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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
Thank You