The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control

Akl, Christelle; Akik, Chaza; Ghattas, Hala; Obermeyer, Carla Makhlouf

doi:10.1186/s12889-020-08678-6

Table 1 Studies of hypertension awareness, treatment and control in the Arab countries, 2000–2017 (percent among respondents by stage and absolute-percent losses between stages)

From: The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control

Study	Sample size	Age^a	Prevalence^b (%)	Among Hypertensives ^c
Study	Sample size	Age^a	Prevalence^b (%)	Loss 1 (%)	Aware (%)	Loss 2 (%)	Treated (%)	Loss 3 (%)	Controlled (%)
HOUSEHOLD
Algeria
Hamidaa,F. et al. (2013) [46]	722	> = 40	50.0	−57.5	42.5	−1.7	40.8	−32.5	8.3
Bahrain
Al-Mahroos, F. et al. (2000) ^e [43]	2090	40–69	30	−38.0	62.0	−6.3	55.7	−42.3	13.4
Jordan
Jaddou, H.Y. et al. (2011)^f [40]	4117	> = 25	32.3	−43.9	56.1	−20.6	35.5^g	−21.43	14.07^g
Kheirallah, K. A et al. (2015) ^h [41]	517^g	> = 25	44.3	−63.8	36.2	−3.0	33.2^g	−23.2	10.0^g
KSA
Saeed, A.A. et al. (2011) ^f [45]	4758	15–64	25.5	−55.3	44.7	−12.6	32.1^g	−20.2	11.9 ^g
El-Bcheraoui C. et al. (2014) ^f [44]	10,735	> = 15	15.2	−57.8	42.2ⁱ	−5.4	36.8ⁱ	−20.2	16.6ⁱ
Yusufali, A. M. et al. (2017) ^j [25]	1545	35–70	30.0	−39.0	61.0^g	−2.0	59.0^gf	−29.0	30.0^g
Morocco
Tazi, M.A. et al. (2009) ^f [28]	1802	> = 20	39.6	−78.1	21.9	−13.1	8.8	−7.7	1.1
Palestine
Yusufali, A. M. et al. (2017) ^j [25]	1545	35–70	37.0	−40.0	60.0	−2.0	58.0^g	−35.0	23.0^g
Tunisia
Ben Romdhane, H.et al. (2005) [31]	1837	40–69	44.3	−58.1	41.9	−10.9	31.0^g	−26.9	4.1^g
Hammami, S. et al. (2011) [36]	598	> = 65	52.0	−19.0	81.0	−2.6	78.4	−54.0	24.4^g
Ben Romdhane, H. et al. (2012) ^f [47]	8007	35–74	30.6	−61.2	38.8	−5.9	32.9^g	−25.0	7.9
UAE
Yusufali, A. M. et al. (2017) ^j [25]	1545	35–70	52.0	−48.0	52.0	−2.0	50.0^g	−37.0	13.0^g
Yemen
Modesti, P. A. et al. (2013) ^f [20]	10,242	15–69	12.8	−55.5	44.5	−4.1	40.4	−30.7	9.7^g
HEALTH CARE FACILITIES
Kuwait
Awad, A. I& Alsaleh, F. (2015) ^f [33]	1610	20–79	20.0	−41.9	58.1^f	0	58.1^g	−19.3	38.8^g
Palestine (West Bank)
Khdour, M. R. et al. (2013) [48]	2077	25–92	27.6	−49.0	51.0	−10.8	40.2	−30.5	9.7
Sudan
Abdelsatir, S. et al. (2013) [38]	389	41 ± 15	39.6	−27.9	72.1	−17.1	55.0^g	−19.9	35.1
Tunisia
Laouani Kechrid,C.et al. (2004) [37]	600	> = 60	69.3	−31.5	68.5	−2.1	66.4	−50.6	15.8
Yemen
Noman, O. et al. (2008) [42]	994	NA	22.3ⁱ	−63.8	36.2ⁱ	−5.6	30.6ⁱ	−3.6	27.0ⁱ
Multicountry study
Nejjari, C. et al. (2013) [39]	28,500^j	> = 18	45.4	−54.8	71.0	−6.2	64.8^g	−34.5	30.3^g
Other (malls, plazas, centers)^l
Lebanon
Matar, D. et al. (2015) [35]	1697	> = 21	36.9	−47.0	53.0	−4.1	48.9	−21.9	27.0

NA Not available
^aNumber of BP measurements was not mentioned in three studies (Al-Mahrous et al., 2000; Jaddou et al., 2011; Noman et al., 2008). For the other studies, BP were recorded as the average of a) 2 BP measurements (AbdelSatir et al., 2013; Awad & Alsaleh, 2015; Ben Romdhane et al., 2005; Ben Romdhane et al., 2012; Hammami et al., 2011; Khdour et al., 2013; Kheirallah et al., 2015; Nejjari et al., 2013; Shah et al., 2015; Yusufali et al., 2017), b) the last 2 BP measurements out of 3 (Hamidaa et al., 2013; Tazi et al., 2009), c) 3 BP measurements (El-Bcheraoui et al., 2014; Laouani Kechrid et al., 2004; Saeed et al., 2011), d) 2 or 3BP (Matar et al., 2015), e) 4 BP out of 6 (Modesti et al., 2013)
^bAge is reported in years either as age group or as mean age ± standard deviation; one study did not report the sample population’s age (Noman et al., 2008)
^cPrevalence of hypertension was identified when participants reported (1) being on current anti-hypertensive drugs and/or (2) having blood pressure measures of SBP > =160 mmHg and/or DBP > =95 mmHg for Al-Mahroos et al. (2000); SBP > =140 mmHg and/or DBP > =80 mmHg for Kheirallah et al. (2015); and SBP > =140 mmHg and/or DBP > =90 mmHg for all the remaining studies. Awareness, treatment and control were defined as the authors reported them in the original publications
^dProportion of patients lost when moving from one stage to another (absolute difference), calculated as follows: Loss 1 (%) = % aware - all hypertensives (i.e. 100%); Loss 2 (%) = % treated - % aware; and Loss 3 (%) = % controlled - % treated
^eInvitations were sent to individuals at households inviting them to participate in a screening survey at health centers
^fNationally representative studies
^gEstimates, based on our calculations
^hSample consisted of Ghawarna (an African-Descendant Ethnic Minority) living in Jordan
ⁱAwareness, treatment and contol rates are weighted in the original publications (El-Bcheraoui et al., 2014; Noman et al., 2008)
^jCrude prevalence of awareness, treatment and control retrieved from the Supplementary Table S1 (Yusufali et al., 2017)
^kTotal sample size was 28,500: Algeria (n = 11,905); Morocco (n = 10,714) & Tunisia (n = 5881)
^lA study conducted by Shah et al. (2015) at a government VISA screening center reported simultaneously rates of awareness, treatment and control of hypertension. However, as the sample consists of South Asian male immigrants solely and not general populations, we did not report the results in this table

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