Hypertension in Saudi Arabia

To determine the prevalence of hypertension among Saudis of both gender, between the ages of 30-70 years in rural as well as urban communities. This work is part of a major national study on Coronary Artery Disease in Saudis Study [CADISS]. This is a community-based study conducted by examining subjects in the age group of 30-70 years of selected households during a 5-year period between 1995 and 2000 in Saudi Arabia. Data were obtained from history using a validated questionnaire, and examination including measurement of blood pressure. The data were analyzed to provide prevalence of hypertension. Logistic regression was used to develop a risk assessment model for prevalence of hypertension. The total number of subjects included in the study was 17,230. The prevalence of hypertension was 26.1% in crude terms. For males, the prevalence of hypertension was 28.6%, while for females; the prevalence was significantly lower at 23.9% [p<0.001]. The urban population showed significantly higher prevalence of hypertension of 27.9%, compared to rural population's prevalence of 22.4% [p<0.001]. The prevalence of CAD among hypertensive patients was 8.2%, and 4.5% among normotensive subjects [p<0.001]. Increasing weight showed significant increase in prevalence of hypertension in a linear relationship. Hypertension is increasing in prevalence in KSA affecting more than one fourth of the adult Saudi population. We recommend aggressive management of hypertension as well as screening of adults for hypertension early to prevent its damaging consequences if left untreated. Public health awareness of simple measures, such as low salt diet, exercise, and avoiding obesity, to maintain normal arterial blood pressure need to be implemented by health care providers

Metabolic syndrome in Saudi Arabia

Metabolic syndrome [MS] is a well-established risk factor for the development of coronary artery disease [CAD]. We designed this study to obtain the prevalence of MS and each of its components in Saudi Arabia. This study is part of Coronary Artery Disease in Saudi Study [CADISS]. We conducted this community-based national epidemiological health survey by examining Saudi subjects in the age group of 30-70 years of selected households over a 5-year period between 1995 and 2000 in Saudi Arabia. We interviewed all subjects, examined and took measurements of their blood pressure, weight, height, waist circumference, as well as fasting samples of plasma glucose, triglycerides, and high-density lipoprotein [HDL] cholesterol. We obtained the prevalence of MS based on the presence of at least 3 of the following: abdominal obesity [waist circumference >102 cm [40 inch] in male and >88 cm [35 inch] in female], triglycerides >=150 mg/dl [1.69 mmol/L], HDL cholesterol <40 mg/dl [1.03 mmol/L] in male and <50 mg/dl [1.29 mmol/L] in female, blood pressure >=130/85 mm Hg, fasting glucose >=110 mg/dl [6.1 mmol/L] as defined by the Adult Treatment Panel [ATP] III in 2001. We included 17,293 subjects in this survey during the study period. The overall age-adjusted prevalence of MS in Saudi Arabia obtained from this study is 39.3%. Age adjusted prevalence in males is 37.2% and crude prevalence is 40.9% [95% confidence interval [CI] 39.8-42], while females have a higher prevalence of 42% and crude prevalence of 41.9% [95% CI 40.9-42.9]. Saudi subjects from urban areas have significantly higher prevalence of 44.1% [95% CI 43.2-45] compared to those living in rural areas of 35.6% [95% CI 34.3-36.7] [p<0.0001]. Low HDL affects 81.8% of females and 74.8% of males with MS leading all other factors, and it continued to be consistent in all different age groups. Metabolic syndrome is a risk factor for CAD, as the prevalence of CAD was higher among patients with MS [6.7%] compared to subjects without MS [4.6%] [p<0.0001]. The prevalence of MS is high in Saudi Arabia. Low HDL cholesterol plays a major role in the contribution to the MS in Saudi Arabia. Therefore, we recommend routine assessment for the components of MS in patients with CAD, furthermore, we encourage aggressive management of the MS for primary prevention of CAD, particularly, measures to increase HDL cholesterol

Diabetes mellitus in Saudi Arabia

Diabetes mellitus [DM] is a major public health problem worldwide, and it is a known risk factor for coronary artery disease [CAD]. New recommendations for the diagnosis of diabetes have changed the epidemiology of DM. Therefore, we designed this study with the objective to determine the prevalence of DM among Saudis of both sexes, between the ages of 30-70-years in rural as well as urban communities. This work is part of a major national project: Coronary Artery Disease in Saudis study [CADISS] that is designed to look at CAD and its risk factors in Saudi population. This study is a community-based national epidemiological health survey, conducted by examining Saudi subjects in the age group of 30-70-years of selected households over a 5-year period between 1995 and 2000. Data were obtained from history, fasting plasma glucose levels, and body mass index. The data were analyzed to classify individuals as diabetic, impaired fasting glucose and normal, using 1997 American Diabetes Association [ADA] criteria, which was adopted by the World Health Organization [WHO] in 1998, to provide prevalence of DM in the Kingdom of Saudi Arabia [KSA]. A total of 17232 Saudi subjects were selected in the study, and 16917 participated [98.2% response rate]. Four thousand and four subjects [23.7%], out of 16917 were diagnosed to have DM. Thus, the overall prevalence of DM obtained from this study is 23.7% in KSA. The prevalence in males and females were 26.2% and 21.5% [p<0.00001]. The calculated age-adjusted prevalence for Saudi population for the year 2000 is 21.9%. Diabetes mellitus was more prevalent among Saudis living in urban areas of 25.5% compared to rural Saudis of 19.5% [p<0.00001]. Despite the readily available access to healthcare facilities in KSA, a large number of diabetics 1116 [27.9%] were unaware of having DM. The overall prevalence of DM in adults in KSA is 23.7%. A national prevention program at community level targeting high risk groups should be implemented sooner to prevent DM. We further recommend a longitudinal study to demonstrate the importance of modifying risk factors for the development of DM and reducing its prevalence in KSA

Inhospital mortality of acute myocardial infarction in Saudi Arabia

In a retrospective study, medical records of 145 patients with confirmed diagnosis of acute myocardial infarction were reviewed. The overall inhospital mortality rate was only 6.9%; this is lower than the previous 20% rate reported from our center. Variables with the strongest univariate association with high inhospital mortality were higher Killip class, development of a new bilateral bundle-branch block [present 66.7%, absent 5.6%; P=0.01], cardiac arrest [present 45.5%, absent 3.7%; P<0.0001], streptokinase [given 0%, not given 10%; P=0.03], development of a new complete heart block [present 37.5%, absent 5.1%; P=0.01], beta-blocker [given 2.4%, not given 12.9%; P=0.02], nitroglycerin [given 3.8%, not given 41.7%; P<0.0001], and aspirin [given 3.3%, not given 13.8%; P=0.04]. In a stepwise discriminant analysis [in descending order of importance], higher Killip class, nitroglycerin therapy, development of a new bilateral bundle-branch block, and cardiac arrest were the only variables found to influence inhospital mortality independently. We conclude that [1] there has been a decrease in inhospital mortality of acute myocardial infarction in our center as compared with the earlier reported data; [2] nitroglycerin was the only drug to influence inhospital mortality independently; and [3] patients with other poor prognostic features may benefit from aggressive invasive intervention

Patients' knowledge of hypertension and its management

Hypertension is a common medical problem that requires lifelong treatment. Awareness of patients about the seriousness of their disease and the necessity and efficacy of the prescribed drugs have the potential of enhancing compliance. We evaluated the knowledge of 46 consecutive hypertensive patients regarding the potential complications of hypertension and risk factors that would potentiate the risk of atherosclerosis development. The awareness of the patients about nonpharmacological measures to control blood pressure and the possible side effects of their current medical therapy was also examined. We found that the level of education was the only significant factor that had an influence on the patients' score. Mean scores for uneducated and university graduates were 38% and 79% of the optimal score, respectively, with a P value < 0.001. On the other hand, age, sex, and duration of either hypertension or current drug therapy had no significant effect. The mean score of all patients was low enough to indicate a disappointing lack of knowledge of our hypertensive patients. We conclude that hypertensive patients, like other victims of chronic diseases, should be provided with knowledge about their disease which will surely be reflected on their compliance. This task is the responsibility of the treating physician, shared by the mass media, hospitals, and social and medical groups