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.

Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial.

BACKGROUND: Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME) study aimed to investigate whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension. METHODS: The TIME study is a prospective, pragmatic, decentralised, parallel-group study in the UK, that recruited adults (aged ≥18 years) with hypertension and taking at least one antihypertensive medication. Eligible participants were randomly assigned (1:1), without restriction, stratification, or minimisation, to take all of their usual antihypertensive medications in either the morning (0600-1000 h) or in the evening (2000-0000 h). Participants were followed up for the composite primary endpoint of vascular death or hospitalisation for non-fatal myocardial infarction or non-fatal stroke. Endpoints were identified by participant report or record linkage to National Health Service datasets and were adjudicated by a committee masked to treatment allocation. The primary endpoint was assessed as the time to first occurrence of an event in the intention-to-treat population (ie, all participants randomly assigned to a treatment group). Safety was assessed in all participants who submitted at least one follow-up questionnaire. The study is registered with EudraCT (2011-001968-21) and ISRCTN (18157641), and is now complete. FINDINGS: Between Dec 17, 2011, and June 5, 2018, 24 610 individuals were screened and 21 104 were randomly assigned to evening (n=10 503) or morning (n=10 601) dosing groups. Mean age at study entry was 65·1 years (SD 9·3); 12 136 (57·5%) participants were men; 8968 (42·5%) were women; 19 101 (90·5%) were White; 98 (0·5%) were Black, African, Caribbean, or Black British (ethnicity was not reported by 1637 [7·8%] participants); and 2725 (13·0%) had a previous cardiovascular disease. By the end of study follow-up (March 31, 2021), median follow-up was 5·2 years (IQR 4·9-5·7), and 529 (5·0%) of 10 503 participants assigned to evening treatment and 318 (3·0%) of 10 601 assigned to morning treatment had withdrawn from all follow-up. A primary endpoint event occurred in 362 (3·4%) participants assigned to evening treatment (0·69 events [95% CI 0·62-0·76] per 100 patient-years) and 390 (3·7%) assigned to morning treatment (0·72 events [95% CI 0·65-0·79] per 100 patient-years; unadjusted hazard ratio 0·95 [95% CI 0·83-1·10]; p=0·53). No safety concerns were identified. INTERPRETATION: Evening dosing of usual antihypertensive medication was not different from morning dosing in terms of major cardiovascular outcomes. Patients can be advised that they can take their regular antihypertensive medications at a convenient time that minimises any undesirable effects. FUNDING: British Heart Foundation.

Implications of ACC/AHA Versus ESC/EAS LDL-C Recommendations for Residual Risk Reduction in ASCVD: A Simulation Study From DA VINCI.

PURPOSE: Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated. METHODS: DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated. RESULTS: Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81-115) mg/dl and 32% (25-43%), respectively. Median LDL-C reductions of 24 (12-46) and 39 (27-91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7-25%) and 22% (15-32%), respectively, and ARRs of 4% (2-7%) and 6% (4-9%), respectively. CONCLUSION: In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach.

May Measurement Month 2017: an analysis of blood pressure screening results from Mauritius.

Hypertension is a growing burden worldwide. According to the World Health Organization, ∼1.13 billion people worldwide suffer from hypertension. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programmes worldwide. We provide the results of the 2017 MMM (MMM17) edition in Mauritius. This cross-sectional survey of participants aged 18 years and over was carried out in May 2017. Hypertension was defined as systolic BP of at least 140 mmHg or diastolic BP of at least 90mmHg or in those on antihypertensive medication. Blood pressure measurement and statistical analysis followed the standard MMM protocol. The screening was conducted by the Non-Communicable Diseases and Health Promotion Unit, which is under the aegis of the Ministry of Health and Wellness, mainly in workplaces and community centres, in both rural and urban areas across Mauritius. Of the 2302 individuals screened, after multiple imputations, 375 (16.3%) had untreated hypertension. May Measurement Month 2017 was the very first BP screening campaign initiated in Mauritius. These results suggest that MMM17 was useful in the identification of potential patients with raised BP.

May Measurement Month 2018: an analysis of blood pressure screening results from Pakistan.

The May Measurement Month (MMM) screening campaigns comprise an opportunistic assessment of the arterial blood pressure (BP) of Pakistani adults (≥18 years old) and evaluate the level of awareness and spectrum of the problem of hypertension and the associated risk factors. The prospective study was carried out in May 2018 in multiple medical screening camps at hospitals, pharmacies, and public areas with the help of local health care workers under ethical guidelines. The volunteers took BP measurements using OMRON digital BP devices, in a seated position, and three successive readings were noted after 5 min rest. The mean values of the second and third readings were attained. Data were analysed centrally by the MMM project management team and multiple imputations were performed, where BP readings were missing. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or in those taking antihypertensive medication. This study included 25 076 participants, of whom 14 726 (58.7%) were hypertensive. Among all hypertensives, only 11 681 were aware of their hypertension status. After imputation, age and gender standardization, mean systolic and diastolic BP were 129.8 mmHg and 82.9 mmHg, respectively. MMM17 data revealed that 55.2% of those screened were hypertensive in Pakistan, while in 2018 the proportion rose slightly to 58.7%. The prevalence of hypertension among those screened for MMM in Pakistan was high in both years. Although most patients with hypertension were treated, the majority remained uncontrolled. Further efforts to improve awareness and control are needed.

May Measurement Month 2017-2019: an analysis of blood pressure screening results from Lithuania.

In 2017, Lithuania joined the global May Measurement Month (MMM) campaign which aims at raising awareness of raised blood pressure worldwide. Presented here are the data arising from the 2017, 2018, and 2019 campaigns. An opportunistic cross-sectional survey of individuals aged ≥18 years was carried out in Lithuania in 2017, 2018, and 2019. Two thousand nine hundred and nineteen participants were recruited in the MMM campaigns in response to the media engagement and interactions with the study team. The mean age of participants was 46.1 years (SD 16.3) years, 58.9% were females. Blood pressures were measured using electronic devices provided by Omron according to the MMM protocol. Of the 2919 screened participants, 1308 (44.8%) had hypertension. Of all hypertensive participants, the awareness rate, the treatment rate, and the control rates (<140/90 mmHg) were 79.5%, 41.0%, and 14.2%, respectively. Of those on antihypertensive medication, the control rate was 34.8%. The high percentage of participants with hypertension was either untreated (59.0%) or treated but uncontrolled (65.2%) suggests the usefulness of such screening programmes to improve awareness of hypertension control in Lithuania.

May Measurement Month 2017-19: an analysis of blood pressure screening results from Paraguay.

The aim of this study was to highlight the importance of measuring blood pressure (BP) and to identify and reduce the BPs of those people who require intervention to lower their BP according to current guidelines. A total of 7782 individuals aged ≥18 years were recruited during the 3 years of the May Measurement Month (MMM) campaign (2017: 1196, 2018: 2285, 2019: 4301). Recruitment was through opportunistic sampling at a variety of screening sites distributed throughout the country. Each participant underwent a pre-specified questionnaire with questions on risk factors concluding with three BP measurements at 1 min intervals and measurement of weight and height. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or those receiving antihypertensive therapy. Of all 7782 participants, 3323 had hypertension (42.7%) of whom 61.8% were aware and 50.4% were not receiving antihypertensive medication. Of those treated (49.6%), 43.8% had controlled BP (<140/90 mmHg). Among all hypertensive patients (with and without medication), 21.7% had controlled BP. In relation to previous surveys carried out in the country, awareness of hypertension increased two-fold, with no change in the proportion of hypertensive patients on treatment and the proportion of hypertensive patients with controlled BP which remained low.

May Measurement Month 2017-2019: an analysis of blood pressure screening results from Guatemala.

In 2018, the Ministry of Public Health and Social Assistance of Guatemala published the last update of the prevalence of noncommunicable diseases (NCDs), and as in other low-income countries, the prevalence of NCD morbidity and mortality had risen. The prevalence of hypertension in Guatemala has been reported in a range from 18.7 to 22.7% which could be underestimated, because the country does not have an adequate statistical surveillance system. May Measurement Month (MMM) 2017, 2018, and 2019 in Guatemala was an opportunistic survey, which followed the methodology previously published. Blood pressure (BP) measurements were carried out in various locations, mainly hospitals and clinics (48.9%) or pharmacies (34.2%) in Guatemala City. In all patients, three BP measurements were taken after 5 min of rest and sitting in the correct recommended position. The mean of the second and third BP measurements was used for the analyses. Multiple imputation was used to impute the missing readings, based on the global MMM data. After multiple imputation, of all 3265 participants, 43.4% had hypertension. Of all participants with hypertension, 74.7% were aware of their diagnosis, 69.2% were on antihypertensive medication, and 63.1% had controlled BP (<140/90 mmHg). Of all those with hypertension, 43.6% had controlled BP. MMM is the largest hypertension survey ever carried out globally. The MMM results from Guatemala reported here provide complementary and strong data on the impact of hypertension in the country and help to make hypertension visible as a priority health problem, which requires urgent solutions.

May Measurement Month 2017-2019: an analysis of blood pressure screening results from Ukraine.

Hypertension is a key cardiovascular disease risk factor leading to premature mortality worldwide. The purpose of the May Measurement Month (MMM) campaign in Ukraine is to improve awareness of hypertension at the individual and population level. Adults (≥18 years) were screened at sites in Ukraine. Data from the MMM17 (19 sites), MMM18 (1 site), and MMM19 (5 sites) campaigns are included in the present analysis. Ideally, three blood pressure (BP) measurements were taken for each participant, and data on lifestyle factors and comorbidities were collected. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mm Hg (based on the mean of the second and third readings) or being on antihypertension medication. Multiple imputation was used to estimate participants' mean BP where readings were missing. Linear regression models were used to evaluate associations between BP and participant characteristics. Of all 46 549 screenees, 33 307 (71.6%) had hypertension, and 82.6% of whom were on antihypertensive medication. Of all those on medication, 31.4% were controlled to BP < 140/90 mmHg, and of all 33 307 participants with hypertension, 25.9% had controlled BP. Of all participants, 6.6% took statins and 11.2% took aspirin. The analysis of the MMM 2017, 2018, and 2019 campaigns has shown a high proportion of hypertension, insufficient level of awareness, and critically low level of effective BP control in Ukraine. Further MMM screening is needed to increase awareness of high BP and to help improve diagnosis, management, and treatment of hypertension.

May Measurement Month 2017-2019: an analysis of blood pressure screening results from Dominican Republic.

Arterial hypertension is the main risk factor that contributes to cardiovascular disease and represents a leading cause of morbidity and mortality globally. May Measurement Month (MMM) is a global screening campaign with the aim of improving awareness of hypertension at the individual and population level, an initiative that has been supported in the Dominican Republic (DR) since 2017. Adults (≥18 years) were recruited by sampling in different places in the DR, three blood pressure (BP) readings were performed per participant, and data on risk factors and comorbidities were collected. Hypertension was defined as systolic BP ≥140 mm Hg, diastolic BP ≥ 90 mm Hg (mean of second and third readings), and/or taking antihypertensive medication. Multiple imputation was used to estimate participants' mean BP when three readings were not available. Of 3693 participants, 2134 (57.8%) had hypertension, of whom 1646 (77.1%) were taking medication, but only 38.6% of those on treatment had their BP under control(<140/90 mmHg). The remaining 61.4% of the participants received inadequate treatment. A total of 66% of treated patients were taking a single antihypertensive drug. MMM provides an important platform for the standardized compilation of BP data and the creation of awareness of hypertension in the DR and other nations of the world. The data generated from the 2017-2019 MMM campaigns highlight the importance of adequate detection, knowledge, and control of BP.

May Measurement Month 2018-2019: an analysis of blood pressure screening results from Austria.

Arterial hypertension is a global burden leading to over 10.8 million deaths per year worldwide. May Measurement Month (MMM) is a global project initiated by the International Society of Hypertension to raise the awareness of high blood pressure (BP) in the population. Following the MMM protocol 2508 participants ≥18 years had their BP measured in Austria in MMM18 and MMM19. Of those screened, 54.6% were found to be hypertensive, defined as a BP ≥140/90 mmHg and/or being on treatment for hypertension. Among those individuals with hypertension, 56.1% were on medication but only 42.0% of those treated had controlled BP (<140/90 mmHg). Lower BPs were found in those with previous myocardial infarction (MI), probably explained by a medical monitoring system of patients with MI in Austria. Those with hypertension were referred for further medical investigations and were provided lifestyle advice. Among a high number of individuals receiving antihypertensive treatment, BP is still not controlled. Further screening and monitoring of therapeutic effects is urgently required.

May Measurement Month 2019: analysis of blood pressure screening in Bishkek, Kyrgyzstan.

High blood pressure (BP) is one of the leading causes of death in Kyrgyzstan. The world's largest event in the field of increasing awareness of raised BP is the May Measurement Month (MMM) campaign. Kyrgyzstan joined MMM in 2019. The inclusion criteria for participants in the study were: age ≥18 years and providing informed consent. Hypertension was defined as the presence of systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg based on the mean of the second and third of three sitting BP measurements or on treatment for hypertension. Most of the participants (96.9%) were surveyed inside two large shopping malls of Bishkek. The total number of people who took part in the screening was 2013. The mean age was 38.8 (± 12.6) years, and 1006 were women (50.0%) and 1007 men (50.0%). One-hundred eighty-four participants had hypertension (9.1%), of whom 59 (32.0%) were aware of their diagnosis, and hypertension was controlled in 25 participants (13.7%). The mean BMI was 24.0 (± 4.1) kg/m2, 34 (1.7%) participants had diabetes mellitus, 12 (0.6%) had a history of myocardial infarction, 4 (0.2%) had a history of stroke, 314 (15.6%) were smokers. 41 (2.0%) drank alcohol 1-3 times a month, 46 (2.3%)-once per week. MMM screening allows us to gather up-to-date data on the prevalence, awareness and control of hypertension among volunteer screenees in Bishkek, Kyrgyzstan.

May Measurement Month 2018: an analysis of blood pressure screening results from Benin.

Hypertension is the strongest cardiovascular risk factor worldwide. May Measurement Month (MMM) is an international campaign for blood pressure (BP) screening initiated by the International Society of Hypertension. This work aims to estimate the proportion and the levels of awareness, treatment, and control of hypertension in participants of the MMM survey in Benin in 2018. A cross-sectional survey focused on people aged ≥18 years was conducted in May 2018 in nine rural and urban areas in Benin. A sampling of volunteers was done. BP was measured following the MMM protocol. Hypertension was defined as a systolic BP ≥140 mm Hg and/or a diastolic BP ≥90 mm Hg (mean of the second and third readings) and/or taking antihypertensive medication. Linear regression was used to identify BP associations. A total of 2035 people were screened, including 55.9% women. The mean age was 44.2 ± 15.9 years. The percentage with hypertension was 35.4%. Of 721 participants with hypertension, 56.2% were aware of their diagnosis, 39.7% were on antihypertensive medication, and 13.6% were controlled (<140/90 mmHg). The results confirm the significant proportion of hypertension in Benin. Education programs on risk factors, early detection, and better management strategies should be developed.

May Measurement Month 2017-19: an analysis of blood pressure screening results from Niger.

The aim of this study was to screen for cardiovascular risk factors with particular focus on high blood pressure (BP) in Niger and thereby to raise awareness among the population of Niger about raised BP and the associated risk to health. The city of Niamey served as our study location during the month of May in 2017, 2018, and 2019. We screened volunteer adults aged ≥18 years, who completed a pre-established questionnaire and had three sitting BP measurements taken. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg (based on the mean of the second and third BP readings) or being on antihypertensive medication. We screened 2297 adults of which 42.9% were women and 57.1% men. Of the 2297 screened, 33.2% were found to be hypertensive of whom only 26 (3.4%) were recorded as being on treatment. Approximately 30% of those screened were found to be obese or overweight. High BP is a real public health danger, and this study finds alarming figures that highlight the need for improved policies for screening and management of hypertension. Raising awareness and improving detection of hypertension remain essential to reduce the burden of cardiovascular disease.

May Measurement Month 2019: blood pressure screening results from Chile.

Hypertension is a major preventable cause of death worldwide. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high blood pressure (BP) and identifying individuals with increased BP. A cross-sectional survey of volunteers aged ≥18 years old was carried out in May 2019 in Chile. Participating sites were distributed across the country, most of them from the Public Health System outpatient clinics. In addition, clinical research sites, universities, and private clinics participated. Blood pressure measurement protocol, hypertension categories, and statistical analysis followed the MMM protocol. Hypertension was diagnosed as mean systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or receiving antihypertensive medication. Overall, 6876 individuals were screened. After multiple imputations, hypertension prevalence was 35.4%, of which 65.9% were aware of their condition. While 60.1% were on antihypertensive medication and 34.4% of the total number of hypertensives had their BP controlled. Of participants not receiving antihypertensive treatment, 17.9% were identified as hypertensive. The MMM 2019 survey demonstrated a high proportion of participants with hypertension, with only one-third of these individuals having controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). The high percentage of participants with hypertension who were either untreated (39.9%) or were treated but uncontrolled (57.2%) suggesting that such opportunistic screening programmes may be a useful tool to improve hypertension control in Chile.

May Measurement Month 2019: an analysis of blood pressure screening results from Botswana.

The May Measurement Month (MMM) 2019 campaign aimed to raise awareness of the health issues surrounding raised blood pressure (BP) among the general public. It also sought to identify and facilitate reduction of BPs of participants who require intervention to lower their BP according to current country treatment guidelines. Participants aged ≥18 years were recruited on site through interactions with the study team, educational fliers, and as voluntary walk-ins in response to the media engagement prior to the campaign. Blood pressures were measured using validated upper-arm cuff electronic devices provided by Omron Healthcare in partnership with International Society of Hypertension. With the participant seated, their back supported and legs resting uncrossed on the ground, three BP and heart rate readings were taken and recorded, 1 min apart. Participants' basic demographic data were also collected. Hypertension was defined as being on treatment for hypertension, or a systolic BP ≥140 mmHg and/or a diastolic BP ≥90 mmHg (based on the mean of the last two of three readings). Of the 5459 screened participants, 1750 (32.1%) had hypertension, of whom 784 (44.8%) were aware they were hypertensive and 726 (41.5%) were on antihypertensive medication. Among those on antihypertensive treatment, 47.0% had their BP controlled (<140/90 mmHg). Only 19.5% of all those with hypertension had their BP controlled. A total of 1024 (21.6%) of the 4733 participants not on antihypertensive treatment were hypertensive. Intensified preventive and treatment measures to control BP at the health system, individual and population levels remain a critical requirement for Botswana.

May Measurement Month 2019: an analysis of blood pressure screening results from Zambia.

In Zambia, hypertension accounts for the highest proportion of deaths due to cardiovascular diseases causing 3.3% of all deaths, killing an average of 670 people per year. May Measurement Month (MMM) is an annual global screening campaign aiming to improve awareness of blood pressure (BP) at the individual and population level. Adults (≥18 years) recruited through opportunistic sampling were screened at multiple sites within Lusaka during May and June 2019. Ideally, three BP readings were measured for each participant, and data on lifestyle factors and comorbidities were collected. Data were analysed centrally by the MMM project team and multiple imputations were performed where necessary. Of the total of 9232 enrolled, 8.7% of them had never had their BP measured, 2.5% had diabetes mellitus, 1.9% had had a myocardial infarction, 1.5% had had a stroke, 10.6% were current smokers, and 10.0% consumed alcohol once or more per week. Blood pressure fell from a mean of 128.6/82.9 mmHg for the 1st reading to a mean of 123.2/80.0 mmHg for the 3rd reading. The lowest proportion of participants with hypertension was identified by the 3rd reading alone (30.0%). Of all the participants, 30.7% had hypertension, though only 42.6% of them were aware of their diagnosis. Seven hundred and eighty-three (27.6%) were on antihypertensive medication though only 35.0% of them had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Compared with MMM17 data, there is deterioration of the monitored parameters calling for urgent and accelerated public health policy and clinical practice interventions. We think that the MMM campaign should continue annually to raise awareness of this treatable condition.

May Measurement Month 2019: an analysis of blood pressure screening results from Slovenia.

Accounting for an estimated 10.4 million deaths each year, arterial hypertension is a worldwide epidemic. However, it is a treatable condition that can be readily recognized with cost-effective blood pressure (BP) measurements. Alongside continuous improvements in BP control and treatment, worldwide strategies aim to achieve a high level of hypertension awareness. May Measurement Month (MMM) is a global campaign initiated by the International Society of Hypertension to raise awareness of high BP. Slovenia began with yearly cost-free BP measurements and awareness campaigns in 2005 when World Hypertension Day was announced by the World Hypertension League and in 2017, we joined the MMM initiative. In May 2019, we performed a cross-sectional survey following the standardized MMM protocol. Healthcare personnel obtained BP measurements in a sample of adult subjects (≥18 years) across all regions of the country, mostly in healthcare facilities and pharmacies. In total, 4974 individuals (61.1% female), with a mean age of 59.6 years, were screened. After multiple imputation for missing data, 3037 (61.1%) participants had hypertension. Of individuals not receiving antihypertensive medication, 973 (33.4%) were hypertensive. Of those who reported receiving antihypertensives, 1110 (53.8%) had uncontrolled BP. MMM19 was the largest BP screening campaign undertaken in Slovenia so far. We again identified a substantial number of participants with possible hypertension and uncontrolled BP despite taking antihypertensive medication, which were then referred to their general practitioners or dedicated hypertension centres for further evaluation and management. Taken together, our findings underline the importance of opportunistic screening programmes.

May Measurement Month 2019: an analysis of blood pressure screening results from Taiwan.

To bolster the awareness of high blood pressure (BP) and to monitor the trend of hypertension control rate. Similar to May Measurement Month (MMM) 2017 and 2018 campaigns, we conducted the MMM 2019 campaign in 643 community pharmacies across Taiwan, and recruited adults aged 20 years or over in May and June of 2019. After filling in an anonymous questionnaire regarding medical history and lifestyle habits and having 10-min sitting rest, pharmacists took triplicate upper-arm BP readings on participants using an automated oscillometric sphygmomanometer. The means of the second and third BP readings were used as the screening BP estimates. Hypertension was defined if one of the followings was met: use of antihypertensive medications, systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg. Controlled BP was defined as BP of <140/90 mmHg. Of the 24 851 participants enrolled (mean age, 55.8 ± 15.2 years), 12 427 (50.0%) were women. Among 12 351 (49.7%) participants with hypertension, 10 463 (84.7%) were aware of their high BP, and 10 142 (82.1%) received antihypertensive medications. While 59.2% of all hypertensive participants had controlled BP, the BP control rate was 72.0% in treated hypertensive participants. MMM campaigns offer a feasible way to monitor the trends in both awareness and control of hypertension. This nationwide annual BP screening campaign, from 2017 to 2019, demonstrated continued improvement in hypertension control in Taiwan.

May Measurement Month 2019: an analysis of blood pressure screening results from Saudi Arabia.

High blood pressure (BP) is a major risk factor for cardiovascular diseases and was identified as the most significant single preventable cause of mortality. The prevalence of hypertension in Saudi Arabia is high. To raise awareness and identify undiagnosed hypertension, the Saudi Ministry of Health participated in the May Measurement Month (MMM) 2019 global screening initiative of the International Society of Hypertension. Ninety-two primary care centres across the Kingdom recruited respondents aged ≥18 years through opportunistic sampling, from 1 May to 30 August of 2019. Data collection included sociodemographic, lifestyle habits, environmental, and anthropometric indicators. Blood pressure was measured twice using automated BP devices. A total of 25 023 adults were screened with a mean age of 42.4 (16.7) years and a mean body mass index of 27.5 (6.0) kg/m2. In total, 43.6% of participants were females and 56.4% were males. Of all the participants with hypertension, 60.8% were aware, 60.8% were on antihypertensive medication, and 39.3% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Moreover, out of 4440 participants on antihypertensive medication, only 64.6% had controlled BP. The high numbers of individuals with hypertension and with undiagnosed hypertension highlight the importance of BP screening campaigns to increase awareness, detection, and target treatment on a national level. Findings from this study can form a baseline by which to measure progress in future iterations of MMM.