Abstract
Hypertension is the leading source of morbidity and death. In the 21st century, there still is a major gap between high and low to middle-income countries in awareness, management, and control; countries in the Middle East represent an example of such disparities. In this review of the literature, light is shed on the prevalence and modifiable risk factors of hypertension specific to the region, as well as regional disparities in diagnosis and management. The crude prevalence rate is estimated to be around 29.5% with wide variability between countries. Various modifiable factors affect the prevalence of hypertension in this region such as excessively high rates of smoking, obesity, a sedentary lifestyle, some gender gap, and a suboptimal healthcare system; socio-economic factors and disparities in education, literacy, and urbanization play a significant role. Patient adherence to treatment is a determining factor of blood pressure control and nonadherence adversely affect outcomes. In addition, physician adherence to international guidelines is poor. Recognizing these barriers to hypertension management, this review serves as a call for increased national and regional efforts to implement favorable healthcare policies and improve clinical outcomes.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50. https://doi.org/10.1161/CIRCULATIONAHA.115.018912. Epub 2016/08/10PubMed PMID: 27502908; PubMed Central PMCID: PMCPMC4979614
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23. https://doi.org/10.1016/S0140-6736(05)17741-1. Epub 2005/01/18PubMed PMID: 15652604
UN. World Economic Situation and Prospects 2020. New York: UN; 2020.
Krishnan NLI, Gabriel; Narayan, Ambar; Tiwari, Sailesh; Vishwanath, Tara. 2016. Uneven Odds, Unequal Outcomes: Inequality of Opportunity in the Middle East and North Africa. Directions in Development-Poverty;. Washington, DC: World Bank. https://openknowledge.worldbank.org/handle/10986/24596
Alsheikh-Ali AA, Omar MI, Raal FJ, Rashed W, Hamoui O, Kane A, et al. Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study. PLoS One 2014;9:e102830 https://doi.org/10.1371/journal.pone.0102830. Epub 2014/08/05PubMed PMID: 25090638; PubMed Central PMCID: PMCPMC4121128
Yusufali AM, Khatib R, Islam S, Alhabib KF, Bahonar A, Swidan HM, et al. Prevalence, awareness, treatment and control of hypertension in four Middle East countries. J Hypertens. 2017;35:1457–64. https://doi.org/10.1097/HJH.0000000000001326. Epub 2017/05/10PubMed PMID: 28486270
Sarki AM, Nduka CU, Stranges S, Kandala NB, Uthman OA. Prevalence of hypertension in low- and middle-income countries: a systematic review and meta-analysis. Med (Baltim). 2015;94:e1959 https://doi.org/10.1097/MD.0000000000001959. Epub 2015/12/20PubMed PMID: 26683910; PubMed Central PMCID: PMCPMC5058882
Tailakh A, Evangelista LS, Mentes JC, Pike NA, Phillips LR, Morisky DE. Hypertension prevalence, awareness, and control in Arab countries: a systematic review. Nurs Health Sci. 2014;16:126–30. https://doi.org/10.1111/nhs.12060. Epub 2013/10/15PubMed PMID: 24118852; PubMed Central PMCID: PMCPMC4445843
Motlagh B, O’Donnell M, Yusuf S. Prevalence of cardiovascular risk factors in the Middle East: a systematic review. Eur J Cardiovasc Prev Rehabil. 2009;16:268–80. https://doi.org/10.1097/HJR.0b013e328322ca1b. Epub 2009/04/29PubMed PMID: 19398913
Tohme RA, Jurjus AR, Estephan A. The prevalence of hypertension and its association with other cardiovascular disease risk factors in a representative sample of the Lebanese population. J Hum Hypertens. 2005;19:861–8. https://doi.org/10.1038/sj.jhh.1001909. Epub 2005/07/22PubMed PMID: 16034449
Al Riyami AA, Afifi MM. Hypertension in Oman: distribution and correlates. J Egypt Public Health Assoc. 2002;77:383–407. Epub 2007/01/16. PubMed PMID: 17216969
Tazi MA, Abir-Khalil S, Chaouki N, Cherqaoui S, Lahmouz F, Srairi JE, et al. Prevalence of the main cardiovascular risk factors in Morocco: results of a National Survey, 2000. J Hypertens. 2003;21:897–903. https://doi.org/10.1097/00004872-200305000-00013. Epub 2003/04/26PubMed PMID: 12714863
Matar D, Frangieh AH, Abouassi S, Bteich F, Saleh A, Salame E, et al. Prevalence, awareness, treatment, and control of hypertension in Lebanon. J Clin Hypertens (Greenwich). 2015;17:381–8. https://doi.org/10.1111/jch.12485. Epub 2015/01/27PubMed PMID: 25619545
Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A, Haghazali M, Asgari F, et al. Third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health. 2009;9:167 https://doi.org/10.1186/1471-2458-9-167. Epub 2009/06/02PubMed PMID: 19480675; PubMed Central PMCID: PMCPMC2697989
El-Reshaid K, Al-Owaish R, Diab A. Hypertension in kuwait: the past, present and future. Saudi J Kidney Dis Transpl. 1999;10:357–64. Epub 2008/01/24PubMed PMID: 18212446
Ashour Z, Ibrahim MM, Appel LJ, Ibrahim AS, Whelton PK. The Egyptian National Hypertension Project (NHP). Design and rationale. The NHP Investigative Team. Hypertension. 1995;26:880–5. https://doi.org/10.1161/01.hyp.26.6.880. Epub 1995/12/01PubMed PMID: 7490143
El-Shahat YI, Bakir SZ, Farjou N, Hashim T, Bohaliga A, Al-Hossani H, et al. Hypertension in UAE Citizens - Preliminary Results of a Prospective Study. Saudi J Kidney Dis Transpl. 1999;10:376–81. Epub 2008/01/24PubMed PMID: 18212449
Al-Noumani H, Wu JR, Barksdale D, Alkhasawneh E, Knafl G, Sherwood G. Relationship between medication adherence and health beliefs among patients with hypertension in Oman: pilot study. Sultan Qaboos Univ Med J. 2017;17:e329–e33. https://doi.org/10.18295/squmj.2017.17.03.012. Epub 2017/10/25PubMed PMID: 29062557; PubMed Central PMCID: PMCPMC5642364
Mathers C, Stevens G, Hogan D, Mahanani WR, Ho J. Global and regional causes of death: patterns and trends, 2000-15. In: Jamison DT, Gelband H, Horton S, Jha P, Laxminarayan R, et al., editors. Disease control priorities: improving health and reducing poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017.
Ibrahim MM. Epidemiology of hypertension in egypt. Saudi J Kidney Dis Transpl. 1999;10:352–6. Epub 2008/01/24. PubMed PMID: 18212445
Al-Nozha M, Al-Khadra A, Arafah MR, Al-Maatouq MA, Khalil MZ, Khan NB, et al. Metabolic syndrome in Saudi Arabia. Saudi Med J. 2005;26:1918–25.
Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, Zachariah R, et al. Hypertension and treatment outcomes in Palestine refugees in United Nations Relief and Works Agency primary health care clinics in Jordan. Trop Med Int Health. 2014;19:1276–83. https://doi.org/10.1111/tmi.12356. Epub 2014/07/22PubMed PMID: 25039838
Arnaout MS, Almahmeed W, Ibrahim M, Ker J, Khalil MT, Van Wyk CT, et al. Hypertension and its management in countries in Africa and the Middle East, with special reference to the place of beta-blockade. Curr Med Res Opin. 2011;27:1223–36. https://doi.org/10.1185/03007995.2011.576239. Epub 2011/04/21PubMed PMID: 21504302
World health statistics 2020: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2020.
Health and well-being profile of the Eastern Mediterranean Region: an overview of the health situation in the Region and its countries in 2019. Cairo: WHO Regional Office for the Eastern Mediterranean; 2020.
Vialle-Valentin CE, Serumaga B, Wagner AK, Ross-Degnan D. Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries. Health Policy Plan. 2015;30:1044–52. https://doi.org/10.1093/heapol/czu107. Epub 2014/09/27PubMed PMID: 25255920; PubMed Central PMCID: PMCPMC4654757
Abukhdeir HF, Caplan LS, Reese L, Alema-Mensah E. Factors affecting the prevalence of chronic diseases in Palestinian people: an analysis of data from the Palestinian Central Bureau of Statistics. East Mediterr Health J. 2013;19:307–13. Epub 2013/07/26. PubMed PMID: 23882954; PubMed Central PMCID: PMCPMC4143143
Virdis A, Giannarelli C, Neves MF, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Curr Pharm Des. 2010;16:2518–25. https://doi.org/10.2174/138161210792062920. Epub 2010/06/17PubMed PMID: 20550499
Khattab A, Javaid A, Iraqi G, Alzaabi A, Ben Kheder A, Koniski ML, et al. Smoking habits in the Middle East and North Africa: results of the BREATHE study. Respir Med. 2012;106:S16–24. https://doi.org/10.1016/S0954-6111(12)70011-2. Suppl 2Epub 2013/02/08PubMed PMID: 23290700
Abdulle AM, Nagelkerke NJ, Abouchacra S, Pathan JY, Adem A, Obineche EN. Under- treatment and under diagnosis of hypertension: a serious problem in the United Arab Emirates. BMC Cardiovasc Disord. 2006;6:24 https://doi.org/10.1186/1471-2261-6-24. Epub 2006/06/07PubMed PMID: 16753071; PubMed Central PMCID: PMCPMC1501045
Qasim H, Alarabi AB, Alzoubi KH, Karim ZA, Alshbool FZ, Khasawneh FT. The effects of hookah/waterpipe smoking on general health and the cardiovascular system. Environ Health Prev Med. 2019;24:58 https://doi.org/10.1186/s12199-019-0811-y. Epub 2019/09/16PubMed PMID: 31521105; PubMed Central PMCID: PMCPMC6745078
Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prev Med. 2009;37:518–23. https://doi.org/10.1016/j.amepre.2009.07.014. Epub 2009/12/01PubMed PMID: 19944918; PubMed Central PMCID: PMCPMC2805076
Rezk-Hanna M, Doering L, Robbins W, Sarna L, Elashoff RM, Victor RG. Acute effect of hookah smoking on arterial stiffness and wave reflections in adults aged 18 to 34 years of age. Am J Cardiol. 2018;122:905–9. https://doi.org/10.1016/j.amjcard.2018.05.033. Epub 2018/07/31PubMed PMID: 30057235
Azar RR, Frangieh AH, Mroue J, Bassila L, Kasty M, Hage G, et al. Acute effects of waterpipe smoking on blood pressure and heart rate: a real-life trial. Inhal Toxicol. 2016;28:339–42. https://doi.org/10.3109/08958378.2016.1171934. Epub 2016/04/26PubMed PMID: 27109645
Garrison RJ, Kannel WB, Stokes J 3rd, Castelli WP. Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med. 1987;16:235–51. https://doi.org/10.1016/0091-7435(87)90087-9. Epub 1987/03/01PubMed PMID: 3588564
Susic D, Varagic J. Obesity: a perspective from hypertension. Med Clin North Am. 2017;101:139–57. https://doi.org/10.1016/j.mcna.2016.08.008. Epub 2016/11/26PubMed PMID: 27884225
Channanath AM, Farran B, Behbehani K, Thanaraj TA. Association between body mass index and onset of hypertension in men and women with and without diabetes: a cross-sectional study using national health data from the State of Kuwait in the Arabian Peninsula. BMJ Open. 2015;5:e007043 https://doi.org/10.1136/bmjopen-2014-007043. Epub 2015/06/06PubMed PMID: 26044759; PubMed Central PMCID: PMCPMC4466600
Dalacoura K. Women and Gender in the Middle East and North Africa: Mapping the Field and Addressing Policy Dilemmas at the Post-2011 Juncture.MENARA Final Reports, 3. 2019. http://www.menaraproject.eu/wp-content/uploads/2019/03/menara_fr_3-1.pdf.
Donnelly TT, Al-Thani ABM, Benjamin K, Al-Khater AH, Fung TS, Ahmedna M, et al. Arab female and male perceptions of factors facilitating and inhibiting their physical activity: Findings from a qualitative study in the Middle East. PLoS One. 2018;13:e0199336 https://doi.org/10.1371/journal.pone.0199336. Epub 2018/07/17PubMed PMID: 30011280; PubMed Central PMCID: PMCPMC6047779
Modesti PA, Bamoshmoosh M, Rapi S, Massetti L, Al-Hidabi D, Al, et al. Epidemiology of hypertension in Yemen: effects of urbanization and geographical area. Hypertens Res. 2013;36:711–7. https://doi.org/10.1038/hr.2013.14. Epub 2013/03/15PubMed PMID: 23486167; PubMed Central PMCID: PMCPMC3734526
Mowafi H. Conflict, displacement and health in the Middle East. Glob Public Health. 2011;6:472–87. https://doi.org/10.1080/17441692.2011.570358. Epub 2011/05/19PubMed PMID: 21590557
Rosenthal T. Immigration and acculturation: impact on health and well-being of immigrants. Curr Hypertens Rep. 2018;20:70 https://doi.org/10.1007/s11906-018-0872-0. Epub 2018/07/05PubMed PMID: 29971699
Geldsetzer P, Manne-Goehler J, Marcus ME, Ebert C, Zhumadilov Z, Wesseh CS, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1.1 million adults. Lancet. 2019;394:652–62. https://doi.org/10.1016/S0140-6736(19)30955-9. Epub 2019/07/23PubMed PMID: 31327566
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75:1334–57. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026. Epub 2020/05/07PubMed PMID: 32370572
Lotfaliany M, Akbarpour S, Mozafary A, Boloukat RR, Azizi F, Hadaegh F. Hypertension phenotypes and incident cardiovascular disease and mortality events in a decade follow-up of a Middle East cohort. J Hypertens. 2015;33:1153–61. https://doi.org/10.1097/HJH.0000000000000540. Epub 2015/02/24PubMed PMID: 25699976
Khdour MR, Hallak HO, Shaeen M, Jarab AS, Al-Shahed QN. Prevalence, awareness, treatment and control of hypertension in the Palestinian population. J Hum Hypertens. 2013;27:623–8. https://doi.org/10.1038/jhh.2013.26. Epub 2013/04/12PubMed PMID: 23575447
Gupta P, Patel P, Strauch B, Lai FY, Akbarov A, Maresova V, et al. Risk factors for nonadherence to antihypertensive treatment. Hypertension. 2017;69:1113–20. https://doi.org/10.1161/HYPERTENSIONAHA.116.08729. Epub 2017/05/04PubMed PMID: 28461599
Alhaddad IA, Hamoui O, Hammoudeh A, Mallat S. Blood pressure control in treated hypertensive Middle Eastern patients: a post hoc analysis based on JNC8 definitions. Vasc Health Risk Manag. 2019;15:35–46. https://doi.org/10.2147/VHRM.S188981. Epub 2019/03/19PubMed PMID: 30881006; PubMed Central PMCID: PMCPMC6410753
Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324. https://doi.org/10.1161/HYP.0000000000000066. Epub 2017/11/15PubMed PMID: 29133354
zaei S, Mahmoudi Z, Sheidaei A, Aryan Z, Mahmoudi N, Gohari K, et al. Salt intake among Iranian population: the first national report on salt intake in Iran. J Hypertens. 2018;36:2380–9. https://doi.org/10.1097/HJH.0000000000001836. Epub 2018/07/14PubMed PMID: 30005027
Nasreddine L, Akl C, Al-Shaar L, Almedawar MM, Isma’eel H. Consumer knowledge, attitudes and salt-related behavior in the Middle-East: the case of Lebanon. Nutrients. 2014;6:5079–102. https://doi.org/10.3390/nu6115079. Epub 2014/11/18PubMed PMID: 25401502; PubMed Central PMCID: PMCPMC4245581
Nair SC, Satish KP, Sreedharan J, Ibrahim H. Assessing health literacy in the eastern and middle-eastern cultures. BMC Public Health. 2016;16:831 https://doi.org/10.1186/s12889-016-3488-9. Epub 2016/08/20PubMed PMID: 27538529; PubMed Central PMCID: PMCPMC4991078
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Abboud, M., Karam, S. Hypertension in the Middle East: current state, human factors, and barriers to control. J Hum Hypertens 36, 428–436 (2022). https://doi.org/10.1038/s41371-021-00554-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41371-021-00554-z
This article is cited by
-
Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH)
BMC Endocrine Disorders (2024)
-
The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know
Current Atherosclerosis Reports (2023)
-
Roadmap for the Management of Type 2 Diabetes and Hypertension in the Middle East: Review of the 2022 EVIDENT Summit
Advances in Therapy (2023)
-
Spotlight on hypertension in the Middle-East
Journal of Human Hypertension (2022)