May Measurement Month 2021: an analysis of blood pressure screening results from Georgia (2024)

Associated Data

Data Availability Statement

Abstract

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.

Keywords: Hypertension, Blood pressure, Screening, Treatment, Control

Introduction

The annual blood pressure (BP) awareness campaign, May Measurement Month (MMM), was initiated in 2017 by the International Society of Hypertension (ISH) and Georgia where hypertension is a major public health challenge has participated on an annual basis since then,^1–3 with the exception of 2020 due to the COVID-19 pandemic. In 2021, data from the Institute for Health Metrics and Evaluation (IHME),⁴ in Georgia in 2021, suggested that mortality from cerebrovascular diseases amounted to 266.3 deaths per 100 000 deaths and ischaemic heart diseases (IHDs) amounted to 154.21/100 000 deaths. The top three causes of death were IHD, stroke, and hypertension. According to the National Center for Disease Control and Public Health, the share of cardiovascular diseases (CVD) mortality in the country in 2021 was 37.0%. In 2021, the share of CVD among all new cases was 9.3%, that of IHDs—10.4%, and of cerebrovascular diseases—3.6%.⁵

The screened population in MMM campaigns has increased between in 2017 and 2019 from 6144 to 13 267.^1–3 Despite these positive dynamics in terms of raising awareness of hypertension, the MMM 2017–19 data revealed on-going public health challenges in the treatment of hypertension, mainly in regard to low rates of treatment and control. In 2021, Georgia took part again in the MMM, despite difficulties in mass screening the population due to the COVID-19 pandemic. However, the longer/flexible duration of the campaign gave us the possibility to cover a wide range of regions based on epidemiological considerations and this report presents the results from 2021.

Methods

The Georgian Society of Hypertension (GSH), which is an associated member of the ISH, and National Centre for Disease Control and Public Health (NCDC) co-ordinated the campaign in the country. Ethical approval was obtained in March 2021 (Institutional Review Board of the National Center for Disease Control and Public Health). The screening was carried out at more than 400 sites, on a national scale mostly in clinics, pharmacies, and other places of public gathering. More than 500 volunteer doctors (80%) and medical students (20%) participated in the screening. To familiarize them with the research tools and standard BP measurement method, their training was conducted by GSH and NCDC working groups in Tbilisi and other large cities. Social/mass media representatives, medical societies, and other stakeholders were actively involved in the recruitment process. The MMM21 campaign started on May 17th and lasted for almost six months. Sources of funding included ISH, GSH, NCDC, and pharmaceutical companies such as ‘Egis’, ‘Krka’, Berlin-Chemie/MENARINI, and Omron-Georgia Ltd.

Blood pressure measurements in the sitting position were taken three times with 1 min intervals, using Omron BP monitors. Pulse rates were either measured by the BP device or manually between BP readings. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg based on the mean of the second and third BP readings and/or being on antihypertensive treatment. In addition, a questionnaire was administered, collecting information on demographics and medical history including recent COVID-19 vaccination, use of hormone replacement therapy (HRT), and hormonal contraception.

Data were entered on pre-prepared paper forms and later transferred to spreadsheets. Data were analysed centrally by the MMM project team, and multiple imputation was performed using global data⁶ to impute the mean of readings two and three where this was missing (which was the case for only one participant).

Results

In total, 4935 individuals were screened. The mean age of participants was 53.6 years (SD 17.1) of whom 40.3% were men, 59.7% were women, and 99.6% were Caucasian. Only 26 persons (0.2%) reported never having had a BP measurement taken by medical personnel before, 19.0% of the respondents were taking aspirin, and 9.8% were taking statins. After multiple imputation, the number of hypertensive persons was 2836 (57.5%) out of whom 2441 (86.1%) were aware and 83.5% were on medication. Of those on hypertensive medication, 41.6% had their BP controlled. Of all participants with hypertension, 34.7% were controlled (Table 1).

We found significantly higher systolic and diastolic BPs in participants with a previous stroke, previous MI, and in those with diabetes (Figure 1). Participants on antihypertensive medication also had significantly higher systolic and diastolic BPs, and those with a previous diagnosis of hypertension had significantly higher systolic, but not diastolic, BPs.

Discussion

Hypertension remains one of the main public health problems in the Georgian population. In MMM 2017, awareness of participants with hypertension was 77.9%, and in 2018 was 82.8%.¹ Awareness in 2021 was marginally higher than in previous campaigns, at 86.1%. This small but positive trend may reflect the impact of MMM and similar campaigns. The strong association between higher BPs among those receiving antihypertensive drugs confirms significant room for improvement in the delivery of drug treatment for hypertension that likely involves the drugs and doses used. The percentage of participants with hypertension detected in MMM21was 57.5% similar to the average rate previously detected (59.4%). Data from the latest nationwide epidemiological survey STEPS in 2016 reported the prevalence of hypertension in the adult population is 37.7%.⁷

According to other recent pilot screening activities (World Heart Day, World Salt Awareness Week, and etc.), the prevalence of hypertension in the population surveyed was up to 50%.⁸

Due to restrictions related to the COVID-19 pandemic, the coverage of the MMM21 campaign was reduced but at the same time the pandemic has positively changed the attitude of some individuals towards their own health. Therefore, the volunteers who attended the screening campaign may have been more motivated to attend and may have been at greater risk of hypertension, leading to the higher rates of hypertension found in our study. The data quality from completed MMM questionnaires has improved importantly since 2017 albeit in-part reflecting ad hoc supervision when required. May Measurement Month is currently considered (in the absence of routine systematic and opportunistic screening) to be the best tool to assess hypertension management in the country.

Although campaign years cannot be directly compared, the rate of controlled hypertension within the campaign: 34.8% and 41.6% in 2019 and 2021, suggest that educational interventions such as MMM among the population and medical personnel deserve increasing support among policy makers.

Acknowledgements

The GSH and the NCDC would like to thank all the volunteers and congratulate them for a successful conduction of the campaign. Special thanks to MMM co-ordination group for the support provided.

Contributor Information

Bezhan Tsinamdzgvrishvili, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. Tsinamdzgvrishvili Cardiology Center, 2, Gudamakari str., Tbilisi 0141, Georgia. Internal Diseases Department, Iv.Javakhishvili Tbilisi State University, 2, Chavchavadze Ave., Tbilisi 0128, Georgia.

Amiran Gamkrelidze, National Center for Disease Control and Public Health of Georgia, Non-Communicable Diseases Department 99, Kakheti Highway, Tbilisi 0198, Georgia.

Dali Trapaidze, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. Internal Diseases Department, Iv.Javakhishvili Tbilisi State University, 2, Chavchavadze Ave., Tbilisi 0128, Georgia. National Center for Disease Control and Public Health of Georgia, Non-Communicable Diseases Department 99, Kakheti Highway, Tbilisi 0198, Georgia.

Lela Sturua, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. National Center for Disease Control and Public Health of Georgia, Non-Communicable Diseases Department 99, Kakheti Highway, Tbilisi 0198, Georgia. Petre Shotadze Tbilisi Medical Academy, Public Health Department, 51/2, KetevanTsamebuli Ave., Tbilisi 0144, Georgia.

Nino Grdzelidze, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. National Center for Disease Control and Public Health of Georgia, Non-Communicable Diseases Department 99, Kakheti Highway, Tbilisi 0198, Georgia.

Tamar Abesadze, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. Tsinamdzgvrishvili Cardiology Center, 2, Gudamakari str., Tbilisi 0141, Georgia.

Nana Mebonia, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. National Center for Disease Control and Public Health of Georgia, Non-Communicable Diseases Department 99, Kakheti Highway, Tbilisi 0198, Georgia. Tbilisi State Medical University, Medical Faculty, 33, Vazha-Pshavela Ave., Tbilisi 0177, Georgia.

Nia Giuashvili, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. National Center for Disease Control and Public Health of Georgia, Non-Communicable Diseases Department 99, Kakheti Highway, Tbilisi 0198, Georgia. University of Georgia, School of Health Science, 77 a Kostava str., Tbilisi 0171, Georgia.

Nino Gogilashvili, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia.

Nino Chikovani, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia. Tsinamdzgvrishvili Cardiology Center, 2, Gudamakari str., Tbilisi 0141, Georgia.

Thomas Beaney, Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK. Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W6 8RP, UK.

Gaia Kiru, Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.

Sima Toopchiani, Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.

Neil R Poulter, Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.

Funding

None declared.

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References