The Prevalence of Hypertension in Different Geographical Regions of Saudi Arabia

this study reveals that in adult Saudis there are differences in the prevalence of .
hypertension in relation to gender, age and geographical regions. The prevalence increases
with age, and it is highest among the 40-75-year age group. The females tend to have
.insignificantly higher prevalence than males in that age group

Al-Nozha MM, Osman AK. The prevalence of hypertension in different Geographical regions
.of Saudi Arabia. Ann Saudi Med 1998;18(5):401-7

Hypertension prevalence, awareness, treatment and control in national surveys from

England, the USA and Canada, and correlation with stroke and ischaemic heart disease
mortality: a cross-sectional study

this study found marked differences in hypertension prevalence, awareness, treatment and
control rates in England, the USA and Canada. Canada has the lowest prevalence of
hypertension at 19% followed by England and the USA at about 30% each. A previous study
based on earlier cycles of these surveys also found little difference in the prevalence of
hypertension between England and the USA.The main determinants of hypertension are
known. These include poor dietary habits, excess sodium intake, physical inactivity, obesity,
excess alcohol consumption, as well as age, gender, race and sociodemographic factors

offres M, Falaschetti E, Gillespie C. Hypertension prevalence, awareness, treatment and

control in national surveys from England, the USA and Canada, and correlation with stroke
and ischaemic heart disease mortality: a cross-sectional study. BMJ Open 2013; 3:e003423.
.doi: 10.1136/bmjopen-2013-003423

Hypertension: trends in prevalence, incidence, and control

Prior to 1990, population data suggest that hypertension prevalence was decreasing;
however, recent data suggest that it is again on the rise. In 1999-2002, 28.6% of the U.S.
population had hypertension. Hypertension prevalence has also been increasing in other
countries, and an estimated 972 million people in the world are suffering from this problem.
Incidence rates of hypertension range between 3% and 18%, depending on the age, gender,
ethnicity, and body size of the population studied. Despite advances in hypertension
treatment, control rates continue to be suboptimal. Only about one third of all
hypertensives are controlled in the United States. Programs that improve hypertension
.control rates and prevent hypertension are urgently needed
 3

Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control.
Annu Rev Public Health 2006;27:465-90

High blood pressure prevalence and significant correlates: a quantitative analysis from
coastal karnataka, India

The prevalence of hypertension was 43.3%, with the prevalence being more among males
(51.6%) as compared to females (38.9%). Of the total prevalence 23.1% (287) were known
cases, and 20.2% (250) were newly detected cases. Based on the seventh report of the Joint
National Committee (JNC VII) on high blood pressure, prehypertension was noted among
38.7%. Advancing age, male gender, current diabetic status, central obesity, overweight and
obesity as defined by body mass index, and family history of hypertension were identified as
.significant correlates for hypertension by multivariate logistic regression

Rao C R, Kamath V G, Shetty A, Kamath A. High blood pressure prevalence and .

significant correlates. A quantitative analysis from coastal Karnataka, India. ISRN
Preventive Medicine. Volume 2013, Article ID 574973, 6 pages,
http://dx.doi.org/10.5402/2013/574973

Evaluation and treatment of severe asymptomatic hypertension

Poorly controlled hypertension is a common finding in the outpatient setting. When patients
present with severely elevated blood pressure (i.e., systolic blood pressure of 180 mm Hg or
greater, or diastolic blood pressure of 110 mm Hg or greater), physicians need to
differentiate hypertensive emergency from severely elevated blood pressure without signs
or symptoms of end-organ damage (severe asymptomatic hypertension). Most patients who
are asymptomatic but have poorly controlled hypertension do not have acute end-organ
damage and, therefore, do not require immediate workup or treatment (within 24 hours).
However, physicians should confirm blood pressure readings and appropriately classify the
hypertensive state. A cardiovascular risk profile is important in guiding the treatment of
severe asymptomatic hypertension; higher risk patients may benefit from more urgent and
aggressive evaluation and treatment. Oral agents may be initiated before discharge, but
intravenous medications and fast-acting oral agents should be reserved for true
 hypertensive emergencies. High blood pressure should be treated gradually. Appropriate,
.repeated follow-up over weeks to months is needed to reach desired blood pressure goals

Kessler CS, Joudeh Y. Evaluation and treatment of severe asymptomatic hypertension. .

Am Fam Physician 2010;81(4):470

Poor hypertension control: let's stop blaming the patients -

Physician behavior--not patient noncompliance--is the major cause of poor hypertension

control in the United States, many studies show. Hypertension control is unlikely to improve
unless physicians become more aggressive in treating mildly elevated systolic blood pressure

Pavlik VN. Poor hypertension control: let's stop blaming the patients. Cleve Clin J Med , .
2002;69(10):793

Impact of poorly controlled hypertension on healthcare resource utilization and cost

Study design: A retrospective database study of managed care patients in New Mexico from
.January 1, 1996, to December 31, 1997

Poor control of hypertension is associated with higher drug costs and more physician visits.
.Aggressive treatment might help reduce managed care costs and resource utilization

Paramore LC, Halpern MT, Lapuerta P. Impact of poorly controlled hypertension on

.healthcare resource utilization and cost. Am J Manag Care 2001;7(4):389-98

Hypertension in Saudi Arabia

Hypertension is increasing in prevalence in KSA affecting more than one fourth of the adult
Saudi population. We recommend aggressive management of hypertension as well as
screening of adults for hypertension early to prevent its damaging consequences if left
untreated. Public health awareness of simple measures, such as low salt diet, exercise, and
avoiding obesity, to maintain normal arterial blood pressure need to be implemented by
.health care providers

Al-Nozha MM, Abdullah M, Arafah MR. Hypertension in Saudi Arabia. Saudi Med J
.2007;28(1):77-84

Hypertension in Asir region, southwestern Saudi Arabia: an epidemiologic study

 A population study was carried out to determine the prevalence of hypertension among
Saudis at primary health care level in the Asir region, Southwestern Saudi Arabia. All primary
health care centers (PHCCs) were visited (238 PHCCs). Data were collected in relation to the
updated Saudi population census for 1991. Chronic case registries were revised to identify
existing cases of hypertension by age and sex till the end of 1991. Results showed that the
prevalence of hypertension amounted to 2.4% among Saudis aged 45 years and more. Males
and females aged 45 years and more living at high altitude had a significantly higher risk of
.developing hypertension (p < 0.05) compared to those living at sea level

Mahfouz AA, al-Erian RA. Hypertension in Asia region, southwestern Saudi Arabia: an .
.epidemiologic study. Southeast Asian J Trop Med Public Health 1993;24(2):284-6

Prevalence of physical inactivity in Saudi Arabia: a brief review

Major lifestyle changes in recent years in Saudi Arabia may be leading to physical inactivity
and a low level of physical fitness. This paper reviews the current literature about physical
inactivity in the Saudi Arabian population and discusses its implications for health. Available
data from a small number of studies suggests a high prevalence (43.3%-99.5%) of physical
inactivity among Saudi children and adults alike. Furthermore, the proportion of Saudi
children and adults who are at risk due to inactivity is much higher than for any other
coronary heart disease risk factor. It is recommended that a national policy encouraging
activity in daily life be established and more studies are carried out to address physical
.activity patterns with representative samples of the Saudi Arabian population

10

Al-Hazzaa HM. Prevalence of physical inactivity in Saudi Arabia: a brief review. East Mediterr
.Health J 2004;10(4-5):663-70

Risk factors of coronary artery disease in different regions of Saudi Arabia

A national nutrition survey was carried out in Saudi Arabia between 1989 and 1994. One
objective was to investigate the prevalence of well established atherogenic risk factors
among adults 18 years and older, namely obesity, hypercholesterolaemia,
hypertriglyceridaemia, diabetes mellitus and high systolic and diastolic blood pressure.
Obesity prevalence was positively correlated with all five coronary artery disease risk factors
investigated. Variation among regions in relation to the prevalence of these risk factors was
observed. Saudi Arabia's ecology has resulted in variation in the lifestyle and food
consumption patterns of the people of the different regions, which might be a major
.underlying cause of the variation and high prevalence of coronary artery disease risk factors
 11

Osman AK, Al-Nozha MM. Risk factors of coronary artery disease in different regions of
.Saudi Arabia. East Mediterr Health J 2000;6(2-3):465-74

Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult

Population: A National Survey

This cross-sectional study aimed at estimating prevalence, awareness, treatment, control,

and predictors of hypertension among Saudi adult population. Multistage stratified sampling
was used to select 4758 adult participants. Three blood pressure measurements using an
automatic sphygmomanometer, sociodemographics, and antihypertensive modalities were
obtained. The overall prevalence of hypertension was 25.5%. Only 44.7% of hypertensives
were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled.
Awareness was significantly associated with gender, age, geographical location, occupation,
and comorbidity. Applying drug treatment was significantly more among older patients, but
control was significantly higher among younger patients and patients with higher level of
physical activity. Significant predictors of hypertension included male gender, urbanization,
low education, low physical activity, obesity, diabetes, and hypercholesterolemia. In
conclusion prevalence is high, but awareness, treatment, and control levels are low
indicating a need to develop a national program for prevention, early detection, and control
.of hypertension

12

Saeed AA, Al-Hamdan NA, Bahnassy AA. Prevalence Awareness, Treatment, and Control
of Hypertension among Saudi Adult Population: A National Survey. Int J Hypertens 2011;
2011:174135. doi: 10.4061/2011/174135. Epub 2011 Sep 6

Gender differences in the regulation of blood pressure

Men are at greater risk for cardiovascular and renal disease than are age-matched,
premenopausal women. Recent studies using the technique of 24-hour ambulatory blood
pressure monitoring have shown that blood pressure is higher in men than in women at
similar ages. After menopause, however, blood pressure increases in women to levels even
higher than in men. Hormone replacement therapy in most cases does not significantly
reduce blood pressure in postmenopausal women, suggesting that the loss of estrogens may
not be the only component involved in the higher blood pressure in women after
menopause. In contrast, androgens may decrease only slightly, if at all, in postmenopausal
women. In this review the possible mechanisms by which androgens may increase blood
pressure are discussed. Findings in animal studies show that there is a blunting of the
pressure-natriuresis relationship in male spontaneously hypertensive rats and in
ovariectomized female spontaneously hypertensive rats treated chronically with
testosterone. The key factor in controlling the pressure-natriuresis relationship is the renin-
angiotensin system (RAS). The possibility that androgens increase blood pressure via the RAS
is explored, and the possibility that the RAS also promotes oxidative stress leading to
production of vasoconstrictor substances and reduction in nitric oxide availability is
proposed

13

Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension

2001;37(5):1199-1208

The progression from hypertension to congestive heart failure

Multivariable analyses revealed that hypertension had a high population-attributable risk for
CHF, accounting for 39% of cases in men and 59% in women. Among hypertensive subjects,
myocardial infarction, diabetes, left ventricular hypertrophy, and valvular heart disease were
predictive of increased risk for CHF in both sexes. Survival following the onset of
hypertensive CHF was bleak; only 24% of men and 31% of women survived 5 years

Hypertension was the most common risk factor for CHF, and it contributed a large
proportion of heart failure cases in this population-based sample. Preventive strategies
directed toward earlier and more aggressive blood pressure control are likely to offer the
greatest promise for reducing the incidence of CHF and its associated mortality

15

Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression fro m hype rtens ion t o .
c onge stive hear t fail ure. JAMA 1996;275(20):1557-1562

]Hypertension and hyperlipidemia

Hypertension and hyperlipidemia are well-established and partially overlapping risk factors
for cardiovascular disease. Analyses of cardiovascular morbidity in relationship to changes in
blood pressure and in serum cholesterol levels have shown that combined reduction of both
risk factors are important to achieve a reduction in morbidity. Statins have been shown to be
effective in preventing both coronary and cerebrovascular events in both hypertensive and
normotensive cases. Consequently, most recent guidelines recommend that statin
treatment be considered in hypertensive patients aged less than 80 years who have an
estimated risk of cardiovascular death of 5% or more based on the Systematic Coronary Risk
.Evaluation (SCORE) model

16

ansen HS, Larsen ML. Hypertension and hyperlipidemia. Ugeskr Laeger 2009;
.171(24):2028-2030

Death rates from ischemic heart disease in women with a history of hypertension in
pregnancy
There is an indication of increased death rates among women with a history of hypertension
in pregnancy, where ischemic heart disease may be more common than in the general
.population

17

Jónsdóttir LS, Arngrímsson R, Geirsson RT, Sigvaldason H, Sigfússon N. Death rates from
ischemic heart disease in women with a history of hype rt en sion i n pregnancy. A ct a
.Obst et Gynecol Scand 1995;74(10):772-6