims to raise awareness of high BP. Bulgaria first joined the third campaign of MMM in 2019, and an overview of the results of Bulgarian participation in MMM21 is presented in this paper. Hypertension was defined as receiving BP-lowering medications or having a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. Statistical analysis followed the standard MMM protocol. In Bulgaria, 155 screening sites were set up in primary and secondary care facilities, in pharmacies, and outdoor spaces across 16 administrative districts. Out of 3908 individuals screened, 2896 participants (74.1%) had hypertension. Of 2896 participants with hypertension, 76.4% were on treatment of whom 48.5% had controlled BP (<140/90 mmHg). Out of 1696 participants not on antihypertensive medication, 684 (40.3%) had elevated BP. Men were found to have higher rates of undiagnosed hypertension and lower rates of control than women. By identifying almost two-thirds of the whole screened cohort with the possibility of newly diagnosed or uncontrolled hypertension, our results confirm the importance of BP screening.

May Measurement Month 2021: an analysis of blood pressure screening results from Uganda.

High blood pressure (BP) is the leading cause of cardiovascular disease in Uganda accounting for more than 50% of cardiovascular related deaths each year. In Uganda, more than 25% of adults have high BP with lack of awareness being the main barrier to achieving satisfactory control rates. May measurement month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of BP screening programmes. A cross-sectional survey of voluntary screenees aged 18 years and above was carried out between May and September 2021. Screening was carried out in two outpatient departments of two referral hospitals within the capital city, Kampala. BP measurements, the definition of hypertension and statistical analysis followed the standard MMM protocol. A total of 1671 people were screened and included in analysis. After multiple imputation, 1018 (60.9%) had hypertension. Of all 1018 participants with hypertension, 765 (75.1%) were aware and 750 (69.3%) were on antihypertensive medicine. Of the participants on antihypertensive medicine, 248 (35.2%) had controlled BP (<140/90 mmHg). Previous history of stroke and taking alcohol 1-6 times per week were significantly associated with higher diastolic BP. The MMM21 Uganda campaign highlights the importance of measuring BP as it generates real-time data on untreated and inadequately treated hypertension. This should motivate government and policy makers to promote routine local screening for BP.

May Measurement Month 2021: an analysis of blood pressure screening results from Hungary.

Elevated blood pressure (BP) is the most important risk factor for cardiovascular diseases (CVDs), which are still the leading cause of mortality in Hungary. Therefore, screening programmes identifying subjects with hypertension have an important role in CVD prevention. In 2017, the International Society of Hypertension initiated May Measurement Month (MMM) aimed at raising awareness of elevated BP. Hungary joined the MMM campaigns in 2017, 2019, and 2021, and a summary of the results from 2021 is presented here. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in September 2021. Measurement of BP, the definition of hypertension, and statistical analysis followed the standard MMM protocol. In Hungary, 30 sites were set up in primary and secondary care facilities, in pharmacies, and in malls. Both cities and villages were involved in all regions. A total of 1414 individuals were screened, and 558 subjects (39.5%) had hypertension. Out of 1065 participants not on antihypertensive medication, 209 (19.6%) had elevated BP. Among treated individuals (n = 349), 206 (59.0%) had controlled BP (<140/90 mmHg). Almost 40% of the participants had hypertension. Among untreated participants, one in five had elevated BP, while among patients on antihypertensive medication, 41% had uncontrolled BP. These results confirm the importance of screening of hypertension in untreated individuals and that efforts are required to adequately control BP in treated hypertensive patients.

May Measurement Month 2021: an analysis of blood pressure screening results from Mexico.

May Measurement Month 2021 (MMM21) in Mexico was an opportunistic survey that aimed to improve blood pressure awareness at the individual and population levels and to analyse the impact of the COVID-19 pandemic on the prevalence, knowledge, and rates of hypertension in the country. This survey followed the methodology of MMM, previously published. The total number of participants screened was 77 547, of which 47 793 (61.6%) were female and 29 178 (37.6%) were male. The mean age (SD) was 46.2 (16.6) years. Of all 77 547 participants, 14 939 (19.3%) had hypertension, of which 48% were aware. The frequency and awareness of hypertension in this survey are similar to those reported before the pandemic (MMM19-Mexico and the 2019 National Health Survey), suggesting that the impact of the COVID-19 pandemic in these parameters of arterial hypertension was not as important as expected. These data are concordant with the official reports in Mexico that showed that the pandemic had a severe impact on cardiovascular mortality but did not modify mortality due to hypertension or stroke.

May Measurement Month 2021: an analysis of blood pressure screening results from Venezuela.

Cardiovascular diseases continue to be the main cause of death in Venezuela, and hypertension is the principal risk factor. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. May Measurement Month 2021 included 46 732 participants with a mean age of 56.4 years (SD 14.4), 57.9% of whom were female. The percentage with hypertension was 60.3% (57.9% of females and 63.7% of males), 82.3% (84.8% of females and 79.2% of males) were aware, and 80.2% were taking antihypertensive medication. Of those on antihypertensive medication, 44.2% (41.2% of females and 48.2% of males) were not controlled [blood pressure (BP) ≥ 140/≥90 mmHg], with 61.3% receiving one drug, 30.0% two drugs, and 8.7% three or more drugs. 87.5% of those on treatment reported taking it regularly. Conditions associated with higher BP levels include fewer years of education, having a previous diagnosis of hypertension, and women who were hypertensive during a previous pregnancy. Physical activity and pregnancy were conditions associated with lower BP levels. A previous positive COVID-19 test was reported in 11.1%, and one or more COVID-19 vaccinations reported in 22.7% of participants. Of those on antihypertensive medication, 78.8% reported their treatment was not affected by COVID-19. Results are consistent with previous MMM campaigns and indicate that the screening campaign is feasible and useful to identify hypertension even in exceptional conditions such as the COVID-19 pandemic.

May Measurement Month 2021: an analysis of blood pressure screening results from Georgia.

The annual global May Measurement Month screening campaign initiated by the International Society of Hypertension aims to raise awareness of raised blood pressure (BP) and in the absence of systematic screening is a useful surrogate indicating the size of the problem of hypertension in the general population in Georgia. May Measurement Month screening was carried out at 400 sites in Georgia in 2021, and more than 500 volunteers, including physicians (80%) and medical students (20%), carried out in the screening. Adults aged ≥18 years were recruited opportunistically, and three BP readings were measured, along with a questionnaire collecting information on demographics, lifestyle, and co- morbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg, based on the mean of the second and third readings, or in those on antihypertensive medication. A total of 4935 individuals were screened, with a mean age of 53.6 years (SD 17.1). A total of 2836 (57.5%) were found to have hypertension, of whom 2441 (86.1%) were aware of their condition and 83.5% were on hypertensive medication. Of those on medication, 41.6% had their BP controlled (<140/90 mmHg). Of all participants with hypertension, 34.7% were controlled. May Measurement Month data highlight the scale of hypertension in Georgia, with low rates of control in those on medication. Educational interventions among the population and medical personnel to raise awareness of high BP and improve control rates are of high importance, which require strong advocacy among policy makers.

May Measurement Month 2021: an analysis of blood pressure screening results from a suburban community in the Democratic Republic of the Congo.

Hypertension remains the most powerful contributor to the global morbidity and mortality. May Measurement Month (MMM), a worldwide screening campaign initiated by the International Society of Hypertension (ISH), is organized annually to increase awareness of high blood pressure (BP). We screened 20 913 adult (≥18 years) residents of suburb hamlets of Mbujimayi (mean age 35.1 ± 15.1 years; Black ethnicity: 98.8%; women: 29.6%; diabetes: 1.6%; alcohol drinkers: 16.8% and smokers: 6.7%, previous myocardial infarction: 1.4%; stroke: 0.8%; taking aspirin: 3.2%; taking statins: 1.9%). Three sitting BP readings were taken, and hypertension was defined as a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Half of the participants had never had their BP checked, whilst 4.2% of respondents had participated in the MMM19 campaign. 0.9% and 1.7% reported COVID-19 vaccination and positive test, respectively. After multiple imputation of missing BP readings, 14.0% of respondents had hypertension of which 35.8% were aware, 28.0% were on antihypertensive medication and 14.1% had controlled BP. Of those on antihypertensive medication, 40.4% were on monotherapy, 37.2% adhered to taking their medication regularly, and 50.4% had controlled BP (<140/90 mmHg). In regression analyses adjusted for age, sex, and antihypertensive treatment, smoking was associated with lower systolic BP, having more years of education was associated with higher systolic and diastolic BP, and physical activity was associated with lower systolic and diastolic BP. This campaign contributes somewhat to reducing the 'black hole' on the prevalence of hypertension in DRC pending systematic countrywide BP screening.