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Systematic ReviewSystematic Review
Open Access

Overview of hypertension in Saudi Arabia

A systematic review and meta-analysis

Sulaiman A. Alshammari, Abdullah S. Alshammari, Hotoon S. Alshammari and Shaik S. Ahamed
Saudi Medical Journal October 2023, 44 (10) 951-964; DOI: https://doi.org/10.15537/smj.2023.44.10.20230178
Sulaiman A. Alshammari
From the Department of Family & Community Medicine (Alshammari S), College of Medicine, King Saud University Medical City, King Saud University; from the Psychiatric Department (Alshammari A), Eradah Hospital, Ministry of Health, Riyadh; from the Department of Family & Community Medicine (Alshammari H), King Saud University Medical City; from the Department of Family & Community Medicine, Almaarefa University, Riyadh; from the Department of Family & Community Medicine (Ahamed), College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.
MSc, FRCGP
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Abdullah S. Alshammari
From the Department of Family & Community Medicine (Alshammari S), College of Medicine, King Saud University Medical City, King Saud University; from the Psychiatric Department (Alshammari A), Eradah Hospital, Ministry of Health, Riyadh; from the Department of Family & Community Medicine (Alshammari H), King Saud University Medical City; from the Department of Family & Community Medicine, Almaarefa University, Riyadh; from the Department of Family & Community Medicine (Ahamed), College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.
MBBS
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Hotoon S. Alshammari
From the Department of Family & Community Medicine (Alshammari S), College of Medicine, King Saud University Medical City, King Saud University; from the Psychiatric Department (Alshammari A), Eradah Hospital, Ministry of Health, Riyadh; from the Department of Family & Community Medicine (Alshammari H), King Saud University Medical City; from the Department of Family & Community Medicine, Almaarefa University, Riyadh; from the Department of Family & Community Medicine (Ahamed), College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Shaik S. Ahamed
From the Department of Family & Community Medicine (Alshammari S), College of Medicine, King Saud University Medical City, King Saud University; from the Psychiatric Department (Alshammari A), Eradah Hospital, Ministry of Health, Riyadh; from the Department of Family & Community Medicine (Alshammari H), King Saud University Medical City; from the Department of Family & Community Medicine, Almaarefa University, Riyadh; from the Department of Family & Community Medicine (Ahamed), College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    - Prisma flow chart summarizes the search’ screening and selection of the reviewed hypertensive articles.

  • Figure 2
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    Figure 2

    - Forest plot for studies showing the prevalence of hypertension and pooled prevalence.

  • Figure 3
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    Figure 3

    - Forest plot for studies shows the proportion of subjects who had awareness of hypertension and pooled proportion.

  • Figure 4
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    Figure 4

    - Forest plot for studies shows the proportion of subjects who had treatment for hypertension and pooled proportion.

  • Figure 5
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    Figure 5

    - Forest plot for studies shows the proportion of subjects control hypertension and pooled proportion.

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    Figure 6

    - Risk factors of hypertension.

Tables

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    Table 1

    - The general characteristics, the estimated prevalence of pre-HTN, HTN, awareness, treatment and control rates of HTN in the included studies.

    snAuthor, yearData collection yearSample sizeMale-female ratioMean±SD
     National community studies
    1Osman & Al Nozha,31 20001989-1994625342.7%-57.4%18+
    2Al-Nozha et al,32 20071995-20001723047.7%-52.3%30-70
    3Saeed et al,33 20112005475849.2%-50.8%15–64
    4Khoja et al,34 20182006-2007294650.4%-49.6%60+ (70.1±0.3)
    5El Bcheraoui et al,35 201420131073548.9%-51.1%15+
    6Al-Daghri et al,36 20112011663045.1%-54.9%18-80
     Regional community studies
    7Abolfotouh et al,37 1996NR173950.8%-49.2%30+
    8Al-Baghli et al,38 20092004197681NR30+
    9Elkhalifa et al,39 2011200824346.1%-53.9%30+
    10Alsuwaida & Alghonaim,40 2011200881449.1%-50.9%(18+) 35.8±11.5
    11Gutierrez et al,41 2018201643254.4%-45.6%18+
    12Saquib et al,42 20172015-2016400all male55+ (63±7.5)
    13Mirza A,43 20162012770 relatives of medical students63.6%-36.4%≥30
    14Ahmed H,44 20142012-2013280043.8%-56.2%14 to 100 (Mean 45)
    15Alkahtani SA,45 20162014915all male employees20–64
    16Alyabsi M,46 20202017-202010 79966.3%-33.7%18+ (33.27±10.73)
    17Al-Mohaissen M,47 20202016518all female college students17–29 (20.5±1.8)
    18Alanazi AM,48 20182017232medical students 58.6%-41.4%NR
    19Baig M,49 20152014610male studentsMean 22.40±3.90
    20Madkhali A,50 20222018-2019423 secondary schools students48.7%-51.3%15–19 (17.1±0.9)
    21Rehmani R,51 20132010133957.4%-42.6%14+ (30.7±12.7)
     Primary health care studies for awareness and control
    22Elzubier & Al-Shahri,52 1997199631135.7%-64.3%53.2±0.65
    23Al-Tuwijri & Al-Rukban,53 2006200125547.5%-52.5%57.2±11.1
    24Al-Rukban et al,54 2007200420121.4%-78.6%58.3+12.5
    25Safar et al,55 2014201015,94245.0%-55.0%63±10
    26AlQuaiz et al,56 20212015-2016299732.3%-67.7%30–75 (43.1±11.7)
    27Kalantan et al,57 2001NR111440.0%-60.0%35–85 (47.7±10.7)
    28Al-Qahtani,58 2018NR38251.8%-48.2%18+ (62.71±14.16)
     Hospital affiliated outpatients
    29Ahmed & El-Awad,59 20011994-199620353.0%-47.0%18–75 (46.9±12.6)
     Total 278873  
    • HTN: hypertension, SD: standard deviation, NR: not reported, sn: study number

    • View popup
    Table 1

    - The general characteristics, the estimated prevalence of pre-HTN, HTN, awareness, treatment and control rates of HTN in the included studies (continuation).

    snAuthor, yearRegionHTN% (95%CI)Awareness % (95%CI)Treatment % (95%CI)Control % (95%CI)QA
     National community studies
    1Osman & Al Nozha,31 2000Nat25.9NRNRNR7
    2Al-Nozha et al,32 2007Nat26.1 (25.4-26.8)33.1%75%25%9
    3Saeed et al,33 2011Nat25.5 (24.3-26.8)44.7 (41.9-47.5)71.8379
    4Khoja et al,34 2018Nat29.7   8
    5El Bcheraoui et al,35 2014Nat15.2 (14.5-15.9) PreHTN 40.6 (39.7-41.5)42.236.816.68
    6Al-Daghri et al,36 2011Nat32.6 (31.7-33.6)   8
     Regional community studies
    7Abolfotouh et al,37 1996Asir/Abha21.6%23.57620.27
    8Al-Baghli et al,38 2009Eastern province13 (12.9-13.2)NRNR34.3 (33.7-34.9)7
    9Elkhalifa et al,39 2011Jeddah22.6 (17.5-28.4)NRNRNR6
    10Alsuwaida & Alghonaim,40 2011Riyadh27.661.470.240.89
    11Gutierrez et al,41 2018Tabuk11.1 preHTN 18.5   6
    12Saquib et al,42 2017Qassim71.3 6 6
    13Mirza A,43 2016Makkah31.9% (27.6–36.2)53.9% 38.1%6
    14Ahmed H,44 201413 towns in Hail33.40%   7
    15Alkahtani SA,45 2016Private sector Dammam and Al-Khobar34% (44.6% prehypertensive)   6
    16Alyabsi M,46 2020The Saudi Biobank14.5% (14.37 - 14.61) 24.8% (24.69 - 24.98)Not controlled 27.8% (24.31- 31.59)8
    17Al-Mohaissen M,47 2020Princess Nourah University, Riyadh27.1%   7
    18Alanazi AM,48 2018Northern Border University, Arar13.8%   6
    19Baig M,49 2015King Abdulaziz University, Rabigh and Jeddah7.5%   6
    20Madkhali A,50 2022Samtah city, Jazan4.2% prehypertensin 5%   6
    21Rehmani R,51 2013Al-Hasa and Dammam9%   7
     Primary health care studies for awareness and control
    22Elzubier & Al-Shahri,52 1997East   37.27
    23Al-Tuwijri & Al-Rukban,53 2006Riyadh ALL 40.47
    24Al-Rukban et al,54 2007Riyadh ALL 25.47
    25Safar et al,55 2014Aseer   40%6
    26AlQuaiz et al,56 2021Riyadh18.1  9.68
    27Kalantan et al,57 2001Qassim3022.8  7
    28Al-Qahtani,58 2018Najran ALL 51.3%7
     Hospital affiliated outpatients
    29Ahmed & El-Awad,59 2001Abha   48.86
    • HTN: hypertension, NR: not reported, ALL: all participants, SN: study number QA: quality assessment

    • View popup
    Table 2

    - Meta-analysis for pooled prevalence of hypertension across the published studies.

    Author name and yearSample sizeProportion (%)95%CIWeight (%)
    FixedRandom
    Osman & Al Nozha, 2000625325.90824.825 to 27.0132.274.09
    Al-Nozha et al, 20071723026.10025.445 to 26.7626.264.10
    Saeed et al, 2011475825.49424.260 to 26.7581.734.09
    Khoja et al, 2018294629.70128.055 to 31.3881.074.08
    El Bcheraoui et al, 20141073515.20314.528 to 15.8963.904.10
    Al-Daghri et al, 2011663032.59431.466 to 33.7382.414.09
    Abolfotouh et al, 1996173921.62219.707 to 23.6320.644.40
    Al-Baghli et al, 200919768113.00012.852 to 13.14971.824.11
    Elkhalifa et al, 201124322.63417.530 to 28.4190.0893.79
    Alsuwaida & Alghonaim, 201181427.64124.593 to 30.8520.304.01
    Gutierrez et al, 201843211.1118.307 to 14.4610.163.92
    Saquib et al, 201740071.25066.544 to 75.6390.153.91
    Mirza A, 201677031.94828.664 to 35.3710.284.00
    Ahmed H, 2014280033.39331.646 to 35.1741.024.08
    Alkahtani SA, 201691533.98930.921 to 37.1610.334.02
    Alyabsi M, 20201079914.49213.833 to 15.1703.924.10
    Al-Mohaissen M, 202051827.02723.247 to 31.0720.193.95
    Alanazi AM, 201823213.7939.630 to 18.9100.0853.77
    Baig M, 20156107.5415.574 to 9.9310.223.97
    Madkhali A, 20224234.2552.541 to 6.6420.153.92
    Rehmani R, 201313398.9627.486 to 10.6210.494.05
    AlQuaiz et al, 2021299718.08516.722 to 19.5101.094.08
    Kalantan et al, 2001111429.98227.302 to 32.7680.414.03
    Total (fixed effects)27237815.43815.302 to 15.574100.00100.00
    Total (random effects)27237822.65818.946 to 26.598100.00100.00
    • View popup
    Table 3

    - Meta-analysis for pooled proportion of subjects who had awareness about hypertension across the published studies.

    Author and yearSample sizeAwareness proportion (%)95%CIWeight (%)
    FixedRandom
    Al-Nozha et al, 20071723033.09932.397 to 33.80845.0116.87
    Saeed et al, 2011475844.70443.284 to 46.13012.4316.80
    El Bcheraoui et al, 20141073542.19841.262 to 43.13928.0416.86
    Abolfotouh et al, 1996173923.50721.543 to 25.5854.8316.66
    Alsuwaida & Alghonaim, 201181461.42557.983 to 64.7842.1316.36
    Mirza A, 201677053.89650.301 to 57.4612.0116.33
    Total (fixed effects)3827636.96536.482 to 37.451100.00100.00
    Total (random effects)3827642.73935.179 to 50.475100.00100.00
    • View popup
    Table 4

    - Meta-analysis of for pooled proportion of cases who had treatment for hypertension among hypertensive subjects across the published studies.

    Author and yearSample sizeTreatment proportion (%)95% CIWeight (%)
    FixedRandom
    Al-Nozha et al, 20071723075.00374.349 to 75.64835.6716.68
    Saeed et al, 2011475871.79570.493 to 73.0709.8516.67
    El Bcheraoui et al, 20141073536.79635.882 to 37.71622.2216.68
    Abolfotouh et al, 1996173976.02173.942 to 78.0113.7816.66
    Alsuwaida & Alghonaim, 201181470.14766.873 to 73.2751.6916.61
    Alyabsi M, 20201079924.83624.023 to 25.66222.3616.68
    Total (fixed effects)4607554.22053.764 to 54.675100.00100.00
    Total (random effects)4607559.44038.140 to 79.025100.00100.00
    • CI: confidence interval

    • View popup
    Table 5

    - Meta-analysis for the pooled proportion of hypertension control cases among hypertensive subjects across the published studies.

    StudySample sizeControl cases Proportion (%)95% CIWeight (%)
    FixedRandom
    Al-Nozha et al, 20071723024.96224.317 to 25.6166.456.36
    Saeed et al, 2011475836.99035.616 to 38.3801.786.35
    El Bcheraoui et al, 20141073516.60015.901 to 17.3174.026.35
    Abolfotouh et al, 1996173918.82116.992 to 20.7210.666.73
    Al-Baghli et al, 200919768134.30034.091 to 34.51073.966.36
    Alsuwaida & Alghonaim, 201181440.78637.387 to 44.2520.306.28
    Mirza A, 201677038.05234.609 to 41.5870.296.28
    Alyabsi M, 20201079972.82271.972 to 73.6594.046.35
    Elzubier and Al-Shahri, 199731137.29931.907 to 42.9350.126.15
    Al-Tuwijri & Al-Rukban, 200625540.39234.317 to 46.6940.0966.11
    Al-Rukban et al, 200720125.37319.513 to 31.9750.0766.05
    Safar et al, 20141594240.00139.240 to 40.7675.966.36
    AlQuaiz et al, 202129979.6108.578 to 10.7211.126.34
    AlQahtani, 201838251.30946.172 to 56.4250.146.19
    Ahmed & El-Awad, 200120348.76841.709 to 55.8650.0766.05
    Total (fixed effects)26481734.41934.238 to 34.600100.00100.00
    Total (random effects)26481734.96727.625 to 42.685100.00100.00
    • CI: confidence interval

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Overview of hypertension in Saudi Arabia
Sulaiman A. Alshammari, Abdullah S. Alshammari, Hotoon S. Alshammari, Shaik S. Ahamed
Saudi Medical Journal Oct 2023, 44 (10) 951-964; DOI: 10.15537/smj.2023.44.10.20230178

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Overview of hypertension in Saudi Arabia
Sulaiman A. Alshammari, Abdullah S. Alshammari, Hotoon S. Alshammari, Shaik S. Ahamed
Saudi Medical Journal Oct 2023, 44 (10) 951-964; DOI: 10.15537/smj.2023.44.10.20230178
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Keywords

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  • treatment
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  • hypertension
  • blood pressure
  • Saudi Arabia

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