challenges of persistent hypertention ... prof samir sally

الرحيم الرحمن الله بسم

CONTRIBUTING FACTORS TO RESISTANT

HYPERTENSIONDr Samir Sally, MDConsultant Medicine & Nephrology,Mansoura Urology and Nephrology

Centre

First part

Global Mortality 2000 Impact of Hypertension and Other Health

Risk Factors

Attributable mortality in millions (total: 55,861,000)

Developing regionDeveloped region

0 87654321

High BPTobacco

High cholesterol

Unsafe sexHigh BMI

Physical inactivityAlcohol

Underweight

Adapted from Ezzati et al. Lancet 2002;360:1347–60

Control rate maximum 40% in European countries

7European Heart J 2011

Stroke and ischaemic heart disease (IHD) mortality versus systolic blood

pressure (SBP) by ageM

orta

lity

(floa

ting

abs

olut

e ri

sk a

nd 9

5% C

I)

Usual SBP (mmHg)

50–59 years

60–69 years

70–79 years

80–89 years

Stroke Age at risk:256

128

64

32

16

8

4

2

1

0120 140 160 180

IHD

Usual SBP (mmHg)

50–59 years

60–69 years

70–79 years

80–89 yearsAge at risk:

40–49 years

256

128

64

32

16

8

4

2

1

0120 140 160 180

Prospective Studies Collaboration. Lancet 2002;360:190313

Hypertension… A growing burden in Saudi Arabia

High prevalence of hypertension in KSA compared to other countries in Africa and Middle East

1 .Arnaout MS, Almahmeed W, Ibrahim M, et al. Current Medical Research & Opinion 2011; 27 (6): 1223–1236.

26% of Saudi Arabia population suffer

from

hypertension

Hypertension... A disease that requires attention

Cardiovasculardisease was

responsible for

47% of all deaths

in Saudi Arabia1

Control rate of

hypertension

was low

25%1

50% of Saudi

diabetic patientsfailed to achieve

their target BP of

130/85 mmHg1

1 .Arnaout MS, Almahmeed W, Ibrahim M, et al. Current Medical Research Opinion 2011; 27 (6): 1223–1236.

Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey

Abdalla . A Saeed,* . -Nasser A Al Hamdan, . Ahmed ABahnassy, Abdelshakour . M Abdalla, Mostafa

. . A F Abbas, and Lamiaa . Z Abuzaid

Int J Hypertens. Published online 2011 September 6 .

Cross-sectional study. Multistage stratified sampling was

used to select 4758 adult participants. The overall prevalence of

hypertension was 25.5% .Only 44.7% of hypertensives were

aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled.

conclusion Prevalence is high, but

awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension

Few patients under control?Why ?

More Than 70% of Physicians Suspect Poor Compliance as the Reason For Antihypertensive

Treatment Failure

UK France Italy0

20

40

60

80

100

Poor patient complianceProducts not effectiveSide effects

Ménard and Chatellier. J Hum Hypertens 1995;9:S19–S23 ;Andrade et al. Arq Bras Cardiol 2002;79:375–84

Doc

tors

cit

ing

reas

on

)%(

*

* In patient surveys, side effects are a major reason for poor compliance

Compliance at 1 Year With Antihypertensive Treatment

*P<0.007 vs. ACEIsBloom BS et al. Clin Ther. 1998;20:671-681.

38%

43%

50%

58%

64%*

Com

plia

nce

at 1

Yea

r

)%(

65

60

55

50

45

40

35Diuretics Beta Blockers CCBs ACEIs ARBs

Second part

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