According to the World Health Organization (WHO), an estimated 1.13 billion people worldwide have hypertension.1 Two-thirds of the worldwide population with hypertension live in low- and middle-income countries.2 Unfortunately, the vast majority are living with uncontrolled hypertension, establishing hypertension as a leading cause of premature death worldwide.2 As a result of the continued increase in prevalence rates of hypertension, the WHO has established a target goal to reduce the prevalence by 25% by 2025.3

For individuals with hypertension, self-care is essential to attain personal blood pressure goals, manage hypertension, and avoid complications. Self-care is conceptualized as a process of maintaining health with health-promoting practices, and monitoring and managing the signs and symptoms of a chronic condition.4 Hypertension self-care includes adherence to medication, physical activity, diet, smoking cessation, and other health-promoting behaviors that maintain health; self-monitoring of blood pressure and other blood-pressure-related symptoms, and managing the signs and symptoms of blood pressure changes.5 Research for the past decade has elucidated the complexities of self-care in chronic illness, cardiovascular disease, and hypertension and provided evidence that improving self-care is associated with improved outcomes important to patients.6 Thus, research aimed at achieving the aforementioned WHO goals must include assessment of hypertension self-care in populations at the greatest risk for poor outcomes.

Until recently, hypertension self-care measurement targeted discrete behaviors (eg, assessing medication adherence, weight loss, or physical activity levels), which limited the evaluation of self-care intervention effectiveness.7 In this issue of the Journal of Cardiovascular Nursing, we publish the results of the update of Self-care of Hypertension Inventory (SC-HI) V3.08 and 4 studies testing the psychometric properties of theoretically based hypertension self-care measures that have been translated and tested for use in populations who speak Arabic,9 Polish,10 Chinese,11 and Vietnamese.12 Two of these studies9,10 describe the results of cross-cultural adaptation, translation, and psychometric testing of the SC-HI version 2.05; 2 studies11,12 are translations of Han et al's13 Hypertension Self-care Profile.

The instruments based upon 2 widely used self-care theories14,15 address a critical gap in hypertension self-care research among global populations. For example, the prevalence of hypertension in Arab countries is extremely high; approximately half of cardiovascular deaths are attributed to high systolic blood pressure.16 In Poland, 35% of adults are given a diagnosis of hypertension, but only 26% have adequately controlled blood pressure.17 Similar high prevalence, poor control, and high morbidity and mortality rates are found in China and Vietnam.2 Across these regions and countries, uncontrolled blood pressure and poor outcomes are attributed in part to low medication adherence, poor health-promoting practices, and lack of blood pressure monitoring or screening by providers. Alsaqer and Bebis9 describe the urgent need for interventions to address blood pressure prevention and control in Arab countries and cite the lack of psychometrically valid measures in Arabic to assess the patients' ability to maintain, monitor, and manage their hypertension that has hampered self-care research to date.

To facilitate hypertension self-care measurement across the globe, the studies in this issue describe the rigorous methods applied for cross-culture adaptation, translation, and psychometric testing, and the results that support research use in low- and middle-income countries targeted by the WHO goals. Certain limitations cut across each analysis including cultural and language differences within regions and countries. Self-care is influenced by many sociocultural factors18; testing in populations with more diverse sociodemographic characteristics may be indicated.

Research to address gaps in self-care measurement also requires that instruments reflect current clinical guidelines as well as advances in the theory upon which they have been developed. The update of the SC-HI V3.0,8 based on recent clinical guidelines for hypertension and the new self-care of chronic illness theory,4 is available in this issue. The SC-HI V3.0 reflects emerging self-care science from nurse researchers that emphasizes the importance of observing oneself for changes in signs and symptoms. The update is now consistent with the family of self-care measurements and reflects the 3 theoretical concepts of self-care maintenance, monitoring, and management that are essential to self-care in persons with high blood pressure. The Self-Care Confidence Scale is now a distinct instrument that can be applied across cardiovascular diseases including hypertension to assess confidence in the relevant condition-specific behaviors. The SC-HI V3.0 update was important in several ways. First, it incorporated updated clinical guidelines.6,19,20 The new scale structure now also aligns with the science of self-care and supports research that cuts across multiple cardiovascular diseases and common comorbid conditions. The psychometric results of the new self-care monitoring scale provide insight into the nuances of monitoring practices that extend beyond using a blood pressure device and also suggest new approaches for hypertension self-care intervention research.

In this issue of the Journal of Cardiovascular Nursing, we add to the growing portfolio of hypertension self-care measures for use in global populations and suggest future research implications. Research to achieve the WHO goals to reduce hypertension and improve prevention and management is strengthened by psychometrically valid instruments that assess self-care as a process rather than measuring individual behaviors separately. Research is also strengthened when instruments are translated and tested using strong methods to ensure reliability and validity in diverse global populations.

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