Get Your Blood Pressure Checked: May Measurement Month
How common is hypertension?
Hypertension, or high blood pressure, affects approximately 1.13 billion people worldwide and accounts for 10.8 million deaths per year. This equates to almost 30 000 people dying from hypertension worldwide, daily. From 2000 to 2010 there was a noticeable increase in people suffering from hypertension, which mainly affected lower income countries, where it rose dramatically. In higher income countries there was actually a decrease in hypertension. By 2010, 75 % of all the people with hypertension were living in lower middle or lower income countries.
In Sub-Saharan Africa, 15 to 70 % of the population suffer from hypertension. Unfortunately, there is a discrepancy between the total number of people with hypertension, those who have been diagnosed with hypertension but are untreated, those who do receive treatment and those whose hypertension is effectively controlled. It is tragic that only about 7 % of people with hypertension in Sub-Saharan Africa have controlled blood pressure. Fundamental to this problem is that many people suffering from hypertension are not even aware that their lives are in jeopardy because their blood pressure has never been checked. Hypertension is known as the silent killer because there are often no symptoms until complications occur, like a heart attack or stroke. Checking your blood pressure is the only way to detect the risk and try to prevent the complications.
Hypertension leads to drastic complications: heart attacks, heart failure, strokes and kidney failure. These debilitating complications can largely be prevented by making sure that the blood pressure is controlled. Half of all strokes could be prevented by good blood pressure control. Similarly, 40 % of heart failure can be attributed to hypertension. These complications result in severe disability and may be expensive to manage, and, in some cases, there may be little benefit. Checking blood pressure is key to controlling it and ultimately preventing these complications.
The great news is that, when we know it is there, hypertension is treatable. Good blood pressure control decreases the chance of these complications, allowing people to live healthy happy lives. The partnership between patient and healthcare provider can mitigate against the dire effects of hypertension.
Blood pressure monitoring is easy. It can be done in almost any environment, such as at home, at the pharmacy and at the doctor. While it is easy to measure, it must be done accurately to ensure appropriate results. The requirements for performing adequate BP monitoring are published but, in practice, the application of these requirements is very poor. The South African Hypertension guidelines state that blood pressure should be taken after five minutes of rest with the back supported and legs uncrossed. No caffeine consumption or smoking for thirty minutes prior to the blood pressure check. Multiple readings should be taken. The correct cuff size should be used. Monitoring your own blood pressure at home is currently recommended for everyone, as an adjunct to health care provider screening. It is even more important to do this when you have hypertension as it provides extra information for the health care provider. Information on validated blood pressure measuring equipment is available on the Southern African Hypertension Society Website.
Physician adherence to guidelines and ensuring patients reach their target blood pressures is equally important. All patients should have their blood pressure checked at each health care visit. Once someone has been diagnosed with hypertension it is important that they know that they need to achieve lifelong blood pressure control. The diagnosis of hypertension is made when the average of the blood pressure readings is at 140/90 mmHg or more. The aim is then to control the blood pressure to less than 130/80 mmHg. Should the blood pressure be higher than 160/100 mmHg it is recommended that you seek health care assistance in the next few days. Hypertension may require treatment with medications, which are easily available. It will also requires a change in lifestyle.
May Measurement Month
The May Measurement Month campaign, developed by the International Society of Hypertension, is a drive to improve public awareness of hypertension. The goal is to encourage people to have their blood pressure checked so that they know if they have hypertension and so that they can get it managed. Through this campaign over 4.2 million people were screened between 2017 and 2019. In 2019, half a million (one third) of the adults who were screened during the campaign had never had their blood pressure checked before.
The campaign has successfully improved awareness of hypertension, revealed elevated hypertension in people previously undiagnosed with hypertension as well as heightened awareness of poorly controlled blood pressures. In 2019, 92 countries across the world, including South Arica, were involved. During each year of the campaign, it was consistently revealed that one third of the people who were screened had hypertension. Of the people with hypertension, less than 60 % were aware that they had it and of those who were actually taking hypertension medication, less than 60 % had controlled blood pressures.
This discrepancy between overall number of people with hypertension, those aware that they have hypertension, those on treatment and those controlled has persisted through time, location and populations throughout the campaign. The May Measurement campaign attempts to address this at all levels by engaging with volunteers, medical personnel across the board and by creating awareness within entire populations.
In 2018, over 3000 people were screened in South Africa as part of the May Measurement Month campaign. About a third of the participants were diagnosed with hypertension and 56.7 % were aware of their condition. Less than 50 % were receiving antihypertensive therapy. This campaign gave us the opportunity to engage with people with poorly controlled blood pressure on a one to one basis.
Lifestyle measures can improve the blood pressure on their own and may, if done consistently, decrease the need for medication. The lifestyle changes that are suggested are:
- 30 minutes of exercise five to seven days a week
- Have a good body weight (a body mass index between 18.5 and 24.5 kg/m2 )
- Eat a diet rich in fresh fruit and vegetables
- Eat a low salt diet
- Drink a maximum of two (for women) or three (for men) units of alcohol per day and
- Do not smoke.
Antihypertensive medication includes a range of medication classes, with many different options in each class. There are many different indications for specific classes of antihypertensives and your doctor will weigh up the risks and benefits of prescribing specific medication. In general, people requiring antihypertensive therapy should start on a combination of two antihypertensive classes in a single combined pill.
In 2021, because of the COVID-19 pandemic, the International Society of Hypertension May Measurement Month will occur from May through to November. This will prevent large gatherings but continue to create awareness of hypertension as well as provide opportunities for everyone to check their blood pressure.
In summary, it is important to check your blood pressure, at least every year. If your blood pressure is raised, take steps to decrease it to avoid complications of hypertension: heart, brain and kidney disease. Please get your blood pressure checked.
Dr Erika Jones
Certificate in Nephrology and Hypertension, PhD
Consultant Nephrologist and Hypertension Specialist, GSH and UCT
Follow on Twitter: @eswjones