May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Cardiovascular risk factors among the inhabitants of an urban Congolese community: results of the VITARAA Study

Objective: The objective is to assess cardiovascular risk profile in an urban Congolese population. Design and Methods: From July 2007 to March 2008, we investigated 1824 inhabitants (≥10 year old) randomly recruited from the Adoula quarter (Kinshasa, Congo). Measurements included: anthropometry, medical history and lifestyle habits via questionnaire, blood pressure and pulse rate (Omron M6, HEM 7001E), blood glucose, plasma lipids, and semi-quantitative proteinuria tests. We used stepwise logistic regression to model the odds for hypertension and diabetes. Results: In 1292 adult participants ≥20 years (56.6% women, mean age 37 ± 15 years), the prevalence of hypertension and known diabetes was 30.9% and 4.2%, respectively. Among participants with hypertension respectively 46.6%, 29.3% and 18.3% were aware, on treatment and controlled. Control was better among women and subjects below age 55, but lower in overweight/obese subjects. The odds for hypertension independently increased with age (P < 0.0001), overweight/obesity (P < 0.0001), pulse rate (P = 0.0249) and high legumes consumption (P = 0.0453). The odds for diabetes increased with age (P = 0.0009) and overweight/obesity (P = 0.0016). The prevalence of other risk factors was 5.5%, 42.2%, 42.8% and 30.9%, for smoking, overweight/obesity, abdominal adiposity and hypercholesterolemia; 4.6% of participants had proteinuria. Smoking predominated in men (10.8% vs. 1.4%), obesity (8.6% vs. 21.5%) and hypercholesterolemia (23.2% vs. 37.4%) in women. Hypertension clustered with three or more risk factors including diabetes or proteinuria in 68.7%. Conclusion: Our findings highlight the staggering rates of cardiovascular risk factors in sub-Saharan Africa and underscore the pressing need to move their prevention and control higher on the political agenda

Cardiovascular risk factors among the inhabitants of an urban Congolese community: Results of the VITARAA Study

Objective: The objective is to assess cardiovascular risk profile in an urban Congolese population. Design and Methods: From July 2007 to March 2008, we investigated 1824 inhabitants (≥. 10. year old) randomly recruited from the Adoula quarter (Kinshasa, Congo). Measurements included: anthropometry, medical history and lifestyle habits via questionnaire, blood pressure and pulse rate (Omron M6, HEM 7001E), blood glucose, plasma lipids, and semi-quantitative proteinuria tests. We used stepwise logistic regression to model the odds for hypertension and diabetes. Results: In 1292 adult participants ≥. 20. years (56.6% women, mean age 37. ±. 15. years), the prevalence of hypertension and known diabetes was 30.9% and 4.2%, respectively. Among participants with hypertension respectively 46.6%, 29.3% and 18.3% were aware, on treatment and controlled. Control was better among women and subjects below age 55, but lower in overweight/obese subjects. The odds for hypertension independently increased with age (. P<. 0.0001), overweight/obesity (. P<. 0.0001), pulse rate (. P=. 0.0249) and high legumes consumption (. P=. 0.0453). The odds for diabetes increased with age (. P=. 0.0009) and overweight/obesity (. P=. 0.0016). The prevalence of other risk factors was 5.5%, 42.2%, 42.8% and 30.9%, for smoking, overweight/obesity, abdominal adiposity and hypercholesterolemia; 4.6% of participants had proteinuria. Smoking predominated in men (10.8% vs. 1.4%), obesity (8.6% vs. 21.5%) and hypercholesterolemia (23.2% vs. 37.4%) in women. Hypertension clustered with three or more risk factors including diabetes or proteinuria in 68.7%. Conclusion: Our findings highlight the staggering rates of cardiovascular risk factors in sub-Saharan Africa and underscore the pressing need to move their prevention and control higher on the political agenda.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

May Measurement Month 2019: an analysis of blood pressure screening results from the Democratic Republic of the Congo

Abstract Hypertension, the foremost cause of global morbi-mortality, is linked with a high mortality from numerous cardiovascular endpoints. The May Measurement Month (MMM) campaign is an annual initiative of the International Society of Hypertension (ISH) to collect information on blood pressure (BP) and other risk factors for cardiovascular disease (CVD) in adults. MMM2019 in the Democratic Republic of the Congo (DRC) was an opportunistic cross-sectional survey of volunteers aged ≥18 years that took place in Kinshasa and Mbuji-Mayi after the training of observers to familiarize with the ISH ad hoc methods. We screened 29 857 individuals (mean age: 40 years; 40% female). Hypertension was present in 7624 (25.5%) individuals. Of them, 2520 (33.1%) were aware, 1768 (23.2%) on treatment with 910 (51.5%) controlled BP (systolic BP &amp;lt;140 mmHg and/or diastolic BP &amp;lt;90 mmHg). Of all hypertensives screened, 11.9% had controlled BP. Of all respondents, 16.7% had participated in MMM18 and 60.5% did not have their BP verified during the last year. Fasting, pregnancy, and underweight status were linked with lower BP levels whilst smoking, drinking, antihypertensive medication, previous stroke, diabetes as well as being overweight/obese were associated with higher BP levels. Our results reflect the high rate of hypertension in the DRC with low levels of awareness, treatment, and control. A nationally representative sample is required to establish the nationwide hypertension prevalence.</jats:p

Analysis of blood pressure and selected cardiovascular risk factors in the Democratic Republic of the Congo: the May Measurement Month 2018 results

Abstract Hypertension (HT) is the largest contributor to cardiovascular disease mortality and is characterized by high prevalence and low awareness, treatment, and control rates in sub-Saharan Africa. May Measurement Month (MMM) is an international campaign intended to increase awareness of high blood pressure (BP) among the population and advocate for its importance to the health authorities. This study aimed to increase awareness of raised BP in a country where its nationwide prevalence is yet unestablished. Investigators trained and tested how to use the campaign materials, collected participants’ demographic data, lifestyle habits, and obtained from each one three BP measurements. Hypertension was defined as a BP ≥140/90 mmHg, or use of antihypertensive medication. Of the 18 719 screened (mean age 41 years; 61.4% men), 26.1% were found to be hypertensive of whom 46.3% were aware of their condition and 29.6% were taking antihypertensive medication. The control rate of HT was 43.0% in those on medication and 12.7% among all hypertensive respondents. Comorbidities found were—diabetes (3.3%), overweight/obesity (35.5%); and a previous stroke and a previous myocardial infarction were reported by 1.2% and 2.0%, respectively. Imputed age- and sex-standardized BP was higher in treated hypertensive individuals (135/85 mmHg) than those not treated (124/78 mmHg). Based on linear regression models adjusted for age and sex (and an interaction) and antihypertensive medication, stroke survivors, those who drank once or more per week (vs. never/rarely), and overweight/obese participants were associated with higher BP. MMM18 results in the Democratic Republic of the Congo corroborated the high prevalence of HT in Kinshasa screenees with low rates of treatment and control. Extension of the MMM campaign to other parts of the country is advisable.</jats:p

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Abstract Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk. </jats:sec

General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants

Background—Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-toheight ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods—We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson’s correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings—The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31–3·28) lower for women and 1·28 kg/m2 (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation—BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Africa, have higher WHtR than in the other regions

General and abdominal adiposity and hypertension in eight world regions : a pooled analysis of 837 population-based studies with 7·5 million participants

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices ofabdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and acrosspopulations of different world regions and quantified how well these two metrics discriminate between people withand without hypertension.Methods We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged20–64 years in representative samples of the general population in eight world regions. We graphically compared theregional distributions of BMI and WHtR, and calculated Pearson’s correlation coefficients between BMI and WHtRwithin each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies acrossregions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people whohave hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminatebetween participants with and without hypertension using C-statistic and net reclassification improvement (NRI).Findings The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjustingfor age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbeanand the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europefor both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve anequivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m² (95% CI2·31–3·28) lower for women and 1·28 kg/m² (1·02–1·54) lower for men than in the high-income western region. Inevery region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adipositymetrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI andWHtR were used, performance improved only slightly compared with using either adiposity measure alone.Interpretation BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominaladiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension.However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of centralAsia, Middle East and north Africa, have higher WHtR than in the other regions.Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices ofabdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and acrosspopulations of different world regions and quantified how well these two metrics discriminate between people withand without hypertension.Methods We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged20–64 years in representative samples of the general population in eight world regions. We graphically compared theregional distributions of BMI and WHtR, and calculated Pearson’s correlation coefficients between BMI and WHtRwithin each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies acrossregions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people whohave hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminatebetween participants with and without hypertension using C-statistic and net reclassification improvement (NRI).Findings The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjustingfor age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbeanand the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europefor both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve anequivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m² (95% CI2·31–3·28) lower for women and 1·28 kg/m² (1·02–1·54) lower for men than in the high-income western region. Inevery region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adipositymetrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI andWHtR were used, performance improved only slightly compared with using either adiposity measure alone.Interpretation BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominaladiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension.However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of centralAsia, Middle East and north Africa, have higher WHtR than in the other regions.A