May measurement month 2022: an analysis of blood pressure screening findings from Sierra Leone

Elevated blood pressure is a leading modifiable risk factor for death and disability worldwide. Its high prevalence and underdiagnosis, especially in low-resource settings like Sierra Leone, make it a significant public health challenge. We aimed to assess the prevalence of elevated blood pressure among adults in Sierra Leone and explore its associations with demographic and lifestyle factors. By providing current data, we seek to contribute to the global understanding of elevated blood pressure and inform public health strategies in Sierra Leone. We conducted an opportunistic cross-sectional study from May 17 to September 30, 2022, as part of the International Society of Hypertension's May Measurement Month initiative. We recruited 818 participants aged 18 and older through convenience sampling at healthcare settings, workplaces, and public spaces across Sierra Leone. Blood pressure was measured using standard OMRON devices following the MMM protocol. We collected data on demographic characteristics, lifestyle factors, medical history, and medication use via structured questionnaires. Hypertension was defined as a systolic BP of ≥ 140 mmHg, a diastolic BP of ≥ 90 mmHg, or current use of antihypertensive medication. Among the participants (mean age 38.0 years, predominantly Black), the prevalence of hypertension was 25.7% (210 out of 818 participants). However, only 17% (140 out of 818) of the participants were previously diagnosed with hypertension. The findings revealed a wide range of antihypertensive medication use among people with known hypertension, ranging from no medication to the use of five or more medication classes. Approximately 43.6% of the participants with known hypertension were taking one antihypertensive medication, while 22.9% were taking two medications. Notably, 42.9% of the participants with known hypertension did not adhere to their antihypertensive medication regimen, citing cost, availability, side effects, and forgetfulness as common reasons. Our study underscores the critical importance of community-based screening in detecting undiagnosed hypertension. It emphasizes the need for expanded screening and referral programs to increase awareness, promote prevention, and improve hypertension management in Sierra Leone.