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 2 Gender differences in prevalence of awareness, treatment and control of hypertension in Arab countries, 2000–2017 (percent among respondents by sex, and male/female ratios)^a

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

Country	Study^b	Age^c	Male (%)	Female (%)	Ratio M/F	Significance
AWARENESS OF HYPERTENSION
Awareness among hypertensive subjects (%)
Egypt	Mohamed, M. R. et al. (2000) [55]	> = 18	62.9	49.5	1.27	P = 0.002^e
Jordan	Jaddou, H. Y. et al. (2000) [49]	> = 25	79.4	83.6	0.95	NS
	Jaddou, H. Y. et al. (2003) [50]	> = 25	50.0	55.6	0.90	p = 0.02
	Jaddou, H. Y. et al. (2011) [40]	> = 25	54.7	56.7	0.96	NS
	Kheirallah, K.A.et al (2015) [41]	> = 25	34.1	37.6	0.91	NS
KSA	Kalantan, K. A. et al. (2001) [56]	35–85	28.5	19.0	1.50	P = 0.049
	Saeed, A.A. et al. (2011) ^d [45]	15–64	37.3	53.3	0.70	P < 0.001
	Amin, T. T. et al. (2014) [52]	24–63	67.5	85.7	0.79	P = 0.025^e
	El-Bcheraoui, C. et al. (2014)^{f, d} [44]	> = 15	38.8^f	47.1^f	0.82	Undiagnosed OR = 1.85[1.49–2.27]^g, p < 0.05
	Mirza, A.A. et al. (2016) [51]	> = 30	49.7	62.8	0.79	NS
Lebanon	Matar, D. et al. (2015) [35]	> = 21	50.4	57.9	0.87	OR = 0.6 [0.4–0.9]^g, p < 0.05
Morocco	Tazi, M.A.et al (2009) ^d [28]	> = 20	13.5	27.3	0.49	P < 0.001^e
Oman	Al-Riyami, A. et al. (2003) ^d [59]	> = 20	NA	NA	NA	Significantly higher among females than males
	Barakat, H. et al. (2008) [53]	> = 20	14.9	21.4	0.70	NS^e
	Abd El-Aty, MA. et al. (2015) ^{f, d} [27]	> = 18	13.7^f	39.1^f	0.35	Unawareness OR = 2.5 [1.7–3.3]^g, p < 0.001
Palestine	Khdour, M. R. et al. (2013) [48]	> = 25	39.8	53.8	0.74	p < 0.01^e
Tunisia	Ben Romdhane, H. et al. (2005) [31]	40–69	30.2	48.3	0.63	OR = 0.4 [0.3–0.5]^g, p < 0.001
Tunisia	Ben Romdhane, H. et al. (2012) ^d [47]	35–74	28.8	44.8	0.64	OR = 0.5 [0.4–0.6]^g, p < 0.001
Yemen	Gunaid, A.A. et al. (2008) [54]	> = 35	25.0	38.0	0.66	NS^e
Yemen	Modesti, P. A. et al. (2013) ^d [20]	15–69	40.7	47.6	0.86	NS^g
TREATMENT OF HYPERTENSION
Treatment among hypertensive subjects (%)
Algeria	Temmar, M. et al. (2007) [57]	40–99	13.7	43.1	0.32	p < 0.0001^e
Algeria	Hamida,F.et al. (2013) [46]	> = 40	32.0	45.0	0.71	P = 0.032^e
KSA	El-Bcheraoui, C. et al. (2014) ^{f, d} [44]	> = 15	33.0^f	42.2^f	0.78	NA
Lebanon	Matar, D. et al. (2015) [35]	> = 20	46.1	54.0	0.85	NS
Palestine	Khdour, M. R. et al. (2013) [48]	> = 25	36.1	43.3	0.83	p = 0.02
Yemen	Modesti, P. A. et al. (2013) ^d [20]	15–69	36.5	43.6	0.84	NS^g
Treatment among aware hypertensive subjects (%)
Jordan	Jaddou, H. Y. et al. (2011) [40]	> = 25	67.0	61.9	1.08	P = 0.01
KSA	Saeed, A.A. et al. (2011) ^d [45]	15–64	74.2	69.2	1.07	NS
Morocco	Tazi, M.A. et al. (2009) ^d [28]	> = 20	26.3	44.9	0.59	P = 0.042^e
Tunisia	Ben Romdhane, H et al. (2005) [31]	40–69	72.5	74.6	0.97	NS
Tunisia	Ben Romdhane, H. et al. (2012)^d [47]	35–74	85.3	84.6	1.01	NS
CONTROL OF HYPERTENSION
Control among hypertensive subjects (%)
KSA	El-Bcheraoui, C. et al. (2014) ^{f, d} [44]	> = 15	13.9^f	20.5^f	0.68	NA
Control among aware hypertensive subjects (%)
KSA	Siddiqui, S. et al. (2001) [60]	> = 18	37.7	23.8	1.58	NS^e
KSA	Mirza, A.A. et al. (2016) [51]	> = 30	37.2	39.5	0.94	NS
Jordan	Jaddou, H.Y. et al. (2000) [49]	> = 25	25.9	34.8	0.74	NS
Jordan	Khader, A.et al. (2014) [61]	> = 0/18	80.0	85.0	0.94	OR = 1.4[1.2–1.4], p < 0.001
Oman	Abd El-Aty, MA. et al. (2015) ^{f, d} [27]	> = 18	26.9^f	38.3^f	0.70	Uncontrolled OR = 3.3[1.4–5.0]^g, p < 0.001
Sudan	Babiker, F. A. et al. (2013) [62]	> = 20	39.0	85.0	0.46	p < 0.001
Algeria, Morocco Tunisia	Nejjari, C.et al. (2013) [39]	> = 18	34.0	36.6	0.93	p = 0.01
Control among treated hypertensive subjects (%)
Algeria	Temmar, M. et al. (2007) [57]	40–99	13.9	28.0	0.50	NS^e
Algeria	Hamida,F. et al. (2013) [46]	> = 40	17.1	21.3	0.80	NS^e
Jordan	Jaddou, H. Y. et al. (2011) [40]	> = 25	42.9	38.2	1.12	NS
Jordan	Kheirallah, K.A. et al. (2015) [41]	> = 25	23.3	24.5	0.95	NS
KSA	Saeed, A.A. et al. (2011) ^d [45]	15–64	32.0	41.1	0.77	NS
Lebanon	Matar, D.et al. (2015) [35]	> = 21	48.9	62.3	0.78	p = 0.021
Morocco	Tazi, M.A.et al (2009) ^d [28]	> = 20	20.0	11.3	1.77	NS^e
Palestine	Khdour, M. R. et al. (2013) [48]	> = 25	29.3	35.9	0.82	p = 0.01
Tunisia	Ben Romdhane, H. et al. (2005) [31]	40–69	16.8	12.0	1.40	NS
	Masmoudi, J. et al. (2010) [58]	61.8 ± 11.9	46.3	27.1	1.71	p = 0.047
	Ben Romdhane, H. et al. (2012) ^d [47]	35–74	27.5	22.8	1.21	NS
Yemen	Modesti, P. A. et al. (2013) ^d [20]	15–69	17.2	28.8	0.60	OR = 0.5 [0.3–0.9]^g, p < 0.05

F Female, M Male, NA Not available, NS Not significant, OR Odds ratio
^aFour studies were based on hypertensive populations (Khader et al., 2014, Siddiqui et al. 2001, Babiker et al., 2013 and Masmoudi et al., 2010) while the remaining studies were based on general populations
^bNumber of BP measurements was not mentioned in 5 studies (Barakat et al., 2008; Jaddou et al., 2000; Jaddou et al., 2003; Jaddou et al., 2011; Masmoudi et al., 2010;). For the other studies, BP were recorded as the average of a) 2 BP measurements (Al Riyami et al., 2003; Amin et al., 2014; Ben Romdhane et al., 2005; Ben Romdhane et al., 2012; Gunaid et al., 2008; Kalantan et al., 2001; Kheirallah et al., 2015; Khdour et al., 2013; Mirza et al., 2016; Mohamad et al., 2000; Nejjari et al., 2013;), b) the last 2 BP measurements out of 3 (Hamidaa et al., 2013; Tazi et al., 2009; Temmar et al., 2007), c) 3 BP measurements (Abel el Aty et al., 2015; Babiker et al., 2013; El-Bcheraoui et al., 2014; Saeed et al., 2011), d) 2 or 3BP (Matar et al., 2015), e) 4 BP out of 6 (Modesti et al., 2013), f) on several separate occasions (Khader et al., 2014), and g) last 3 BP readings at least 3 months apart (Siddiqui et al., 2001)
^cAge is reported in years either as age group or as mean age ± standard deviation
^dNationally representative studies
^eIndicates that significance was calculated based on reviewer’s calculations using chi-square test for aggregated data
^fAwareness/unawareness, controlled/uncontrolled blood pressure rates are weighted in the original publications (Abd El-Aty et al., 2015; El-Bcheraoui et al., 2014)
^gResults of multivariate regression analyses were reported. The odd ratios for awareness/unawareness, undiagnosed, treatment and controlled/uncontrolled blood pressure are all presented with “female” being the reference variable. In Abd El-Aty et al., 2015 and El-Bcheraoui et al., 2014 odd ratios for undiagnosed hypertension, unawareness and uncontrolled blood pressure are reported

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