Abdalla SAEED ABDELWAHID, Nasser Abdulrahman AL-HAMDAN

Isolated Diastolic Hypertension among Adults in Saudi Arabia: Prevalence, Risk Factors, Predictors and Treatment. Results of a National Survey

Background: In the past, diastolic hypertension was the main criterion for treatment, but currently, systolic pressure is the main criterion because it was thought that Isolated Diastolic Hypertension (IDH) is not associated with complications. Studies later revealed that IDH car-ries significant risks. Quantifying the magnitude and risk factors of IDH in the community is essential for all inter-vention strategies. Aims: This study aims to determine the prevalence, risk factors, predictors, treatment modalities and lifestyle practices of IDH adult patients in the Kingdom of Saudi Arabia (KSA). Study Design: Cross-sectional study. Methods: A community-based cross-sectional study using STEPwise approach among adults using a multi-stage, stratified, cluster random sample was carried out. Data were collected using questionnaires which included socio-demographics, blood pressure, biochemical, an-thropometric measurements and lifestyle practices. Sta-tistical analysis included calculating means and standard deviations, proportions, univariate and multiple logistic regression analysis. Results: Of a total 4562 subjects, 180 (3.95%) suffered from IDH, which was significantly related to age, gender, employment, smoking, diabetes mellitus, obesity and hypercholesterolemia. More than 93% were using some form of treatment, with 77.2% on prescribed drugs, 63% using diet, and 23% using exercise. Significant predic-tors of IDH were retirement and hypercholesterolemia.Conclusion: IDH is associated with some sociodemo-graphic characteristics and co-morbidity. Given the risk of cardiovascular disease associated with IDH, the find-ings of this study emphasize the need for diagnosing the disease in middle-aged persons focusing on the modifi-able risk factors of IDH

PDF

___

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23.
Wang H, Dwyer-Lindgren L, Lofgren K, Rajaratnam JK, Mar- cus JR, Levin-Rector A, et al. Age-specific and sex-specific mor- tality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2071- 94.
El Bcheraoui C, Memish ZA, Tuffaha M, Daoud F, Robinson M, Jaber S, et al. Hypertension and Its Associated Risk Factors in the Kingdom of Saudi Arabia, 2013: A National Survey. Int J Hypertens 2014;2014:564679.
Al-Nozha MM, Abdullah M, Arafah MR, Khalil MZ, Khan NB, Al-Mazrou YY, et al. Hypertension in Saudi Arabia. Saudi Med J 2007;28:77-84.
Bromfield S, Muntner P. High blood pressure: the leading global burden of disease risk factor and the need for worldwide preven- tion programs. Curr Hypertens Rep 2013;15:134-6.
Kannel WB. Role of blood pressure in cardiovascular morbidity and mortality. Prog Cardiovasc Dis 1974;27:5.
Franklin SS, Pio JR, Wong ND, Larson MG, Leip EP, Va- san RS, et al. Predictors of new-onset diastolic and systol- ic hypertension: the Framingham Hear Study. Circulation 2005;111:1121-7.
Franklin SS, Milagros JJ Wong ND, L'Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle- aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANESIII). Hy- pertension 2001;37:869-74.
Sever P. Abandoning Diastole. BMJ 1999;318:1773-6.
Saudi Hypertension Management Guidelines. National Com- mission for Hypertension & Saudi Hypertension Management Group 2007, KSA.
Whitworth JA; World Health Organization, International So- ciety of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21:1983-92.
Campbell N, Kaczorowski J, Lewanczuk R, Feldman R, Poirier L, Kwong M, et al; Canadian Hypertension Education Program. 2010 Canadian Hypertension Education Program (CHEP) rec- ommendations: the scientific summary - an update of the 2010 theme and the science behind new CHEP recommendations. Can J Cardiol 2010;26:236-40.
Swales JD. Systolic versus diastolic pressure: paradigm shift or cycle? J Hum Hypertens 2000;14:477-9.
Hozawa A, Ohkubo T, Nagai K, Kikuya M, Matsubara M, Tsuji I, et al. Prognosis of isolated systolic and isolated diastolic hy- pertension as assessed by self-measurement of blood pressure at home - the Ohasama study. Arch Intern Med 2000;160:3301-6.
Veterans Administration Cooperative Study on Antihyperten- sive Agents: Effects of treatment on morbidity in hypertension. 1. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 1967;202:1028.
Arima H, Anderson C, Omae T, Woodward M, Hata J, Murakami Y, et al . PROGRESS Collaborative Group. . Effects of blood pressure lowering on major vascular events among patients with isolated diastolic hypertension. the perindopril protection against recurrent stroke study (PROGRESS) trial. Stroke 2011; 42:2339-41.
Arima H, Murakami Y, Lam TH, Kim HC, Ueshima H, Woo J, et al; Asia Pacific Cohort Studies Collaboration. Effects of Prehy- pertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region. Hypertension 2012;59:1118-23.
Beevers DG. Epidemiological, pathophysiological and clinical significance of systolic, diastolic and pulse pressure. J Hum Hy- pertens 2004;18:531e533.
Midha T, Lalchandani A, Nath B, Kumari R, Pandey U. Preva- lence of isolated diastolic hypertension and associated risk factors among adults in Kanpur, India. Indian Heart J 2012;64:374-9.
Biswas M, Manna CK. Prevalence of hypertension and sociode- mographic factors within the Scheduled Caste community of the District Nadia, West Bengal, India. High Blood Press Cardio- vasc Prev 2011;18:179-85.
Tesfaye F, Byass P, Wall S. Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a si- lent epidemic. BMC Cardiovasc Disord 2009;9:39.
Asekun-Olarinmoye E, Akinwusi P, Adebimpe W,Isawumi M , Hassan M, Olowe O, Makanjuola O, et al .Prevalence of hyper- tension in the rural adult population of Osun State, southwestern Nigeria. Int J Gen Med 2013;6:317-22.
Al Riyami A, Elaty MA, Morsi M, Al Kharusi H, Al Shukaily W, Jaju S. Oman World Health Survey: Part 1 - Methodology, Sociodemographic Profile and Epidemiology of Non-Communi- cable Diseases in Oman. Oman Med J 2012;27:425-43.
Huang J, Wildman RP, Gu D, Muntner P, Su S, He J. Prevalence of isolated systolic and isolated diastolic hypertension subtypes in China. Am J Hypertens 2004;17:955-62.
Bonita R, de Courten M, Dwyer T, Jamorzik K, Winkelmann R. Surveillance of risk factors for Non Communicable diseases. The WHO Stepwise approach: WHO, 2001.
STEPwise WHO.http://.www.who.int/chp/steps/2005_Saudi Arabia_STEPS_Report_EN.pdf
Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah A, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet 2014;383:1899-911.
Primatesta P, Falaschetti E, Gupta S, Marmot MG, Poulter NR. Association between smoking and blood pressure: evidence from the health survey for England. Hypertension 2001;37:187-93.
Chirinos JA, Franklin SS, Townsend RR, Rajj L. Body mass in- dex and hypertension hemodynamic subtypes in the adult US population. Arch Intern Med 2009;169-80.
Tin LL, Beevers DG, Lip GY. Systolic vs diastolic blood pressure and the burden of hypertension. J Hum Hypertens 2002;16:147- 50.
Luna RL, Luna LC. Is diastolic pressure losing its clinical use- fulness? Arq Bras Cardiol 2007;89:e19-21.