| Abstract|| |
This report from the National Epidemiological Study of Hypertension in the United Arab Emirates (NESH-UAE) represents the preliminary results of phase I, comprising the prevalence, awareness, treatment and control of hypertension among UAE citizens (adults aged 18-75 years). The data reported in this study represent only the region of the Sharjah district, UAE. There were 3150 individuals enrolled for the study. Hypertension was defined as systolic pressure > 140 mmHg, and/or diastolic pressure >90 mmHg, and/or reported treatment with one or more antihypertensive medications. The overall prevalence in this screened sample was 36.6%. Most of the study subjects were in the productive age, from 30-50 years. In the hypertensive group there are more females than males (53% vs. 47% respectively). Overall, 26% of hypertensive persons were aware that they had high blood pressure, 41% being treated with antihypertensive medications, and 19 % were under control (systolic pressure <140 and diastolic pressure <90 mmHg). We plan to extend the study to other regions in the country in order to attain a representative sample and results about this disease. These preliminary results indicate that hypertension is highly prevalent in the UAE. The rates of awareness, treatment and control are relatively low. Furthermore, they argue for a nation-wide effort to prevent and control high blood pressure in the UAE in order to prevent the related complications.
|How to cite this article:|
El-Shahat YM, Bakir SZ, Farjou N, Hashim T, BoHaliga A, Al-Hossani H, Jaffar AR. Hypertension in UAE Citizens - Preliminary Results of a Prospective Study. Saudi J Kidney Dis Transpl 1999;10:376-81
|How to cite this URL:|
El-Shahat YM, Bakir SZ, Farjou N, Hashim T, BoHaliga A, Al-Hossani H, Jaffar AR. Hypertension in UAE Citizens - Preliminary Results of a Prospective Study. Saudi J Kidney Dis Transpl [serial online] 1999 [cited 2014 Apr 17];10:376-81. Available from: http://www.sjkdt.org/text.asp?1999/10/3/376/37247
| Introduction|| |
It has been known for more than a century that high blood pressure reduces life expectancy and increases morbidity and mortality. , In contrast, considerable experimental, epidemiological and clinical evidence indicates that controlling blood pressure is beneficial, since it reduces the rate of cardiovascular diseases and related mortality. There is always a need for clinical trials, epidemiological studies, and basic research on the mechanisms of hypertension. Moreover, the availability of an increased variety of therapeutic approaches provides new exciting ways of controlling this disease and minimizing the adverse effects, which may influence cardiovascular complications and adherence to therapy.
The rapid improvement and spectacular progress in health services in the United Arab Emirates (UAE) has dramatically changed the health profile in this country as well as other Gulf countries. The prolongation of life expectancy actualized the problem of cardiovascular disease as the leading cause of morbidity and mortality in these countries. Little data is available on hypertension among citizens of the UAE. For this reason, and for a better estimation of the prevalence of hypertension in the UAE, a national project was initiated in 1997. Additional goals were to assess in Phase I the life style factors (e.g., environmental, social and economic factors) and their relation to the prevalence of hypertension. In Phase II and Phase III, we plan to assess patients' compliance to treatment, study comorbid conditions, determine individual's genetic susceptibility to hypertension and identify genetic markers.
| Methods|| |
The- study was conducted according to a protocol for a national program. The recruited staff was updated about the recent knowledge in hypertension (academic and clinical). Three regions were chosen in the UAE (Sharjah, Abu Dhabi and Al Ain), which have different cultural, dietary, marriage customs and social habits. The study is designed to progress in three phases: Phase I: Screening, Phase II: intervention and Phase III: Follow-up.
In this report we present the preliminary results of the phase I study conducted in Sharjah district. Adult UAE Citizens (ages 18 to 75 years) were screened and classified according to the criteria set by the Sixth Joint National Committee (JNC-VI) on Detection, Evaluation and treatment of high blood Pressure (BP).  Hypertension was defined as systolic BP > 140 mmHg and/or diastolic BP > 90 mmHg, and/or self-reported treatment with antihypertensive medications. We used a questionnaire including a brief medical history, demographic variables, socioeconomic characteristics, and dietary and smoking habits. The known hypertensive patients were assessed regarding compliance to treatment and control of blood pressure. The population of this study was a stratified random sample, where every third patient attending the primary health care center was included. A site visit to different governmental departments was also made, and all employees in these locations were included in the study. Trained and certified observers using a standard mercury sphygmomanometer according to the standard methods  measured the blood pressure. They also recorded weight, height, body circumference, history and physical examination. Blood pressure was measured at least twice in the study subjects. Accordingly, the study subjects were classified to the following groups: normotensive subjects undiagnosed hypertensive subjects and previously diagnosed hypertensive subjects receiving medical treatment.
Awareness of hypertension was defined as self-report of a high BP measurement in the past. Treatment of hypertension was defined according to direct and clear information of the participant about receiving antihypertensive medication(s). Control of hypertension was defined as systolic BP <140 mmHg, and/or diastolic BP <90 mmHg with or without the use of antihypertensive medications.
We estimated the prevalence rate and the degrees of awareness, treatment and control of hypertension, according to the data from the most recent national census in the region of Sharjah and in the UAE (1996) to give approximate estimates.
| Results|| |
There were 3,150 subjects screened for hypertension in the region of Sharjah. Of these, 1463 (46%) were of the age group 31-50 years [Figure - 1]. There were 1670 (53%) women of whom 1323 (42%) had history of pregnancy. Two thousand five hundred and fifty one (81%) of the participants belonged to the medium socioeconomic class [Figure - 2], 2520 (80%) were married, and 2457 (78%) had children. The BP of the participants was classified according to the JNC-IV guidelines  There were 810 (26%) with optimal, 724 (23%) with normal and 463 (14%) with high normal blood pressure, and 1009 (32%) with stage-I, 126 (4%) with stage-II and 18 (1%) with stage-Ill hypertension [Figure - 3]. The prevalence of hypertension in the study sample was 36.6%. When calculated according to the census in the region of Sharjah district it was to be estimated 31.6%.
Of the study subjects, 788 (25%) were aware that they had high blood pressure, while hypertension was discovered and confirmed for the first time in 441 (14%). At the time of the study, 334 (41%) of those who were aware of their disease were receiving treatment on a regular basis. Furthermore, 150 (19%) of those who were aware of their disease had controlled blood pressure (systolic BP < 140 mmHg, and/or diastolic BP <90 mmHg). The control rates were slightly better in women than in men (statistically not significant).
| Discussion|| |
The prevalence of hypertension varies from country to country according to age, gender, race, body-weight and dietary habits. An understanding of the extent, severity and nature of hypertension in a population is essential for the appropriate application of detection, investigation, therapy and follow-up programs of hypertension.
Recent studies have confirmed both the high prevalence of hypertension and its great importance as a risk factor in cardiovascular disease. , The reported prevalence rate of hypertension in USA, varies widely from 6.2 to 50%; the lowest was in a university medical clinical survey in the US  and the highest was in the elderly over 65 years in the USNH survey.  However, a prevalence rate of 14 to 17% reported in the community by Framingham and the Hypertension Detection Follow-up Program studies , seems to represent the true prevalence of hypertension in the general population. The prevalence of hypertension noted in this study, though higher than the average reported in the Framingham study, was similar to the one reported in the Egyptian National Project (26.3%).  However, it may in fact be higher than the prevalence of hypertension in our community at large.
The majority of the patients in this study are in the middle-age group and represent the productive and socially active portion of the population. It is known that blood pressure readings tend to rise with age, and so does the prevalence rate of hypertension, which may be as high as 50% in the elderly.  A community based survey like ours would reflect better the true prevalence of hypertension among such group. ,
In this survey, more female patients were hypertensive. This result differs from the Framingham study where the ratio of male to female was equal. , This female predominance in the prevalence of hypertension could be related to obesity, sedentary life and the excessive use of nonsteroidal anti-inflammatory drugs (personal observation).
A quarter of patients with hypertension in this study was young. It is usually this group of patients who are subjected to detailed investigations in search of a cause of hypertension.
The rates of awareness, treatment and control in our participants were almost the same as found in other studies.,, The high prevalence rate of hypertension coupled with the low degree of awareness among affected individuals as well as the poor control of the disease among known hypertensive subjects, all have important implications for health-care providers, public health officials and health policy decision makers.
It seems that hypertension is emerging as an important public health problem in the UAE. Identification and treatment of hypertension must become as important as control of infectious diseases and maternal and child health care. Indeed, prevention initiatives and measures taken for the treatment of hypertension should be implemented through the available community-based health-care clinics managed by the Ministry of Health. Such endeavors must be carefully integrated with the efforts of individual clinicians and other healthcare providers.
Mass media can help to educate the general population about hypertension and its complications. Education for healthcare providers at all stages of professional training is essential. In addition, the development of professional societies that focus on education and research in hypertension are of enormous value. 
Health screening programs and mandatory blood pressure recording in adults attending any health clinic are also important. Once detected, patients with hypertension should preferably be followed up in specialized clinics run by medical personnel involved in hypertension treatment. , Patient education is indispensable for compliance.
Our national study (NESH-UAE) should be of considerable interest, and importance to the scientific, medical, and public health communities in the UAE and neighboring countries. The heterogeneity as well as the diversity of the communities and environment in the three areas which were chosen to conduct this study will enable us to study the environmental risk factors on the prevalence of hypertension and its complications. The type and extent of the NESH-UAE data collection (e.g. standardized BP measurements, ECG, Laboratory investigations etc.) present unique opportunities for descriptive and analytic studies.
| Acknowledgment|| |
We would like to thank H.E. Sheikh Mohammed Bin Saqr Al-Qassemi, Director of Sharjah Health District and DeputyChairman of the National Committee of "NESH-UAE", for his kind support and all the staff working in Sharjah Health District, in making this work possible.
| References|| |
|1.||The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Institute of Health, National Heart, Lung, and Blood Institute. NIH Publications, 1997;98-4080. |
|2.||Frohlich ED, Grim C, Labarthe DR, et al. Recommendations for human Blood Pressure Determination by Sphygmomano-meter: Report of a special task force appointed by the Steering Committee. American Heart Association 1988;11: 210A-222A. |
|3.||Whelton PK, He J, Klag MJ, et al. Blood Pressure in Westernized Population. In: Swales JD, ed. Text Book of Hypertension. Oxford, UK: Blackwell Scientific Publications 1994:11-21. |
|4.||Rocella EJ, Burt V, Horan MJ, Culter J. Changes in hypertension awareness, treatment, and control rates. 20-year trend data. Ann Epidemiol 1993,3:547-9. |
|5.||Alderman MH, Ochs OS. Treatment of hypertension at the University Medical Clinic. Arch Intern Med 1977;137:1707-10. [PUBMED] |
|6.||Blood pressure of persons 18-74 years in the United States 1971-1972. National Health Survey, National Center for Health Statistics. Series II, No. 150, Washington DC, U.S. Department of Health, Education and Welfare, 1964. |
|7.||Five-year findings of the hypertension detection and follow-up program I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979;242:2562-71. |
|8.||Ibrahim MM, Rizk H, Appel LJ, et al. Hypertension prevalence, awareness, treatment and control in Egypt. Results from the Egyptian National Hypertension Project (NHP). NHP investigative team. Hypertension 1995;26(6 Part l):886-90. |
|9.||The Australian therapeutic trial in mild hypertension. Report by the Management Committee. Lancet 1980; 1:1261-7. [PUBMED] |
|10.||Jamison DT, Mosley WH, Measham AR, Bobadilla JL, eds. Disease Control Priorities in Developing Countries. Oxford, UK: Oxford University Press; 1993. |
|11.||VA Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension II. Results in patients with diastolic blood pressure averaging 90 through 114 mmHg. JAMA 1970;213:1143-52. |
|12.||Helgeland A. Treatment of mild hypertension: a five year controlled drug trial: The Oslo Study. Am J Med 1980;69:725-32. [PUBMED] |
|13.||Whelton PK, Brancati FL, Appel LJ, Klag MJ. The Challenge of Hypertension and Atherosclerotic Cardiovascular Disease in Economically developing Countries. High Blood Pressure and Cardiovascular Prevention. 1995;4:36-45. |
|14.||Satterfield S, Cutler JA, Langford HG, et al. Trials of hypertension prevention. Phase I design. Ann Epidemiol 1991;1:455-71. |
Yassin Ibrahim M El-Shahat
Department of Nephrology & Hypertension, Al-Jazeira & Central Hospital, P.O. Box 2427, Abu Dhabi
United Arab Emirates
[Figure - 1], [Figure - 2], [Figure - 3]