Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa

Background Treatment and control of hypertension are associated with a substantial reduction in adverse cardiovascular disease outcomes. Although South Africa aims to reduce the burden of cardiovascular diseases, there is limited evidence on the hypertension care cascade (HCC) performance in rural areas where stroke and hypertension are high. This study estimated HCC performance and identified predictors of hypertension screening among adults in the Ingwavuma community of KwaZulu-Natal, South Africa. Methods This was a cross-sectional study. Data were collected using the WHO STEPwise approach to surveillance (STEPS) questionnaire from 400 adult participants, excluding pregnant women and those with physical or cognitive impairments. Three hundred and ninety-three participants had complete data, and 131 had high blood pressure. We calculated progression rates for screening, diagnosis, treatment and control of hypertension from the sub-sample of participants with high blood pressure and assessed the bivariate association between HCC stages and participant characteristics and their effect sizes. We used binary and multivariable logistic regression to identify predictors of hypertension screening. Results Eighty-eight per cent of participants reported prior screening for hypertension. However, only 53.5% of patients under pharmacological treatment for hypertension had controlled blood pressure. In bivariate regression, employed participants were 80.3% (COR = 0.197, 95% CI [0.042–0.921]) more likely to be screened. In multivariable regression, the likelihood of hypertension screening was 82.4% (AOR = 0.176, 95% CI [0.047–0.655]) lower among participants in a cohabiting union than single participants. Similarly, employed participants were 87.4% (AOR = 0.129, 95% CI [0.017–0.952]) less likely to be screened than their unemployed counterparts. Conclusions The considerable attrition from the HCC across socio-demographic categories indicates a need for community-wide interventions. Empowering health care workers for community-based health promotion and hypertension management through point-of-care diagnostic tools could improve HCC performance. Efforts to improve the HCC should also focus on social determinants of health, notably gender and formal educational attainment.

Pediatric hypertension screening and recognition in primary care clinics in Canada

Objectives Screening for hypertension in children is recommended by pediatric consensus guidelines. However, current practice is unknown. We evaluated rates of blood pressure assessment and hypertension recognition in primary care. Methods This retrospective cohort study evaluated electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network between 2011 and 2017. Children aged 3 to <18 years with at least one clinical encounter were included. Screening, follow-up, and hypertension recognition rates were evaluated. Descriptive statistics and multivariate logistical regression were used to determine patient and provider characteristics associated with increased screening and recognition of pediatric hypertension. Results Among 378,002 children, blood pressure was documented in 33.3% of all encounters, increasing from 26.7% in 2011 to 36.2% in 2017; P=0.007. Blood pressure was documented in 76.0% of well child visits. Follow-up visits occurred within 6 months for 26.4% of children with elevated blood pressure, 57.1% of children with hypertension, and within 1 month for 7.2% of children with hypertension. Patient factors associated with increased blood pressure screening include being overweight (OR 2.15, CI 2.09 to 2.22), having diabetes (OR 1.69, CI 1.37 to 2.08), chronic kidney disease (OR 7.51, CI 6.54 to 8.62), increased social deprivation (OR 1.10, CI 1.09 to 1.11), and urban residence (OR 1.27, CI 1.15 to 1.4). Overall prevalence of hypertension was 1.9% (n=715) and of those, 5.6% (n=40) had recognized hypertension. Factors associated with increased recognition include male sex, overweight, and hyperlipidemia. Conclusions Rates of hypertension screening and recognition are low in primary care settings in Canada, suggesting pediatric hypertension should be a priority for implementation and dissemination of interventions.

May Measurement Month 2019: an analysis of blood pressure screening results from Albania

This article discusses the results of the May Measurement Month (MMM) 2019 campaign, which contributed to a third round of MMM hypertension screening campaigns carried out in Albania, a transitional country in the Western Balkans. The hypertension screening campaign in Albania was carried out during the period 1–31 May 2019 in 30 sites in many districts of the country. Overall, 19 154 participants aged ≥18 years were included (approximately 68% of these were women), with an overall mean age of 47.0 ± 15.3 years. Blood pressure (BP) was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or on treatment for hypertension. Self-reported data consisted of height and weight, pre-existing conditions, including smoking status and alcohol consumption. Overall, the proportion of participants with hypertension was 38.6%. Less than two-thirds (64.7%) of hypertensive individuals were aware of their condition. Also, less than half (48.3%) of participants on antihypertensive medication had controlled BP (<140/90 mmHg). The most sizable correlations of high BP were with known hypertension status, use of antihypertensive medication, and obesity. The MMM campaign contributes to routine hypertension screening in Albania. Hence, health professionals and policymakers in Albania should act on the findings of MMM screening campaigns and continue its support as a valuable tool for early detection of hypertension in the general population.

May Measurement Month 2019: an analysis of blood pressure screening results from Malaysia

Despite hypertension remaining the leading cause of death worldwide, awareness of hypertension and its control rate is still suboptimal in Malaysia. This study aims to determine the proportion of both diagnosed and undiagnosed hypertension, awareness and its control rate during the yearly May Measurement Month (MMM) campaign that has been coordinated by the International Society of Hypertension. Participants aged ≥18 years were recruited at various screening sites namely universities, health facilities, shopping malls, and other sites. Participant’s socio-demographic, environmental, and lifestyle data were captured using a questionnaire. Three blood pressure (BP) readings as well as anthropometric measurements were obtained from all participants. The mean of the second and third BP readings was used in analyses. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. A total of 3062 participants were recruited. The proportion with hypertension in our study was 18.7% (n = 572). The proportion who were aware of their BP status was 63.2%. More than half (57.2%) of the hypertensives were on antihypertensive medication and 70.3% of those treated were controlled. In conclusion, in this BP screening campaign, one in five were hypertensive with almost two thirds aware of their hypertensive status. BP control among those who are taking medications was high at 70% but under 60% of hypertensives were on treatment. Hypertension screening programmes are important to promote awareness and control of hypertension as well as to reduce the devastating complications associated with this disorder.

The use of vector electrocardiography for pulmonary hypertension screening in patients with atrial septal defects

Funding Acknowledgements Type of funding sources: None. Background Patients with unrepaired atrial septal defects accumulate yearly risk of developing pulmonary arterial hypertension due to vascular remodeling in response to chronically increased pulmonary circulation. Electrocardiography, though readily available, has so far been of limited screening utility in this population. We hypothesize that vectorcardiographic parameters will aid in identifying increased ventricular afterload and thus provide an additional screening tool for pulmonary hypertension in this patient population. Purpose To establish whether vector electrocardiography can be used as a non-invasive screening tool for pulmonary hypertension screening in patients with atrial septal defects. Methods Retrospective chart review of patients with the diagnosis of secundum atrial septal defect who underwent cardiac catheterization at the University of Minnesota from January 2012 to September 2020. We excluded patients with other congenital heart diagnoses, insufficient hemodynamic data, or no sinus rhythm electrocardiogram. An electrocardiogram prior to or on the day of the intervention was assessed. Parameters analyzed include: Sokolow-Lion right ventricular hypertrophy criteria, PR duration, QRS duration, corrected QT intervals, QRS and Twave frontal plane axes, rSR’, rSR’ with the R’ of 5mm or more, as well as vectorcardiographic parameters (Kohr’s regression-related method) the QRS vector magnitude, T wave vector magnitude, and spatial QRS-T angle. These results were then used to compare those with and without pulmonary hypertension (diagnosed by mean pulmonary artery pressure of 25mmHg or more along with body surface area-indexed pulmonary vascular resistance of 3 Woods units/meter squared with normal left atrial/pulmonary vein wedge pressure). Mann-Whitney U-testing was used for non-parametric testing for significance within the dataset. Results Three hundred and five patients were identified with secundum atrial septal defects, but after exclusion, there were a total of 122 patients meeting criteria for assessment. Eight ASD patients had pulmonary hypertension (37% male, median age 7.5 years, interquartile range 0.4 to 23 years) while 114 patients did not (31% male, median age 5 years, interquartile range 3 to 13 years, p-value 0.68). Only the spatial QRS-T angle significantly differentiated pulmonary hypertension (median 104 degrees, interquartile range 55 to 137 degrees) from those ASD patients without pulmonary hypertension (median 37 degrees, interquartile range 21 to 63 degrees) with a p-value of 0.002. At a cut-off of 124 degrees, the positive and negative predictive values for identification of pulmonary hypertension was 36.4% and 96.4%, respectively, with an odds ratio of 13.4 (95% confidence interval of 2.9 to 63.7). Conclusions The spatial QRS-T angle may be a useful, non-invasive screening tool for pulmonary hypertension in patients with secundum atrial septal defects.