May Measurement Month 2021: an analysis of blood pressure screening results from the UK and Republic of Ireland

Abstract

We participated in the UK and Republic of Ireland May Measurement Month 2021 (MMM21) campaign to raise awareness about blood pressure (BP) measurement and the dangers posed by elevated BP and hypertension. In addition, the campaign aimed to collect and report levels of BP awareness and control in the community setting. The MMM21 campaign set up opportunistic community screening sites at hospitals, general practice (GP) surgeries, community pharmacies, gyms, and various other public places. The campaign screened 1322 participants (mean age 46 years, 55% women) and found that 522 (39.5%) had hypertension (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or on antihypertensive medication) at the time of testing. Of the 522 participants identified with hypertension, only 47.2% were aware of their condition. Of those on antihypertensive medication, only 45.7% had controlled BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg), and of all hypertensives, only 19.0% were controlled. Our UK and Ireland data continue to shed further light on low levels of awareness and control of hypertension in the UK and Ireland community setting. This evidence supports a critical need to further highlight the importance of identifying and taking action against raised BP.

Introduction

Our goal in participating in the May Measurement Month (MMM) global blood pressure (BP) screening awareness campaign was to raise awareness of the importance of BP measurement, as well as the dangers posed by elevated BP and hypertension. These data collected also help create an evidence base detailing the extent of awareness, treatment, and control rates associated with hypertension.

The 2017, 2018, and 2019 MMM UK and Republic of Ireland campaigns successfully screened 7695, 5000, and 10 194 participants, respectively, of which 40.3%, 34.3%, and 33.4% were found to have hypertension (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or on antihypertensive treatment), with 21.9%, 42.8%, and 29.7% of those with hypertension taking antihypertensive medications. From these three MMM campaigns, of those receiving antihypertensive treatment, only 59.5%, 51.5%, and 38.2% of participants had controlled BP (<140/90 mmHg). These data highlighted the inappropriately high proportion of undiagnosed and uncontrolled hypertension in the community.^1–3

In 2020, the MMM campaign was suspended due to the COVID-19 pandemic for health and safety reasons. In 2021, COVID-19 restrictions were partially lifted, allowing the MMM campaign to be re-launched. Our MMM21 campaign was used to ascertain whether these annual figures were stable estimates of undiagnosed hypertension in the community and indicators of sub-optimal BP control in those with hypertension.

Methods

In May 2021, community-based opportunistic screening sites targeting individuals aged 18 years and older were set up and directed by MMM country leads in England, Scotland, Wales, and the Republic of Ireland. Sites included hospitals, general practice (GP) surgeries, community pharmacies, gyms, and various other public places. Ethics approval was granted and covered all BP screening events.

Hypertension was defined when the participants’ BP at the time of screening included a systolic BP ≥ 140 mmHg and/or a diastolic BP ≥ 90 mmHg (based on the mean of the second and third of three BP readings) or they were currently taking antihypertensive medication(s). In addition to data collected during the 2017, 2018, and 2019 campaigns, new variables detailing COVID-19 vaccinations and previous infection were recorded. Participants with their BP ‘controlled to target’ on the day of testing were those taking antihypertensive medication who presented with systolic BP < 140 mmHg and diastolic BP < 90 mmHg.

Similar to previous years, Omron devices were supplied to national sites that did not have access to validated systems. In Wales, Cardiff Metropolitan University provided funding for marketing material and promotional purposes, while in England, the University of Manchester supplied funding for screening sites set up in Manchester and Leeds. In Ireland, Croí, the West of Ireland Cardiac & Stroke Foundation led a community pharmacy-focussed campaign in Mayo and provided funding for both marketing and promotional material for the campaign.

Governmental, celebrity, public health endorsements via social media, national webpages, and newspaper articles were used to promote the campaign locally and nationally.

As with previous years, data were collected using the MMM app or Microsoft Excel spreadsheets. All data were processed locally by Croí (in Ireland) and the MMM lead in Wales. Data were analysed centrally by the MMM global project team, and where needed, multiple imputations were performed to impute the mean of the second and third BP readings.⁴

Results

May Measurement Month 2021 screened a total of 1322 participants in the UK and the Republic of Ireland (Table 1). The mean age was 46 years, with a male:female gender ratio of 45:55. Data were collected across a range of ethnic groups, with 80.1% of those screened reported as White ethnicity (others included East/Southeast Asian, 4.5%; Black, 2.6%; South Asian, 5.4%; other, 2.3%; mixed, 2.3%; Middle Eastern, 1.7%; and unknown, 1.2%). Only 73 (5.5%) participants reported to have never had their BP measured prior to the screening campaign. Of those screened, 67 (5.1%) were currently taking statins, 28 (2.1%) were taking aspirin, 1.8% reported as having diabetes, 1.5% as having a previous myocardial infarction, and 1.1% a previous stroke.

Table 1.

Total participants and percentages with hypertension, awareness of hypertension, on antihypertensive medication and with controlled blood pressure

Total participants	Number (%) with hypertension	Number (%) of hypertensives aware	Number (%) of hypertensives on medication	Number (%) of those on medication with controlled BP	Number (%) of all hypertensives with controlled BP
1322	522 (39.5%)	246 (47.2%)	217 (41.6%)	99 (45.7%)	99 (19%)

The majority of participants (1074, 81.2%) had received one or more previous COVID-19 vaccinations, and at the time of testing, 82% (1085) had not previously tested positive for COVID-19.

Of all participants, 522 (39.5%) participants were found to have hypertension, of whom, only 246 (47.2%) were aware of their condition and 217 (41.6%) were on antihypertensive medication. Of the 217 participants on antihypertensive medication, 99 (45.7%) had their BP controlled to target, and of all hypertensive participants, only 19.0% achieved control. Of the 1105 participants not taking antihypertensive medication, 305 (27.6%) were found to have hypertension.

Discussion

In this opportunistic sample of 1322 people in the UK and Ireland, four in every 10 people were found to have hypertension and presented with low rates of awareness and control. These results highlight a lack of public awareness of raised BP, while the number of people requiring better control of their BP remains a major public health issue that needs to be urgently addressed.

This year, nearly 40% of the screened population had hypertension, compared with approximately 33% in 2019 and returning to proportions similar to 40% observed during the 2017 campaign.^1,3 The percentage of people with hypertension taking antihypertensive medication is higher this year at 42%, compared with 30% in 2019. Only 46% of those with hypertension and on medication had their BP controlled to target compared with 38% in 2019. Differences in estimates across years cannot be directly interpreted as trends given that recruitment was not randomized, but nevertheless, higher rates of treatment and control in MMM21 suggest there may not have been a worsening of BP treatment as a result of the pandemic.

It should be noted that there are a number of factors that may have affected the data collected this year. Firstly, the convenience sampling may have introduced self-selection bias, and so estimates cannot be interpreted as nationally representative prevalence. Furthermore, there may be differences to previous years arising directly from the pandemic, for example, if people in the community with comorbidities may have been more inclined to self-isolate during this screening period.

Furthermore, the COVID-19 pandemic also limited the number of screening sites available and numbers of people measured throughout this MMM2021 campaign around the UK and Ireland. Differences in the locations of screening sites may also impact on the comparability of findings across years. During previous UK and Ireland campaigns, screening sites were concentrated in venues including hospitals, GP practices, pharmacies, shopping centres, and gyms. However, this year, in the UK, many hospitals, GP surgeries, and pharmacies were unable to accommodate the screening. In Ireland, data were predominantly collected from the community pharmacy settings.

Together with COVID-19 lockdowns and different levels of restrictions, the sampling size was understandably reduced compared with previous years. Furthermore, a number of cases geographically are concentrated around select parts of South Wales, Manchester, London, and the West of Ireland, which may reduce generalizability.

The National Health Service England published a 5-year action plan in 2017, highlighting their commitment to early detection and prevention of cardiovascular diseases, noting that hypertension remains the principal population risk factor that needs to be addressed.⁵ Hypertension has been commonly referred to as the ‘silent killer’ because patients are often believed to be unaware of their condition due to the lack of symptoms. Indeed, our data support the fact that hypertension is a widely prevalent but under-detected condition in the UK and Ireland, with less than half of those with hypertension aware of their condition and less than half on antihypertensive medication. Therefore, managing this high-risk health condition is imperative. Interestingly, MMM2021 data show that only 5.5% of participants screened have never previously had their BP measured and 49.1% have had their BP checked within the past 12 months.

Due to the relatively low number of people screened who reported to have had a previous COVID-19 infection, we were unable to assess the relationship between COVID-19 and levels of hypertension.

These data indicate the critical need for better community awareness, widening of identification pathways and taking direct action against raised BP in the community. May Measurement Month data continue to shed light on the current public health issues regarding hypertension and help raise awareness of the condition through the campaign. Only by having better community and primary care initiatives that target the health needs of the nation can we minimize population cardiovascular risk and the economic burden associated with high BP.

Funding

This study was supported by Cardiff Metropolitan University, Manchester Medical School, and Croí, the West of Ireland Cardiac & Stroke Foundation (Ireland).

Data availability

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