Abstract
The May Measurement Month (MMM) campaign was carried out in Georgia in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged ≥18 years were recruited opportunistically at 274 sites, across the country. Three seated BP readings were taken for each participant, along with completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled BP was defined as being on antihypertensive medication with a BP < 140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 4269 were screened, with a mean age of 57.4 years and 63.0% of whom were female. Of all participants, 2904 (68.0%) had hypertension, of which 2601 (89.6%) were aware, and 2570 (88.5%) were on antihypertensive medication. Of those on antihypertensive medication, 1009 (39.3%) had controlled BP, and of all participants with hypertension, 34.7% had controlled BP. The MMM campaign in Georgia identified significant numbers of participants with inadequately treated hypertension. Despite increased awareness among the population, effective hypertension management still requires significant improvement and an increase in the number of controlled cases in the country.
Keywords: Hypertension, Blood pressure, Screening, Treatment, Control
Introduction
Raised blood pressure (BP) is one of the largest contributors to the global burden of disease.1 According to 2022 May Measurement Month (MMM) results, the prevalence of arterial hypertension among certain population groups is 68%.2 In 2022, the share of cardiovascular diseases (CVD) among all new cases of diseases in Georgia was 11.9%, that of ischaemic heart diseases (IHDs)—13.0%, and of cerebrovascular diseases—4.8%.3 The top three causes of death in Georgia were IHD, stroke, and hypertension.3 According to the National Statistics Office of Georgia (GeoStat), the share of CVD mortality in the country in 2022 was 35.9%.4
May Measurement Month was initiated in 2017 by the International Society of Hypertension (ISH) and has since run annually, except for 2020 due to the COVID-19 pandemic. In 2022, the MMM campaign continued, with an aim of continuing to raise awareness of the dangers of raised BP and included 757 350 participants worldwide.2
Georgia has participated in the campaign since 2017 and actively carries out actions among the country’s adult population every year. All BP screenings were carried out by medically trained volunteers, and participants were provided with educational material regarding the importance and benefits of prevention, early detection, and adequate, regular treatment for BP.
In this paper, we report on the findings of the MMM22 campaign in Georgia.
Methods
May Measurement Month is a cross-sectional opportunistic survey of consenting adults aged 18 years or over. The Georgian Society of Hypertension (GSH) with National Center for Disease Control and Public Health (NCDC) carried out the MMM campaign from May to September. Screening sites were set up in hospitals/clinics, public area and workplace, in big cities, and regions—Tbilisi, Kutaisi, Batumi, Zugdidi, and Telavi. Up to 250 volunteer interviewers were trained. The campaign was advertised through local public health centres, as well as through local radio and television broadcasts. Workplace screenings for organized groups were conducted under a written agreement with the institution’s administration.
In accordance with the standard MMM protocol, participants ideally had three seated BP readings measured at 1 min intervals.2 Omron devices were used to measure BP. A questionnaire was also completed, collecting information on demographics, comorbidities, lifestyle risk factors, and antihypertensive medication use. Hypertension was defined as a raised BP (a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg based on the mean of the second and third readings), or being on antihypertensive medication. Controlled BP was defined as being on medication with a BP < 140/90 mmHg. Participants with raised BP received diet and lifestyle advice, along with essential information on managing hypertension under a doctor’s care at all stages of the disease.
Data were collected locally with a paper questionnaire and later in the form of an electronic database and submitted to the central MMM team for cleaning and analysis. In cases where any BP reading was missing, to ensure comparability between participants, the average of the second and third readings was estimated by multiple imputation using chained equations, based on global data as described previously.2 For comparison with other countries participating in MMM, results are also presented after age and sex standardization using the World Health Organization world standard population, and assuming an equal gender split.2 The study received ethical approval from IRB #2022-011Ethics Council in NCDC. As for the financial support, the Georgian representative office of Omron and pharmaceutical companies—Aegis, Berlin-Hamm, Krka, Abbott—provided logistical support making it possible to implement the campaign on a national scale. NCDC’s important contribution provided the campaign with required printing materials.
Results
In total, 4269 were screened during MMM22 in Georgia. The mean (standard deviation) age was 57.4 (15.9) years, 2688 (63.0%) were female, and 99.4%-were white. Of all participants, 160 (3.7%) reported never having had a BP measured before.
Multiple imputation was used to estimate missing BP readings for the one participant missing data on the second or third BP reading. Of all participants, 2904 (68.0%) were found to have hypertension, of whom 2601 (89.6%) were aware, and 2570 (88.5%) were on antihypertensive medication (Table 1). Of those on antihypertensive medication, 1009 (39.3%) had controlled BP, and of all hypertensives, 34.7% had controlled BP. Of participants who were not taking antihypertensive medication, 334 (19.7%) were found to have raised BP. In total, 1895 (44.4%) were found to have either untreated or inadequately treated hypertension.
Table 1.
Total participants and numbers with hypertension, awareness, on medication, and with controlled blood pressure, before and after age and sex standardization
| Total participants | Number (%) with hypertension | Number (%) of hypertensive aware | Number (%) of hypertensive on medication | Number (%) of those on medication with controlled BP | Number (%) of all hypertensive with controlled BP | |
|---|---|---|---|---|---|---|
| Actual | 4269 | 2904 (68.0) | 2601 (89.6) | 2570 (88.5) | 1009 (39.3) | 1009 (34.7) |
| Standardized | 4269 | 1900 (44.5) | 1402 (73.8) | 1364 (71.8) | 727 (53.3) | 727 (38.2) |
After age and sex standardization, 1900 (44.5%) were found to have hypertension, of whom 1402 (73.8%) were aware, 1364 (71.8%) were on antihypertensive medication, and 727 (38.2%) were controlled (Table 1).
Among hypertensive participants, treatment rates were higher in women than men (90.4% vs. 85.5%), and of those treated, control rates were higher in women than men (41.5% vs. 35.3%).
Additionally, financial access to antihypertensive drugs has improved due to a state programme that provides medication for the treatment of chronic diseases.
Discussion
The MMM22 programme identified a total of 1895 (44.4%) participants with untreated or inadequately controlled hypertension, highlighting the scale of hypertension in Georgia.
The results of MMM22 show continued positive progress in terms of awareness (89.6% vs. 85.4% in MMM19).5 However, while the rate of controlled hypertension has increased since the start of the campaign in 2017 (33.2–39.3%),5,6 greater improvement is needed. Key focus areas to increase awareness include better communication and improved treatment adherence.
Strengths and limitations
A strength of the MMM campaign is the use of a standardized protocol across countries, which aids comparability of findings. Participants in MMM were recruited opportunistically using convenience sampling and as a result, prevalence estimates should not be interpreted as estimates of national prevalence. Hypertension was defined based on three BP readings at a single visit for pragmatic reasons which is not compatible with optimal methods of diagnosis at the individual level recommended in guidelines.7 Consequently, the rate of hypertension detected is likely to represent an overestimate.
As for the limitations, extrapolation of the results to the country level is not recommended due to the absence of the study design-selection procedure. Moreover, the results in the form of population groups are very important. It expresses trends in the population of a country. Screening of population groups was carried out on a countrywide basis therefore there were no geographical restrictions.
Conclusion
The MMM campaign proved to be a very important tool for assessing the management of arterial hypertension in the country at all levels of medical service delivery. With the involvement of medical personnel at the screening sites, the campaign provided an opportunity to address key issues and facilitate educational interventions. With the reforming of the planned primary health care system in the country, the insights learnt from the campaign should support the basis for systemic changes.
Acknowledgements
The GSH and the NCDC would like to thank all the volunteers and congratulate them for a successful conduct of the campaign. Special thanks to MMM coordination 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.
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, 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, 99, Kakheti Highway, Tbilisi 0198, Georgia; Petre Shotadze Tbilisi Medical Academy, 51/2, KetevanTsamebuli Ave., Tbilisi 0144, Georgia.
Nino Grdzelidze, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia.
Tamar Abesadze, Georgian Society of Hypertension, 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, 99, Kakheti Highway, Tbilisi 0198, Georgia; Tbilisi State Medical University, 33, Vazha-Pshavela Ave., Tbilisi 0177, Georgia.
Nino Gogilashvili, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia; Internal Diseases Department, Iv.Javakhishvili Tbilisi State University, 2, Chavchavadze Ave., Tbilisi 0128, Georgia.
Nino Chikovani, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia.
David Beruashvili, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia.
Angelina Nikachadze, Georgian Society of Hypertension, 2, Gudamakari str., Tbilisi 0141, Georgia.
Thomas Beaney, Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK; School of Public Health, Imperial College London, 90 Wood Lane, London W12 0BZ, UK.
Gabriele Kerr, Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK; School of Public Health, Imperial College London, 90 Wood Lane, London W12 0BZ, UK.
Neil R Poulter, Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK; School of Public Health, Imperial College London, 90 Wood Lane, London W12 0BZ, UK.
Funding
Georgian Society of Hypertension, the National Center for Disease Control and Public Health of Georgia, and pharmaceutical companies, ensured financial support of the project.
Data availability
Data are not publicly available but access can be requested with permission from the MMM Management Board, on request through the MMM website: maymeasure.org.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are not publicly available but access can be requested with permission from the MMM Management Board, on request through the MMM website: maymeasure.org.