1
|
Amir A, Alasnag M, Al-Raddadi R, Al-Bassam T, Saeed K, Yazıcıoğlu M, Shabana A. Patient journey for hypertension and dyslipidemia in Saudi Arabia: highlighting the evidence gaps. Arch Public Health 2023; 81:122. [PMID: 37400868 DOI: 10.1186/s13690-023-01121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/30/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND In recent years, Saudi Arabia has witnessed staggering rates of hypertension and dyslipidemia-related cardiovascular (CV) deaths, overburdening the healthcare ecosystem of the country. Appropriate public health interventions can be devised through quantitative mapping of evidence. Identification of potential data gaps can prioritize future research needs and develop a 'best-fit' framework for patient-centric management of hypertension and dyslipidemia. METHODS This review quantified data gaps in the prevalence and key epidemiological touchpoints of the patient journey including awareness, screening, diagnosis, treatment, adherence, and control in patients with hypertension and dyslipidemia in Saudi Arabia. Studies published in English between January 2010 and December 2021 were identified through a structured search on MEDLINE, Embase, BIOSIS, and PubMed databases. An unstructured search on public and government websites, including Saudi Ministry of Health, without date limits was carried out to fill data gaps. After exclusion of studies based on predefined criteria, a total of 14 studies on hypertension and 12 studies and one anecdotal evidence for dyslipidemia were included in the final analyses. RESULTS The prevalence of hypertension was reported to be 14.0%-41.8% while that for dyslipidemia was 12.5%-62.0%. The screening rate for hypertension was 100.0% as revealed by the nationwide surveys. Among hypertensive patients, only 27.6%-61.1% patients were aware of their condition, 42.2% patients underwent diagnosis, 27.9%-78.9% patients received antihypertensive treatment, 22.5% patients adhered to treatment medication, while blood pressure (BP) control was achieved in 27.0%-45.0% patients. Likewise, among patients with dyslipidemia, 10.5%-47.3% patients were aware of their condition, 34.6% patients were screened, and 17.8% underwent diagnosis. Although high treatment rates ranging from 40.0%-94.0% were reported, medication adherence recorded was 45.0%-77.4% among the treated patients. The overall low control rates ranged from 28.0%-41.5%. CONCLUSIONS The study findings highlight evidence gaps along key touchpoints of patient journey. Reinforcing the efforts for high-quality evidence-based research at a national level may pave a path for better resource utilization and provide guidance to practice and amend health policies for patients, healthcare practitioners (HCPs), and healthcare policy makers for better patient outcomes in Saudi Arabia.
Collapse
Affiliation(s)
- Ashraf Amir
- Family Medicine Department, International Medical Center, Jeddah, Saudi Arabia
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital-Jeddah-Saudi Arabia, PO Box 9862, Jeddah, 21159, Saudi Arabia.
| | - Rajaa Al-Raddadi
- Faculty of Medicine, Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tawfik Al-Bassam
- Department of Internal Medicine, Medical Reference Center, Jeddah, Saudi Arabia
| | - Kanwal Saeed
- Research, Development and Medical, Pfizer Upjohn, Dubai, UAE
| | - Mehmet Yazıcıoğlu
- Emerging Markets Medical Portfolio Implementation Lead, Viatris, Istanbul, Turkey
| | | |
Collapse
|
2
|
Al-Ghamdi S, Aldosari KH, Hussain ABO. Predictors of Cardiovascular Morbidity Among Adult Hypertensive Patients: A Cross-Sectional Study from the Kingdom of Saudi Arabia. Patient Prefer Adherence 2023; 17:1361-1369. [PMID: 37303588 PMCID: PMC10257473 DOI: 10.2147/ppa.s407546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023] Open
Abstract
Background Hypertension is a public health issue affecting over a billion people globally. 15% of the adults in the Kingdom of Saudi Arabia (KSA) are thought to have hypertension. A large proportion of them remain undiagnosed or are sub-optimally treated. Those with inadequately treated hypertension have a high risk of life-threatening cardiovascular complications such as ischemic heart disease, left ventricular hypertrophy and heart failure. This study was undertaken to elucidate the cardiovascular morbidity seen in a sample of adult hypertensive patients in Saudi Arabia and identify key demographic and clinical factors associated with cardiovascular morbidity. Methods A multicentric cross-sectional study was conducted from November 2019 to November 2021 at three hospitals in Al-Kharj KSA. Totally, 105 adult patients with a documented history of primary hypertension for at least 5 years irrespective of treatment status presenting themselves to the study sites were included. Patients with secondary hypertension, and those without confirmed cause and duration of hypertension were excluded. Logistic regression analysis was performed to determine the factors associated with cardiovascular morbidity. Results The study included 105 participants aged 47.75±13.46 years. 50 (47.6%) were males and 62 (59%) were not Saudis. Left Ventricular Hypertrophy, 64 (61%), diastolic dysfunction, 44 (41.9%), and retinopathy, 33 (31.4%) were the most frequently observed morbidities. Participants aged over 45, those with diabetes, or those with dyslipidemia were more likely to have cardiovascular morbidities (adjusted odds ratio (AOR)): 4.01 (1.29-12.46), p = 0.016, AOR: 6.4 (1.62-25.28), p = 0.008, and AOR: 6.71 (1.46-30.83), p = 0.014, respectively. Conclusion Older age, the presence of comorbid diabetes mellitus, and dyslipidemia are associated with a higher likelihood of cardiovascular morbidity in hypertensive patients of Saudi Arabia.
Collapse
Affiliation(s)
- Sameer Al-Ghamdi
- Department of Family and Community Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Khalid Hadi Aldosari
- Adult Critical Care Medicine Department, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Abo Baker Omar Hussain
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| |
Collapse
|
3
|
Alhabeeb W, Tash AA, Alshamiri M, Arafa M, Balghith MA, ALmasood A, Eltayeb A, Elghetany H, Hassan T, Alshemmari O. National Heart Center/Saudi Heart Association 2023 Guidelines on the Management of Hypertension. J Saudi Heart Assoc 2023; 35:16-39. [PMID: 37020975 PMCID: PMC10069676 DOI: 10.37616/2212-5043.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 03/17/2023] Open
Abstract
Background Hypertension is a highly prevalent disease in Saudi Arabia with poor control rates. Updated guidelines are needed to guide the management of hypertension and improve treatment outcomes. Methodology A panel of experts representing the National Heart Center (NHC) and the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to the local population, clinical practice and the healthcare system. The recommendations were reviewed to ensure scientific and medical accuracy. Recommendations Hypertension was defined and a new classification was proposed as relevant to the Saudi population. Recommendations on diagnosis, clinical evaluation, cardiovascular assessment were detailed, along with guidance on measurement modalities and screening/follow-up. Non-pharmacological management is the first line of hypertension treatment. Pharmacological therapy should be used appropriately as needed. Treatment priority is to control blood pressure regardless of the drug class used. The choice of treatment should be tailored to the patient profile in order to achieve treatment targets and ensure patient compliance. Recommendations were provided on pharmacological options available in Saudi Arabia, as well as guidance on the treatment of special conditions. Conclusion Hypertension management should be based on appropriate screening, timely diagnosis and lifestyle changes supplemented with pharmacological therapy, as needed. Clinical management should be individualized, and careful consideration should be given to special conditions and patient groups.
Collapse
Affiliation(s)
- Waleed Alhabeeb
- Department of Cardiac Sciences, King Saud University, Riyadh,
Saudi Arabia
| | - Adel A. Tash
- Consultant Cardiac Surgeon, Adult Cardiac Surgery, Ministry of Health,
Saudi Arabia
| | - Mostafa Alshamiri
- Professor of Cardiac Sciences, King Saud University Medical College, Riyadh,
Saudi Arabia
| | - Mohamed Arafa
- Professor of Cardiac Sciences, King Saud University,
Saudi Arabia
| | - Mohammed A. Balghith
- Senior Cardiologist, King Abdulaziz, National Guard Hospital, Riyadh,
Saudi Arabia
| | - Ali ALmasood
- Consultant Cardiologist, Specialized Medical Center, Riyadh,
Saudi Arabia
| | - Abdulla Eltayeb
- Senior Cardiologist, Almana Group of Hospitals, Dammam,
Saudi Arabia
| | - Hossam Elghetany
- Consultant Cardiologist, Dr. Soliman Fakeeh Hospital, Jeddah,
Saudi Arabia
| | - Taher Hassan
- Consultant Cardiologist, Bugshan Center,
Saudi Arabia
| | - Owayed Alshemmari
- Consultant Cardiologist Dr. Sulaiman Alhabib Hospital, Ar-Rayyan Hospital, Riyadh,
Saudi Arabia
| |
Collapse
|
4
|
Assiri GA, Bannan DF, Alshehri GH, Alshyhani M, Almatri W, Mahmoud MA. The Contraindications to Combined Oral Contraceptives among Reproductive-Aged Women in an Obstetrics and Gynaecology Clinic: A Single-Centre Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031567. [PMID: 35162588 PMCID: PMC8835169 DOI: 10.3390/ijerph19031567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/15/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to determine the estimated proportion of contraindications among women taking combined oral contraceptives (COCs) and to assess the risk factors associated with their contraindications. This study was cross-sectional. Reproductive-aged women (18–49 years) on any COCs between 2018 and 2020 were recruited from one obstetrics–gynaecology clinic in a university-affiliated hospital and were included. Contraindications were defined using the World Health Organization (WHO) Medical Eligibility Criteria (MEC) for Contraceptive Use. Data were collected from electronic medical records for all included women, as well as a standardised, pretested, structured survey for one-third of the women. In this cross-sectional study, 380 women using COCs were included. Their mean age was 31.645 ± 7.366 years. Among them, 131 (34.5%) participated via a survey and electronic records, while the other 249 (65.5%) participated via electronic records only. The majority of the participants had a Bachelor’s degree (59.0%) and were married (62.1%). The overall estimated proportion of patients with at least one contraindication to COCs according to category 3 (relative contraindications) or 4 (absolute contraindications) was 31.3% (95% CI 26.63–35.99). The most common contraindications observed were controlled hypertension, category 3 (12.1%); major surgery with prolonged immobilisation, category 4 (4.7%); migraine with aura at any age, category 4 (4.2%); breastfeeding from six weeks to less than six months postpartum, category 3 (4.0%); and diabetes mellitus with complications, category 4 (3.2%). Significant factors associated with contraindications to COCs were married women (OR 2.19, 95% CI 1.38–3.46), those aged 35 years or more (OR 2.33, 95% CI 1.49–3.66), and those with one or more live births (OR 2.19, 95% CI 1.38–3.46). Ensuring proper assessment prior to prescribing and considering alternatives suitable for long-term use among women taking an oral contraceptive regularly is recommended.
Collapse
Affiliation(s)
- Ghadah A. Assiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (W.A.)
- Correspondence:
| | - Douha F. Bannan
- Pharmacy Practice Department, King Abdulaziz University, Jeddah 80260, Saudi Arabia;
| | - Ghadah H. Alshehri
- Pharmacy Practice Department, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia;
| | - Manal Alshyhani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (W.A.)
| | - Walaa Almatri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (W.A.)
| | - Mansour A. Mahmoud
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Tibah University, Al-Madinah Al-Munawarah 42353, Saudi Arabia;
| |
Collapse
|
5
|
Thirunavukkarasu A, Naser Abdullah Alshahrani A, Mazen Abdel-Salam D, Homoud Al-Hazmi A, Farhan ALruwaili B, Awad Alsaidan A, Narapureddy BR, Muteb AL-Ruwaili A, Ghuwayli aljabri F, Khalaf Albalawi R, Alanazi KAF. Medication Adherence Among Hypertensive Patients Attending Different Primary Health Centers in Abha, Saudi Arabia: A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:2835-2844. [PMID: 36303595 PMCID: PMC9592733 DOI: 10.2147/ppa.s388365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Optimal blood pressure control is achieved by medication adherence. This will reduce the risk of associated morbidities and mortalities. The present study aimed to determine medication adherence and its associated factors among hypertensive patients attending different primary health centers (PHC) in Abha, Saudi Arabia (KSA). METHODS A cross-sectional study was conducted among ten different PHCs in Abha, KSA. Simple random sampling procedure was utilized to choose 400 participants. A structured anonymous questionnaire was used in the present study. Analysis of the data was done using the SPSS program, version 23. A logistic regression statistical test was applied to identify the independent associated factors of medication adherence. Furthermore, we have applied Spearman's test to find the correlation between overall B-IPQ score and medication adherence score. RESULTS A total of 400 hypertensive patients responded in the present survey. More than one-third of the participants (36.3%) were in the high adherence category group, while the remaining participants (63.7%) were either low or medium adherence category. The binary logistic regression analysis revealed that low and medium adherence category is significantly associated with age (adjusted odds ratio [AOR] = 0.96, 95% CI =0.93-0.99, p = 0.021), married participants (AOR = 0.42, 95% CI =0.33-0.58, p = 0.001), residing at village (AOR = 1.49, 95% CI =1.14-1.73, p = 0.038), and participants with monthly family income of 5000 to 7000 SAR (AOR = 3.06, 95% CI =1.62-5.79, p = 0.001). A negligible positive correlation was revealed between illness perception and medication adherence. CONCLUSION The present study revealed that hypertensive patients poorly adhere to their antihypertensive medications. This low adherence is significantly associated with the age, monthly income, people living in rural areas, and married participants. The present study results recommend sustained efforts to implement health education programs and awareness-raising interventions targeted at hypertensive patients.
Collapse
Affiliation(s)
- Ashokkumar Thirunavukkarasu
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
- Correspondence: Ashokkumar Thirunavukkarasu, Email
| | - Abdullah Naser Abdullah Alshahrani
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
- Department of Public Health, Asir Health Affairs, Asir Region, Saudi Arabia
| | - Doaa Mazen Abdel-Salam
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmad Homoud Al-Hazmi
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Bashayer Farhan ALruwaili
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Aseel Awad Alsaidan
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Bayapa Reddy Narapureddy
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Aliyah Muteb AL-Ruwaili
- Department of Public Health, Ministry of Health, Jouf Health Affairs, Sakaka, Aljouf, Saudi Arabia
| | | | | | | |
Collapse
|