Assef Hamdan, MD Intern Doctor at Palestinian MoH Prevalence of Uncontrolled Hypertension among Treated Patients in Nablus- Palestine Assef Hamdan, MD Intern Doctor at Palestinian MoH Acknowledgment: Dr. Samar Musmar, MD, FAAFP Dr. Zaher Nazzal, MD, PhD, ABCM Issa Alwaneh, MD, GP

CONTENTS INTRODUCTION AIM & OBJECTIVES METHODOLOGY RESULTS STRENGTH Vs LIMITATIONS CONCLUSION & RECOMMENDATIONS

INTRODUCTION HTN is defined as a systolic blood pressure of ≥ 140 mm Hg and/or a diastolic blood pressure of ≥ 90 mm Hg or taking antihypertensive medication. (JNC-7 & AHA- 2012 update) Prehypertension state: BP of (120-139/ 80 -89) mm Hg. Between 2006 and 2011, there was a significant increase in the number of people visiting US emergency rooms and/or admitted for a raised blood pressure. (Harrison L. Medscape. Sep. 2014)

Introduction… HTN is a major Global public health crisis as it is already affecting one billion people worldwide! (WHO- 2013) 12% of adults in the West Bank- Palestine are known to have HTN. No studies conducted on the control of Blood pressure. (Palestinian MoH) The AHA estimates that direct and indirect costs of HTN are more than $93.5 billion per year. This silent killer is the most important modifiable risk factor for cardiovascular diseases.

AIM & OBJECTIVES To determine the prevalence of uncontrolled hypertension among on-treatment patients. To assess the relationship between the control of HTN and the socio-demographic and medical features of patients. To find out any relationship between HTN control and the management approach (No. of medications, Salt restriction habit)

METHODOLOGY Population: Data Collection: Sample Size/ Technique: Design: Cross-sectional Population: *Hypertensive patients *Aged >18 yrs *Taking medicine for ≥ 3 months Time Frame: Sep –Dec/ 2013 Setting: Out-patient follow-up HTN clinics Data Collection: Questionnaire/ measurements Sample Size/ Technique: 218, convenient sampling

Methodology… Data Collection: data collection sheet questionnaire anthropometric and BP measurements Analysis: data entry and coding via SPSS program Chi-square test uni- and multivariate logistic regression Age Gender Smoking Salt Restriction Educational Level Number of drugs Diabetic Status Marital Status Uncontrolled HTN– JNC 7

RESULTS Prevalence of Uncontrolled HTN

Global Percentages of Uncontrolled HTN

Confidence interval (CI) Relationship between HTN Control and Selected Risk Factors after Adjustment for Confounding Factors Variable Odds Ratio (OR) Confidence interval (CI) P -Value Diabetes 1.91 1.09 - 3.32 0.010 BMI 2.45 1.15 – 5.25 0.009 Smoking 4.07 1.21 - 4.45 0.001 Education 1.87 1.06 – 3.29 0.002 No. of Drugs 1.86 1.36 - 4.81 0.004

Strength Limitations Critical public health issue, national and international In Nablus governorate only In the line of so many regional and global studies, the 1st in Palestine Possible bias: some patients could have been missed; the diabetics Layout of the study( cross-sectional/ evidence-based approach… ) No causal relationships

CONCLUSION & RECOMMENDATIONS HTN is NOT adequately controlled in the majority  More burden of the disease. (Improving the quality of HTN care is needed). Diabetics, smokers, obese and low-educated patients are more prone to uncontrolled HTN. (should be targeted for greater attention to BP control). Mono-therapy is NOT recommended for BP control. Further studies...

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