Prevalence of hypertension and prehypertension and its associated cardioembolic risk factors; a population based cross-sectional study in Alkharj, Saudi Arabia

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.

Intraluminal Thrombus of the Extracranial Cerebral Arteries in Acute Ischemic Stroke: Manifestations, Treatment Strategies, and Outcome

Background

Intraluminal thrombus (ILT) of the cervical arteries is an uncommon finding that can lead to acute or recurrent ischemic stroke. Currently, antithrombotic therapy in the form of antiplatelet and/or anticoagulation is considered the mainstay of treatment, but evidence of which one has a better outcome is lacking.

Methods

A retrospective cohort study included 28 patients diagnosed with acute stroke or transient ischemic attack with ILT of the extracranial arteries from 2013 to 2022. The primary efficacy outcome was assessed as recurrent stroke, and the primary safety outcome was assessed as hemorrhagic complications. Secondary outcomes were assessed as the resolution of thrombi by CT angiography (CTA) and clinical improvement by the Modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS).

Results

Out of 28 patients, more than half (57.1%; n = 16) were males with a mean age of 57.8 ± 9.5 years and an average BMI of 26.9 ± 4.5 kg/m2. As initial treatment, twenty-four patients received anticoagulation and four received antiplatelet agents. Recurrent strokes were found in four patients (14.29%), and all were initially treated with anticoagulation. One patient in the anticoagulation group had a significant retroperitoneal hemorrhage. None of the patients in the antiplatelets group had a recurrent stroke or bleeding event. Initial treatment with antiplatelet agents significantly improved the NIHSS on day 7 (P = 0.017). A significant improvement in NIHSS on day 90 was observed in the anticoagulant group (P = 0.011). In the follow-up CTA performed on 24 patients, 18 (75%) showed complete resolution (3 out of 3 (100%) in the antiplatelet group and 15 out of 21 (71.43%) in the anticoagulant group).

Conclusion

Initial treatment with anticoagulants improves neurologic outcomes in patients with ILT-induced acute ischemic stroke but carries the risk of recurrent stroke and bleeding. However, initial treatment with dual antiplatelet agents appears to have comparable efficacy without sequelae, particularly in atherosclerosis-induced ILT.

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.

Effect of Arabic Qahwa on Blood Pressure in Patients with Stage One Hypertension in the Eastern Region of Saudi Arabia

Hypertension (HT), which is a condition of increased blood pressure (BP), is a major health problem globally. In Saudi Arabia, morbidity and mortality rates are increasing due to HT. Arabic Qahwa (AQ) is a commonly consumed beverage in Saudi Arabia and has numerous health benefits. We conducted a randomized control trial to investigate the effect of AQ on BP among patients with HT (Stage 1). Based on the inclusion criteria, 140 patients were randomly selected, and 126 patients were followed up. After obtaining demographic information, we assessed the BP, heart rate, and lipid profile before and after the intervention of consuming four cups of AQ daily for four weeks. A paired 't' test was used with a significance level of 5%. In the AQ group, there were significant changes (p = 0.009) in systolic blood pressure (SBP), with means of 134.72 ± 3.23 and 133.14 ± 3.69 observed pre and post-test, respectively. Similarly, the diastolic blood pressure (DBP) pre- and post-test mean scores were 87.08 ± 1.8 and 85.98 ± 1.95, respectively, which also showed significance (p = 0.001). There were also significant changes (p = 0.001) observed in the lipid profile of the AQ group. In conclusion, AQ is effective in reducing SBP and DBP in patients with stage one HT.

Prevalence and Awareness of Hypertension among a Rural Jazan Population

BACKGROUND

Hypertension (HTN) is a major global public health problem. Knowledge of the risk factors and repercussions of HTN is crucial to preventing the disease. Rural populations have lower levels of knowledge of the disease than urban populations. However, no studies have assessed the levels of awareness of HTN and their determinants in rural regions of Saudi Arabia.

OBJECTIVES

This study aimed to assess the awareness of HTN and its determinants among a rural population of Jazan region, Saudi Arabia.

METHODOLOGY

We conducted a cross-sectional analytical study among six primary healthcare centers selected randomly from the rural areas of Jazan region. We targeted all Saudi adults visiting these centers. Information was gathered using interview questionnaires completed by 607 people. SPSS was utilized to analyze the collected data.

RESULTS

In all population groups, the prevalence of diagnosed HTN increased with age, particularly gradually increasing in those aged younger than 40 years and then rapidly and sharply increasing in those aged 40 years and over. The women (43.3%) had a higher prevalence of HTN than the men (34.6%), which is comparable with findings in other areas in Saudi Arabia and the Middle East. Approximately 65.6% of the participants without HTN and 34.4% of the participants with HTN did not know their normal blood pressure. Approximately 61.7% of the participants without HTN and 59.0% of the participants with HTN felt that pharmaceuticals are insufficient in curing HTN, while 60.7% and 64.7% believed that HTN can be cured.

CONCLUSIONS

The global prevalence of HTN is increasing annually owing to rapid changes in lifestyle and dietary habits. Furthermore, because adherence to antihypertensives is poor in rural Jazan, the Ministry of Health and researchers advocate implementing a program to increase awareness and assess patient adherence to prescribed medication for the control of HTN.

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.

Prevalence of overweight and obesity in patients with major depressive disorder with anxiety: Mediating role of thyroid hormones and metabolic parameters

BACKGROUNDS

Anxiety is a common comorbidity in major depressive disorder (MDD); however, its role in overweight and obesity in MDD patients remains unclear. We examined the relationship between severe anxiety and overweight and obesity, as well as the mediating role of thyroid hormones and metabolic parameters in MDD patients.

METHODS

This cross-sectional study recruited 1718 first-episode drug-naïve MDD outpatients. All participants were rated on the Hamilton Depression Rating Scale for depression and Hamilton Anxiety Rating Scale for anxiety and measured in thyroid hormones and metabolic parameters.

RESULTS

A total of 218 (12.7 %) individuals had severe anxiety. The prevalence of overweight and obesity in patients with severe anxiety was 62.8 % and 5.5 %, respectively. Severe anxiety symptoms were related to overweight (Odds Ratio [OR]: 1.47, 95 % CI: 1.08, 2.00) and obesity (OR: 2.10, 95 % CI: 1.07, 4.15). The association between severe anxiety and overweight was mainly attenuated by thyroid hormones (40.4 %), blood pressure (31.9 %), and plasma glucose (19.1 %). For obesity, the association with severe anxiety was mainly attenuated by thyroid hormones (48.2 %), blood pressure (39.1 %), and total cholesterol (28.2 %).

LIMITATIONS

Due to the cross-sectional design, no causal relationship could be derived.

CONCLUSIONS

Thyroid hormones and metabolic parameters can explain the risk of overweight and obesity associated with severe anxiety in MDD patients. These findings add to the knowledge of the pathological pathway of overweight and obesity in severe anxiety comorbid MDD.

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.

Trends of the burden of hypertension in Saudi Arabia between 1990 and 2019: an analysis from the Global Burden of Diseases study.. [DOI: 10.21203/rs.3.rs-2609599/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Hypertension is a widely prevalent condition associated with significant morbidity and premature mortality, primarily because it is a risk factor for CVDs. The aim of this study was to estimate the trend of the burden of hypertension in Saudi Arabia in the last three decades. Methods: We conducted a systematic analysis of secondary data obtained from the Global Burden of Disease Study (GBD). We estimated sex-stratified, age-standardised and age-specific rates (per 100,000) of prevalence, deaths, and disability-adjusted years (DALYs) associated with hypertension in adults aged 20-94 years in Saudi Arabia between 1990 and 2019. Results: In Saudi Arabia, the age-standardised prevalence of hypertension increased from 87.7 cases per 100,000 in 1990 to 94.9 per 100,000 in 2019. More women than men had hypertension throughout the past three decades. The death and DALYs rate, however, decreased during this time. In 1990, 9.2 deaths per 100,000 in women and 3.0 deaths per 100,000 in men were due to hypertension; the respective rates declined to 6.5 and 2.8 in 2019. While the rates of DALYs in women declined steadily from 211.7 to 151.8 per 100,000 DALYs between 1990 and 2019, the rate in males did not decline considerably. The burden of hypertension–prevalence, deaths, and DALYs–were greater in older people. Conclusion: The prevalence of hypertension has increased in Saudi Arabia during the last 30 years; however, death rates and DALY related to hypertension has decreased during this time. Age- and sex-specific strategies are needed to decrease the prevalence of hypertension 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.

Traditional Chinese Medicine constitution types of high-normal blood pressure: A meta-analysis

Objective

We determined the distribution of constitutional types of high-normal blood pressure in Traditional Chinese Medicine (TCM) and provided evidence for the prevention of high-normal blood pressure and hypertension.

Methods

Eight digital databases were searched from January 2011 to November 2022, including PubMed, EMBASE, Web of Science, EBSCOhost, CNKI, CBM, Wangfang, and CQVIP. We performed a meta-analysis with the random-effects model or fixed-effects model to describe the distribution of constitutional types of high-normal blood pressure in TCM. The studies were assessed based on heterogeneity testing and the potential for publication bias. The meta-analysis was performed on Stata software 15.0.

Results

A total of 17 studies with 8118 participants were included in this meta-analysis. The proportion of the biased constitution (82.3%; 95% CI: 75.6%-89.1%, p < 0.001) was higher than the balanced constitution (17.3%; 95% CI: 10.7-23.8%, p < 0.001). Phlegm-dampness constitution, Yin-deficiency constitution, and damp-heat constitution accounted for 16.0% (95%CI: 10.5-21.5%, p < 0.001), 14.8% (95% CI: 11.0-18.6%, p < 0.001), 11.3% (95% CI: 8.0-14.5%, p < 0.001) of the total high-normal blood pressure cases, respectively. The subgroup analyses performed that region, age and gender were positively associated with the distribution of constitution types of high-normal blood pressure in TCM. Compared with the general population, the risk of high-normal blood pressure in people with the phlegm-dampness constitution, Yin-deficiency constitution, and blood-stasis constitution was 2.665 (95%CI: 2.286-3.106, p < 0.001), 2.378 (95%CI: 1.197-4.724, p = 0.013), 1.965 (95%CI: 1.634-2.363, p < 0.001) times of the general population, respectively. Meanwhile, the risk of high-normal blood pressure was lower in people with a balanced constitution (0.248, 95%CI: 0.165-0.372, p < 0.001).

Conclusions

Phlegm-dampness constitution, Yin-deficiency constitution, and damp-heat constitution were the common constitution types of high-normal blood pressure. There might also be differences in the distribution characteristics of TCM constitution among people with high-normal blood pressure in different regions, ages, and genders. Finally, a balanced constitution might be a protective factor for hypertensive people.

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.

Prevalence and determinants of undiagnosed hypertension in the Western region of Saudi Arabia

Recent data regarding the prevalence and determinants of undiagnosed hypertension in Saudi Arabia are particularly lacking. This study aimed to investigate the prevalence of undiagnosed hypertension and to identify potential associates of hypertension risk among adults in the Western region of Saudi Arabia. Cross-sectional data for 489 Saudi adults were collected from public places in the cities of Madinah and Jeddah. Demographic, anthropometric (height, weight, waist circumference), and blood pressure (assessed by a digital sphygmomanometer) data were collected from all participants during face-to-face interviews. The American College of Cardiology and American Heart Association guidelines were used to evaluate blood pressure status. Sodium intake was assessed using a semi-validated food frequency questionnaire. The prevalence of undiagnosed, elevated blood pressure, stage I, or stage II hypertension was 9.82%, 39.5%, and 17.2%, respectively. The proportions of individuals with undiagnosed hypertension were higher among men and smokers (p < .001 for both). Blood pressure status was positively associated with weight, body mass index, and waist circumference among participants (p < .001 for all). Higher body mass index and waist circumference were associated with increased odds of stage I and stage II hypertension. Sodium intake was not associated with blood pressure status. A strikingly high prevalence of undiagnosed hypertension was observed among the study sample. National intervention programs are necessary to encourage regular screening and follow-up for the early detection and management of hypertension.

The Use of Dietary Approaches to Stop Hypertension (DASH) Mobile Apps for Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review

Background

Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile apps have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP.

Objective

This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and consequently reduce BP. A secondary aim was to assess engagement, satisfaction, acceptance, and usability related to DASH mobile app use.

Methods

The Embase (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The reference lists of the included articles were also checked. Studies were eligible if they (1) were randomized controlled trials (RCTs) or pre-post studies of app-based interventions for adults (aged 18 years or above) with prehypertension or hypertension, without consideration of gender or sociodemographic characteristics; (2) used mobile phone apps alone or combined with another component, such as communication with others; (3) used or did not use any comparator; and (4) had the primary outcome measures of BP level and adherence to the DASH diet. For eligible studies, data were extracted and outcomes were organized into logical categories, including clinical outcomes (eg, systolic BP, diastolic BP, and weight loss), DASH diet adherence, app usability and acceptability, and user engagement and satisfaction. The quality of the studies was evaluated using the Cochrane Collaboration’s Risk of Bias tool for RCTs, and nonrandomized quantitative studies were evaluated using a tool provided by the US National Institutes of Health.

Results

A total of 5 studies (3 RCTs and 2 pre-post studies) including 334 participants examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the 3 RCTs had a high risk of bias. One pre-post study had a high risk of bias, while the other had a low risk. As a consequence, no firm conclusions could be drawn regarding the effectiveness of DASH smartphone apps for increasing DASH diet adherence and lowering BP. All the apps appeared to be acceptable and easy to use.

Conclusions

There is weak emerging evidence of a positive effect of using DASH smartphone apps for supporting self-management to improve DASH diet adherence and consequently lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps.

Validity and reliability of the Arabic version of the revised illness perception questionnaire for patients with hypertension

Background

Hypertension is one of the leading causes of morbidity and mortality in Saudi Arabia affecting 31.4% of the population. The Illness Perception Questionnaire-Revised (IPQ-R) is a validated and reliable tool for assessing the perception of hypertension among patients. This cross-sectional study aimed to translate the Revised Illness Perception Questionnaire (IPQ-R) into Arabic and validate it among Arabic patients with hypertension from the outpatient departments of the Prince Sattam University Hospital and King Khalid Hospital (KKH) in Al-Kharj City in the Kingdom of Saudi Arabia.

Methods

A bilingual panel of doctors and medical translators was assembled to translate the IPQ-R into Arabic. The questionnaire was administered to 100 adult Arabic speaking patients with clinically diagnosed primary hypertension. Patients with secondary hypertension or complications of hypertension were excluded from the study.

Results

Fifty-seven patients (57%) were male and sixty-five (65%) were older than 40 years. Headache was the most common symptom of hypertension reported by 65% of the participants. The internal consistency of the questionnaire excluding the domain of 'Disease Identity' was 0.76 indicating satisfactory consistency. There were weak to moderate positive linear correlations (r = 0.003-0.561) between the domains of IPQ-R suggesting a reasonable discriminant validity among the domains.

Conclusion

The Arabic version of the IPQ-R for hypertensive patients is a consistent, valid, and reliable tool to be used by researchers or clinicians for assessing knowledge, beliefs, and attitudes of Arabic speaking patients with hypertension living in Saudi Arabia.

Prevalence of Cardiovascular Risk Factors Among Patients With Diabetes Mellitus Type 2 at King Fahad University Hospital, Saudi Arabia

Background

Diabetes mellitus is considered a major risk factor for cardiovascular diseases. Patients with diabetes mellitus type 2 (DM-II) are at twice as high risk for the development of cardiovascular diseases than the general population. Thus, we aimed to assess the most prevalent cardiovascular risk (CVR) factors among DM-II patients in the Eastern province of Saudi Arabia.

Method

This is a cross-sectional, retrospective, and observational study conducted on DM-II patients at King Fahad University Hospital (KFUH) Al Khobar, Saudi Arabia, from January 2016 to December 2021. The total number of participants was 373 who were patients with DM-II. The patients' demographic information (age, sex, marital status, height, weight, body mass index (BMI), waist, hip circumference, and waist-hip ratio were calculated or obtained from hospital electronic records as were the CVR factors, age, gender, smoking habits, physical activity, BMI, haemodynamic measurements, glycosylated haemoglobin (HbA1C) levels and lipid profile.

The collected data were analyzed by using SPSS Statistics v.28 (IBM Corp., Armonk, NY). The descriptive statistics were reported using mean±SD for numerical data and relative frequencies (%) for categorical data. P < 0.05 were counted significant. Quantitative data were analyzed using the ANOVA test to compare the means of the three groups. Qualitative data were analyzed and compared using the chi-square test. Fisher’s exact test was also used to study the statistical significance of variables. Spearman rank correlation was used to study the relationship between HbA1C and other CV risk factors. 

Results

The mean age was 58 (± 13) years; females were 57% of the sample. Around 92% were smokers, 84% had a sedentary lifestyle, 72% had dyslipidemia, 58% were obese, 30% were overweight, 58% reported poorly control of their diabetes, 50% had hypertension and 32% had pre-hypertension. Furthermore, 89% of participants had two or more CVR factors other than DM-II. We found a significant association between high body mass index, dyslipidemia, high systolic blood pressure and pulse pressure (p<0.05) with HbA1C.

Conclusion

The majority of participants had two or more cardiovascular risk factors in addition to DM-II. Poor control of DM-II and cardiovascular risk factors cannot be ignored and primary to tertiary prevention must be the top priority when managing the diabetic population in order to prevent devastating outcomes and progression of reversible morbidity.

Diet-related knowledge, attitudes, and behaviors among young and middle-aged individuals with high-normal blood pressure: A cross-sectional study in China

Background

Dietary modifications play an important role in the prevention and management of high-normal blood pressure (BP). The aim of this study was to investigate diet-related knowledge, attitudes, and behaviors, and the socio-demographic determinants of these, among young and middle-aged Chinese individuals with high-normal BP.

Methods

Data from the 2015 China Health and Nutrition Survey (CHNS) were analyzed in this study. A total of 1,756 subjects with high-normal BP were included. A chi-square test and binary logistic regression analysis were conducted to identify the risk factors toward diet-related knowledge, attitudes, and behaviors.

Results

A total of 37.4% of the participants knew about the Chinese Food Pagoda (CFP) or the Dietary Guidelines for Chinese Residents (DGCR). Overall, 39.8% of the subjects were classified as having adequate diet-related knowledge literacy, 27.8% reported positive diet-related attitudes to healthy eating, and 35.3% reportedly looked for nutrition knowledge. Of note, 72.4% and 80.1% of the participants reported liking to eat fruits and vegetables, respectively. Individuals with a middle school education [odds ratio (OR) = 1.784, 95% CI = 1.236-2.576], high school/vocational education (OR = 1.944, 95% CI = 1.305-2.896), and college degree or above (OR = 2.089, 95% CI = 1.341-3.322), who were living in a rural area (OR = 1.311, 95% CI = 1.048-1.639), proactively looking for nutrition knowledge (OR = 1.529, 95% CI = 1.227-1.906), and reported liking to eat vegetables (OR = 1.939, 95% CI = 1.409-2.688), were more likely to have sufficient dietary knowledge literacy. Managers (OR = 1.655, 95% CI = 1.039-2.635) were more likely to have positive dietary attitudes. Female gender (OR = 1.396, 95% CI = 1.089-1.790), high school/vocational school education (OR = 2.071, 95% CI = 1.269-3.379), college degree and above (OR = 2.207, 95% CI = 1.262-3.862), knowledge about the CFP or DGCR (OR = 8.138, 95% CI = 6.326-10.468), and sufficient dietary knowledge literacy (OR = 1.338, 95% CI = 1.050-1.705) were associated with an increased likelihood of looking for nutrition knowledge.

Conclusion

Individuals with high-normal BP, predominantly males, living in rural area, with lower education, farmers, workers, service workers, and workers in the non-government employment unit may have poor diet-related knowledge, attitudes, and behaviors.

Prevalence of hypertension and pre-hypertension in the Middle East region: a systematic review & meta-analysis

Hypertension is a leading cause of mortality and morbidity globally. This study aimed to obtain an overall regional estimate of the prevalence of hypertension and pre-hypertension and present the disease pattern based on the age and time in the Middle East region. We searched PubMed, Google Scholar, Medline for articles on the prevalence of hypertension, pre-hypertension among countries of the Middle East region from 1999 to 2019. STATA-14 was used to analyze the data. Data were pooled using a random-effects meta-analysis model, and heterogeneity between studies was assessed using I² test and subgroup analysis. A total of eighty-three studies with 479816 participants met the criteria for inclusion in the meta-analysis process. The overall prevalence of hypertension and pre-hypertension in the Middle East region were 24.36% (95% CI: 19.06-31.14) and 28. 60% (95% CI: 24.19-33.80), respectively. An increasing trend in the prevalence of hypertension was observed with the increasing age. The prevalence of hypertension in the ≤ 49-year-old age group was 17.13% (95% CI: 13.79-21.27) and in people over 60 years was 61.24% (95% CI: 55.30-67.81) (P < 0.001). This pattern has been similar among both males and females. On the other hand, a decreasing trend in the prevalence of pre-hypertension was observed with the increasing age. The increasing trend in the prevalence of hypertension and decreasing trend in the prevalence of pre-hypertension with age are significant concerns in the Middle East region. Screening for the prevention and control of hypertension should prioritize public health programs.

Proteinuria and its associated factors in patients attending family medicine clinics in Dammam, Saudi Arabia

BACKGROUND

Urinalysis is a simple, valuable, and low-cost tool for the detection of proteinuria, a significant risk factor for renal and cardiovascular diseases. The purpose of this study was to determine the rate of proteinuria and its associated risk factors in patients attending Family Medicine Clinics in Dammam, Saudi Arabia, as no study of that nature had previously been conducted.

MATERIALS AND METHODS

In this register-based cross-sectional study, data including urinary protein and other urinalysis components ordered between January 2018 and January 2020 were collected from electronic medical records. In addition, data regarding nationality, gender, age, blood pressure, body mass index, serum human chorionic gonadotropin, fasting glucose, hemoglobin A1c (HbA1c), 25-hydroxy Vitamin D level, blood urea nitrogen (BUN), uric acid, creatinine, estimated glomerular filtration rate (eGFR), and lipid profile was also obtained. Proteinuria was classified as negative if no or trace protein was present, and positive if protein was ≥1+, and was considered overt proteinuria.

RESULTS

In total, results of 2942 urinalysis tests were included. The mean age of the patients was 42.4 ± 14.5 years; majority of the patients were females (62.3%) and were Saudis (68.8%). The rate of proteinuria was 4.2%. Saudi nationality, female gender, age ≥ 40 years, high systolic blood pressure, high diastolic blood pressure, fasting glucose ≥126, HbA1c ≥6.5%, BUN >20 mg/dl, creatinine >1.3 mg/dl, low eGFR <60, and high low-density lipoproteins cholesterol were significantly associated with proteinuria based on bivariate analysis. Using a logistic regression model, a statistically significant association was observed between proteinuria and advancing age, the presence of urinary casts, elevated serum creatinine level, and Saudi nationality.

CONCLUSION

The only variables that were independently associated with proteinuria using the logistic regression were the presence of casts in the urine, Saudi nationality, high creatinine level, and older age. These variables should be borne in mind by treating physicians.

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 and associated risk factors of hypertension and pre-hypertension among the adult population: findings from the Dubai Household Survey, 2019

BACKGROUND

Minimal data is available on the prevalence and correlates of hypertension and prehypertension in Dubai. The study aims to measure the prevalence of hypertension and pre-hypertension and the associated socio-demographic characteristics, behavioral risk factors and comorbidities among the adult population of Dubai.

METHODS

This study used data from the Dubai Household Health Survey, 2019. A cross-sectional population survey based on a complex stratified cluster random design. The total eligible sample included 2530 adults (18+). Sociodemographic and behavioral factors were considered as independent covariates. The main study outcome variables, pre-hypertension and hypertension, were ordinal, with normotension as the reference group.

RESULTS

The overall prevalence of hypertension in adults was 32.5% (38.37% in males and 16.66% in females). Prehypertension was prevalent in 29.8% of adults in Dubai (28.85% in males and 32.31% in females). The multivariate logistic regression analysis revealed that age groups, gender, occupation, and high Body Mass Index were significantly associated with a higher risk of hypertension at the level of P < 0.05. No clear trend toward a higher correlation of hypertension was noted with the increase in age, except after the age of 50 years. Males were five- times more likely to be hypertensive than females. Participants enrolled in skilled and service works had a five times higher risk of hypertension, compared with the reference group (professionals). Obese subjects had a 5.47-times greater correlation of hypertension compared with normal-weight subjects. Physically active individuals were less likely to develop hypertension. For the correlates with prehypertension in the present analysis, skilled and service workers and those working in elementary jobs had a higher risk of prehypertension, compared with the reference group (professionals) Individuals with a status of overweight were associated with a higher prevalence of prehypertension compared with people of normal weight.

CONCLUSIONS

This study showed a high prevalence of prehypertension and hypertension among adults in Dubai. Some socio-demographic and behavioral risk factors were correlated with prehypertension and hypertension among the studied population. Interventions aiming at increasing public awareness about such risk factors are essential.

Investigating the incidence and risk factors of hypertension: A multicentre retrospective cohort study in Tabuk, Saudi Arabia

Background

Hypertension is a major global health concern affecting approximately 1.13 billion people worldwide, with most of them residing in developing countries. The aim of this study was to determine the incidence of different stages of hypertension and its associated modifiable and non-modifiable risk factors among patients in military-setting hospitals in Tabuk, Saudi Arabia.

Methods

This retrospective cohort study was conducted at two hospitals in Tabuk, Saudi Arabia. The data were collected from hospital electronic records from 1 January 2019 to 31 December 2019. The blood pressure levels of patients from the last three separate medical visits were recorded. Descriptive statistics and multinomial logistic regression were used for the data analysis.

Results

The study included 884 hypertensive patients. The incidences of stage of elevated BP, stage 1, stage 2, and hypertension crisis were 60.0, 29.5, 7.0, and 3.5 cases per 1000 persons. Multivariate analysis indicated that progression from the stage of elevated blood pressure to hypertension crisis was significantly associated with advanced age (odds ratio [OR] = 3.62, 95% confidence interval [CI] = 1.99–8.42), male sex (OR = 2.84, 95% CI: 0.57–5.92), and a positive family history of hypertension (OR = 1.95, 95% CI: 1.23–3.09). Other key determinants of the development of stage of elevated blood pressure to hypertension crisis were current smoking status (OR = 1.74, 95% CI: 1.23–4.76), and physical inactivity (OR = 6.48, 95% CI: 2.46–9.14).

Conclusion

The incidence stage of elevated blood pressure was high among the patients investigated at armed forces hospitals in Tabuk, Saudi Arabia. The logistic regression model proposed in the present study can be used to predict the development of different stages of hypertension. Age, sex, marital status, family history, smoking status, and physical activity play an important role in the development of hypertension. Better strategies to improve awareness, screening, treatment, and management of hypertension are required in Saudi Arabia.

Medication Adherence Among Hypertensive Patients Attending Different Primary Health Centers in Abha, Saudi Arabia: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Optimal blood pressure control is achieved by medication adherence. This will reduce the risk of associated morbidities and mortalities. The present study aimed to determine medication adherence and its associated factors among hypertensive patients attending different primary health centers (PHC) in Abha, Saudi Arabia (KSA).

METHODS

A cross-sectional study was conducted among ten different PHCs in Abha, KSA. Simple random sampling procedure was utilized to choose 400 participants. A structured anonymous questionnaire was used in the present study. Analysis of the data was done using the SPSS program, version 23. A logistic regression statistical test was applied to identify the independent associated factors of medication adherence. Furthermore, we have applied Spearman's test to find the correlation between overall B-IPQ score and medication adherence score.

RESULTS

A total of 400 hypertensive patients responded in the present survey. More than one-third of the participants (36.3%) were in the high adherence category group, while the remaining participants (63.7%) were either low or medium adherence category. The binary logistic regression analysis revealed that low and medium adherence category is significantly associated with age (adjusted odds ratio [AOR] = 0.96, 95% CI =0.93-0.99, p = 0.021), married participants (AOR = 0.42, 95% CI =0.33-0.58, p = 0.001), residing at village (AOR = 1.49, 95% CI =1.14-1.73, p = 0.038), and participants with monthly family income of 5000 to 7000 SAR (AOR = 3.06, 95% CI =1.62-5.79, p = 0.001). A negligible positive correlation was revealed between illness perception and medication adherence.

CONCLUSION

The present study revealed that hypertensive patients poorly adhere to their antihypertensive medications. This low adherence is significantly associated with the age, monthly income, people living in rural areas, and married participants. The present study results recommend sustained efforts to implement health education programs and awareness-raising interventions targeted at hypertensive patients.

Hypertension and pre-hypertension in Middle East and North Africa (MENA): A meta-analysis of prevalence, awareness, treatment, and control

Hypertension (HTN) is one of the most important public health challenges, especially in developing countries. Despite individual studies, information on the exact prevalence of prehypertension (pre-HTN) and HTN in the Middle East and North Africa (MENA) is lacking. This meta-analysis was conducted to evaluate prevalence of pre-HTN and HTN, awareness, treatment, and control in the MENA region. PubMed, Web of Science, and Scopus databases were searched from inception to April 30, 2021. Keywords included hypertension, pre-hypertension, awareness, treatment, and control. The quality of the included studies was evaluated using the Hoy scale. A random-effects model was evaluated based on overall HTN. The heterogeneity of the preliminary studies was evaluated using the I² test. A total of 147 studies involving 1,312,244 participants were included in the meta-analysis. Based on the results of the random-effects method (95% CI), the Prevalence of pre-HTN and HTN were 30.6% (95% CI: 25.2, 36.0%; I² = 99.9%), and 26.2% (95% CI: 24.6, 27.9%; I² = 99.8%), respectively. The prevalence of HTN awareness was 51.3% (95% CI: 47.7, 54.8; I² = 99.0%). The prevalence of HTN treatment was 47.0% (95% CI: 34.8, 59.2; I² = 99.9%). The prevalence of HTN control among treated patients was 43.1% (95% CI: 38.3, 47.9; I² = 99.3%). Considering the high prevalence of HTN, very low awareness, and poor HTN control in the region, more attention should be paid to preventive programs for HTN reduction.

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 relationship between overweight and thyroid function in first-episode, untreated Chinese patients with major depressive disorder with different ages of onset

BACKGROUND

Major depressive disorder (MDD) and obesity are common. There are many differences in many aspects of MDD patients at different ages of onset (AOO); however, there are currently no studies on differences in obesity or overweight. This study aims to evaluate whether thyroid function changes with body weight, and to explore the related factors of overweight in MDD patients with different AOOs.

METHODS

A total of 1716 first-episode, untreated Chinese Han outpatients with MDD were recruited from a general hospital. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Positive Symptom subscale of the Positive and Negative Syndrome Scale (PANSS) were used to evaluate anxiety, depression and psychotic symptoms, respectively. The participants were divided into two groups: early adulthood onset (EAO, <45 years old) and mid-adulthood onset (MAO, >=45 years old).

RESULTS

Compared with EAO patients, MAO patients scored higher on the HAMD, HAMA, CGI-S and PANSS positive symptoms subscale, and they also had higher systolic and diastolic blood pressure (BP), higher serum levels of thyroid stimulating hormone (TSH), FBG, cholesterol (TC) and low-density lipoprotein, but they had lower serum levels of free triiodothyronine 3 and high-density lipoprotein. TSH, anti-thyroglobulin (TgAb), TC and systolic BP were correlated with overweight in MAO patients, while TSH and FBG were correlated with overweight of EAO patients.

CONCLUSIONS

The results indicate that TSH is related to overweight in both AOO subgroups, and the influencing factors of overweight related to thyroid function may be different in different AOOs.

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.

Association between prehypertension and psychological distress among adults in Saudi Arabia: A population-based survey

Background

Prehypertension is a precursor to hypertension status. Psychological distress has been identified earlier among hypertensives; however, there is little evidence for the presumptive relationship between prehypertension and psychological distress.

Objective

The study aimed to assess the psychological wellbeing of the Al-Kharj, Saudi Arabia population, using the General Health Questionnaire (GHQ-12) and correlating it with prehypertensive patients in the same population.

Methods

A cross-sectional analysis of the population of Al-Kharj, Saudi Arabia, was carried out between January and June of 2016. With an 85 percent response rate, a total of 1016 participants participated in the study. A multiple linear regression analysis was performed to assess the relationship between prehypertension and psychological distress.

Results

The findings of the adjusted analysis demonstrated that, on average prehypertensive patients were more distressed psychologically than non-hypertensive patients (unstandardized Beta regression coefficient = 3.600; P-value 0.025). Similarly, on average women were found to be more psychologically distressed than men (unstandardized Beta = 1.511, P-value 0.002). Civil workers and unemployed individuals were more psychologically distressed than employed individuals (unstandardized Beta = 1.326, P-value 0.041) while adjusting for the sociodemographic and other variables such as BMI, diabetes status, cholesterol, and smoking status.

Conclusion

The current study shows that as compared to normotensive patients, self-rated mental wellbeing and psychological wellbeing are all considerably poorer among prehypertensive patients. To prevent individuals from having negative psychological outcomes and their long-term complications, the Government of Saudi Arabia needs to concentrate on prehypertensive, female, and unemployed individuals. Well-designed longitudinal studies, primarily in Saudi Arabia, are needed in the future to research the cause and impact of poor mental health and prehypertension.

Cardiovascular Health and The Intestinal Microbial Ecosystem: The Impact of Cardiovascular Therapies on The Gut Microbiota

It has become evident over the past several years that the intestinal microbial ecosystem plays a critical role in the development and prevention of cardiovascular diseases (CVDs) and other metabolic disorders, such as hypertension, obesity, diabetes mellitus, and metabolic syndrome. The intestinal microbiota ecosystem functions as a major virtual endocrine organ that interacts and responds to molecules' signals within the host. Several meta-organismal pathways are involved in the gut-host interaction, including trimethylamine-N-oxide (TMAO) and short-chain fatty acids (SCFA). Host phenotype and cardiovascular diseases (CVDs) varying from hypertension, insulin resistance, and obesity to more specific inflammatory processes, such as atherosclerosis and hypercoagulability, have shown to be affected by the gut-host interaction. Additionally, several studies that involved animals and humans demonstrated a striking connection between the development of new CVDs and an imbalance in the gut microbiota composition along with the presence of their derived metabolites. Through this review article, we aim to evaluate the role of the normal gut microbiota ecosystem, its association with CVDs, effects of the therapies used to control and manage CVDs in the gut microbiota environment and explore potential therapeutic interventions to amplify disease outcomes in patients with CVDs.

Hypertension among Mongolian adults in China: A cross-sectional study of prevalence, awareness, treatment, control, and related factors: Hypertension among Mongolian adults in China

The objectives of the study were to comprehend the prevalence of hypertension (HTN) and prehypertension (PHT), awareness, treatment, and control of HTN and its distribution in urban, agricultural, pastoral, and semi-agricultural/semi-pastoral areas, and to explore the related factors of HTN among Mongolian adults in China. From August 2018 to August 2020, a multi-stage stratified cluster random sampling method was conducted to investigate the prevalence of HTN among Mongolian adults aged ≥18 years living in China (n = 2558). Inclusion criteria for HTN were systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg and/or had hypertensive history and/or taking antihypertensive drugs for HTN. The prevalence rates of HTN and PHT were 44.77% and 32.03%, respectively. The prevalence rates of PHT in urban, agricultural, pastoral, and semi-agricultural/semi-pastoral areas were 34.93%, 34.73%, 26.03%, and 33.44%, respectively, and the prevalence rates of HTN were 35.97%, 40.15%, 49.68%, and 48.07%, respectively. The awareness, treatment and control rates of HTN were 66.48%, 58.93%, and 16.48%, respectively. In this survey, the overweight, obesity, and central obesity rates were 34.30%, 30.67%, and 58.08%, respectively. Compared with Chinese adults ≥18 years, the prevalence rate of HTN among Mongolian adults in China aged ≥ 18 years was relatively high; the prevalence rate of PHT and HTN awareness, treatment, and control rates were similar. The prevalence of HTN and the rates of obesity and central obesity were higher in pastoral regions than in the other three types of regions, and the rate of overweight was highest in agricultural regions.

Pre-Hypertension and Its Determinants in Healthy Young Adults: Analysis of Data from the Korean National Health and Nutrition Examination Survey VII

The purpose of this cross-sectional study was to identify risk factors in the normotensive and pre-hypertensive group based on the blood pressure results of healthy young adults from the Korean National Health and Nutrition Examination Survey 2018. The participants were 2225 healthy young adults between the ages of 19 and under 45, excluding those with a diagnosis of hypertension or taking antihypertensive medications. Of the 2225 participants, the normotensive group was 1498 (67.3%) and the pre-hypertensive group 727 (32.7%). Determinants of pre-hypertension were analyzed using multiple logistic regression based on a complex sample design. Factors related to pre-hypertension in young adults were age, smoking, waist circumference, diabetes, anemia, cholesterol levels including HDL cholesterol, and uric acid levels. Pre-hypertension is a pre-stage that can prevent the morbidity of hypertension through lifestyle control, so its management is very important. Furthermore, a young adult is a stage in the growth and development of human beings, in which lifestyles such as healthy behaviors, eating habits, and exercise are fixed. Therefore, it is very important to improve lifestyles such as diet, exercise, and smoking cessation and to control risk factors in young adults who are at the pre-hypertension stage for health promotion. Continuous health examinations should be conducted for young adults, and education that can be practiced based on clinical data through this should be implemented for community health.

Blood Pressure and Cardio-Metabolic Risk Profile in Young Saudi Males in a University Setting

Background and Objectives: The prevalence of cardiovascular diseases (CVDs) poses significant clinical and public health challenges across the world. This study aimed to study the metabolic risk factors and the association with blood pressure alteration. Materials and Methods: This was a cross-sectional study conducted between 2017 and 2018 among 284 male university students in Eastern province, Saudi Arabia. The obesity and cardiovascular measurements were taken using standardized instruments, including blood pressure (BP), mean arterial pressure, body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and basal metabolic rate (BMR). Statistical Analysis: Blood pressure was classified according to the United States of America, Sixth Joint National committee (JNC-VI) guidelines. The mean and standard error were calculated for each hypertension group variable. Logistic regression was applied to predict associations. Results: The prevalence of hypertension in the present study was 61.6%., and that of overweight and obesity was 16.5% and 34.9%, respectively. The cut-off values of BMI and WC were 22.23 and 75.24, respectively. Conclusions: The results demonstrated that BMI, WC, WHR, and WHtR significantly predict hypertension and that WC has a greater discrimination capacity than other measures. The findings also emphasize the importance of cardiovascular risk screening for young adults to detect any alterations in blood pressure and thus identify the population that is vulnerable to CVDs at an early stage. The findings highlight the need for health and university policymakers to adopt measures to monitor and control hypertension and obesity at the university level.

Trends in the prevalence of hypertension according to severity and phenotype in Chinese adults over two decades (1991-2015)

Until recently, few studies have reported the secular trend and associated factors of hypertension severities and phenotypes in China. In this study, the authors aimed to assess the trend in the prevalence of hypertension according to severity and phenotype in Chinese adults from 1991 to 2015 and to explore potential cardiometabolic factors. From the China Health and Nutrition Survey (CHNS), the authors included 164 682 records of adults (≥18 years). The prevalence of hypertension by severity (stage 1 and stage 2 hypertension) and by phenotype (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic-diastolic hypertension [SDH]), during 1991-2015 was explored. The potential effects of demographic, socioeconomic, geographic, and cardiometabolic factors on hypertension severities and phenotypes were assessed by multivariable logistic regression. During 1991-2015, the overall prevalence of hypertension increased dramatically from 15.7% to 23.3%. For stage 1 and stage 2 hypertension, the age-standardized prevalence increased from 10.1% to 15.6% and from 5.5% to 7.4%, respectively. For ISH and SDH, the age-standardized prevalence rates rose from 3.6% to 6.4% and from 6.9% to 10.4%, respectively. Advanced age and medium/high urbanization were positively associated factors, whereas females, higher educational attainments, and residing in Southern China were negatively associated factors. Additionally, general obesity, central obesity, diabetes, and elevated triglyceride levels were linked to ISH, IDH, and SDH. The present study documents an increasing trend in the prevalence of hypertension, including different severities and phenotypes, among Chinese adults over more than two decades. Efforts for the prevention and management of hypertension are in urgent need in China.

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.

Prevalence of prehypertension and its risk factors in midlife and late life: Indonesian family life survey 2014-2015

BACKGROUND

Early detection of prehypertension is important to prevent hypertension-related complications, such as cardiovascular disease, cerebrovascular disease and all-cause mortality. Data regarding the prevalence of prehypertension among mid- and late-life population in Indonesia were lacking. It is crucial to obtain the prevalence data and identify the risk factors for prehypertension in Indonesia, which may differ from that of other countries.

METHODS

The cross-sectional analysis utilized multicenter data from Indonesian Family Life Survey-5 (IFLS-5) from 13 provinces in 2014-2015. We included all subjects at mid-and late-life (aged ≥40 years old) from IFLS-5 with complete blood pressure data and excluded those with prior diagnosis of hypertension. Prehypertension was defined as high-normal blood pressure according to International Society of Hypertension (ISH) 2020 guideline (systolic 130-139 mmHg and/or diastolic 85-89 mmHg). Sociodemographic factors, chronic medical conditions, physical activity, waist circumference and nutritional status were taken into account. Statistical analyses included bivariate and multivariate analyses.

RESULTS

There were 5874 subjects included. The prevalence of prehypertension among Indonesian adults aged > 40 years old was 32.5%. Age ≥ 60 years (adjusted OR 1.68, 95% CI 1.41-2.01, p <  0.001), male sex (adjusted OR 1.65, 95% CI 1.45-1.88, p <  0.001), overweight (adjusted OR 1.44, 95% CI 1.22-1.70, p <  0.001), obesity (adjusted OR 1.77, 95% CI 1.48-2.12, p <  0.001), and raised waist circumference (adjusted OR 1.32, 95% CI 1.11-1.56, p = 0.002) were the significant risk factors associated with prehypertension. Prehypertension was inversely associated with being underweight (adjusted OR 0.74, 95% CI 0.59-0.93, p = 0.009).

CONCLUSIONS

The prevalence of prehypertension in Indonesian mid- and late-life populations is 32.5%. Age ≥ 60 years, male sex, overweight, obesity, and raised waist circumference are risk factors for prehypertension.

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.

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.

The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey

Background

Hypercholesterolemia (HC) is an important precursor to many cardiovascular, cerebrovascular, and peripheral vascular diseases. A report conducted by the American Heart Association showed the prevalence of HC to be 11.9%, with around 28.5 million adults age ≥ 20 years having high cholesterol levels. This study aimed to evaluate the prevalence of HC and its associated risk factors among the general population of Al-Kharj, Saudi Arabia.

Method

A cross-sectional study was conducted on the general population of Al-Kharj, Saudi Arabia in 2016. The representative sample consisted of 1019 individuals, who all participated on a voluntary basis. The statistical analysis was performed using SPSS version 25.

Results

The results of this study showed the prevalence of HC in the sample to be 12.5%. There was a significant moderate positive association between increasing age and the prevalence of HC (r = 0.240, P < 0.0001). Males had a significantly higher prevalence of HC (56.7%) compared to their female counterparts (43.3%) (X² = 23.093, P ≤ 0.0001). BMI was positively and significantly associated with high cholesterol status. Participants in the overweight category had a significantly higher risk of HC (OR = 1.727; 95% CI = 1.58–1.914; P = 0.046). The non-obese (< 25 kg/m²) participants had an inverse significant association with the risk of hypercholesterolemia. (OR = 0.411; 95% CI = 0.216–0.783; P = 0.007).

Conclusion

In this population-based study, the predominant risk factors of HC in Al-Kharj region were being of a Saudi nationality, male, having obesity, being unemployed, and being a civilian worker. There is a clear need for future screening studies of HC, as most previous studies have reported contradictory prevalence data (because they were conducted in different regions of KSA). Furthermore, well-designed prospective cohort studies are needed in the future to assess how the association between lifestyle behavioural factors such as dietary intake patterns and levels of physical activity may affect the relative risk of HC status.

Overweight and obesity in people living with HIV

ABSTRACT Objective To identify overweight and obesity and as associated variables in people living with HIV. Method Cross-sectional, quantitative and analytical study, developed in specialized services in southeastern Brazil. Individual specifics were carried out from 2014 to 2016. Pearson's Chi-Square test, Logistic Regression and OddsRatio (OR) were used. Results Of the 340 respondents, 47.7% were overweight. The highest abdominal circumferences and lipid changes were predominantly among the highest body mass index (BMI). The greatest chances of obtaining BMI values>25 kg/m² were among men (OR: 1.87; 95% CI: 1.02-2.42), having metabolic syndrome (OR: 5.66; 95% CI: 3.26-9.83) and the undue (OR: 3.89; 95% CI: 2.17-7.00). However, having self-reported hypertension was configured as a protective factor (OR: 0.18; 95% CI: 0.08-0.44). Conclusion The frequency of obesity and overweight between PLHIV was high. There was an association of male gender, metabolic syndrome and smoking with weight gain. The presence of self-reported hypertension was considered a protective factor.

The relationship between chronic pain, prehypertension, and hypertension. A population-based cross-sectional survey in Al-Kharj, Saudi Arabia

Background: Chronic pain and hypertension are highly prevalent in both developing and developed countries. Although they may appear to be two separate phenomena, several studies in developed countries have found them associated at the population level. Studies in developing countries are scarce and association between pain with prehypertension are rarely explored. The objective of this study was to explore the potential association between prehypertension, hypertension, and chronic pain in a Saudi population.Methods: A cross-sectional general population-based study was conducted on a random sample of employees and university students over a period of 6 months from January 2016 to June 2016 in Al Kharj, Saudi Arabia. A total of 1200 general population adults (aged 18 years and above) were invited to participate in the study.Results: With a response rate of 85.9%, 1031 individuals were included in the final analysis. Among the general population of Al-Kharj, statistically significant association was found between age and chronic pain [Odds ratio (OR) = 1.764 [95% C.I. = 1.391-1.927], P < 0.0001] and between hypertension and chronic pain [(OR) = 1.039 [95% C.I. = 1.018-1.060], P < 0.0001], respectively. The association between prehypertension and chronic pain was not statistically significant [(OR) = 1.211 [95% C.I. = 0.879-1.668, P = 0.243].Conclusion: Results of this survey suggests a statistically significant relationship between hypertension (but not prehypertension) and chronic pain. The temporality of the relationship between hypertension and chronic needs to be explored in future longitudinal studies.

Bisoprolol responses (PK/PD) in hypertensive patients: A cytochrome P450 (CYP) 2D6 targeted polymorphism study

BACKGROUND

Bisoprolol is an effective β1-adrenergic blocker, an inter-individual genetic variability was recorded in its response. This study aimed at investigating the association of CYP2D6*2A (rs1080985) and CYP2D6*10 (rs1065852) single-nucleotide polymorphism (SNP) with Bisoprolol response in cardiac patients attending King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia.

PATIENTS AND METHODS

In the study, 107 patients were enrolled. Five mL of venous blood was collected from each patient and genotyping for CYP2D6*2A and CYP2D6*10 using Vivid® CYP2D6 Green Screening Kit (Life Technologies, USA). Response to Bisoprolol was evaluated through assessment of diastolic and systolic blood pressure and by measuring Bisoprolol plasma level using triple quad mass spectrometer (TQ-MS).

RESULTS

All patients were found to carry homozygous wild type CYP2D6*10 (GG) and none were carrying heterozygous (GA) or mutant homozygous (AA) genotype. CYP2D6*2A allele was detected in the homozygous wild type (GG) in 70 out of 107 patients, the heterozygous (GC) in 19 patients, and the homozygous mutant (CC) in 18 patients with minor allele frequency (MAF) of 25.7%. The plasma concentrations of Bisoprolol in CC carriers were significantly lower than those in GG & CC carriers by 25%, and 51%; respectively. Higher systolic and diastolic blood pressures were also observed in CC carriers than GG and CC carriers.

CONCLUSION

There is a possible association of CYP2D6*2A genotype with plasma concentration of bisoprolol. This could provide a helpful tool to choose the optimum dose for bisoprolol, depending on the patient's genotyping, in order to increase effectiveness and ameliorate its toxicity.

Knowledge Related to Hypertension Risk Factors, Diet, and Lifestyle Modification: A Comparative Study Between Hypertensive and Non-Hypertensive Individuals

Introduction

This study was conducted to explore the three-dimensioned knowledge level of hypertension risk factors (i.e. a three parts questionnaire in addition to the demographic section that discusses in each a dimension of hypertension-related knowledge which is hypertension high-risk factors dimension, diet modifications dimension, and lifestyle behavior modifications dimension to either prevent or control hypertension), the needed diet and lifestyle modifications to either cope with or prevent hypertension among the study participants. The study also examined the significance of the relationship between the two groups and their knowledge of hypertension three dimensions as well as their age, gender, family history, education, and participants’ occupation.

Methodology

In this cross-sectional study, a disproportionate stratified random sampling was used which stratified the sample into two groups i.e. hypertensive and non-hypertensive individuals between 30 and 50 years old from the community of the city of Abha, Saudi Arabia. A developed modified three-dimensioned self-administered online questionnaire was used which was tested afterward for reliability and validity. For this study, the sample size is 384 while the response rate achieved is 60.4% where the data was collected within a timeframe of two weeks.

Results

The respondents had a high level of knowledge regarding the risk factors, diet modifications, and lifestyle modifications. Both groups have the same knowledge level that does not differ significantly. Gender is not a factor of significance for hypertension, but a family history of hypertension shows a significant relationship among the two groups. Age, education, and occupation do not relate significantly among both groups.

Conclusion

The results might be contributed to the participants' high educational level as well as the fact that a lot of them have a family history of hypertension. 

Association between Chronic Pain and Diabetes/Prediabetes: A Population-Based Cross-Sectional Survey in Saudi Arabia

Background. Diabetes is a debilitating chronic health condition that is associated with certain pain syndromes. The present study sought to evaluate chronic pain and its association with diabetes mellitus at a population level. Methods. A population-based cross-sectional questionnaire survey study was conducted in Al-Kharj, Saudi Arabia, from January 2016 to June 2016. Participants from both private and governmental institutions were selected following a multistage sampling technique and using a cluster sampling method. Anthropometric measurements were taken, including body weight, height, body mass index (BMI) and waist circumference. A blood sample was also drawn from each respondent for fasting blood sugar, HbA1c, and fasting lipid profile. A P value of less than 0.05 indicated statistical significance. Results. A total of 1003 subjects were included for final analysis. Compared to prediabetic and nondiabetic individuals, diabetic subjects had a higher prevalence of lower limb pain (11.1%), back pain (8.9%), abdominal pain (6.7%), and neck pain (4.4%) (X2 = 27.792, P=0.015). In a multiple logistic regression model, after adjusting for age, gender, education level, cholesterol, and smoking status, diabetic/prediabetic patients had a significantly higher prevalence of chronic pain ((OR) = 1.931 (95% CI = 1.536–2.362), P=0.037). Increased age was also significantly associated with chronic pain ((OR) = 1.032 (95% CI = 1.010–1.054, P=0.004). Conclusion. Results of this study found a significant association between diabetes and prediabetes and chronic pain symptoms. Prospective studies are needed to explore temporality of such association.

The Privatization of Health Care System in Saudi Arabia

Saudi Arabia's Vision 2030 highlights the development of the health care sector through privatization. This study examines the factors that prompted the privatization of the health care sector in Saudi Arabia. This is a scoping review based on an extensive review of both published and unpublished documents. We have accessed different search engines and databases to collect various research publications, journal articles, government reports, policy and planning documents, and relevant press reports/articles. While privatization of the health care sector in Saudi Arabia has experienced an upward trend, the public health care sector remains vital to bring in overall improvements in the health of all sections of Saudi Arabia's population. Keeping this in view, the government must strengthen its public health care sector to ensure affordable, accessible, and high-quality health care for all. This manuscript focuses on the policy aspect of the privatization of health care and is based on secondary research material. Increased privatization leads to rising expenses in health care, while adversely affecting equity and accountability in the provision of its services. Although this study is an independent analysis of Saudi Arabia's health care system, lessons learned from this context could be used widely for policy-making in other countries with similar socioeconomic settings.

Association of cardiovascular risk factor clustering and prehypertension among adults：Results from the China health and retirement longitudinal study baseline

Background: Prehypertension is common in China, but its causes and associated factors have not been well studied. This study aimed to examine the age and gender-specific associations between CVD risk factor clustering and prehypertension among adults in China.Methods: This cross-sectional study used data from participants (n = 8735) aged over 45 in the China Health and Retirement Longitudinal Study (CHARLS) Baseline conducted from 2011-2012. The participants' data were collected using standard questionnaires, anthropometric, and biochemical tests. Logistic regression analyses were used to examine the associations between cardiovascular risk factors, their clustering and prehypertension.Results: Overall, 21.1%, 39.5%, 27.6% and 11.8% participants had 0, 1, 2, ≥ 3 CVD risk factors in prehypertension group, respectively. Diabetes and overweight/obesity were significantly associated with prehypertension (OR, 1.24; 95% confidence interval [CI], 1.06-1.44; OR, 1.55; 95% CI, 1.38-1.75) in the overall population, and diabetes was associated with prehypertension only in men (OR, 1.26; 95% CI, 1.00-1.58) and older adults (OR, 1.32; 95% CI, 1.03-1.69). Moreover, participants with 1, 2 and ≥3 risk factors had increased odds of having prehypertension (OR, 1.29; 95% CI, 1.12-1.49; OR, 1.59; 95% CI, 1.31-1.78; OR, 2.05; 95% CI, 1.66-2.53, respectively) and existed dose-response relationship, regardless of age and gender.Conclusions: This study indicated that CVD risk factor clustering was significantly associated with prehypertension and hypertension. These results provide valuable information for health professionals to better understand the impact of CVD risk factor clustering on prehypertension and hypertension.

The prevalence and predictors of pre-hypertension and hypertension in Kherameh cohort study: a population based study on 10,663 persons in south of Iran

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) mortality and morbidity among Iranians. The present study aimed to estimate the prevalence of pre-HTN and HTN and some of its related factors in south of Iran. This cross-sectional survey was conducted on the data of the Persian cohort study in Kherameh. The participants consisted of 10,663 people aged 40-70 years. HTN was defined as either systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mmHg or taking medications. Pre-HTN was defined as SBP = 120-139 mmHg and/or DBP = 80-89 mmHg. The logistic regression method was used to identify the factors associated with pre-HTN and HTN. The age-standardized prevalence rate (ASPR) of pre-HTN was 19.66% (95% CI: 19.45-19.86%) and 18.59% (95% CI: 18.36-18.83%) in males and females, respectively. Also, the ASPR of HTN was 21.44 (95% CI: 21.22-21.65%) in males and 33.53% (95% CI: 33.22-33.85%) in females. Male gender, old age, being unemployed, low education level, high body mass index (BMI), no smoking, diabetes, cerebro-cardiovascular disease, suffering from another chronic disease, family history of CVD, and negative family history of cancer and other chronic diseases were independently associated with pre-HTN (p < 0.05). All variables, except for gender, smoking, and family history of cancer, were significantly associated with HTN. Drug abuse was also correlated to HTN (p < 0.05). This study revealed the increased prevalence of HTN in rural and urban areas. Therefore, the health system needs to develop strategies to raise the accessibility of screening and diagnostic services.

The management of prehypertension in young adults

The incidence of prehypertension (blood pressure 120-139 and/or 80-89 mm Hg) in young adults worldwide ranges from ~37.5% to 77.1%. Identifying high-risk groups of prehypertension in young adults is helpful for early and effective interventions and treatments to reduce the occurrence of future hypertension and organ damage. This review summarized the epidemiological characteristics, disease intervention measures, and disease progression characteristics of prehypertension to provide a basis for the development of targeted intervention measures for young adults with prehypertension.

Associations of obesity and serum leptin level with elevated blood pressure among urban secondary school students of a northeastern city of India: A baseline observation

BACKGROUND

Elevated blood pressure has been found to be associated with body mass index (BMI) and serum leptin levels among adults. But there is a paucity of reports regarding such associations among adolescents.

OBJECTIVES

To estimate the prevalence of prehypertension and hypertension and its associations with BMI and serum leptin levels among the secondary school going students of the Agartala Municipal Corporation area.

MATERIALS AND METHODS

This school-based cross-sectional study was conducted from 1st April 2018 to 31st December 2018, among 1,000 students studying in different secondary level schools located in Agartala municipal corporation area chosen by multistage sampling ensuring proportionate representation in the sample.

RESULT

Prevalence of prehypertension and hypertension were found to be 42.40% and 15.70%, respectively, 55.20% had normal, 22.80% had low, and 22.00% had high BMI. Serum leptin levels were found to be normal among 54.70% of the students, whereas, 36.70% had high and 8.60% had low levels, respectively. Logistic regression analysis has identified male sex (OR = 0.231, 95% CI = 0.172-0.310, P = 0.000) and high BMI (OR = 4.289, 95% CI = 2.857-6.440, P = 0.000) as the significant determinants of elevated blood pressure, but the effect of serum leptin level and family history of hypertension did not attain the level of statistical significance.

CONCLUSION

Prevalence of prehypertension and hypertension among urban school-going adolescents were found to be 42.40% and 15.70%, respectively and were significantly associated with their sex and BMI and serum leptin level, but regression analysis failed to detect any significant effect of serum leptin level in determining the blood pressure of the study subjects.