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Opportunistic screening for hypertension: what does it say about the true epidemiology?

Journal of Human Hypertension volume 36, pages 364–369 (2022)Cite this article

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Abstract

This study aimed to assess the reliability of opportunistic screening programs in estimating the prevalence, treatment, and control rate of hypertension in the general population. Two recent epidemiological surveys obtained data on hypertension in the adult general population in Greece. The EMENO (2013–2016) applied a multi-stage stratified random sampling method to collect nationwide data. The MMM (2019) collected data through opportunistic (voluntary) screening in five large cities. Hypertension was defined as blood pressure (BP) ≥ 140/90 mmHg (single occasion; average of 2nd–3rd measurement; electronic devices) and/or use of antihypertensive drugs. Data from a total of 10,426 adults were analyzed (EMENO 4,699; MMM 5,727). Mean age (SD) was 49.2 (18.6)/52.7 (16.6) years (EMENO/MMM, p < 0.001), men 48.6/46.5% (p < 0.05) and body mass index 28.2 (5.7)/27.1 (5.0) kg/m2 (p < 0.001). The prevalence of hypertension in ΕΜΕΝΟ/MMM was 39.6/41.6% (p < 0.05) and was higher in men (42.7/50.9%, p < 0.001) than in women (36.5/33.6%, p < 0.05). Among hypertensive subjects, unaware were 31.8/21.3% (EMENO/MMM, p < 0.001), aware untreated 2.7/5.6% (p < 0.001), treated uncontrolled 35.1/24.8% (p < 0.001), and treated controlled 30.5/48.3% (p < 0.001). In conclusion, the prevalence of hypertension was similar with random sampling (EMENO) and opportunistic screening (MMM). However, opportunistic screening underestimated the prevalence of undiagnosed hypertension and overestimated the rate of hypertension treatment and control. Thus, random sampling national epidemiological studies are necessary for assessing the epidemiology of hypertension. Screening programs are useful for increasing awareness of hypertension in the general population, yet the generalization of such findings should be interpreted with caution.

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Fig. 1: Awareness, treatment, and control of hypertension in EMENO and MMM studies.

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Funding

The EMENO survey was implemented under the Operational Program “Education and Lifelong Learning” and was co-funded by the European Union (European Social Fund) and national resources (grant number MIS 376659). Additional funding was received by the Hellenic Diabetes Association. The MMM survey was supported by the Hellenic Society of Hypertension, Elpen Greece, Menarini Greece, and Servier Greece. Microlife, Switzerland donated 20 automated blood pressure monitors for the EMENO study and Omron Hellas, Leoussis S.A., Greece, 25 automated blood pressure monitors for the MMM study.

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Authors and Affiliations

  1. Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece

    Ariadni Menti, Angeliki Ntineri, Michail Chatzopoulos & George S. Stergiou

  2. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Natasa Kalpourtzi, Argiro Karakosta & Giota Touloumi

  3. Department of Primary Care, General Practice & Health Services Research, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece

    Magda Gavana

  4. Environmental Health, University of Patras, Medical School, Patras, Greece

    Apostolos Vantarakis

  5. Rheumatology Clinic, Department of Medicine, University of Ioannina, Ioannina, Greece

    Paraskevi V. Voulgari

  6. Department of Hygiene & Epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece

    Christos Hadjichristodoulou

  7. Third Department of Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece

    Eugenia Gkaliagkousi

  8. Second Propedeutic Department of Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Michael Doumas

  9. Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece

    Rigas G. Kalaitzidis

  10. Department of Cardiology, Asklepeion General Hospital, Athens, Greece

    Manolis S. Kallistratos

  11. Cardiology Department, Hippokration Hospital, Athens, Greece

    Vasiliki Katsi

  12. Department of Medicine, General Hospital of Kavala, Kavala, Greece

    Xenophon Krokidis

  13. Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Efstathios Manios

  14. Department of Cardiology, Heraklion University Hospital, Iraklio, Greece

    Maria Marketou

  15. Department of Medicine, Heraklion University Hospital, Iraklio, Greece

    John A. Papadakis

  16. Department of Cardiology, Laiko General Hospital, Athens, Greece

    Dimitrios Papadopoulos

  17. Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece

    Pantelis Sarafidis

  18. Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Greece

    Grigoris Trypsianis

  19. Division of Biostatistics, University of Crete, School of Medicine, Heraklion, Greece

    Grigoris Chlouverakis

  20. Institute of Epidemiology Preventive Medicine and Public Health, Corfu, Greece

    Yannis Alamanos

  21. First Department of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece

    Pantelis Zebekakis

Authors
  1. Ariadni Menti
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  2. Natasa Kalpourtzi
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  3. Magda Gavana
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  4. Apostolos Vantarakis
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  5. Paraskevi V. Voulgari
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  6. Christos Hadjichristodoulou
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  7. Eugenia Gkaliagkousi
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  8. Michael Doumas
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  9. Rigas G. Kalaitzidis
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  10. Manolis S. Kallistratos
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  11. Argiro Karakosta
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  12. Vasiliki Katsi
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  13. Xenophon Krokidis
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  14. Efstathios Manios
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  15. Maria Marketou
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  16. Angeliki Ntineri
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  17. John A. Papadakis
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  18. Dimitrios Papadopoulos
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  19. Pantelis Sarafidis
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  20. Grigoris Trypsianis
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  21. Michail Chatzopoulos
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  22. Grigoris Chlouverakis
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  23. Yannis Alamanos
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  24. Pantelis Zebekakis
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  25. Giota Touloumi
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  26. George S. Stergiou
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Corresponding author

Correspondence to George S. Stergiou.

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Conflict of interest

GT has received EU and National resources grants as well as a grant from the Hellenic Diabetes Association, all paid to her institution, to support this study and grants unrelated to this study and paid to her institution from Gilead Sciences Europe, UCL, ECDC, EU, University of Bristol, Harvard University, and National funds; GSS has received research grants and consultation fees by Microlife AG, Switzerland, and lecturer and consultation fees by Omron Healthcare Japan & Europe. Nothing to declare by other authors.

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Menti, A., Kalpourtzi, N., Gavana, M. et al. Opportunistic screening for hypertension: what does it say about the true epidemiology?. J Hum Hypertens 36, 364–369 (2022). https://doi.org/10.1038/s41371-021-00532-5

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  • DOI: https://doi.org/10.1038/s41371-021-00532-5

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