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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2019  |  Volume : 30  |  Issue : 1  |  Page : 33-38
Blood pressure control, lifestyle and disease awareness of Saudi hypertensive patients


1 Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
2 Medical Intern, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

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Date of Submission28-Oct-2018
Date of Acceptance24-Nov-2018
Date of Web Publication26-Feb-2019
 

   Abstract 


Mortality and morbidity from hypertension have reached epidemic proportion worldwide. It has been estimated that 874 million adults globally have systolic blood pressure (SBP) of 140 mm Hg or higher. A recent study from Saudi Arabia found 15.2% of adult Saudis were hypertensive of whom 57.8% unaware of this diagnosis. We aim to evaluate the lifestyle advices given to Saudi hypertensive patients, their current lifestyle to determine the effects of these factors on their BP control. Nonrandom convenience sampling of Saudi patients followed up in the clinic by cross-sectional questionnaire. Their BP, blood sugar, and other anthropometric data were measured and provided self-filled questionnaire. Of all participants, 148 known hypertensives on treatment were included in the study with a mean age of 45.7 ± 29.0 years. The mean SBP and diastolic BP were 134.7 ± 21.4 and 85.0 ± 18.9 mm Hg, respectively. The overall awareness score was 77.5% with the highest awareness score for “BP can be controlled by proper management” (93.2%) and the lowest score given for “BP is not affected by alcohol consumption” (63.4%). We found significantly lower mean SBP in those with higher awareness in five of the nine awareness areas inquired. We believe that educating hypertensive patients about their diseases and lifestyle advices has a significant impact on disease control and well-being.

How to cite this article:
Al Duraihim H, Alghamdi G, AlNemer M, Abdulaal AE, Al Sayyari A. Blood pressure control, lifestyle and disease awareness of Saudi hypertensive patients. Saudi J Kidney Dis Transpl 2019;30:33-8

How to cite this URL:
Al Duraihim H, Alghamdi G, AlNemer M, Abdulaal AE, Al Sayyari A. Blood pressure control, lifestyle and disease awareness of Saudi hypertensive patients. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Jul 20];30:33-8. Available from: http://www.sjkdt.org/text.asp?2019/30/1/33/252930



   Introduction Top


Mortality and morbidity from hypertension have reached epidemic proportion worldwide.[1] It has been estimated that 874 million adults have systolic blood pressure (SBP) of 140 mm Hg or higher.[2] Only about half of hypertensive patients in the USA had controlled BP (<140/<90 mm Hg diastolic) in 2007.[3]

A recent study from Saudi Arabia found 15.2% of adult Saudis were hypertensive of whom 57.8% unaware of this diagnosis. Among those aware that they have hypertension, 78.9% reported compliance with their medication for their condition with 45% having controlled BP.[4]

Some of the factors have been found to improve BP control include enhanced awareness of what BP control means,[5],[6] what its complications are,[7] use of home BP monitoring (although ambulatory and home BP monitoring are not fully interchangeable[8] and adhering to lifestyle changed recommended by their physicians.[9],[10]

In this study, we evaluate the effect of awareness, lifestyle changes, home BP monitoring, and – on the degree BP control among young Saudis with diagnosed with hypertension. We also evaluate BP status and demographic variables in a group of young Saudis who were not diagnosed with hypertension.


   Patients and Methods Top


This is a cross-sectional questionnaire-based study in Saudi patients followed up in the clinic for hypertension. Their BP, blood sugar, height, and weight were measured, and they completed questionnaire with fourth sections. The first enquired about their weekly drugs, symptoms, clinic visits, smoking habits, diet type, and the number of antihypertensive medications they use; the second section enquired about what recommendations for lifestyle changes they were given by their doctors, the third section enquired about their awareness about hypertension and its complications; the fourth section enquired about home BP measurement, emergency room (ER) visits, and compliance.

A further 389 participants surveyed did not have the diagnosis of hypertension was made on them to evaluate their BP, frequency of undiagnosed among them, body mass index (BMI) and random blood sugar and mean age.

We investigated the effect on SBP and diastolic BP (DBP) among the group diagnosed with high BP by awareness/nonawareness of complications, the recommendations they receive on lifestyle changes and of home BP measurement, ER visits, and compliance.

Descriptive statistics were generated using JMP Pro.


   Results Top


One hundred and forty-eight participants, who were told that they have hypertension on at least two clinic visits were included in the study. The mean age, mean weight, height, and BMI were 46.2 ± 29.3 years, 70.7 ± 16.1 kg, 160.9 ± 9.3 cm, and 27.0 ± 6.9, respectively [Table 1]. Only 16 (12%) of these patients were smokers. The mean random blood sugar was 6.8 ± 3.5 mmol/L. The SBP, mean DBP and mean, mean BP were, respectively, 143.4 ± 21.4, 84.4 ± 17.9, and 91.3 ± 13.9 mm Hg [Table 1].
Table 1: Some basic information about the group.

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A further 389 participants surveyed did not have the diagnosis of hypertension made on them. Among this group, the mean SBP and DBPs were 118.0 ± 18.5 and 85.0 ± 18.9 2 mm Hg, respectively. Out of these patients, had undiagnosed 13.3% SBP (±140 mm Hg) and 15.2% had undiagnosed DBP. The mean age, BMI, and random blood sugar were significantly lower in the group not known to have hypertension compared to the group with known hypertension (P = 0.0001, 0.04, and 0.0025, respectively) [Table 2].
Table 2: Comparing the group told that they have hypertension to the group who was not.

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[Table 3] shows the self-reported diet, exercise, symptoms, clinic visits, smoking habits, and some medications taken. It can be seen that almost two-third of the patients visited their doctors 3–6 monthly, almost half use only one type of medication. Headaches is the most common symptom suffered (42.7%) with 27.6% reporting no symptoms; 13.8% smoke, 57.6% exercise 20–60 min weekly with 75.3% walk as an exercise activity and 39.7% use low-salt diet [Table 3].
Table 3: Self-reported diet, exercise, symptoms, clinic visits, smoking habits and number of medications.

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[Table 4] shows that a total of seven pieces of advice asked about regarding required lifestyle changes were given to the patients to varying degrees of frequency with the lowest (given to 63.8% of the patients) being to “avoid alcohol” and the highest (given to 87.8% of the patients) being to “exercise.” The overall frequency of the advice given for lifestyle behavior was 77.9%.
Table 4: Recommendations for lifestyle changes for hypertensive patients given by their doctor.

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When we compared the mean SBP levels in those told of these life to those not told of them, we find significant differences only in those “told to avoid stress” (133.0 ± 2.1 and 157.7 ± 5.2 mm Hg respectively (P = 0.0007) and in those told “old to avoid alcohol” (133.1 ± 2.5 and 141.3 ± 3.5 mm Hg, respectively (P = 0.05). No significant differences were seen in the DBP.

The patients' awareness of participants about hypertension and its complications is shown in [Table 5]. This section of the questionnaire tested the participants' awareness on nine relevant issues. The overall awareness score was 77.5% with the highest awareness score for “BP can be controls by proper management” (93.2%) and lowest score given for “BP is not affected by alcohol consumption” (63.4%).
Table 5: Degree of awareness about hypertension.

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On evaluating the awareness/non-awareness of complications affect SBP control, we found significantly lower mean SBP in those higher awareness in five of the nine awareness areas shown in [Table 5]. No significant difference in the DBP was seen in any y of these areas of awareness.

The next section of the questionnaire asked about the participants' home BP measurement, ER visits, and compliance. This reveals that 42.7% measure their BP at home, 22.8 % visited the ER for high BP over the previous 12 months, 77.5% claimed that they are complaint and 16.4% have no problem taking their medications [Table 6].
Table 6: Home BP measurement, ER visits and compliance.

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There was no difference in the mean SBP between those measuring their BP at home and those who do not. However, those who visited the ER during the previous 12 months had significantly higher SBP compared to those who did not (143.7 ± 4.7 and 132.7 ± 2.7 mm Hg respectively; P = 0.037). No differences were seen in the DBP.


   Discussion Top


In our group with diagnosed hypertension, 41.4% had uncontrolled SBP (±140 mm Hg) and 34.8% had uncontrolled DBP (±90 mm Hg). In a study for Kenya, only 66.6% of patients followed up for hypertension had uncontrolled hypertension.[11] However, the mean age in the Kenyan group was higher than ours (63 versus 46.2 years). In a cohort of elderly American patients (aged ≥65 years), the prevalence of uncontrolled hypertension was 54.3%.[12]

On the other hand, in the group not previously told that they have hypertension, 13.3% had undiagnosed systolic hypertension (±140 mm Hg) and 15.2% had undiagnosed diastolic hypertension. Results from NHANES 2011–2012 study, the overall prevalence of uncontrolled hypertension using JNC 7 criteria in the general population was 16.6%.[13]

In our study, the mean age, BMI and random blood sugar were significantly lower in the group not known to have hypertension compared to the group with known hypertension.

Appropriate lifestyle modifications have been shown to reduce blood pressure.[14] Weight loss of 3%–9% reduces SBP by 3 mm Hg, salt diet by 5 mm Hg and alcohol moderation by 4 mm Hg.[9],[10] In our study, we found that the overall frequency of the advice given for lifestyle behavior was 77.9%. Lower mean SBP was seen in those told “to avoid stress” and those not told and in those told “ to avoid alcohol”. Among our patients, 57.6% exercise 20–60 min weekly (as walking in 75.3%) and 39.7% use low-salt diet.

Awareness of BP and its complications have also been shown to be associated with reduction in BP. One report states that 90% of hypertensive patients knew that lowering BP would improve health[15] and with increasing awareness reported between 1976 and 1991 (from 51% to 73%).[16] Nevertheless, the awareness of optimal BP remains suboptimal.[7]

The overall awareness score in our study was 77.5% with the highest awareness score for “BP can be controlled by proper management” (93.2%) and the lowest score given for “BP is not affected by alcohol consumption” (63.4%). We found significantly lower mean SBP in those with higher awareness in five of the nine awareness areas enquired about. Unawareness by the patients of their optimal SBP was found to be an independent factor of poor BP control[17] [Table 7].
Table 7: Does awareness/non-awareness of complications affect SBP control?

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Of all the patients included in our study, 42.7% measure their BP at home. This compares to reported 44% to 66% of individuals with hypertension who measured their own BP. The use of home blood pressure monitoring is associated with small but significant reduction in BP (2.2 mm Hg for SBP and 1.9 mm Hg DBP).[18],[19] The patients more likely to monitor home blood pressures tend to possess higher hypertension awareness. In our study, however, we found no difference in the mean SBP between those measuring their BP at whom and those who do not.

In the present study, 22.8% visited the ER for high-BP over the previous 12 months. This group of patients had significantly higher SBP compared to those who did not attend the ED in the previous 12 months. The reported incidence of hypertensive emergencies among patients in the USA has dropped from 7% to 1% of patients with hypertension.[20] However, the overall incidence of visits to the ED necessitated by hypertensive emergencies more than doubled between 2006 and 2013.[21]


   Conclusion Top


The prevalence of uncontrolled hypertension in our group of young hypertensive patients visiting clinics was high (41.4% had uncontrolled SBP and 34.8% had uncontrolled DBP). In the even younger group, we studied and were not previously told that they have hypertension we found undiagnosed Systolic hypertension in 13.3% and undiagnosed diastolic hypertension in 15.2%. The overall awareness score in our study was 77.5%. Some aspects of awareness and lifestyle modifications reduced the SBP but not the DBP.



 
   References Top

1.
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA 2003;289:2560-72.  Back to cited text no. 1
    
2.
Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA 2017;317:165-82.  Back to cited text no. 2
    
3.
Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010;303:2043-50.  Back to cited text no. 3
    
4.
El Bcheraoui C, Memish ZA, Tuffaha M, et al. Hypertension and its associated risk factors in the Kingdom of Saudi Arabia, 2013: A national survey. Int J Hypertens 2014;2014: 564679.  Back to cited text no. 4
    
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Balazovjech I, Hnilica P Jr. Compliance with antihypertensive treatment in consultation rooms for hypertensive patients. J Hum Hypertens 1993; 7:581-3.  Back to cited text no. 5
    
6.
Howard G, Prineas R, Moy C, et al. Racial and geographic differences in awareness, treatment, and control of hypertension: The REasons for Geographic and Racial Differences in Stroke Study. Stroke 2006;37:1171-8.  Back to cited text no. 6
    
7.
Alexander M, Gordon NP, Davis CC, Chen RS. Patient knowledge and awareness of hypertension is suboptimal: Results from a large health maintenance organization. J Clin Hypertens (Greenwich) 2003;5:254-60.  Back to cited text no. 7
    
8.
Stergiou GS, Asayama K, Thijs L, et al. Prognosis of white-coat and masked hypertension: International database of HOme blood pressure in relation to cardiovascular outcome. Hypertension 2014;63:675-82.  Back to cited text no. 8
    
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Lochner JE, Rugge JB, Judkins DZ. Clinical inquiries. How effective are lifestyle changes for controlling hypertension? J Fam Pract 2006;55: 73-4.  Back to cited text no. 9
    
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Dickinson HO, Mason JM, Nicolson DJ, et al. Lifestyle interventions to reduce raised blood pressure: A systematic review of randomized controlled trials. J Hypertens 2006;24:215-33.  Back to cited text no. 10
    
11.
Mutua EM, Gitonga MM, Mbuthia B, Muiruri N, Cheptum JJ, Maingi T. Level of blood pressure control among hypertensive patients on follow-up in a regional referral hospital in central Kenya. Pan Afr Med J 2014;18:278.  Back to cited text no. 11
    
12.
Iyer AS, Ahmed MI, Filippatos GS, et al. Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: Findings from a propensity-matched prospective population study. J Am Soc Hypertens 2010;4:22-31.  Back to cited text no. 12
    
13.
Sakhuja A, Textor SC, Taler SJ. Uncontrolled hypertension by the 2014 evidence-based guideline: Results from NHANES 2011-2012. J Hypertens 2015;33:644-51.  Back to cited text no. 13
    
14.
Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modifi-cation on blood pressure control: Main results of the PREMIER clinical trial. JAMA 2003; 289:2083-93.  Back to cited text no. 14
    
15.
Oliveria SA, Chen RS, McCarthy BD, Davis CC, Hill MN. Hypertension knowledge, awareness, and attitudes in a hypertensive population. J Gen Intern Med 2005;20:219-25.  Back to cited text no. 15
    
16.
Burt VL, Cutler JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension 1995;26: 60-9.  Back to cited text no. 16
    
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Knight EL, Bohn RL, Wang PS, Glynn RJ, Mogun H, Avorn J. Predictors of uncontrolled hypertension in ambulatory patients. Hypertension 2001;38:809-14.  Back to cited text no. 17
    
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Cappuccio FP, Kerry SM, Forbes L, Donald A. Blood pressure control by home moni-toring: Meta-analysis of randomised trials. BMJ 2004; 329:145.  Back to cited text no. 18
    
19.
Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: Executive summary: A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension 2008;52:1-9.  Back to cited text no. 19
    
20.
Hopkins C. Hypertensive Emergencies Available from: https://emedicine.medscape.com/ article/ 1952052-overview. [Last accessed 13 January 2018].  Back to cited text no. 20
    
21.
Janke AT, McNaughton CD, Brody AM, Welch RD, Levy PD. Trends in the incidence of hypertensive emergencies in US emergency departments from 2006 to 2013. J Am Heart Assoc 2016;5. pii: e004511.  Back to cited text no. 21
    

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Correspondence Address:
Abdullah Eid Abdulaal
King Saud bin Abdulaziz University for Health Sciences, Riyadh
Saudi Arabia
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DOI: 10.4103/1319-2442.252930

PMID: 30804264

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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