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The hypertension, diabetes and chronic kidney disease triangle in Arab countries

Journal of Human Hypertension volume 31, pages 373–375 (2017)Cite this article

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Hypertension and diabetes are major risk factors for cardiovascular disease (CVD).1, 2 Hypertension is the single most important risk factor for ischemic and a major risk factor for hemorrhagic stroke, in addition to coronary heart disease (CHD).1 Similarly, patients with diabetes have a two- to four-fold higher risk of CVD, the leading cause of death in this population.2 Also associated with CVD are the often un(der)diagnosed conditions of pre-hypertension3 and pre-diabetes,4 which often evolve to full disease. A better understanding of the risks associated with these precursor conditions is essential—including in regions where hypertension and especially diabetes are rising at rates not even seen in (high-risk) Western countries.

The report by Khosravi and colleagues in this issue of the Journal fills a significant gap and sets the stage for further explorations in Arab-speaking countries tied by language, heritage and religion.5 Using the Ishafan Cohort Study, an elegantly designed survey with random multistage cluster sampling, the authors examine the independent and joint associations of pre-diabetes and pre-hypertension with subsequent onset of major cardiac outcomes. Summarized, in age- and gender-adjusted analyses, pre-hypertension was predictive of unstable angina and CVD, and comorbid pre-hypertension and pre-diabetes predictive of myocardial infarction. Pre-diabetes was not independently associated with cardiovascular events. The authors also compare their rates to those in other Middle-Eastern countries—showing similarities and differences in results across studies that vary in methodology. Together, this gives a convincing epidemiological perspective on the association of pre-hypertension and pre-diabetes with cardiovascular morbidity and mortality in Iran; and an initial view on the epidemiological dynamics in other countries in the region. This is particularly pertinent given the epidemiology of hypertension and diabetes in the Arab-speaking region.

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Authors and Affiliations

  1. Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA

    I Abraham & S Kurdi

  2. Matrix45, Tucson, AZ, USA

    I Abraham & K MacDonald

  3. College of Pharmacy, University of Dammam, Dammam, Saudi Arabia

    S Kurdi

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  1. I Abraham
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  2. S Kurdi
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  3. K MacDonald
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Correspondence to I Abraham.

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Abraham, I., Kurdi, S. & MacDonald, K. The hypertension, diabetes and chronic kidney disease triangle in Arab countries. J Hum Hypertens 31, 373–375 (2017). https://doi.org/10.1038/jhh.2017.16

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