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1. Epidemiologic features and management of hypertension in Tunisia, the results from the Hypertension National Registry (NaTuRe HTN)

Author

Leila Abid, Rania Hammami, Ikram Chamtouri, Meriam Drissa, Selim Boudiche, MohamedAmine Bahloul, Hedi BenSlima, Khaled Sayahi, Selma Charfeddine, Emna Allouche, Lamia Rais, Badr Kaab, Hassen IbnHadjamor, Lilia BenFatma, Riadh Garbaa, Sabrine Boukhris, Manel Ben Halima, Nesrine Amdouni, Chaima Ghorbel, Sabrine Soudani, Imen Khaled, Syrine Triki, Feten Bouazizi, Imen Jemai, Ouday Abdeljalil, Yemna Ammar, Amani Farah, Adnen Neji, Zeineb Oumayma, Sana Seghaier, Samir Mokrani, Hamza Thawaba, Hela Sarray, Khalil Ouaghlani, Houssem Thabet, Zeineb Mnif, Fatma Boujelban, Mohamed Sghaier, Roueida Khalifa, Sami Fourati, Yasmin Kammoun, Syrine Abid, Chihab Hamza, Syrine Ben Jeddou, Lassaad Sabbah, Rim Lakhdhar, Najla Dammak, Tarek Sellami, Basma Herbegue, Alia Koubaa, Faten Triki, Tarek Ellouz, Aicha Hmoudi, Ikhlas BenAmeur, MohamedMongi Boukhchina, Neila Abid, Wejdene Wachtati, Nizar Nasrallah, Yousra Houidi, Fathia Meghaieth, Elhem Ghodhbane, Mounira Chayeb, Sarra Chenik, Samira Kaabachi, Nizar Saadaoui, Ines BenAmeur, Moufida Affes, Sana Ouali, Mouna Chaker, Hela Naanaa, Meriem Dghim, Mourad Jarrar, Jihene Mnif, Ahmed Turki, Ihsen Zairi, Jamel Langar, Safa Dardouri, Imen Hchaichi, Rafik Chettaoui, Wajih Essmat, Amel Chakroun, Khadija Mzoughi, Rachid Mechmeche, Afef BenHalima, Sahar BenKhala, Slim Chtourou, Abdelkader Maalej, Mohsen Ayari, Moufid Hadrich, Rami Tlili, Fares Azaiez, Imen Bouhlel, Samira Sahnoun, Habib Jerbi, Imtinene BenMrad, Leila Riahi, Mohamed Sahnoun, Abdelhamid BenJemaa, Amel BenSalem, Bassem Rekik, Maroua BenDoudou, Rachid Boujneh, Anissa Joulak, Yosra Mejdoub, Imen Gtif, Gouider Jribi, Elyes Naffeti, Habib Gamra, Soraya BenYousef, Wissem Sdiri, Najeh BenHalima, Youssef BenAmeur, Salem Kachboura, Sondes Kraiem, Wafa Fehri, Leila Bazdeh, MohamedSami Mourali, Sami Milouchi, Habiba Drissa, Faouzi Maatouk, Lilia Zakhama, Faouzi Addad, Samir Kammoun, and Salem Abdesselem

Subjects
Hypertension, Blood pressure control, Epidemiology, Predictors, Registry, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.

Published
2022
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2. Epidemiologic features and Management of Hypertension in Tunisia, the results from the NAtional TUnisian REgistry of HyperTensioN (NaTuRe HTN) about 25890 patients

Author

MohamedSami Mourali, Anissa Joulak, Imen Jemai, Ihsen Zairi, Wajih Essmat, Hela Sarray, Alia Koubaa, Badr Kaab, Sami Fourati, Sana Ouali, Rania Hammami, Syrine Abid, Chihab Hamza, Youssef BenAmeur, Hela Naanaa, Maroua BenDoudou, Houssem Thabet, Mounira Chayeb, Khalil Ouaghlani, Imen Khaled, Jamel Langar, Imtinene BenMrad, Lamia Rais, Najla Dammak, Samir Mokrani, Roueida Khalifa, Imen Hchaichi, Ahmed Turki, Samir Kammoun, Elyes Naffeti, Rachid Boujneh, Mohamed Sahnoun, Aicha Hmoudi, Basma Herbegue, Abdelkader Maalej, Amani Farah, Tarek Sellami, Ikram Chatmouri, Wissem Sdiri, MohamedAmine Bahloul, Leila Riahi, Faouzi Addad, Samira Sahnoun, MohamedMongi Boukhchina, Feten Bouazizi, Wejdene Wachtati, Afef BenHalima, Safa Dardouri, Khaled Sayahi, Slim Chtourou, Hedi BenSlima, Sondes Kraiem, Syrine Triki, Nesrine Amdouni, Khadija Mzoughi, Moufid Hadrich, Nizar Nasrallah, Salem Abdesselem, Imen Bouhlel, Leila Bazdeh, Hamza Thawaba, Syrine Ben Jeddou, Riadh Garbaa, Meriam Drissa, Sana Seghaier, Yemna Ammar, Faten Triki, Mouna Chaker, Nizar Saadaoui, Selim Boudiche, Hassen IbnHadjamor, Sahar BenKhala, Tarek Ellouz, Ines BenAmeur, Sabrine Boukhris, Selma Charfeddine, Ikhlas BenAmeur, Gouider Jribi, Zeineb Oumayma, Elhem Ghodhbane, Mohamed Sghaier, Moufida Affes, Adnen Neji, Rachid Mechmeche, Faouzi Maatouk, Manel Ben Halima, Leila Abid, Sami Milouchi, Meriem Dghim, Amel BenSalem, Fathia Meghaieth, Fatma Boujelban, Imen gtif, Sarra Chenik, Sabrine Soudani, Amel Chakroun, Abdelhamid BenJemaa, Salem Kachboura, Yasmin Kammoun, Yousra Houidi, Fares Azaiez, Bassem Rekik, Chaima Ghorbel, Zeineb Mnif, Habib Jerbi, Samira Kaabachi, Neila Abid, Yosra Mejdoub, Rim Lakhdhar, Jihene Mnif, Lilia BenFatma, Rami Tlili, Rafik Chettaoui, Mourad Jarrar, Lassaad Sabbah, Najeh BenHalima, Soraya BenYousef, Habib Gamra, Habiba Drissa, Mohsen Ayari, Ouday Abdeljalil, Wafa Fehri, Lilia Zakhama, and Emna Allouche

Abstract

BackgroundHypertension is the leading cause of morbi-moratlity in low, middle as well as high incomes countries. Tunisia is a developing country with a high cardiovascular profile and the prevalence of hypertension has widely increased during the last decades. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. MethodsNature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90mmHg. Our objective is to assess the predictors of uncontrolled hypertension in our population. Results Three hundred twenty one investigators from all the Tunisian governorates participated in the study. We enrolled 25890 patients with a female predominance (Sex ratio 1.21) and an average age 64.4±12.2 year-old. Most of individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as BP target and only in 18.6% if we consider 130/80 as a target. The independents predictors of uncontrolled blood pressure were male sex (OR=1.09, 95%CI [1.02-1.16]), age> 65 year-old (OR=1.07, 95% CI[1.01-1.13], diabetes (OR=1.18, 95% CI [1.11-1.25], Smoking (OR=1.15, 95% CI [1.05-1.25]), Obesity (OR=1.14, 95% CI[1.07-1.21]), management in public sector (OR=1.25, 95% CI [1.16-1.34]) and Heart rate >80bpm (OR=1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR=0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR=0.86, 95% CI [0.8-0.93]), salt restriction (OR=0.48, 95% CI [0.45-0.51]), drug compliance (OR=0.57, 95% CI[0.52-0.61]) and regular physical activity (OR=0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. Conclusion Nature HTN showed a remarkable improvement of blood pressure control amongst Tunisian people. The control remains low in patients with high cardiovascular profile and those treated in the public sector. A national health program based on therapeutic education, regular control and continuous giving much support to the public institutions is needed to decrease the hypertension burden affection rate in our population.

Published
2021

3. Epidemiologic features and management of hypertension in Tunisia, the results from the Hypertension National Registry (NaTuRe HTN)

Author

Leila Abid, Rania Hammami, Ikram Chamtouri, Meriam Drissa, Selim Boudiche, MohamedAmine Bahloul, Hedi BenSlima, Khaled Sayahi, Selma Charfeddine, Emna Allouche, Lamia Rais, Badr Kaab, Hassen IbnHadjamor, Lilia BenFatma, Riadh Garbaa, Sabrine Boukhris, Manel Ben Halima, Nesrine Amdouni, Chaima Ghorbel, Sabrine Soudani, Imen Khaled, Syrine Triki, Feten Bouazizi, Imen Jemai, Ouday Abdeljalil, Yemna Ammar, Amani Farah, Adnen Neji, Zeineb Oumayma, Sana Seghaier, Samir Mokrani, Hamza Thawaba, Hela Sarray, Khalil Ouaghlani, Houssem Thabet, Zeineb Mnif, Fatma Boujelban, Mohamed Sghaier, Roueida Khalifa, Sami Fourati, Yasmin Kammoun, Syrine Abid, Chihab Hamza, Syrine Ben Jeddou, Lassaad Sabbah, Rim Lakhdhar, Najla Dammak, Tarek Sellami, Basma Herbegue, Alia Koubaa, Faten Triki, Tarek Ellouz, Aicha Hmoudi, Ikhlas BenAmeur, MohamedMongi Boukhchina, Neila Abid, Wejdene Wachtati, Nizar Nasrallah, Yousra Houidi, Fathia Meghaieth, Elhem Ghodhbane, Mounira Chayeb, Sarra Chenik, Samira Kaabachi, Nizar Saadaoui, Ines BenAmeur, Moufida Affes, Sana Ouali, Mouna Chaker, Hela Naanaa, Meriem Dghim, Mourad Jarrar, Jihene Mnif, Ahmed Turki, Ihsen Zairi, Jamel Langar, Safa Dardouri, Imen Hchaichi, Rafik Chettaoui, Wajih Essmat, Amel Chakroun, Khadija Mzoughi, Rachid Mechmeche, Afef BenHalima, Sahar BenKhala, Slim Chtourou, Abdelkader Maalej, Mohsen Ayari, Moufid Hadrich, Rami Tlili, Fares Azaiez, Imen Bouhlel, Samira Sahnoun, Habib Jerbi, Imtinene BenMrad, Leila Riahi, Mohamed Sahnoun, Abdelhamid BenJemaa, Amel BenSalem, Bassem Rekik, Maroua BenDoudou, Rachid Boujneh, Anissa Joulak, Yosra Mejdoub, Imen Gtif, Gouider Jribi, Elyes Naffeti, Habib Gamra, Soraya BenYousef, Wissem Sdiri, Najeh BenHalima, Youssef BenAmeur, Salem Kachboura, Sondes Kraiem, Wafa Fehri, Leila Bazdeh, MohamedSami Mourali, Sami Milouchi, Habiba Drissa, Faouzi Maatouk, Lilia Zakhama, Faouzi Addad, Samir Kammoun, and Salem Abdesselem

Subjects
Male, Cross-Sectional Studies, Tunisia, Risk Factors, Hypertension, Humans, Female, Registries, Middle Aged, Cardiology and Cardiovascular Medicine, Aged
Abstract

Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.

Published
2021

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