INTERNATIONAL JOURNAL OF CLINICAL AND MEDICAL CASES (ISSN:2517-7346)

Various studies have demonstrated that the prevalence of hypertension in Oman is higher than many other countries. In one such study it was concluded that 23-27% of the population might be suffering from hypertension. The research was conducted in order to study the prevalence and management of hypertension among Omani population in Muscat region. The non-hospitalized patients aged between 18-85 years who visited the Al-Mabelah health center, Al Khoudh health center and Alseeb polyclinics in Muscat were selected for the study. Patient’s age, gender, type of hypertension, treatment and complications associated were collected. The questionnaires were also distributed. The data was collected over a period ranging over six months. It was observed that the majority of people suffering from hypertension were males which might be due to environmental and genetic factors. High prevalence was mainly among the older age group of 51-60 years. It was found that most of patients suffering from hypertension received education at a primary educational level. A family history was an important contributory factor. Higher risk factors of having hypertension were stress and lack of exercise.

Hypertension; Elderly Patients; Genetic Factors

Hypertension (HTN) is a term used to describe high blood pressure, which is a cardio vascular complication in which the systemic arterial blood pressure is elevated. It is a very common disease prevalent worldwide and in Oman. It is known as the “silent killer” since it has no initial symptoms but can lead to long-term disease and complications which require lifelong medication. Hypertension results from increased peripheral vascular smooth muscle tone, and leads to increase in arteriolar resistance and reduces capacitance of the venous system. In most cases, the cause of the increased vascular tone is unknown. Various studies have demonstrated that the prevalence of hypertension in Oman is even higher than many other countries. In one such study it is concluded that the 23-27% of population might be suffering from hypertension.

90% of hypertensive patients are grouped into primary hypertension, which doesn’t have an identifiable cause. The remaining 5-10% of cases (Secondary hypertension) is caused by other conditions that affect the kidneys, arteries, heart or endocrine system. Hypertension has been commonly staged by the degree of blood pressure elevation into” mild”, “moderate” and “severe” hypertension. The risk factors of hypertension in Oman and in other gulf countries involve age, race, lifestyle, genetic heredity, certain pathologies and medication. Untreated hypertension is the major risk factor for heart attack, stroke, myocardial infarction, heart failure, and is a leading cause of chronic kidney failure. Blood pressure affects person’s life expectancy hence it is important to take it into consideration about treating this disease. Lifestyle and dietary changes can improve blood pressure control and decrease the risk of associated complications; however drug treatment is considered necessary for patients who are not responding to lifestyle changes. There are many different medicines from different categories that have been used to treat and control high blood pressure, including: ACE inhibitors (Angiotensin-Converting Enzyme), beta blockers, calcium channel blockers and diuretics [1].

Risk factors include overweight or obesity, unhealthy lifestyle habits, sodium chloride intake, alcohol intake, physical inactivity, smoking and using tobacco, older age, sex / gender. High blood pressure is more common in men. Women are more likely to develop high blood pressure after age 45-65 years. Blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack, and kidney failure, also are more common in blacks. Other factors include family history with hypertension. High levels of stress can lead to a temporary increase in blood pressure [2].

There is no identifiable cause of high blood pressure. Primary (essential) hypertension in most adults tends to develop gradually over many years.Secondary hypertension is caused by an underlying condition. It tends to appear suddenly and causes higher blood pressure than does primary hypertension. Various conditions and medications that can lead to secondary hypertension include kidney problems, adrenal gland tumors, and thyroid problems, certain defects in blood vessels, and certain medications such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs (Chart 1). 

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high level, so it’s called the silent killer. In some rare cases, where a person has very high blood pressure, they can experience symptoms including severe headache, vision problems, nosebleeds, and shortness of breath, dizziness and irregular heartbeat.

In fact, nearly one-third of people who have high blood pressure don’t know it. The only way to know if the blood pressure is high is through regular checkups [3].

High Blood Pressure (HBP) is treated with lifestyle changes and medication. Healthy lifestyle habits can help control high blood pressure. These habits include following a healthy diet,(DASH) diet, which include: fruits, vegetables, and low-fat dairy foods, plenty of potassium, which can help prevent and control high blood pressure, decrease the salt in the diet, being physically active, maintaining a healthy weight, quitting smoking, managing the stress and medications including thiazide diuretics, loop diuretics, potassiumsparing diuretics, beta blockers and Angiotensin-Converting Enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, renin inhibitors (Aliskiren) etc. 

Once blood pressure is under control, a daily aspirin should be taken to reduce the risk of cardiovascular disorders. To reduce the number of daily medication doses need, the doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one [4-6].

Nancy Huang, et al. showed that by healthy eating, reducing dietary sodium, regular physical activity, maintaining healthy body weight and smoking cessation can lower blood pressure, regardless of drug therapy [7].

Fotoula Babatsikou et al. [8] provided evidence that prevalence of hypertension in the elderly in USA, Europe is between 53% and 72%. Regular physical activity, healthy diet and medication are some of the preventive measures that can be adopted for reduction of high blood pressure levels [8]. Manuel Pentane showed that systolic and diastolic blood pressure increased with advanced age and the use of calcium channel antagonist was beneficial in hypertension in elderly population [9]. Maria Czarina study shown in elderly patient clarified that optimal management of hypertension could be achieved by therapeutic lifestyle change, such as reduced dietary sodium intake, weight loss, regular aerobic activity, and moderation of alcohol consumption. He showed also pharmacological agent can reduce mortality in patient with cardiovascular disease [10,11]. Prevalence and associated risk factors of hypertension among people aged 50 years and more in Banepa Municipality, Nepal were studied by Manandhar K. It demonstrated that the prevalence of hypertension was more in male gender, people having non vegetarian eating habits, alcohol consumption and > 25 body max index [11].

An audit of Hypertensive at University Health Center in Oman was done by Thuraya Ahmed Al shidhani et al. In this study the authors talked about evaluation of management of hypertension in primary health care center SQU in Oman. By randomized methods around 150 patients were selected in 2007-2008. Omani females were around 53.3% and males were 46.7% in 2007 and 2008. About 55% of hypertension patients were significantly controlled [12].

Another study on blood pressure patterns among the Omani populations was shown by A.A. Hasab. The study was done on 4732 people who had high blood pressure. Also in this study it was shown that income, blood pressure risk factor with obesity and those aged more than or equals 45 year were more compared to other hypertensive people. [13].

Study on control of hypertension among Type 2 diabetics was conducted by Kawther EL. In this study, authors have discussed about how to assess blood pressure control in patients with type 2 diabetes mellitus. This study was conducted in health center in Oman over a one year period. The result of systolic to diastolic ratio in group 1 was 10:56, group 2 was 23:14, group 3 was 23:16, and group 4 was 41:7. The medications used were ACE, ARB, diuretics, β-blockers, and calcium channel blockers. Only 30% of the hypertensive patients met the recommended blood pressure for diabetics [14].

Prevalence of uncontrolled hypertension in primary care settings in Al Seeb, Wilayat Oman was studied by Rashid Al Saadi, Suleiman et al. Blood pressure control in diabetes was about 6.4% and 18.5% in renal disease. Better control was seen with cardiovascular disease and was 58% [15]. Control and management of hypertension at the university health center in Oman was done by Abdulaziz Al Mahrezi et al. [16]. This study was done on people that were under 18 years of age and older at SQU health center.The prevalence was about 2.4% among 7702 medical records studied for age. It was low compared to the national average. This study showed the control of hypertension was not optimal but was higher than those reported elsewhere [16].

The aim of the present study was to study the prevalence and management of hypertension in Omani population.

The hypothesis of the present study was that Hypertension is common among Omani population.

The objectives of the present study were to assess the prevalence of hypertension according to age, gender; educational levels etc. in patients and to determine the most common risk factors associated with hypertension.

Subjects and setting

The non-hospitalized patients aged between 18-85 years who visited the Al-Mabelah health center, Al Khoudh health center and Alseeb polyclinics in Muscat were selected for the study. Patient’s age, gender, type of hypertension, treatment and complications associated were collected. The questionnaires were also distributed. The data was collected over a period ranging over six months.

Criteria for selecting data

The criteria for inclusion included non-hospitalized hypertensive patients aged between 18-85 years showing symptoms of hypertension and who came to the health centers over a period ranging over six months.

Standard structure of patient medical records

About 150 medical records were checked for non-hospitalized hypertensive patients. They contained the following information:
• Age of the patients 
• Gender of the patient
• Type of hypertension
• Family history
• Treatment
• Complication 

Methodology

It was a survey based retrospective study and 150 patients participated in the study A questionnaire about “prevalence and management of hypertension in Omani population” was prepared which is as follows. The filled questionnaire was analyzed statistically and the results were tabulated.

he results are tabulated as below (Chart 2).

The data was collected from the filled questionnaires. It was compiled in excel sheet and analyzed. It was found that males ware suffering more than females, as shown in the (Table 1 and Figure 1).

It was found that most patients suffering from hypertension were in the age group of 51-60 years, as shown in the (Table 2 and Figure 2).

It was found that most of the patients suffering from hypertension had education at Primary level, as shown in the (Table 3 and Figure 3).

It was found that the majority of hypertensive patients knew that they had hypertension, as shown in the (Table 4 and Figure 4).

It was found that most of the patients suffering from hypertension visited the doctor for checkup every 3-4 months, as shown in the (Table 5 and Figure 5).

It was found that most of the hypertensive patients were measuring their blood pressure reading at home as shown in the (Table 6 and Figure 6).

It was found that the majority of hypertensive patient were not affected by the usual daily activities with hypertension symptoms, as shown in the (Table 7 and Figure 7).

It was found that the majority of hypertensive patients followed the low salt in the diet, as shown in the (Table 8 and Figure 8).

It was found that in majority of patients the risk factor of having hypertension was stress, as shown in the (Table 9 and Figure 9).

It was found that the majority of hypertensive patients were taking their medications as prescribed by doctors, as shown in the (Table 10 and Figure 10).

It was found that the majority of hypertensive patients had a family history with hypertension, as shown in the (Table 11 and Figure 11).

It was found that the majority of hypertensive patients were not doing any exercises, as shown in the (Table 12 and Figure 12).

It was found that most of the hypertensive patients had complication associated with their hypertension, as shown in the (Table 13 and Figure 13).

It was found that most of the hypertensive patients received counseling from their pharmacists, as shown in the (Table 14 and Figure 14).

In conclusion, the research was conducted in order to study the prevalence and management of hypertension among Omani population in Muscat region. The results obtained have met the goals that were aimed in this research. While conducting this research, few restrictions occurred which limited the study. Lack of high rate of individuals and lack of time are some examples of limitations encountered while this research was conducted.

From our study, we have found out that

1. The majority of people suffering from hypertension were males. It might be due to environmental and genetic factors.
2. In addition, high prevalence was mainly among the older age group of 51-60 years. It was found that most of patients suffering from hypertension received education at a primary educational level. A family history was an important contributory factor. Higher risk factors of having hypertension were stress and lack of exercise. It is important to know the risk factors of the hypertension, which might help the provider to optimize treatment for patients and to improve their quality of life.
   

Some of the recommendations from the above study include early detection of hypertension, advocate for healthy lifestyle, especially in young generation by exercising regularly, balanced diet, obesity control etc., quit smoking and alcohol, periodic health checkup for hypertension to avoid any complication associated and safe use of the medication.

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