Hypertension and its associated risk factors in the kingdom of saudi arabia, 2013: a national survey

Cardiac Rehabilitation in Saudi Arabia: Current Status and Future Directions

PURPOSE OF REVIEW

Cardiovascular diseases (CVDs) are the leading cause of mortality in Saudi Arabia. Cardiac rehabilitation (CR) is one of the well-known interventions to control and minimize the burden of CVDs. Despite recommendations, CR utilization remains suboptimal in Saudi Arabia due to many reasons, including limited awareness, logistical barriers, shortage of specialized facilities and trained professionals, and perceptions about CVDs illness. This review is to evaluate the current status, effectiveness, accessibility, and challenges of CR utilization in Saudi Arabia, and to explore potential future directions for improving these services. The review addresses key questions regarding the incidence of CVDs, the characteristics of existing CR programs, barriers to CR access, and stakeholder perspectives.

RECENT FINDINGS

Recent studies demonstrate that the effectiveness of CR, particularly exercise training, in improving outcomes for post-coronary artery bypass grafting (CABG) patients is well-documented, though data on its impact on other cardiac conditions is limited. There are significant barriers to CR utilization in Saudi Arabia, including limited awareness, logistical challenges, a shortage of specialized facilities and trained professionals, and cultural perceptions about CVD. Stakeholder perspectives highlight the necessity for culturally sensitive and inclusive approaches, particularly in addressing gender-specific needs and enhancing patient-provider communication. The Saudi Vision 2030 presents opportunities to expand and enhance CR services in alignment with international standards. This review found that while CR is a crucial intervention for managing CVDs, its utilization in Saudi Arabia is suboptimal due to various barriers. To improve CR access and effectiveness, future strategies should focus on increasing public and professional awareness, developing infrastructure, training healthcare professionals, and fostering public-private partnerships. These measures are essential to making CR more accessible and tailored to the diverse needs of the Saudi population, ultimately enhancing the quality of cardiovascular care and patient outcomes in the region.

Prevalence of Hypertension and Its Associated Risk Factors Among Adults Attending Medical Outpatient Clinics at Ibn Sina General Hospital Authority in Mukalla City, Yemen

BACKGROUND

Hypertension (HTN) is the most generally acknowledged modifiable risk factor for cardiovascular disease, cerebrovascular disease, and end-stage renal disease. Accordingly, the World Health Organization has listed HTN as the third greatest cause of death globally.

OBJECTIVES

The objective of this study was to assess the prevalence of HTN and its associated risk factors among adults attending medical clinics at Ibn Sina Hospital Authority in Mukalla City, Yemen.

METHODS

A cross-sectional descriptive survey was conducted using a self-administered questionnaire applied to 384 male and female adults aged ≥18 years attending Ibn Sina General Hospital Authority outpatient clinics in Mukalla City, Yemen, between December 2022 and May 2023. The participant's body weight, height, and waist circumference were measured. The data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY). P values of <0.05 were considered statistically significant.

RESULTS

Among the 384 participants, 20.5% had HTN, and the remaining (79.5%) did not have HTN, with a substantial proportion (47.2%) reporting a positive family history of HTN. Diabetes mellitus was present in 16.1% of the participants, whereas dyslipidemia and other chronic diseases were reported by 9.3% and 15.8% of the participants, respectively. A total of 75.6% of the participants had never smoked, and 11.7% were past smokers. More than half of the participants (57.29%) had never chewed khat, 20.57% were former khat chewers, and 22.14% were currently chewing khat. Nutritional status, as indicated by body mass index, showed that 29.8% were overweight.

CONCLUSIONS

HTN was found to be prevalent among the study participants. However, the respondents' awareness of the problem and the overall control rates were very low. Certain factors, such as family history of HTN, diabetes mellitus, and high body mass index, were found to be associated with HTN. Therefore, intervention measures are warranted emphasizing modifiable risk factors to prevent HTN.

Hypertension clinical pathway: Experience of Aseer region, Saudi Arabia

BACKGROUND

Hypertension (HTN) is a common chronic health problem with many complications and high morbidity rates. This study aimed to describe the HTN pathway, to assess the performance of screening and registration programs, to explore the challenges and suggest solutions for those challenges.

MATERIALS AND METHODS

This study was conducted in primary care centers in the Aseer region, Saudi Arabia, at the end of 2022. The study consisted of three parts namely: Screening for HTN, registration of known hypertensive patients and opinions of representatives of Primary Healthcare Centers (PHCs) on challenges to the implementation of HTN pathway and suggestions for overcoming these challenges. Three Google forms were developed by the investigators to achieve the objectives of this study. The first two forms were completed by doctors and nurses at each PHC and reviewed by the leader of HTN pathway, and the third form completed by a representative of each PHC. SPSS version 26 was used for data management and analysis. Chi-square test was used to determine association between categorical variables; binary logistic regression analysis was performed to determine the correlates of being hypertensive and having good control of HTN.

RESULTS

A total of 159,243 individuals were screened for HTN, 55% of whom were females and 94% were Saudis. The prevalence of HTN was 13%; 70% were overweight or obese and 14% had diabetes. The total registered number of patients was 55,628; 50% had good HTN control. Major challenges were inadequate health coaches, care coordinators, laboratory and radiology facilities, lack of coordination with hospitals, and ineffective appointment system.

CONCLUSION

This study revealed that the current HTN pathway was successful with regard to screening and registration of patients with HTN. Many challenges need an executive plan with SMART objectives to optimize the care for HTN patients in the region.

Self-Perceived Nutritional Competency of Primary Healthcare Physicians in Qassim, Saudi Arabia

INTRODUCTION

Overnutrition plays a vital role in the development of a spectrum of non-communicable diseases. Diet-related disorders have a huge impact on personal health as well as the country's economy for the management of such disorders. The study aims to assess the primary healthcare physicians' nutrition competency, which will be beneficial for evaluating the current situation and future strategies, training, nutrition care, and disease prevention.

METHODOLOGY

Among 147 primary healthcare physicians by simple random sampling from four cities and two rural areas of Qassim, Saudi Arabia, from December 2022 to December 2023 using a validated (NUTCOMP) tool. Data were entered, cleaned, and analyzed with SPSS software version 21.0 (IBM Corp., Armonk, NY). Informed consent was obtained from all study participants. Chi-square and ANOVA tests were applied to draw the significant differences.

RESULTS

A total of 147 participants enrolled in this study, and the mean age and standard deviation (SD) of the study population were 34.38 ± 6.57. More than half of the physicians (n = 76, 51.7%) continued education on nutrition. Significant mean differences were observed between some and focused nutrition content received physicians versus no nutrition content received physicians concerning nutrition skill, communication, and nutrition attitude consecutively (P < 0.0001, P < 0.0001, and P < 0.0001). The mean nutrition knowledge, skill, communication, attitude score, and SD of PHCC physicians were 26.91 ± 5.42 (maximum 35), 31.19 ± 6.18 (maximum 40), 36.73 ± 7.48 (maximum 45), and 34.74 ± 6.23 (maximum 40), respectively.

CONCLUSIONS

Our study results show primary healthcare physicians perceive themselves to have good nutritional competency.

Prevalence and risk factors of pre-hypertension and hypertension among adults in Southeastern Iran: Findings from the baseline survey of the Zahedan adult cohort study

Hypertension (HTN) stands as the leading modifiable risk factor for cardiovascular disease(CVD) and premature death globally. Understanding its prevalence and risk factors is essential for effective prevention and management of HTN. This study aimed to investigate the prevalence of Pre-hypertension (pre-HTN), HTN, and its risk factors in adults participating in the Zahedan adult cohort study (ZACS). This cross-sectional study used the baseline data of the ZACS. Ordinal logistic regression analysis was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for potential risk factors. Among the 10,016 participants in this study, 60.89% were women, with an average age of 50.44 ± 9.18 years. The prevalence of pre-HTN and HTN was 42.03% (men 45.44%, women 39.84%) and 18.47% (men 21.09%, women 16.79%), respectively. Being male, older age, having higher socioeconomic status (SES), being overweight and obese, having a family history of HTN, comorbidities such as diabetes and CVD, as well as abnormal blood lipid levels (triglycerides and HDL cholesterol) were the most significant predictors of pre-HTN and HTN. These findings highlight that more than half of the participants in this study exhibit pre-HTN or HTN, placing them at risk for CVD and stroke. Implementing comprehensive preventive strategies tailored to these identified risk factors is imperative to alleviate the disease burden, enhance disease management, and improve HTN treatment and control.

Knowledge and Attitudes Toward Cardiovascular Diseases and Their Risk Factors Among the Najran Population in Saudi Arabia

Background Cardiovascular disease (CVD) prevention is of great importance due to the high prevalence of CVDs and elevated treatment expenses among patients and healthcare systems. One of the most effective strategies is the improvement of knowledge and attitude levels toward CVD symptoms and risk factors. Objective This study aimed to explore the level of knowledge and attitude about CVD among the general population in Najran city, Saudi Arabia. Methods A descriptive cross-sectional study was carried out between November and December 2022 among the Najran population. A structured questionnaire comprised socio-demographic characteristics, attitudes, and knowledge about CVD and risk factors. Ethical approval was taken from the ethical committee. Results The study included 527 participants living in Najran city aged 18 to 60 years old. Most participants were Saudi nationals (97.3%, N = 513), two-thirds had a university degree (68.9%, N = 126), and approximately half of them were females (51.8%). Furthermore, about two-thirds of the participants (60.7%, N = 320) showed a good knowledge level, and most reported an excellent attitude (87.3%, N = 460). Participants who had a university degree showed significantly better attitude levels (p-value = 0.043). No factors revealed a significant impact on the knowledge level. Conclusion Moderate knowledge and excellent attitude levels were seen among the Saudi population. Increasing the knowledge level among the total population is essential. It will be reflected in their attitude and practice. Thus, structured educational programs and utilization of available CVD guidelines should be strengthened as a better preventive strategy to overcome this condition. Also, using mass and social media to increase population awareness and good health responsibility is an effective way to limit the risk of CVD incidence.

Overview of hypertension in Saudi Arabia: A systematic review and meta-analysis

OBJECTIVES

To assess the prevalence, awareness, treatment, and control of hypertension in Saudi Arabia.

METHODS

We searched electronic databases and the references lists of found publications between 1990 and 2022. Original cross-sectional studies in English were included using PubMed, Google Scholar, and the Saudi Digital Library. A meta-analysis was performed to assess the combined prevalence, awareness, treatment, and control rates of hypertension.

RESULTS

Twenty-nine studies with 278873 individuals aged 14-100 were considered. The pooled prevalence of hypertension was 22.66% (95% CI:18.95-26.60), Cochran's Q=6221.98, dff=22, p<0.0001; I2=99.65%, Egger's test (p=0.0033) across 23 studies with 272378 people. The pooled hypertension awareness rate was 42.8% from 6 studies with 36046 participants (95% CI:35.66-50.01), Cochran's Q=781.86, dff=5, p<0.0001; I2=99.4% and Egger's test p=0.3772. The pooled proportion of hypertension patients treated in 6 studies involving 46075 samples was 59.4% (95% CI=38.14-79.02), Cochran's Q=9793.79 dff=5, p<0.0001; I2=99.95%, Egger's test p=0.8284. The pooled proportion of hypertension-controlled participants across 15 studies comprising 264817 subjects was 34.97% (95% CI: 27.62-42.68), Cochran's Q=11048.28, dff=14, p<0.0001; I2=99.87% and Egger's test p=0.9760.

CONCLUSION

The prevalence of hypertension was high, with low awareness, treatment, and control rates among Saudis. Therefore, policymakers and healthcare providers must work harmoniously to promote health and to prevent, detect, and control hypertension early.PROSPERO Reg. No.: CRD42023407978.

Sex-specific prevalence, awareness, treatment and control of hypertension in adults in India: a study for developing sex-specific public policy from the longitudinal ageing study in India (LASI) data 2017-2018

BACKGROUND AND OBJECTIVE

Hypertension is a key risk factor for cardiovascular disease and the leading cause of mortality among Indian adults. The difference in health status between men and women is becoming a great burden in itself worldwide. This study aimed to examine the differences between men and women in the prevalence, awareness, treatment, and control of hypertension and related risk factors among people aged 45 and older in India using data from the Longitudinal Ageing Study in India in 2017-2018.

METHODS

Descriptive statistics were presented separately for males and females. Multivariable logistic regression was used to analyze the socio-demographic, lifestyle behaviours, and biological factors associated with the prevalence of hypertension. All statistical analyses were conducted using Stata Version 16.0 statistical software. The study of the data was conducted using survey weights available in the LASI datasets.

KEY FINDINGS

Overall, the study found that 45.1% of the study population had hypertension, with 26.9% self-reporting their condition and 30% having hypertension at the time of measurement. Approximately 41% of males and 59% of females had hypertension. The self-reported hypertension of men was found to differ significantly from measured hypertension by 8.7%, while in women the difference was only 1.2%. Diabetes was found to increase the odds of having hypertension in both males (OR = 3.65, 95% CI (3.37-3.97)) and females (OR = 3.46, 95% CI (3.21-3.74)).

CONCLUSION

The difference between self-reported and measured hypertension in men and women is contributing to sex-gender and health inequalities that must be addressed. For adult females with hypertension, it is important to prioritize obesity, education level, physical activity, and regular clinic visits to manage chronic conditions. Based on our findings, policy recommendations can be made to focus on increasing women's literacy, promoting men's screening for hypertension, banning tobacco and alcohol sales, and organizing hypertension awareness campaigns specifically for men and in rural areas.

Blood Parameter Profiles and Their Clinical Implications in Hypertensive Patients: A Retrospective Chart Review

Introduction Hypertension (HTN) is a chronic condition that serves as a major risk factor for cardiovascular diseases, leading to increased mortality and morbidity. It is a frequent modifiable illness affecting global health, resulting in catastrophic fatalities and morbidity. Aim This study aims to investigate blood parameter profiles and their clinical implications in hypertensive patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. Methods Utilizing retrospective data from 121 patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. The hematological parameter examined were hemoglobin (HB), platelets, hematocrit (HCT), calcium, phosphorus, sodium, potassium, urea, creatinine, and uric acid. The SPSS version 28 software was used for data analysis. Results Significant correlations between various hematological parameters were found in the results, pointing to potential connections between kidney function, the production of blood cells, and electrolyte balance in hypertensive patients. The results align with earlier studies carried out in the area and offer insightful information for clinicians and researchers interested in managing HTN and its complications. Conclusion The study emphasized the significance of considering hypertensive patients' age, gender, and lifestyle when interpreting their blood parameter profiles. The findings imply that a thorough comprehension of these blood parameter values and their potential effects on HTN is necessary for effectively managing HTN in this population. This study on the blood parameter profiles in hypertensive patients in Saudi Arabia provides the relationships between various hematological parameter and their clinical implications. These findings should be considered when creating targeted interventions and strategies to address the specific requirements and difficulties of managing HTN and its associated complications in this population. More research is required to comprehend the underlying reasons for the observed variations in hematological parameter profiles and their effects on the management of HTN.

The Quality of Life in Patients With Valve Prosthesis After Undergoing Surgery for Valvular Heart Diseases

Background and objective Surgery for valvular heart disease by valve replacement procedures has become one of the most frequently performed cardiac operations to improve the quality of life (QoL). Its long-term outcomes are assessed using the quality-of-life index (QLI). This study aimed to evaluate the QoL in patients who received valve prostheses after surgery for valvular heart diseases at King Abdulaziz University in Jeddah from 2010 to 2023. Methods This was a descriptive cross-sectional study of 59 patients aged 18 years or older who underwent surgical mitral and aortic valve replacement, involving either mechanical or tissue valves, from January 2010 to May 2023 They were selected using a non-probability convenient sampling technique. Their medical records were reviewed and the participants were interviewed via phone using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which was used to measure the QoL of patients (https://neurotoolkit.com/whoqol-bref/). Results The study found that the QoL of the participants varied across different domains. The psychological domain had the highest mean score of 79.76, while the physical domain had the lowest mean score of 61.5. The other domains, - social, environmental, and spiritual - had mean scores of 68.05, 69.9, and 73.25, respectively. There was a statistically significant association between the QoL and nationality and chronic diseases. However, the duration after surgery and the type of valve did not significantly correlate with the QoL in the different domains. Conclusion Based on our findings, heart valve replacement improves the QoL of patients. Healthcare organizations and providers should aim to improve the management of chronic diseases to optimize outcomes.

Patient journey for hypertension and dyslipidemia in Saudi Arabia: highlighting the evidence gaps

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.

Predictors of Cardiovascular Morbidity Among Adult Hypertensive Patients: A Cross-Sectional Study from the Kingdom of Saudi Arabia

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.

National and regional prevalence rates of hypertension in Saudi Arabia: A descriptive analysis using the national survey data

Background

Limited studies have examined the prevalence of hypertension (HTN) at the national and regional levels in Saudi Arabia. Therefore, this study aimed to examine the national and regional prevalence of HTN in the Saudi population.

Methods

This study used the data from household health survey carried out by the General Authority for Statistics in 2017. It included 24,012 households representing the Saudi population across all 13 administrative regions. The diagnosis of HTN was confirmed by a self-reported history of a physician diagnosed HTN.

Results

The prevalence of HTN was 9.2% among Saudi population aged 15 years and older. It was relatively higher in women (10.0%) than in men (8.5%). The prevalence of HTN increased with advancing age (aged 65 years and older), accounting for 55.3% in women and 48.0% in men; its prevalence was relatively low among the younger age group, accounting for 0.1% in those aged 15–19 years. A large difference was found in the prevalence of HTN between regions, ranging from 6.0% in Najran region to 10.0% in Makkah region.

Conclusion

This study reported the national and regional prevalence of HTN among Saudi adults using a representative sample with large variations in the prevalence rates according to age, sex, and regions. Older age, men, and Makkah region had higher prevalence of HTN. Our findings will help determine the etiological factors, identify the priorities for healthcare, and generate initiatives for policymakers, and develop preventive and therapeutic strategies for HTN.

Risk Factors Associated With Hypertension in Young Adults: A Systematic Review

On a global scale, hypertension ranks third among the six major risk factors for cardiovascular disease. The risk of heart disease, stroke, and renal failure is all significantly increased by hypertension. We looked for papers on risk factors associated with hypertension in young adults on Google Scholar and PubMed. "Hypertension," "young adults," and "risk factors" were the search terms. Eligibility testing was done in a standardized, non-blinded way. The first author, year of publication, subject related to hypertension in young adults, and risk factors associated with hypertension in young adults were all retrieved from each paper. A PubMed search yielded 150 results. In all, 10 papers were considered in our review, which were published between 2017 and 2021. Most of the studies considered were carried out by foreign research groups. Adults who smoke, chew tobacco, drink alcohol, are obese, engage in sedentary behavior, consume too much salt, and have unhealthy lifestyles are at a higher risk of developing hypertension. In addition to these risk factors, there were additional important risk variables such as illiteracy, illness ignorance, a disregard for one's health, and a society that values men more than women. The way of life is radically altering because of people adjusting to Western culture. Smoking, drinking, being overweight, and eating too much salt are the primary risk factors for hypertension. This shows that in order to live a happier and healthier life, it is important to increase people's understanding of and attitudes toward the prevention and control of hypertension.

Effects of Age, Metabolic and Socioeconomic Factors on Cardiovascular Risk among Saudi Women: A Subgroup Analysis from the Heart Health Promotion Study

Background: Cardiovascular disease (CVD) remains the leading cause of death in women. Along with the effect of age on the risk of CVD, the reproductive profile of women can influence cardiac health among women. Objectives: The objective of this study is to investigate the influence of age and reproductive stages on the development and progression of cardiovascular disease risks in Saudi women. Methods: For this study, we included 1907 Saudi women from the Heart Health Promotion Study. The study cohort was divided into five age groups (less than 40 years, 40-45 years, 46-50 years, 51-55 years, and ≥56 years). The cohort stratification was meant to correspond to the social and hormonal changes in women's life, including reproductive, perimenopausal, menopausal, and postmenopausal age groups. The groups were compared with respect to the prevalence of metabolic, socioeconomic, and cardiac risks, and the age group of less than 40 years was considered as the reference group. The World Health Organization stepwise approach to chronic disease risk factor Surveillance-Instrument v2.1 was used in this study to collect the anthropometric and biochemical measurements and the Framingham Coronary Heart Risk Score was used to calculate the cardiovascular risk (CVR). Logistic regression analysis was conducted to assess the independent effect of age on CVD risks after adjustment of sociodemographic factors. Results: Metabolic and CVR increased progressively with the increase in age. There was a sharp increase in obesity, hypertension, diabetes, and metabolic syndrome, from the age group <40 years to 41-45 years and then again between the age groups of 46-50 and ≥56 years. A similar noticeable increase in metabolic risk factors (high cholesterol, high triglyceride, high Low-Density Lipoprotein) was observed between the age group <40 years and 41-45 years, but with a steady increase with the increase in age between the other age groups. The high and intermediate Framingham Coronary Heart Risk Scores showed a progressive increase in prevalence with the increase in age, where the proportion doubled from 9.4% at the age group 46-50 years, to 22% at the age group 51-55 years. It doubled again at the age group ≥56 years to 53%-these sharp inflections in the risk of CVD correspond to the women's reproductive lives. Conclusions: In Saudi women, CVR increases with the increase of age. The influence of pregnancy and menopause is apparent in the prevalence of increased risks for cardiovascular and metabolic diseases.

National Heart Center/Saudi Heart Association 2023 Guidelines on the Management of Hypertension

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.

A Brief Review of Demographic and Clinical Correlates of Cholesteatoma Surgery in the Qassim Region

Background Cholesteatoma is described as the accumulation of squamous epithelium and keratinocytes within and around the middle ear cleft. There is a paucity of information regarding demographic and treatment outcomes for cholesteatoma in Saudi Arabia. An evaluation of the prevalence of comorbidities, complications and associations, of surgical treatment and demographics in the Qassim region was conducted. Methods This was a six-year retrospective review of patients treated for cholesteatoma at a private health facility, from August 2016 to July 2022. Data for age, gender, nationality, presence of comorbidities, type of surgery, type of anesthesia, and associated complications were collected from the electronic medical records and analyzed with Statistical Package for Social Sciences software. Results A total of 60 participants records were retrieved. The average age of the study population was ([43.2 ±SD] 21.8) years. There was a slightly higher male preponderance (males 51.7% and females 48.3%). Hypertension was the most commonly reported comorbidity (31.7%), followed by diabetes mellitus (25%). Age and gender were not statistically significantly associated with type of surgery or complications. Conclusion Demographic variables were not significantly associated with clinical correlates, however, further studies with larger sample sizes, robust clinical information, and long-term follow-up are required.

Blood Pressure Control and Prescription Pattern of Antihypertensive Drugs in Adherence to the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines in Saudi Arabia: A Retrospective Study

Background Hypertension is the leading risk factor for cardiovascular disease and death. Appropriate treatment of hypertension is necessary to reduce mortality. A prescription-based study is one of the most influential and helpful methods to examine physicians' irrational prescribing practices. This study was designed to investigate the antihypertensive prescription of physicians and their adherence to the treatment guidelines, as well as the blood pressure (BP) control rate in a general hospital in the Kingdom of Saudi Arabia. Methodology A retrospective, cross-sectional study was conducted between February 2020 and June 2021 in an outpatient department. Patients diagnosed with hypertension as per the 2020 International Society of Hypertension guidelines and those who received antihypertensive drugs were included. Study data included prescriptions, patient's age, duration of hypertension, comorbidities, BP, drug therapy type, and antihypertensive class. Results Overall, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (67.1%) were the most prescribed agents, followed by dihydropyridine-calcium channel blockers (62.6%), diuretics (26.1%), and β-blockers (10.1%). Comorbid and stage 2 hypertensive patients mainly received combination therapy (51.6%) rather than monotherapy (48.4%). The study revealed an 83.5% prescription adherence to the treatment guidelines. However, non-adherence was encountered in monotherapy, polytherapy, and elderly-treated patient groups. A 66.4% (at target BP in all cases <140/90 mmHg) and 39.3% (at target BP in comorbid patients <130/80 mmHg) rate of BP control was observed. Furthermore, the rate of BP control was significantly associated with prescription adherence (χ² = 71.316; p < 0.001). Conclusions The degree of prescription adherence and rate of BP control were found to be compatible with other published hypertension studies. However, considerable scope exists for improvement in rational drug utilization and rate of BP control, particularly in high-risk patients. Therefore, treatment guidelines must be followed by clinicians to achieve BP goals and reduce cardiovascular events among the Saudi population.

Patient activation, adherence to hypertension treatment plans and blood pressure control in Saudi Arabia: a cross-sectional study

OBJECTIVES

To explore the relationship between patient activation, adherence to hypertension treatment plans, blood pressure control and other important demographic factors.

DESIGN

A cross-sectional study.

SETTING

Primary healthcare centres in Riyadh province, Saudi Arabia.

PARTICIPANTS

A total of 114 adults with hypertension, including 68 men and 46 women.

OUTCOME MEASUREMENTS

Blood pressure control is achieved if (a) patients under 80 years of age with treated hypertension have blood pressure under 140/90 mm Hg or (b) patients aged 80 years or over with treated hypertension have blood pressure under 150/90 mm Hg. Secondary outcomes included patient activation, adherence to hypertension treatment plans and demographic factors (age, gender, education, income and comorbidity). Data were analysed using Pearson's correlation and multiple regression models.

RESULTS

57% (n=66) of participants did not achieve the ideal blood pressure target. Perfect adherence to hypertension treatment plans was significantly associated with lower systolic (r=-0.38, p<0.01) and diastolic blood pressure (r=-0.50, p<0.01). Age was significantly correlated with patient activation (r=-0.20, p<0.05) and diastolic blood pressure (r=-0.33, p<0.01). There was no statistically significant association between Patient Activation Measure, systolic blood pressure and diastolic blood pressure. In the hierarchical regression analysis, adherence to hypertension treatment plans was found to be a significant predictor and explained 15% of the variance in systolic blood pressure (β=-0.36, p<0.001) and 26% of the variance in diastolic blood pressure (β=-0.51, p<0.001).

CONCLUSION

The individual and family self-management theory can serve as an effective theory for understanding the key factors in achieving ideal blood pressure target. The majority of patients with hypertension reported lower levels of activation and poor blood pressure control. Inadequate adherence to treatment plans was related to poor blood pressure control. This work is pivotal in devising self-management interventions to assist patients in the management of hypertension disease, especially in Saudi Arabia.

Al-Rawi M. Evaluation of knowledge of risk factors and warning signs of stroke - An observational study among future health care professionals

Background and objective

The role of healthcare professionals in society is unique since they are providers of health information and medication counseling to patients. Hence, this study aimed to evaluate Knowledge of Risk Factors and Warning Signs of Stroke among undergraduate health care Students (UHCS) at King Saud University (KSU), Riyadh, Saudi Arabia.

Methodology

An online cross-sectional study was conducted among UHCS at KSU, Riyadh, Saudi Arabia from September to November 2022, using self-administered 34-item questionnaires divided into five sections to assess participants' knowledge of stroke risk factors, warning signs, and management and source of information about the stroke. The Statistical Package for the Social Sciences version 26 was used to analyze the data (SPSS).

Results

Of the 300 questionnaires distributed, 205 students completed the questionnaires, giving a response rate of 68.3%. Of whom 63 (30.7%) were pharmacy, 81 (39.5%) were nursing and 61 (29.8%) were emergency medical services (EMS) Students. One hundred and eighty-two (88.8%) of the students agreed that stroke affects bodily movement. With regards to risk factors, students identified high blood pressure 182 (88.8%), followed by heart disease 175 (85.4%), advanced age 164 (80%), previous Stroke history 158(77.1%), and lack of physical activity 156 (76.1%). Difficulty in speaking or slurred speech 164 (80%), dizziness, and loss of balance 163 (79.5%) were identified as the warning signs of stroke. In this study, 41.3 % of the pharmacy students reported a good level of knowledge than nursing and EMS students. However, 32.2% (N = 66) of the healthcare undergraduates reported good knowledge. The knowledge score was significantly associated with the year of study, and educational degree (p = 0.0001). Furthermore, there were no differences between parents working in healthcare settings (p = 0.99).

Conclusion

In conclusion, the knowledge of stroke among healthcare students at King Saud University varied. The reported knowledge gap mostly relates to stroke risk factors and warning signs. Therefore, increasing public awareness of potential risk factors and stroke warning signs needs to receive more attention.

Patterns of Dyslipidemia in the Anemic and Nonanemic Hypertensive Saudi Population: A Cross-Sectional Study

Background

Risk factors of cardiovascular disease include dyslipidemia, hypertension (HTN), and anemia. Our objective is to assess the patterns of dyslipidemia in the anemic and non-anemic hypertensive Saudi population.

Methods

A retrospective, cross-sectional study of the gender, blood pressure, lipid markers, and CBC parameters of 3111 subjects, which were retrieved from the database of Al-Borg Medical Laboratories over a six-year period (2014-2019), was carried out. Means were compared among study groups and the prevalence, association, and diagnostic accuracy of lipid markers for HTN were evaluated.

Results

TG, LDL/HDL, and TG/HDL were significantly higher (P < 0.0001) in hypertensives. Anemia reduces TC and LDL (P < 0.0001) in both genders, and reduces all markers and increases HDL (P < 0.01) in male hypertensives. HTN was more prevalent in anemics with high TC than normal TC (38.23% vs 11.17%, P < 0.001) and in non-anemics with high TG than normal TG (56.31% vs 21.22%, P < 0.001). Furthermore, non-anemics with high TG/HDL had the highest risk for HTN (RR = 1.20, 95% CI = 1.1551-1.2473, P < 0.0001). Elevated TC (P = 0.0142), TG (P < 0.0001), TC/HDL (P < 0.0001), LDL/HDL (P < 0.0001), and TG/HDL (P < 0.0001), and low HDL (P < 0.0001) were risk factors for HTN as shown by ORs. In anemics, high TC/HDL, LDL/HDL, and TG/HDL were not. Importantly, only TG and TG/HDL had a discriminating capacity for HTN.

Conclusion

The anemic state of hypertensive Saudi patients influences dyslipidemia which warrants further investigation.

Effectiveness of using e-government platform "Absher" as a tool for noncommunicable diseases survey in Saudi Arabia 2019-2020: A cross-sectional study

Background

E-government platforms provide an opportunity to use a novel data source for population health surveillance (also known as e-health). Absher is a Saudi e-government platform with 23 million authenticated users, including residents and citizens in Saudi Arabia. All Absher users were invited to participate in a web-based survey to estimate the prevalence of noncommunicable diseases and their risk factors in Saudi Arabia.

Objective

To assess the potential of using an e-government platform (Absher) to administer web-based health surveys.

Methods

A cross-sectional, web-based health survey was administered to Absher users between April 2019 and March 2020. The survey instrument included eight items and took <5 min to complete. The respondents' data were compared to Saudi Arabia's 2016 census. Descriptive summary statistics of the prevalence of major noncommuncable diseases are presented and compared to population-based prevalence data from Saudi Arabia's World Health Survey (WHS) 2019. All analysis was conducted using Stata 13.0.

Results

Overall, the Absher health survey had a 24.6% response rate, with most respondents being male (84%), Saudi (67%), and between 30 and 44 years of age (49%). Overall, the prevalence of noncommunicable diseases and risk factors among respondents was high for overweight (35%) and obesity (30%) and low for asthma (6%). The prevalence of diabetes, dyslipidemia, and hypertension was between 15 and 17% on average, and 26.5% were smokers. In comparison to population-based World Health Survey estimates, the Absher survey overestimated obesity, diabetes, dyslipidemia, hypertension, and smoking rates, and underestimated overweight, whereas asthma prevalence was similar for Absher and the WHS.

Conclusions

With improvements in the study design, the use of e-government platforms can provide a useful and potentially low-cost data source for public health research.

Prevalence of Prehypertension among Saudi Adults: A Narrative Review

Background:

Prehypertension is a pre-disease state wherein an individual has a blood pressure (BP) measurement above normal (≥120/80 mmHg) but below the hypertensive range (<140/90 mmHg). Large population-based studies have shown that individuals with a BP in the prehypertensive range have an increased risk of developing hypertension and cardiovascular events. Despite these risks and high mortality rates associated with pre-hypertension, there are currently no reviews that define the prevalence of pre-hypertension in the Saudi population.

Objective:

To determine the magnitude of the pre-hypertension problem among Saudi adults and identify areas for future research based on the current gaps in the literature.

Methods:

This narrative review considers studies addressing the prevalence of pre-hypertension among Saudi adults; 8 studies were identified for this review.

Results:

In total, 14,782 men and women participated in these studies. The overall prevalence of pre-hypertension in both sexes ranged from 18.5-54.9%. Men had higher rates of pre-hypertension (24.7-66.1%) than women (7-48.1%).A modifiable risk factor reported in the majority of the studies was increased adiposity.

Conclusion:

Lifestyle changes to reduce weight may be effective in preventing or at least delaying the progression to hypertension and its associated cardiovascular events. Large, prospective, epidemiological studies are needed to estimate the risk of incident hypertension and cardiovascular events in pre-hypertension patients. Randomized clinical trials are also needed to evaluate the effectiveness of lifestyle modification and/or pharmacotherapy in reducing the risk of incident hypertension.

Prevalence of Hypertension and Its Associated Risk Factors Among Patients with Rheumatoid Arthritis in the Kingdom of Saudi Arabia

Purpose

Data regarding hypertension prevalence among patients with rheumatoid arthritis in Saudi Arabia are scarce. This study was aimed at estimating the prevalence of hypertension and its associated risk factors among patients with rheumatoid arthritis in Saudi Arabia.

Patients and Methods

This was a cross-sectional study of adult patients with rheumatoid arthritis who presented at the OPD of two major hospitals in Riyadh city. Patient information such as demographic characteristics, comorbidities, drug use, and other clinical data were captured through medical record review and supplemented by patient interviews. Multivariate logistic regression was used to identify the significant factors for hypertension.

Results

The prevalence of hypertension was found in 32.35% of the 1490 rheumatoid arthritis patients who participated in our study. Logistic regression analyses revealed that advanced age, female sex, low education level, unemployment, smoking, and consulting with physicians less than two times within the past 12 months were risk factors for increased hypertension prevalence among patients with rheumatoid arthritis. A significantly higher risk of hypertension was observed among RA patients with obesity, diabetes, hyperlipidemia, cancer, kidney disease, osteoporosis, and Parkinson’s disease than among patients without these comorbidities.

Conclusion

Hypertension is highly prevalent among patients with rheumatoid arthritis, and advanced age, sex, low educational level, unemployment, smoking, and comorbidities are risk factors for increased hypertension prevalence.

Reply to Alsarwani, R.M. Comment on "Alghnam et al. The Association between Obesity and Chronic Conditions: Results from a Large Electronic Health Records System in Saudi Arabia. Int. J. Environ. Res. Public Health 2021, 18, 12361"

We genuinely thank Dr. Alsarwani for his insights [...].

Assessment of Hydration Status and Blood Pressure in a Tertiary Care Hospital at Al-Khobar

Background

High blood pressure is a major cardiovascular risk factor. It is a leading cause of increasing morbidity and mortality worldwide. One-third of the adult population worldwide suffers from hypertension. Salt intake, obesity, decreased physical activity, and smoking are well known to increase blood pressure. Fluid retention is the main contributing factor to primary hypertension and adversely affects the cardiovascular system. The emerging evidence suggests a relationship between blood pressure and hydration status. Our study aims to assess the correlation between hydration status and blood pressure. We aim to assess the hydration status in subjects with normal and high blood pressure and to investigate the association of hydration status with hemodynamic measurement.

Methodology

This cross-sectional and observational study included adult (>18 years) male and female subjects who agreed to participate. In total, 235 subjects were recruited by convenience sampling from (1) patients and caregivers attending geriatric and internal medicine clinics, and (2) visitors coming to King Fahad University Hospital at Al-Khobar. There were five patients on oral diuretics who were excluded from the study. Data were collected from September 2021 to March 2022. Hydration status was measured by a bioelectrical impedance analyzer (Bioscan 920, Maltron International Ltd. Rayleigh, UK). Hemodynamic measurements included heart rate per minute, systolic blood pressure, diastolic blood pressure, pulse pressure (the difference between systolic and diastolic blood pressure), and mean arterial pressure calculated as blood diastolic pressure plus one-third of pulse pressure. Statistical analyses were performed using SPSS statistics for windows, version 28.0 (IBM Corp., Armonk, NY, USA). Descriptive data were reported using means with standard deviations for numerical data and relative frequencies (percentage) for categorical data. P-values of less than 0.05 were considered statistically significant. Comparison between groups was done using a one-way analysis of variance test.

Results

Extracellular water percentage was higher in hypertensive (45.0 ± 2) than prehypertensive (43.5 ± 3) or normotensive (43.0 ± 2) (p = 0.001) subjects. In contrast, intracellular water percentage and total body water percentage were significantly negatively related to hypertension status.

Conclusions

Our results have shown a strong association between hypertension status and hydration parameters. In our study, hypertensive subjects tended to have lower total body water percentage and intracellular water percentage (bioimpedance value) than normotensive subjects. This might promote more research regarding the relationship between hypohydration and cardiovascular disease pathophysiology. This outcome should raise awareness about proper hydration as hypohydration can be a causative factor for hypertension.

Risk factors associated with in-hospital mortality patients with COVID-19 in Saudi Arabia

Risk factors for in-hospital mortality of COVID-19 patients in Saudi Arabia have not been well studied. Previous reports from other countries have highlighted the effect of age, gender, clinical presentation and health conditions on the outcome of COVID-19 patients. Saudi Arabia has a different epidemiological structure with a predominance of young population, which calls for separate study. The objective of this study is to assess the predictors of mortality among hospitalized patients with COVID-19 in Saudi Arabia. This is a retrospective observational cohort study of hospitalized adult COVID-19 patients at two tertiary hospitals in Saudi Arabia between May to July 2020. Electronic charts were retrospectively reviewed comparing survivors and non-survivors in terms of demographic and clinical variables and comorbid conditions. A total of 564 hospitalized patients with COVID-19 were included in the study. The overall in-hospital mortality rate was 20%. The non-survivors were significantly older than survivors (59.4 ± 13.7 years and 50.5 ± 13.9 years respectively P< 0.001). Diabetes mellitus, hypertension, heart failure and ischemic heart disease were more prevalent among non-survivors (P< 0.001). The mean values of glycosylated hemoglobin HgA1C, D-dimer, ferritin, lactate dehydrogenase LDH, Alanin aminotransferase ALT and creatinine were significantly higher among non-survivors (P < 0.05). Multivariate logistic regression analysis revealed that age (aOR = 1.04; 95% CI 1.02-1.08; P < 0.01), chronic kidney disease (aOR = 4.04; 95% CI 1.11-14.77; P < 0.05), acute respiratory distress syndrome ARDS (aOR = 14.53; 95% CI 5.42-38.69; P < 0.01), Mechanical Ventilation (aOR = 10.57; 95% CI 5.74-23.59; P < 0.01), Shock (aOR = 3.85; 95% CI 1.02-14.57; P < 0.05), admission to intensive care unit (ICU) (aOR = 0.12; 95% CI 0.04-0.33; P < 0.01) and length of stay (aOR = 0.96; 95% CI 0.93-0.99; P < 0.05) were significant contributors towards mortality. The in-hospital mortality rate of COVID-19 patients admitted to tertiary hospitals in Saudi Arabia is high. Older age, chronic kidney disease and ARDS were the most important predictors of mortality.

Undiagnosed hypertension and associated factors among adults in Debre Markos town, North-West Ethiopia: A community-based cross-sectional study

Introduction:

Globally, hypertension is an important risk factor for cardiovascular diseases and all-cause mortality. Despite this high public health burden, no community-based evidence regarding the magnitude and related factors of hypertension has been reported in the study area.

Objective:

The aim of this study was to determine the prevalence and associated factors of undiagnosed hypertension in Debre Markos town, North-West Ethiopia, 2020.

Method:

A community-based cross- sectional study design was conducted from January to March 2020. Socio-demographic and behavioral characteristics of the participants were collected using interviewer-administered semi-structured questionnaires. Physical measurements including body mass index, waist circumference, and blood pressure were collected using standardized measuring instruments. Statistical analysis was collected using SPSS version 21 software. Univariate logistic regression model was used to present the results. The p value less than 0.05 in a multivariable analysis was considered statistically significant at 95% confidence interval.

Results:

From a total of 630 samples, 600 participants, 270 (45%) males and 330 (55%) females with a mean age of 36.32 ± 12.48 years, were participated giving a response rate of 95.2%. The prevalence of undiagnosed hypertension among adults was 12.7%. Of these, 5.5% were males and 7.2% were females. Factors including age (above 60 years) (adjusted odds ratio = 2.92, 95% confidence interval (1.05, 8.06), p = 0.03), body mass index (overweight and obese) (adjusted odds ratio = 3.85, 95% confidence interval (2.16, 6.87), p < 0.01), fatty diet consumption (adjusted odds ratio = 1.88, 95% confidence interval (1.03, 3.42), p = 0.04), family history of hypertension (adjusted odds ratio = 2.21, 95% confidence interval (1.04, 4.69), p = 0.04) were significantly associated with hypertension.

Conclusion:

The prevalence of undiagnosed hypertension among adults was found to be remarkable. Therefore, a community-based health education and hypertension screening strategies are needed to prevent the problem early in life in Debre Markos town and the nation at large.

The use of finite mixture models to examine the serum 25(OH)D levels among Saudis

BACKGROUND

Recorded serum 25(OH)D in survey data varies with observed and unobserved respondent characteristics. The aim of this study was to expose latent population sub-groups and examine variation across groups regarding relationships between serum 25(OH)D and observable characteristics.

METHODS

This study explored the role of unobserved heterogeneity on associations between surveyed 25(OH)D and various factors using a sample (n = 2,641) extracted from the Saudi Health Interview Survey (2013). Linear regression and finite mixture models (FMM) were estimated and compared. The number of latent classes in the FMM was chosen based on BIC score.

RESULT

Three latent classes were identified. Class I (39.82%), class II (41.03%), and class III (19.15%) with mean 25(OH)D levels of 22.79, 34.88, and 57.45 ng/ml respectively. Distinct patterns of associations with nutrition, behaviour and socio-demographic variables were recorded across classes that were not revealed in pooled linear regression.

CONCLUSION

FMM has the potential to provide additional insights on the relationship between 25(OH)D levels and observable characteristics. It should be more widely considered as a method of investigation in this area.

Assessment of Cardiovascular Diseases Knowledge and Risk Factors Among Adult Population in the South Region of Saudi Arabia

Cardiovascular diseases are the main cause of mortality and disability worldwide. This study aimed to assess knowledge of cardiovascular disease and risk factors among the adult population in the south region of Saudi Arabia. A web-based cross-sectional survey of 1,049 participants was completed during August 2021. Data were collected by using 25-item heart disease fact questionnaire. The study population included 526 men (50.1%) and 523 women (49.9%) with a mean age of 36 ± 12 years. The average total knowledge score was 65.7 ± 20.80. The items with the highest knowledge were smoking, overweight, aging, high cholesterol, hypertension, diabetes, and family history. Findings revealed that knowledge regarding cardiovascular diseases is inadequate with a high prevalence of risk factors among the Saudi Arabian population. Healthcare professionals and organizations have a crucial role in raising public awareness regarding health promotion, regular screening, and lifestyles modifications. Interventional studies are needed to investigate the actual magnitude of CVDs and counteract them.

Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study

BACKGROUND

Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts.

OBJECTIVE

The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system.

METHODS

This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants' attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis.

RESULTS

In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users' data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants.

CONCLUSIONS

Only 5 apps were deemed potentially effective and secure. Patients' and doctors' discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall.

The association between medical diseases and orofacial abscess: A retrospective, hospital-based study

OBJECTIVE

This study aimed to identify the most commonly reported medical diseases among dental patients and to assess its association with the development of the orofacial abscess.

METHODS

The medical records (n = 3164) of dental patients who visited the dental hospital at Umm-Al-Qura University (Makkah, Saudi Arabia) were reviewed. Demographic characteristics of eligible patients were collected. Medical diseases were collected as reported by the patients in the medical records. The International Classification of Diseases (ICD-10) was used to classify the reported medical diseases. Simple descriptive statistics were used to define the characteristics of the study variables through a form of counts and percentages. Multivariable logistic regression analysis was carried out to find out the significant predictors of orofacial abscess.

RESULTS

Upon reviewing 3164 medical records, almost half of the patients had medical diseases (n = 1543, 49%). The mean age of the cohort was 30.3 (SD = 16.43). Diabetes mellitus (n = 316, 20%) and hypertension (n = 210, 14%) were the most common reported medical diseases. Male patients reported having more medical diseases compared to the female. Hypertension was found to be significantly high among female patients (X 2 = 3.167, P-value < 0.001). Multivariable logistic regression analysis indicated that the female gender is significantly associated with the development of orofacial abscess after adjustment for age and vascular risk factors (i.e., hypertension) (B = 1.26, S.E. = 0.57, OR = 3.54, 95%CI = 1.13 to 11.40, P-value = 0.028).

CONCLUSION

Dentists should be aware that diabetes mellitus and hypertension are prevalent among patients visiting dental services. The female gender has a higher association of developing orofacial abscess than male. Within the limitation of this study in a single study center with few patients having orofacial abscess, this study found no association between medical diseases and the development of orofacial abscess.

Gender Differences in The Factors associated with Hypertension in Non-Diabetic Saudi Adults-A Cross-Sectional Study

The association between lifestyle practices, obesity and increased BP are under-investigated. We aimed to investigate this association to identify the factors associated with hypertension and prehypertension in Saudis. Non-diabetic adults were recruited from public healthcare centers using a cross-sectional design. Recruits were interviewed using a predesigned questionnaire. Weight, height, waist circumference (WC), hip circumference (HC), neck circumference (NC) and BP were measured. The variables were analyzed by comparing the prehypertensive and hypertensive groups with the normotensive group. A total of 1334 adults were included. The study found that 47.2% of men and 24.7% of women were prehypertensive, and 15.1% of men and 14.4% of women were hypertensive. High BMI, WC, NC, and WC: HC ratios were associated with an increased risk of prehypertension and hypertension in men and women. Low physical activity was associated with an increased risk of elevated BP in men, while sleep duration of ≤6 h and sitting for ≥4 h were associated with increased risk in women. Women from central Asia, southeast Asia, and those of mixed origin had a higher prevalence of hypertension compared to those from Arabian tribes. In conclusion, prehypertension and hypertension increase with age and obesity. Gender differences were apparent in the association between several lifestyle practices and prehypertension or hypertension among various ethnic/racial groups.

Long-term Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rate in the Middle East and North Africa: a Systematic Review and Meta-analysis of 178 Population-Based Studies

PURPOSE OF REVIEW

This study investigated and pooled the long-term trends in prevalence, awareness, treatment, and control of hypertension (HTN) in the Middle East and North Africa (MENA) region. In this systematic review and meta-analysis, we searched MEDLINE/PubMed, Web of Science, Google Scholar, EMBASE, and Scopus between database inception and November 2020. All cross-sectional studies that investigated the prevalence of pre-HTN, HTN, awareness, treatment, and control in the MENA counties were included. The selection study, data extraction, and quality assessment were conducted by two investigators independently. Heterogeneity between studies was assessed using Cochran's Q test and I-squared, and due to sever heterogeneity between studies, the random effect model was used to pool the estimates. Sensitivity analysis was performed to estimate the long-term trends in prevalence, awareness, treatment, and control rates of HTN according to definition of HTN as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for HTN.

RECENT FINDINGS

Overall, 178 studies met the inclusion criteria. Studies comprised 2,262,797 participants with a mean age of 45.72 ± 8.84 years. According to random effect model, the pooled prevalence of pre-HTN and HTN was 33% (95% CI 28, 39) and 26% (25, 27), respectively. Over the past three decades, prevalence of hypertension increased significantly in the region. The pooled awareness, treatment, and control rates were 50% (48, 53), 41% (38, 44), and 19% (17, 21), receptively. The pooled awareness, treatment, and control rates of HTN were lower significantly in men than women. According to definition of HTN as blood pressures above 140/90 mm Hg, over the past three decades, although the awareness and treatment rates did not change significantly, the control rates improved significantly in the region. The findings showed that HTN is a significant public health problem in the MENA region. Although there are low levels of pooled awareness, treatment, and control rates, the control rates improved over the past three decades in the region.

Determinants of tobacco cessation among patients with chronic diseases (diabetes/hypertension) enrolled in Ministry of Health Tobacco Cessation Clinics, Kingdom of Saudi Arabia from 2012-2017: A case control study

OBJECTIVES

To investigate factors associated with tobacco cessation among patients with (diabetes or hypertension) who attended Ministry of Health (MOH) Tobacco Cessation Clinics (TCC), Saudi Arabia over the years 2012-2017.

METHODS

A case control study was conducted with 402 respondents. Data collection took place in Riyadh, Saudi Arabia from January 2018 to April 2018. Cases were patients with diabetes or hypertension who had been abstinent from tobacco for at least 6 months after attending MOH tobacco cessation clinics. Controls were patients with chronic diseases who had not quit tobacco after cessation clinics. Data were collected through a questionnaire by telephone interviews. Descriptive analysis, bivariate analysis, and multivariable regression were carried out.

RESULTS

Overall, 85 (21.1%) respondents had successfully quit tobacco, while 317 (78.9%) had not. Among those who had not quit cigarettes, 97 (42.4%) had reduced cigarette consumption, the mean difference in cigarette smoking from before to after MOH TCC was 01.812±5.928 (95% confidence interval [CI]: 2.584-1.040). Most of those who used other forms of tobacco 16 (72.7%) had not changed their consumption. The likelihood of successfully quitting tobacco increased with those lower educational level (adjusted odds ratio [AOR]=17.01, 95% CI: 1.00-289.2, p=0.05) and among those who reported controlled hypertension (AOR=17.8, 95% CI: 1.5-209.6, p=0.02).

CONCLUSION

To increase abstention rates, chronic disease counseling with regular follow-ups, providing toll-free telephone services should be considered. More effort is needed to reduce non-cigarette tobacco consumption.

Levels of Evidence within Cardiovascular Medicine Research in Saudi Arabia: A Systematic Review

International commitments to reduce the prevalence of non-communicable disease have led the Government of Saudi Arabia to invest more in research related to cardiovascular disease. However, the strength of evidence derived from these research activities remains unclear. The aim of our study was to examine the level of evidence within clinical Cardiovascular Medicine research in Saudi Arabia. We conducted a systematic review of published articles that included a population from Saudi Arabia. Electronic databases EMBASE and MEDLINE (Ovid) were searched up to 25th of April 2021, supplemented by a second search in CENTRAL (Cochrane Central Register of Controlled Trials) and www.clinicaltrials.gov. In addition, the Snowball- and Pearl-growing methods of search were conducted for finding additional eligible articles. Finally, a search was conducted in PubMed database for all eligible articles published by Journal of the Saudi Heart Association from the first indexed issue up to April 2021. Level of evidence of reviewed articles was determined using the Oxford Level of Evidence 2 scale. We calculated the mean level of evidence over 5-year periods, and explored evidence for a time trend for number of published articles and LOE using linear regression. Of the 1113 records identified, 418 met the inclusion criteria for analysis. The articles were published between September 1986 and March 2021. More than half of the included articles were level IV studies (n = 242, 57.8%). Furthermore, we observed no trend over the years for increased mean of level of evidence (β = -0.07, 95% CI [-0.20, -0.06], p = 0.236). Overall, the level of evidence produced by the articles in clinical Cardiovascular Medicine in Saudi Arabia is very low. Prioritizing higher-quality research is critical to produce the clinical practices and policies necessary to reduce the burden of cardiovascular diseases in Saudi Arabia.

Joint modeling of blood pressure measurement and survival time of hypertension patients

Hypertension is a chronic disease that has a major health problem over the centuries due to its significant contribution to the global burden. The objective of this study was to examine the association of survival time and longitudinal Systolic Blood Pressure (SBP) measurement and finding potential barrier that affects SBP measurement and the survival time of hypertension patients. The study considered a cohort of 318 hypertension patients who were aged 18 years or older and were under follow-up from January 1, 2012, to February 30, 2020, at Arba Minch General Hospital. To analyze the data we employed linear mixed effect model, Weibull model, and joint modeling approach for longitudinal and survival data. The results from joint model analysis indicate that systolic blood pressure measurement is significantly associated with survival time of hypertension patients. The results from the longitudinal sub-model reveals that alcohol use, Khat intake, smoking tobacco, stages of hypertension diseases, adherence to treatment, related diseases, and family history had statistical significant relationship with mean change in the [Formula: see text] measurement. Furthermore, from the survival sub-model, we found the survival probability of hypertension patients was determined by family history, stages of hypertension disease, related diseases, and smoking tobacco. The analysis suggests that there is a strong association between SBP measurement and survival time of hypertension patients. Thus we recommend aggressive work by all concerned bodies towards awareness creation about the effect of potential barriers.

The Impact of Financial Incentives on Behavior and Self-Management of Uncontrolled Type 2 Diabetes: Pre- and Post-Quasiexperimental Study

Introduction

Noncommunicable diseases are one of the main challenges that affect health worldwide and have been found to be increasing in both low- and middle-income countries compared with high-income countries. The aim of this study was to assess the impact of financial incentives and a comprehensive care program focusing on patients' behavior and self-management of uncontrolled type 2 diabetes (glycosylated hemoglobin [HbA1c] ≥ 7), as well as modifiable risk factors for disease complications in a Saudi Arabian population.

Methods

This quasiexperimental study, using a pre- and postevaluation approach, was used to compare the level of HbA1c among patients with uncontrolled diabetes before and after the financial incentives and comprehensive care program were implemented. Financial awards were given to patients who achieved a significantly greater decrease in HbA1c levels with his/her responsible physician. The study population included 702 Saudi Arabian patients with type 2 diabetes from 14 regions and 34 primary healthcare centers in the Kingdom of Saudi Arabia. All of these patients (≥ 15 years old) with uncontrolled type 2 diabetes who attended local primary healthcare centers in Saudi Arabia for a follow-up visit from February to October 2018.

Results

The mean age, in years, of the sample was 56.14 (± SD = 9.909); slightly more than half of the patients 401 (57.1%) were females. Most of the participants 645 (91.9%) were married, and 381(54.3%) patients were housewives. Linear mixed modeling revealed that all groups showed improvements over time in the primary outcome of HbA1c levels (p = 0.009), Including the secondary outcomes of body mass index and systolic and diastolic blood pressure (p = 0.04, < 0.001, 0.019 respectively).

Conclusions

Patient behavior was improved, which was reflected by decreases in HbA1c, body mass index, and blood pressure levels. A comprehensive care program is recommended by healthcare providers to increase awareness among patients with diabetes to reduce other risk factors. These kinds of interventions positively motivate patients with diabetes to control their health measurements and to adopt a healthy lifestyle.

Cost Effectiveness of ACEIs/ARBs versus Amlodipine Monotherapies: A Single-Center Retrospective Chart Review

The aim of this retrospective chart review study was to examine the cost effectiveness of angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); and dihydropyridine calcium channel blockers (CCBs) such as amlodipine, monotherapies in the management of essential hypertension among adult patients (≥18 years) without cancer, cardiovascular disease, and chronic kidney disease in the primary care clinics of a university-affiliated tertiary care hospital. Patients were followed up for at least 12 months from the initiation of therapy. Propensity score bin bootstrapping with 10,000 replications was conducted to generate the 95% confidence intervals (CI) for both treatment outcome (e.g., reduction of the systolic (SBP) and diastolic blood pressures (DBP) in mmHG) and the cost (e.g., costs of drugs, clinic visits, and labs in Saudi riyals (SAR)). Among the 153 included patients who met the inclusion criteria, 111 patients were on ACEIs/ARBs, while 44 patients were on amlodipine. On the basis of the bootstrap distribution, we found that the use of ACEIs/ARBs was associated with an incremental reduction of SBP of up to 4.46 mmHg but with an incremental cost of up to SAR 116.39 (USD 31.04), which results in an incremental cost effectiveness ratio (ICER) of SAR 26.09 (USD 6.95) per 1 mmHg reduction with 55.26% level of confidence. With regard to DBP, ACEIs/ARBs were associated with an incremental reduction of DBP of up to 5.35 mmHg and an incremental cost of up to SAR 144.96 (USD 38.66), which results in an ICER of SAR 27.09 (USD 7.23) per 1 mmHg reduction with 68.10% level of confidence. However, ACEIs/ARBs were less effective and costlier than amlodipine in reducing SBP and DBP with 44.74% and 31.89% levels of confidence, respectively. The findings of this study indicate that the use of ACEI or ARB as a monotherapy seems to be more effective than amlodipine monotherapy in the management of essential hypertension in primary care settings with minimal incremental cost.

Quality of Life and Awareness of Hypertension Among Hypertensive Patients in Saudi Arabia

Background and aim

Hypertension possesses significant public health challenges for both developing and developed economies. Therefore, it is crucial to evaluate the awareness of hypertension and health-related quality of life (HRQoL) among patients with hypertension. This study aims to evaluate the knowledge of hypertension and HRQoL among hypertensive patients.

Materials and methods

A cross-sectional study using an anonymous questionnaire was conducted over a period of 4 months (November 2020 to February 2021) in Riyadh, Kingdom of Saudi Arabia (KSA). This study included 437 questionnaires submitted by the hypertensive population.

Results

A total of 437 participants were included in this study, with 55.4% being males (n=242). The majority (85.1%) were aware of the normal values of blood pressure. Many participants had no problems with mobility, personal care, usual activities, pain or discomfort, and anxiety or depression. Age groups showed a significant association with mobility and usual activities. The knowledge of hypertension was significantly associated with HRQoL.

Conclusion

This study found that majority of the hypertensive patients were aware of the standard values of blood pressure. HRQoL concerning physical functioning and general health is found to be good based on the EuroQol visual analogue scale (EQ VAS) in the hypertensive population who are aware of their condition. This study reported a weak yet significant association between hypertension-related knowledge and HRQoL scores. Several factors can affect the HRQoL of the hypertensive population including gender, education, occupation, and income status.

May Measurement Month 2019: an analysis of blood pressure screening results from Saudi Arabia

High blood pressure (BP) is a major risk factor for cardiovascular diseases and was identified as the most significant single preventable cause of mortality. The prevalence of hypertension in Saudi Arabia is high. To raise awareness and identify undiagnosed hypertension, the Saudi Ministry of Health participated in the May Measurement Month (MMM) 2019 global screening initiative of the International Society of Hypertension. Ninety-two primary care centres across the Kingdom recruited respondents aged ≥18 years through opportunistic sampling, from 1 May to 30 August of 2019. Data collection included sociodemographic, lifestyle habits, environmental, and anthropometric indicators. Blood pressure was measured twice using automated BP devices. A total of 25 023 adults were screened with a mean age of 42.4 (16.7) years and a mean body mass index of 27.5 (6.0) kg/m2. In total, 43.6% of participants were females and 56.4% were males. Of all the participants with hypertension, 60.8% were aware, 60.8% were on antihypertensive medication, and 39.3% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Moreover, out of 4440 participants on antihypertensive medication, only 64.6% had controlled BP. The high numbers of individuals with hypertension and with undiagnosed hypertension highlight the importance of BP screening campaigns to increase awareness, detection, and target treatment on a national level. Findings from this study can form a baseline by which to measure progress in future iterations of MMM.

Sex differences in prevalence and risk factors of hypertension in India: Evidence from the National Family Health Survey-4

To estimate sex-specific prevalence and associated socio-economic, demographic, and lifestyle risk factors of hypertension in India. We used data from the National Family Health Survey (NFHS-4) of 2015-16. The analysis based on 6,99,686 women (15-49 years) and 1,12,122 men (15-54 years) whose blood pressure (BP) were measured during the survey. Bivariate distribution was used to show the prevalence of hypertension and, maps were used to present its spatial patterns. Logistic regression model was used to identify sex-specific association between risk factors and hypertension. Results show that the overall prevalence of hypertension was 16.32% among men and 11.56% among women. We also found that the prevalence of hypertension across selected socio-economic, demographic and lifestyle background characteristics and in a majority of the states was higher among men compared to women. Odds ratios from logistic regression analysis direct sex-related differences in risk factors. Hypertension increases with an increase in age and the risk is higher among older women (AOR, 5.58; 95% CI, 5.16-6.03 for women aged 40-49 and AOR, 4.24; 95% CI, 3.94-4.57 for men aged 50-54) compared to men. Education, types of jobs (specially technical, administrative and managerial), marital status and non-vegetarian diet were significantly associated with hypertension in men. While other than age; non-working, consumption of alcohol, and being a diabetic was found to be major risk factors for this disease among women. There are sex-related differences in prevalence as well as risk factors of hypertension in India. In order to prevent early developments of hypertension, awareness related to changing lifestyles such as a diet rich in fruits, vegetables as well as screening to control BP should be promoted among youths and adults in India. The study also recommends sex-specific approaches in health infrastructure and policies besides increasing public awareness.

The association between hypertension and other cardiovascular risk factors among non-diabetic Saudis adults-A cross sectional study

Population specific associations between cardiovascular disease with various risk factors including pre-hypertension and hypertension were reported. We aimed to investigate the association of higher than optimal blood pressure with measures of dysglycemia, dyslipidemia, and markers of inflammation in non-diabetic Saudi adults hoping to improve current Saudi guidelines to prevent cardiovascular disease. Volunteers were recruited randomly from public healthcare centers in Jeddah. Demographic information, blood pressure (BP), and anthropometric measurements were taken. Fasting blood samples were drawn, then again following 1-hour oral glucose tolerance test. Glycated hemoglobin, fasting plasma glucose (FPG), lipid profile, highly sensitive C- reactive protein, gamma glutamyl transferase, and 1-hour plasma glucose were measured. Complete data was found for 742 men and 592 women. Pre-hypertension was found in 47.2% of men, and 24.7% of women, while 15.1% of men, and 14.6% of women were hypertensive. Means of measured variables differed significantly between normotensive, pre-hypertensive, and hypertensive groups of men and women in gender specific manner. Association between measured variables and elevated BP, and hypertension were assessed using logistic regression models. After adjustment for age, body mass index and waist circumference, elevated blood pressure was associated with elevated triglycerides in men, while hypertension was significantly associated with elevated fasting plasma glucose, total cholesterol, triglycerides, low density lipoprotein- cholesterol, and low high density lipoprotein- cholesterol in men, and elevated triglycerides, and total cholesterol in women. Therefore, it is strongly recommended to measure lipid profile, specifically TG, for all diagnosed pre-hypertensive and hypertensive patients in addition to FPG for men.

Prevalence and Correlates of Hypertension Unawareness among Lebanese Adults: The Need to Target Those “Left Behind”

Introduction. Hypertension unawareness is context-specific, and our understanding of factors associated with it has implications on primary healthcare practices locally and contributes to achieving cardiovascular disease (CVD) targets, globally. In this study, we examine the prevalence and correlates of hypertension unawareness among adult Lebanese population. Methods. The study sample included a nationally representative sample of 2214 adults ≥25 years of age from the Noncommunicable Disease (NCD) Risk Factor WHO-STEPS cross-sectional survey conducted in Lebanon. In the first step, hypertension was assessed based on reported morbidity using face-to-face interviews, and in the second step, based on blood pressure (BP) measurement. We defined hypertension prevalence as systolic/diastolic blood pressure ≥140/90 mmHg and/or ongoing treatment for hypertension. Hypertension unawareness was described as lack of prior knowledge of hypertensive status. Those responding negatively to the face-to-face interview question “whether they had ever been told by a health worker that they have hypertension” were labelled as “apparently healthy.” Results. Overall prevalence of hypertension was 30.7%. A total of 369 subjects were unaware of their condition, representing 51.8% of all hypertensives and 15.9% of the apparently healthy. Multivariable analysis controlling for a number of confounders showed that, among apparently healthy participants, insurance coverage and contact with healthcare services were not associated with higher likelihood for hypertension awareness. Among all hypertensives, hypertension unawareness was significantly higher in the young, those with BMI <25 kg/m2 (adjusted OR (aOR): 2.52; 95% CI: 1.35–4.69), no CVD (aOR: 3.30; 95% CI: 1.74–6.29), and participants with no reported family history of hypertension (aOR: 4.87; 95% CI: 2.89–8.22), compared to their counterparts. Conclusion. In Lebanon, unawareness of hypertension occurred in those clinically least perceived to be at risk. These findings are key for optimizing current screening practices and informing NCD prevention efforts in the country and contribute to achieving global targets of the SDGs of “leaving no one behind.”

Using a Commercially Available App for the Self-Management of Hypertension: Acceptance and Usability Study in Saudi Arabia

BACKGROUND

The use of smartphone apps to assist in the self-management of hypertension is becoming increasingly common, but few commercially available apps have the potential to be effective along with adequate security and privacy measures in place. In a previous study, we identified 5 apps that are potentially effective and safe, and based on the preferences of doctors and patients, one (Cora Health) was selected as the most suitable app for use in a Saudi context. However, there is currently no evidence of its usability and acceptance among potential users. Indeed, there has been little research into the usability and acceptance of hypertension apps in general, and less research considers this in the Gulf Region.

OBJECTIVE

This study aims to evaluate the acceptance and usability of the selected app in the Saudi context.

METHODS

This study used a mixed methods approach with 2 studies: a usability test involving patients in a controlled setting performing predefined tasks and a real-world usability study where patients used the app for 4 weeks. In the usability test, participants were asked to think aloud while performing the tasks, and an observer recorded the number of tasks they completed. At the end of the real-world pilot study, participants were interviewed, and the mHealth App Usability Questionnaire was completed. Descriptive statistics were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data.

RESULTS

In total, 10 patients completed study 1. The study found that app usability was moderate and that participants needed some familiarization time before they could use the app proficiently. Some usability issues were revealed, related to app accessibility and navigation, and a few tasks remained uncompleted by most people. A total of 20 patients completed study 2, with a mean age of 51.6 (SD 11.7) years. Study 2 found that the app was generally acceptable and easy to use, with some similar usability issues identified. Participants stressed the importance of practice and training to use it more easily and proficiently. Participants had a good engagement level with 48% retention at the end of study 2, with most participants' engagement being classed as meaningful. The most recorded data were blood pressure, followed by stress and medication, and the most accessed feature was viewing graphs of data trends.

CONCLUSIONS

This study shows that a commercially available app can be usable and acceptable in the self-management of hypertension but also found a considerable number of possibilities for improvement, which needs to be considered in future app development. The results show that there is potential for a commercially available app to be used in large-scale studies of hypertension self-management if suggestions for improvements are addressed.

Evaluation of Quality of Life among Dental Professionals by Using the WHOQOL-BREF Instrument in Eastern Province of Saudi Arabia

Objective

To evaluate the quality of life (QOL) of dental professionals in the Eastern Province of Saudi Arabia.

Methods

This cross-sectional study recruited dental professionals (general dentists, specialists, and consultants) from public and private sectors in the Eastern Province of Saudi Arabia. The World Health Organization's QOL Assessment-BREF (WHOQOL-BREF) questionnaire was administered among study participants. The questionnaire addresses four domains of QOL which are physical, psychological, social relationships, and environment.

Results

There were 313 dental professionals in the study with a mean age of 35.72 (8.58) years. The mean score of QOL in the sample was 63 (13.9) on a 0–100 scale. 75% of the participants rated their QOL as good or very good. Of four domains, the social relationship domain had the highest mean score of QOL (67.04 SD: 23.52) and the physical domain had the lowest score (59.66 SD: 14.69). There were significant differences in the QOL of consultants (66.46 SD: 12.55), specialists (65.42 SD: 12.91), and general dentists (61.06 SD: 14.18) (P 0.010). The participants with medical illness had significantly lower QOL (56.91 SD: 12.83) than those without medical illness (63.67 SD: 13.92) (P 0.01). There were significant differences in the QOL of participants with 0–10 years since graduation (61.97 SD: 14.71), 11–20 years (61.92 SD: 13.56), and more than 20 years (68.53 SD: 10.71) (P 0.009).

Conclusion

The qualifications, medical illness, and years since graduation were important determinants of QOL among dental professionals. Measures should be taken to improve QOL of dental professionals which can enhance the quality of patient care.

Anxiety, Depression, and Common Chronic Diseases, and Their Association With Social Determinants in Saudi Primary Care

INTRODUCTION

Patients with chronic diseases can experience psychological conditions, including anxiety and depression. However, the association between chronic diseases and these psychological conditions remains unclear. This study aimed to identify the relationship between anxiety, depression, and common chronic diseases (hypertension, type 2 diabetes, dyslipidemia, and rheumatoid arthritis), and their association with social determinants at an outpatient primary care setting.

METHODS

The validated hospital anxiety and depression scale was administered electronically to eligible participants. For each condition (anxiety and depression), participants were categorized as normal, borderline abnormal, and abnormal, according to their score out of 21 (≤7 = normal, 8-10 = borderline abnormal, ≥11 = abnormal). The scores and numbers of participants in each category were analyzed and compared with their demographic characteristics and chronic diseases for associations and relationships.

RESULTS

We recruited 271 participants (mean age of 51.65 + 11.71 years) attending primary care clinics. Of these patients, 17.7% and 8.9% had borderline abnormal and abnormal depression, respectively, and 10.3% and 8.9% of patients had borderline abnormal anxiety and abnormal anxiety. Common social determinants and lifestyle factors were examined. Age, gender, and sugary drinks' consumption significantly increased the odds of hypertension and type 2 diabetes; vigorous physical activity 3 times a week, decreased the odds of developing these chronic diseases. Adjusted regression models showed a statistically significant association between the hospital anxiety and depression scale score for borderline and abnormal anxiety and the presence of type 2 diabetes (OR 3.04 [95% CI 1.13, 8.19], P-value = .03 and OR 4.65 [95% CI 1.63,13.22], P-value <.03, respectively) and dyslipidemia (OR 5.93 [95% CI 1.54, 22.86], P-value = .01, and OR 4.70 [95% CI 0.78, 28.35], P-value = .09, respectively). The odds of developing depression were 4 times higher (P-value .04) in patients with rheumatoid arthritis.

CONCLUSION

Among patients attending primary care outpatient clinics, anxiety, and depression were significantly associated with type 2 diabetes and rheumatoid arthritis, respectively. Social determinants and lifestyle factors play a major role in the development of common chronic diseases in Saudi Arabia. Primary care physicians should consider the patients' psychological status, sociodemographic status, and lifestyle risks during the management of chronic diseases.

Impact of the 2017 ACC/AHA guideline on the prevalence of elevated blood pressure and hypertension: a cross-sectional analysis of 10 799 individuals

OBJECTIVES

To assess the effect of the 2017 American College of Cardiology and the American Heart Association (ACC/AHA) hypertension guideline on the prevalence of elevated blood pressure (BP) and hypertension and the initiation of antihypertensive treatment, as well as the level of adherence to the BP target in the Saudi population.

DESIGN

A cross-sectional study.

PARTICIPANTS

A total of 10 799 adults (≥18 years old), with three BP readings during 2017-2020 from the Saudi Biobank was used.

PRIMARY OUTCOME

Hypertension was defined using three sources: the Joint National Committee 7 Blood Pressure Guideline (JNC-7) guideline (systolic BP (SBP)≥140 or diastolic BP (DBP)≥90 mm Hg), the 2017 ACC/AHA guideline (SBP≥130 or DBP≥80 mm Hg) and a self-reported hypertension diagnosis.

RESULTS

The prevalence of hypertension, according to the JNC-7 guideline, was 14.49% (95% CI 14.37 to 14.61), and the 2017 ACC/AHA, 40.77% (95% CI 40.60 to 40.94), a difference of 26.28%. Antihypertensive medication was recommended for 24.84% (95% CI 24.69 to 24.98) based on the JNC-7 guideline and 27.67% (95% CI 27.52 to 27.82) using the 2017 ACC/AHA guideline. Lifestyle modification was recommended for 13.10% (95% CI 12.47 to 13.74) of patients with hypertension who were not eligible for a pharmacological intervention, based on the 2017 ACA/AHA guideline. For patients with prescribed antihypertensive medication, 49.56% (95% CI 45.50 to 53.64) and 27.81% (95% CI 24.31 to 31.59) presented with a BP reading above the treatment goal, based on the 2017 ACA/AHA and JNC-7 guidelines, respectively. Using the two definitions, the risk factors were older age, male gender, diabetes diagnosis, increased body mass index, waist circumference and waist-to-hip ratio.

CONCLUSIONS

According to the 2017 ACC/AHA guideline, the prevalence of hypertension has increased significantly, but there was only a small increase in the proportion of patients recommended for antihypertensive treatment. A large proportion of patients with prescribed antihypertensive medication, had a BP above the target. Unless public health prevention efforts are adopted, the increased prevalence of elevated BP and hypertension will increase cardiovascular disease.