The Iranian blood pressure measurement campaign, 2019: study protocol and preliminary results

Abstract

Purpose

Hypertension is one of the most important risk factors for premature mortality and morbidity in Iran. The objective of the Iranian blood pressure (BP) measurement campaign was to identify individuals with raised blood pressure and providing appropriate care and increase the awareness among the public and policymakers of the importance of tackling hypertension.

Methods

The campaign was conducted in two phases. The first (communication) phase started on May 17th (International Hypertension Day). The second phase started on June 8th, 2019, and lasted up to July 7th during which, blood pressures were measured. The target population was Iranians aged ≥ 30 years. Participants voluntarily referred to health houses in rural and health posts and comprehensive health centers in urban areas in the setting of the Primary Health Care network. Additionally, over 13,700 temporary stations were set up in highly visited places in urban areas. Volunteer healthcare staff interviewed the participants, measured their BP, and provided them with lifestyle advice and knowledge of the risks and consequences of high blood pressure. They referred participants to physicians in case their BP was high. Participants immediately received a text message containing the relevant advice based on their measured BP and their past history.

Results

Blood pressure was measured for a total of 26,678,394 participants in the campaign. A total of 13,722,148 participants (51.4%) were female. The mean age was 46 ± 14.1 years. Among total participants, 15,012,693 adults (56.3%) with no past history of hypertension had normal BP, 7,959,288 participants had BP in the prehypertension range (29.8%), and finally, 3,706,413 participants (13.9%) had either past medical history of hypertension, used medications, or had high BP measured in the campaign.

Conclusion

The campaign was feasible with the objective to increase the awareness among the public and policymakers of the importance of tackling hypertension in Iran.

Introduction

Globally, hypertension is one of the major modifiable risk factors responsible for mortality and morbidity. Worldwide, 10.4 million deaths comprising 18.7% of all deaths were attributable to high systolic blood pressure (SBP) in 2017, increasing by over two times from 6.9 million in 1990. [1] Non-communicable diseases (NCDs) in general, and cardiovascular diseases (CVDs), in particular, are the main outcomes of high blood pressure [1]. A high percentage of deaths attributable to high blood pressure occur in low and middle-income countries. [1, 2]

Controlling hypertension doesn’t require sophisticated invasive treatment modalities. High blood pressure can be easily and effectively controlled by life style modification and anti-hypertensive medications, which are inexpensive and broadly available all over the world. One of the major problems in controlling hypertension in communities is the fact that high blood pressure is silent and asymptomatic in nature and patients remain unaware of their condition until its complications occur, which may take several years. In 1970s, the rule of halves was coined in the United States and later studies showed that it is still present. [3] Only a minority of hypertensive patients are aware of their condition and among the aware patients, a minority are treated and a minority have their blood pressure controlled. Awareness is the first step in this chain and is the mainstay for preventing the high burden attributable to high blood pressure. Public ignorance as to the nature of high blood pressure, its morbid effects, and the methods of maintaining its control is commonly widespread and contributes to the large percentage of undetected and untreated hypertensive patients in communities. Community screening campaigns combined with simplified diagnostic evaluation and intense patient education and follow-up may greatly increase the share of people under continuous treatment and control. [4, 5]

Previous reports for Iran also demonstrate a high burden of ischemic heart disease, stroke and chronic kidney disease that are attributable to high blood pressure, along with rising prevalence of hypertension since 1990. [1, 2, 6] Nationally, 45,700 deaths attributable to high SBP occurred in Iran in 1990, which increased to 96,800 deaths in 2017. [1] Almost 32,200 deaths were premature (under 70 years of age) in 2017. A total of 50,900 deaths were due to ischemic heart disease (IHD), 18,200 deaths were due to stroke, and 6,600 deaths were due to chronic kidney disease (CKD) in 2017 in Iran. [1].

Based on the latest national non-communicable disease risk factors survey (STEPS) conducted in 2016 in Iran, 26.4% of Iranian adults aged ≥ 18 years had raised blood pressure, which is equal to more than 15 million hypertensive individuals among whom, 40% were not aware of their condition. [7] It can be concluded that in Iran, there might be around 6–7 million cases of raised blood pressure who are not aware of their condition. In addition, only 40% of known cases of raised blood pressure receive appropriate care and again the blood pressure is controlled in only 40% of the treated cases.

Inspired by the nine voluntary targets of the global action plan, the Iranian non-communicable diseases committee (INCDC) set 13 national targets for prevention and control of NCDs, out of which, four targets are, directly or indirectly, related to hypertension: (i) 25% relative reduction in the prevalence of hypertension, (ii) 30% relative reduction in salt intake, (iii) 80% coverage of essential drugs and technologies needed for prevention of NCDs, and (iv) 70% coverage of affordable drug and counseling for NCDs.

In line with the national action plan for prevention and control of NCDs, the Ministry of Health and Medical Education (MOHME) decided to conduct a national campaign for blood pressure measurement in collaboration with main stakeholders using the existing healthcare capacity in the country in 2019.

The main goals of the national blood pressure measurement campaign were: (i) to increase the possibility of identifying individuals with raised blood pressure and providing appropriate care; and (ii) to increase the awareness of risk factors and outcomes of hypertension, as well as the importance of its early diagnosis and treatment.

The specific objectives were to:

• measure blood pressure for 50% of the target population (about 20 million adults).

• identify individuals with raised blood pressure.

• increase community awareness of the importance of early diagnosis and treatment of hypertension.

• increase community awareness of hypertension determinants including salt intake, physical inactivity, obesity, dyslipidemia, and smoking,

• increase community awareness of hypertension outcomes including ischemic heart disease, stroke, renal failure, premature mortality and disability.

• increase community awareness of the normal ranges of blood pressure.

This paper presents only the protocol and the blood pressure measurement data.

Methods

Target population

The target population of the campaign was all adult residents of Iran (Iranian and non-Iranian) aged ≥ 30 years, pregnant women at any age, and CKD patients at any age. The services provided throughout the campaign were free of charge. No incentive was provided to participants and/or volunteers.

Timeframe

The campaign was conducted between May 17th and July 5th, 2019 in two phases: The first (communication) phase started on May 17th (International Hypertension Day) to raise awareness at the community level of the campaign and of hypertension and its determinants and outcomes and continued till the end of the campaign. The second phase started on June 8th, 2019 and lasted for four weeks up to July 7th during which, blood pressures were measured in pre-existing health facilities and temporary blood pressure measurement stations.

Implementation plan

Phase 1: communication

The communication phase of the campaign started on May, 17th to strengthen political commitment and stakeholders’ engagement at the national and subnational level, to raise community awareness of the campaign, and to encourage public participation in the campaign.

The following activities were done during this phase:

• Briefing key stakeholders: several intra- and inter-sectoral meetings and summits were held at the national and subnational levels to brief policymakers, decision makers, reference groups including scientific societies, non-governmental organizations (NGOs), and other stakeholders on the impacts of hypertension on health of Iranians, to justify the campaign, and to seek their support in launching the campaign. The motto of the campaign was “Blood Pressure: Know and Act”.

• Developing educational materials: written (posters, pamphlets, brochures), and digital education materials (motion graphics, cartoons, short films, …) were developed by the stakeholders including MOHME, medical universities, NGOs, and other stakeholders. The educational materials were broadly distributed through media including TV, social networks, webpages, and in blood pressure measurement stations and were used in the face to face education for personnel who were going to ultimately implement the campaign.

• Training: Two-hour workshops were held by focal NCD managers in medical universities for all personnel who worked and were involved in the campaign including volunteers and primary health care (PHC) staff. The training covered items including the burden of raised blood pressure at global and national scales, the goals and objectives of the campaign, the definition of hypertension, blood pressure measurement, and device calibration techniques. All of the personnel involved were evaluated by the trainers to perform the interview and the physical exam correctly at the end of the trainings.

Phase 2: blood pressure measurement in the second phase of campaign

Based on the initial plan of the campaign, there were three channels to measure and record blood pressures:

1- PHC network was the main venue for launching the campaign. PHC constitutes about 30,000 health facilities (health houses in rural areas and health posts and comprehensive health centers in urban areas). Community health workers routinely provide primary prevention for maternal and child health, reproductive health care, and a number of chronic diseases including hypertension and diabetes. Community health workers in these facilities were trained to measure the blood pressure of those who actively or passively referred during the entire period of the campaign. The measured blood pressures were recorded in the pre-existing electronic health record system (SIB) hosted in MOHME.

2- During the second phase of the campaign, a total of 13,725 temporary blood pressure measurement stations were established in highly visited public places in urban areas to recruit participants who passively referred. Blood pressures were measured by 47,892 volunteers who worked in the stations. Volunteers were selected from medical and paramedical technicians.

3- A web-based application (https://salamat.gov.ir/) was developed and people could record their measured blood pressure in the website.

All measured blood pressures were recorded in an electronic database specifically developed for the campaign, which was linked to SIB for further follow-up. The unique national identification number was used as the means of tracking the participants in the campaign.

Raised blood pressure definition

Based on the pre-existing protocols (8) for measuring blood pressure in the setting of PHC in Iran, raised blood pressure was defined as systolic or diastolic blood pressures equal to or higher than 140/90 mmHg. Hypertension was defined as having either raised blood pressure measured in the campaign, or reporting previous history of raised blood pressure, or taking anti-hypertensive treatment. Normal blood pressure was defined as systolic and diastolic blood pressures less than 120/80 mmHg with no diagnosis or history of hypertension. Prehypertension was defined as having no diagnosis or history of hypertension, with either systolic blood pressure between 120 and 140 mmHg or diastolic blood pressure between 80 and 90 mmHg. Controlled blood pressure was defined as systolic and diastolic blood pressure less than 140/90 mmHg in patients diagnosed with hypertension and uncontrolled blood pressure was defined as having either systolic or diastolic blood pressure equal or higher than 140/90 mmHg among patients diagnosed with hypertension.

Data collection

The data covering demographic characteristics was collected through interview with participants based on a structured questionnaire (Table 1). These data included living area, contact information, sex and age. If the participant was female, the interviewer asked her whether she was pregnant. The previously diagnosed diseases were also questioned using the same structured questionnaire and included the history of chronic kidney disease, ischemic heart disease, stroke, and previously diagnosed hypertension. The interviewer also asked the participant whether he or she received anti-hypertensive treatment. Finally, the systolic and diastolic blood pressures were measured once based on the previous detailed protocol (8). Blood pressure was measured for the second time if it was high in the first reading.

Table 1: Questionnaire of the Iranian blood pressure measurement campaign, 2019.

1. Province ………………………….

2. University…………………………….

3. Area: urban □ rural □.

4. Center: health house □ health posts □ comprehensive health centers □ outpatient clinic □ hospital□.

Workplace □ public organization □ private organization □ Other □ : name ……………………….

• 5)First name: …………………….
• 6)Last name: …………………….
• 7)Father’s name……………….
• 8)Date of birth………………….
• 9)Gender: male □ female □.
• 10)National Identification Number (NID): …………………………….
• 11)Cell phone: …………………………………………………….
• 12)If the participant was female: Are you currently pregnant? Yes □ No□.
• 13)If the answer is “yes”, what is the week of your pregnancy? Before 20 weeks □ After 20 weeks□.
• 14)Are you currently diagnosed with chronic kidney disease by a physician? Yes □ No□.
• 15)Are you currently hypertensive: Yes □ No□.
• 16)Are you under treatment for hypertension: Yes □ No□.
• 17)Are you currently diagnosed with diabetes? Yes □ No□.
• 18)Are you currently diagnosed with ischemic heart disease? Yes □ No □.
• 19)Are you currently diagnosed with stroke? Yes □ No□.

Blood pressure measurement.

• 20)Systolic blood pressure: first time □□□ mmHg.
• 21)Diastolic blood pressure: first time □□□ mmHg.
• 22)Systolic blood pressure: second time □□□ mmHg.
• 23)Diastolic blood pressure: second time □□□ mmHg.

Follow-up

Based on the campaign protocol, all adults who were identified with raised blood pressure were advised to refer to a physician for further investigation and definite diagnosis of hypertension. Those individuals identified with raised blood pressure who were already registered in the SIB were referred to community health workers and were managed based on the protocols for defining hypertension in the setting of PHC. Individuals who were not registered in the SIB were recorded in the electronic database developed for the campaign. National identification number (ID), as unique identifier, was used to cross link the data between the two databases. Duplicate reports were removed based on the National ID. The preliminary measurement was replaced by the more recent one. For all participants in the campaign, a text message was sent immediately to remind them to refer to a physician for further investigation in case they had uncontrolled blood pressure. Table 2 shows the text messages sent to the participants classified into separate groups based on the level of their measured blood pressures and their past medical history of hypertension.

Table 2.

The text messages received by the participants of the Iranian blood pressure measurement campaign, 2019

	Level of the blood pressure	The past medical history	The text of the message
1	SBP/DBP less than 120/80 mmHg	No history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is optimal. Please check the level of your blood pressure annually
2	SBP/DBP ≥ 120/80 mmHg and less than 140/90 mmHg	No history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is slightly higher than normal. Please check your blood pressure within the coming 4 to 6 weeks
3	SBP/DBP ≥ 140/90 mmHg and less than 180/110 mmHg	No history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is not optimal. Please refer to a physician within the coming week
4	SBP/DBP ≥ 180/110 mmHg and less than 220/130 mmHg	No history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is higher than normal. Please refer to a physician today
5	SBP/DBP ≥ 220/130 mmHg	No history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is extremely high. Please contact the emergency right now.
6	SBP/DBP less than 140/90 mmHg	Positive history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is optimal. Please be in contact with your physician.
7	SBP/DBP ≥ 140/90 mmHg and less than 180/110 mmHg	Positive history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is not optimal. Please refer to a physician within the coming week
8	SBP/DBP ≥ 180/110 mmHg and less than 220/130 mmHg	Positive history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is higher than normal. Please refer to a physician today
9	SBP/DBP ≥ 220/130	Positive history of hypertension	Dear sir/madam. Thanks for your participation. Your blood pressure is extremely high. Please contact the emergency right now.
10	SBP/DBP ≥ 125/80 mmHg	Positive history of chronic renal failure	Dear sir/madam. Thanks for your participation. Your blood pressure is higher than normal. Please refer to a physician.

Monitoring protocol

The main tool for monitoring the performance at the peripheral levels was the electronic dashboard specifically developed for the campaign. Real time monitoring of the following items was feasible for managers at different levels in the health care system through this dashboard: number of stations, number of users, and number of blood pressures recorded in facilities and stations. It was also possible to track the performance of all users in the online system.

A hierarchical monitoring protocol was specifically developed for the campaign. Two teams site visited each medical university: one team directly located in the MOHME and another team located in the adjacent medical universities, divided into 10 educational zones across the country. Four checklists were developed to monitor the campaign at highest level of the medical universities, at the level of districts, at the level of health facilities, and at the level of stations based on a waterfall algorithm. The results of the monitoring were electronically sent to the ministerial level within 48 h after the visit. Medical universities also used the above-mentioned electronic database for monitoring the campaign at the lower levels (district, health center, station). Appropriate measures were taken based on the reports received from the monitoring visits in due time.

Evaluation plan

A protocol was developed to internally evaluate the immediate outcomes of the campaign including the coverage, the quality of provided services, the quality of collected data, the satisfaction rate, the referral rate, and the effectiveness of the campaign in general. A total of 51,041 individuals who had participated in the campaign were randomly selected and interviewed through a telephone survey using a short-structured questionnaire. The results of the evaluation will be disseminated shortly.

Results

The preliminary results of the Iranian blood pressure measurement campaign have been presented in Table 3. Totally, 30,540,737 blood pressure measurements were recorded in the campaign and 26,678,394 adults participated in this campaign after removing duplicate measurements. Among these participants, 15,012,693 adults (56.3%) with no past history of hypertension had normal blood pressure, 7,507,092 (28.1%) participants had a blood pressure in prehypertension range, and finally 4,158,609 (15.6%) participants had either past medical history of hypertension, used medications, or had raised blood pressures (Fig. 1). A total of 13,722,148 participants (51.4%) were female. The prevalence of raised blood pressure was 17.2% in females and 13.8% in males. The prevalence of detected raised blood pressure was 19.2% in stations and 13.9% in PHC facilities.

Table 3.

Preliminary results of the Iranian blood pressure measurement campaign, 2019

	Female	Male	Both
All participants	13,722,148 (51.4%)	12,956,246 (48.6%)	26,678,394
Age (mean ± SD)	46 ± 14.2	46 ± 14.0	46 ± 14.1
Systolic blood pressure (mean ± SD)	112 ± 15	116 ± 14	114 ± 14
Diastolic blood pressure (mean ± SD)	71 ± 12	73 ± 12	72 ± 12
Normal participants	8,338,418 (60.8%)	6,674,275 (51.5%)	15,012,693 (56.3%)
Prehypertensive participants	3,017,074 (22.0%)	4,490,018 (34.7%)	7,507,092 (28.1%)
Participants diagnosed as hypertensive or under anti-hypertensive treatment	2,366,656 (17.2%)	1,791,953 (13.8%)	4,158,609 (15.6%)
Negative history of hypertension with high blood pressure measured in campaign	317,191 (2.3%)	574,220 (4.4%)	891,411 (3.3%)
Positive past history of hypertension	2,049,465 (14.9%)	1,217,733 (9.4%)	3,267,198 (12.2%)
Positive past history of hypertension under treatment	1,969,937 (96.1%)	1,143,918 (93.9%)	3,113,855 (95.3%)
Positive past history of hypertension with controlled blood pressure	1,624,510 (79.3%)	875,719 (71.9%)	2,500,229 (76.5%)
Pregnancy	580,870	N/A	580,870
controlled blood pressure	576,573 (99.3%)	N/A	576,573 (99.3%)
Positive history of CKD	60,836 (0.4%)	71,459 (0.6%)	132,295 (0.5%)
controlled blood pressure	34,418 (56.6%)	34,720 (48.6%)	69,138 (52.3)
Positive history of ischemic heart disease	77,477 (0.6%)	133,420 (1.0%)	210,897 (0.8%)
controlled blood pressure	32,560 (42.0%)	55,839 (41.9%)	88,399 (41.9%)
Positive history of stroke disease	52,777 (0.4%)	58,445 (0.5%)	111,222 (0.4%)
controlled blood pressure	22,748 (43.1%)	23,632 (40.4%)	46,380 (41.7%)

Fig. 1.

The results of National Blood Pressure Measurement Campaign, Iran 2019

Normal blood pressure: systolic and diastolic blood pressures less than 120/80 mmHg with no diagnosis or history of hypertension

Prehypertension: having no diagnosis or history of hypertension, with either systolic blood pressure between 120 to 140 mmHg or diastolic blood pressure between 80 to 90 mmHg

Raised blood pressure: systolic or diastolic blood pressures equal to or higher than 140/90 mmHg

The measured blood pressure was high in 891,411 participants without any history of hypertension, who comprised new detected cases of hypertension (Fig. 1). A total of 3,267,198 participants had positive history of hypertension, among whom 3,113,855 (95.3%) reported that they used anti-hypertensive medication. Totally, 2,500,229 participants with history of hypertension had controlled blood pressure (76.5%) and 766,969 participants (23.5%) had uncontrolled blood pressure.

A total of 132,295 participants reported a history of CKD and the percentage of patients with controlled blood pressure among them was 52.3%. Overall, 1,323,546 diabetic patients, 210,897 patients with a history of myocardial infarction, and 111,222 patients with a history of stroke participated in this campaign. The percentage of controlled blood pressure among these patients were 84.2%, 41.9%, and 41.7%, respectively.

A total of 580,870 pregnant women participated and the percentage of controlled blood pressure was 99.3% among them. During the campaign, 1,529,254 participants were referred to physicians and 23,533 participants were referred to be immediately visited by a physician.

Discussion

Inspired by the May Measurement Month (MMM), which was established by the International Society of Hypertension in 2016 [4, 5], we designed and conducted an extensive campaign with the main objective of making the public aware of the risk factors and consequences of high blood pressure if it remains untreated. We reached our objective to recruit 50% of the target population and to detect individuals with raised blood pressure.

We took advantage of our PHC system to a large extent. The high coverage of PHC with its previous success stories in controlling the communicable diseases and reducing maternal and child mortalities, and the integration of medical education in health services enabled us to conduct this huge campaign.

It seems, however, that our campaign didn’t have adequate sensitivity to detect all hypertensive and unaware patients in the country, which is not concordant with previously existing evidence, neither at global level [9–11] and nor at national level in Iran. [2, 6, 12–16] Our results demonstrate that among over 3,200,000 participants who were aware of their hypertension, over 3,100,000 were under treatment (95.3%). This finding shows that if people get aware of their condition, they will adhere to medication. Additionally, the rate of controlled blood pressure was considerably high (76.5%) among patients under treatment. The control rate was over 40% among patients with a past history of CKD, ischemic heart disease, or stroke. The rate of control was much higher in diabetics (84.2%). These findings imply that secondary prevention of hypertension is better than primary prevention in Iran.

Our findings highlight the necessity of high-quality health care, which is provided in the setting of the PHC network in Iran. Results indicated that the sensitivity of our screening was lower in PHC facilities compared to temporary stations, which reveals the importance of monitoring and evaluation of the health practices in peripheral levels of our health care system and the necessity of providing adequate training to health care staff working in the PHC. Several studies have demonstrated the impacts of access to health care and coverage of the health system on effective control of NCDs and their risk factors. [17] There is existing evidence that even the density of health care providers can very much affect the effectiveness of the health care system in tackling NCDs in Iran. [18] Expansion of the health care systems and increased density of health care providers can improve the technical efficiency of the system, though disparities may continue to exist at sub-national levels. [19].

The large scale of our campaign is its major strength. Our campaign has other substantial strengths. Robust executive protocol, contribution of various stakeholders, various communication modalities, meticulous quality control and monitoring, and involvement of policy makers at all levels including the presidency, involvement of celebrities and religious leaders, establishment of stations in a wide variety of settings including hospitals, pharmacies, mosques, schools, workplaces, shopping centers, and other highly visited sites are all among the notable strengths of this project. The follow-up of identified cases of hypertension and prehypertension and advising life style modifications was another strength of our campaign. The comprehensive training, provided by the staff working in the campaign to participants was another noticeable strength of this program. Training was provided to enhance the participants’ general knowledge of the definition of hypertension, the risk factors and consequences, the normal range of blood pressure, and the necessity of timely diagnosis and treatment of raised blood pressure. The campaign was launched with rather minimal budget, which proves its feasibility to raise the awareness of the public to a considerable extent in low-resource settings. Although the data collected during the campaign may not provide robust evidence for policy making at local levels, it enhances the awareness and knowledge of policy makers at all levels to be more attentive to the potentially high burden of hypertension, both on health of communities and on the economy of the country. Existing evidence confirms that high blood pressure is higher in females compared to males and the trend is rising (unpublished data). Existing evidence also shows that if this rising trend in prevalence of hypertension is going to continue, Iran won’t achieve the targets of the sustainable development goals (SDGs) by 2030. Urgent action is required for implementation of integrated and comprehensive policies in order to directly address NCDS and their risk factors in general and high blood pressure and its consequences in particular in our country.

Limitations

One of the limitations of our campaign was the potential variation in measurement techniques, despite the universal and centralized mode of training. The sensitivity of the campaign in PHC was lower than stations, which may be due to substandard, old and low-quality sphygmomanometers in PHC facilities compared to new digital devices used at the stations. As the campaign was developed over a very short period of time, there may be defects in the executive protocol of the campaign. Blood pressure measurement was conducted once, which is one of the limitations of our campaign. Lack of information on specific antihypertensive medications that were taken by the participants in the campaign is another limitation of the campaign. Due to opportunistic convenience sampling, the recruited individuals can’t be considered representative of the population in Iran. Prevalence rates at national and sub-national level can’t be accurately estimated based on the data collected in this campaign due to self-selection bias. As the campaign is structurally different from a research study, no ethical approval was obtained from the ethics committee of the Ministry of Health and no informed consent was taken from participants. The impact of dietary and life style advice that was given to all participants recruited in this campaign couldn’t be evaluated due to the cross-sectional nature of the campaign. Ultimately, due to inadequacy of budget and logistics, only a few items were included in the baseline questionnaire of the campaign. The distribution of socio-economic status and other distal social determinants of health among the participants were not recorded.

Conclusion

The Iranian blood pressure measurement campaign proves its feasibility in low and middle-income nations. As a large number of people are unaware and untreated, urgent action is mandatory. Due to inadequacy of budget and logistics, routine surveillance systems may not be available in the near future. Mass screening can be an effective approach if it is conducted on an annual basis.

List of abbreviations

BP

Blood Pressure.

SBP

Systolic Blood Pressure.

NCDs

Non-communicable Diseases.

CVDs

Cardiovascular Diseases.

IHD

Ischemic Heart Disease.

CKD

Chronic Kidney Disease.

INCDC

Iranian Non-communicable Diseases Committee.

MOHME

Ministry of Health and Medical Education.

NGOs

Non-governmental Organizations.

PHC

Primary Health Care.

ID

Identification Number.

MMM

May Measurement Month.

SDGs

Sustainable Development Goals.

Authors’ contributions:

All authors contributed to the study design and implementation. AO, SS, and AR wrote the manuscript text. All authors commented on previous versions of the manuscript and read and approved the final version.

Funding:

Iran Ministry of Health and Medical Education (MOHME) provided the funding for the project.

Data Availability

The data that support the findings of this study are available from the principal investigator of the study and so are not publicly available.

Declarations

Ethics approval and consent to participate

The campaign does not involve any experiments on humans and/or the use of human tissue samples. As the campaign is structurally different from a research study, no ethical approval was obtained from the ethics committee of the Ministry of Health and no informed consent was taken from participants.

Consent for publication

N/A.

Competing interests

All authors have organizational affiliation with the subdivisions of the Ministry of Health and Medical Education of Iran.