Ps-bpp02-5: comparison of opportunistic vs survey-based population assessment of hypertension in 14 countries

Objective: We sought to compare the proportion of individuals with hypertension obtained from the large-scale May Measurement Month (MMM) opportunistic screening program with those from the population-based household STEPwise Approach to Non-communicable Risk Factor Surveillance (STEPS) surveys in 14 countries. Design: The MMM program was first implemented in 20117 by the International Society of Hypertension in 92 countries to improve detection and awareness of elevated blood pressure (BP). The STEPS surveys are cross-sectional household surveys developed by the World Health Organization to track non-communicable risk factors in more than 115 countries. Methods: Up to three BP readings were obtained by MMM and STEPS. The average of the second and third BP readings was used to compare the proportion of individuals with hypertension (systolic BP > = 140 mmHg and/or diastolic BP > = 90 or on drug treatment for raised BP) from the MMM 2017–2019 with the prevalence estimates of hypertension from STEPS 2013–2019 by sex and age among adults (> 18 years) across 14 countries (Figure). Countries were selected if data with a maximum 5-year overlap among sources was available and if MMM sample size was > 10,000 observations. Prevalence estimates were paired based on age, sex, and year. Chi-squared tests with alpha of 0.05 were used to test comparisons. Results: In total, 211,852 individuals aged at least 30 years across 14 countries over 3 years (2017–2019) were screened by the MMM program. STEPS surveyed 48,300 adults in 14 countries over 7 years, representing 252,095,678 individuals. Based on MMM, the proportion of females with hypertension across countries (all ages) ranged from 13.2% in United Arab Emirates to 34.9% in Algeria while in males ranged from 45% in Armenia to 22.8% in Ecuador. STEPS hypertension prevalence in females and males, ranged from 41.2% and 42.1%, in Kyrgyzstan to 10.5% and 17.1% in Ecuador, respectively. Countries where prevalence was most similar were Botswana and Kenya. Countries where MMM estimates were higher than STEPS were Mongolia and Malawi. STEPS reported higher estimates than MMM in Kyrgyzstan. Differences on the prevalence of hypertension across surveys showed heterogeneous variation by age, sex, and country (Figure). Conclusion: Hypertension prevalence varies between opportunistically screened MMM and systematically sampled STEPS populations. However, given the high prevalence of hypertension worldwide and the lack of routine health examination surveys in most countries, screening efforts, such as MMM, could be helpful in approximating the population prevalence of hypertension in specific subgroups and to raise hypertension awareness, treatment, and control.