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

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.

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.

Prevalence and Associated Predictors of Hypertension in Adult Patients with Thyroid Nodules at the Royal Commission Hospital, Kingdom of Saudi Arabia

Background

Hypertension and thyroid nodules (TNs) are common medical problems that are increasing in prevalence globally. Hence, we conducted this study to assess the prevalence and associated predictors of hypertension in adult patients with TNs at the Royal Commission Hospital, Kingdom of Saudi Arabia (KSA).

Methods

A retrospective study was conducted between 1 January 2015 and 31 December 2021. Patients with documented TNs based on the Thyroid Imaging Reporting and Data System (TI-RADS) were recruited to assess the prevalence and associated risk factors for hypertension.

Result

Three hundred ninety-one patients with TNs were recruited for this study. The median (interquartile range, IQR) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. The median (IQR) body mass index (BMI) was 30.26 (7.71) kg/m². There was a high prevalence of hypertension (22.5%) in adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed hypertension in patients with TNs and age, sex, diabetes mellitus (DM), bronchial asthma, triiodothyronine (FT3), total cholesterol and high-density lipoprotein (HDL). In the multivariate analysis, age (OR = 1.076 [95% CI 1.048 - 1.105]), sex (OR = 2.28 [95% CI 1.132 - 4.591]), DM (OR = 0.316 [95% CI 0.175 - 0.573]) and total cholesterol levels (OR = 0.820 [95% CI 0.694 - 0.969]) were significantly associated with hypertension.

Conclusion

There is a high prevalence of hypertension in patients with TNs. Age, female sex, DM and elevated total cholesterol are significant predictors of hypertension in adult patients with TNs.

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.