Epidemiology of arterial hypertension in Tunisia: Hammam Sousse Sahloul Heart Study (HSHS)

##plugins.themes.academic_pro.article.sidebar##

Published Feb 13, 2022
Download
pdf
Vol. 100 No. 2 (2022): Issue feb 2022

##plugins.themes.academic_pro.article.main##

Aicha Hamoudi
Asma Ben Abdelaziz
Sarra Melki
Donia Ben Hassine
Nabila Ben Rejeb
Asma Omezzine
Ali Bouslama
Ahmed Ben Abdelaziz

Abstract

Introduction: Tunisia is experiencing a double burden of morbidity, characterized by the explosion of cardiovascular diseases and their risk factors
including arterial Hypertension. The objective of this study, based on the HSHS cohort (Hammam Sousse Sahloul Heart Study), was to determine
the prevalence of hypertension in the general population and to identify its predisposing factors.

Methods: HSHS is a cardiovascular health promotion initiative in the city of Hammam Sousse (Tunisia). The study was conducted via a random
sample of households, using the WHO PEV technique, made up of 33 clusters, of 33 households each. All people aged 20 and over, included,
benefited from a questionnaire, a physical examination and a biological assessment. The Systolic Blood Pressure (SBP) and the Diastolic Blood
Pressure (DBP) were measured from the average of the last two measurements, by an OMRON type tensiometer, of suitable width. These
prevalences were adjusted according to sex and age group, by their weighting coefficients in the general population, and they were accompanied
by their 95% CIs. Binary logistic regression was conducted to identify independent factors associated with hypertension.

Results: The study population was composed of 481 men (33.4%) and 960 women (66.6%), with an average age of 49.6±16.35 years in males
(M) and 46.6±16.18 in females (F). In addition to the family history of hypertension, the sufficient weekly consumption of vegetables and fruits was
low (M: 32.4%, F: 24.9%). The adjusted rate of hypertension in the adult study population was 32.5%, 95%CI[31.9-33.1] (M: 36.4%, 95%CI[35,
5-37.3]; F: 28.4%; 95% CI[27.6-29.2]), reaching in the age group of 60 years and above: M: 74.6% (95%CI[66.9-82.3], F: 82.7% (95%CI[73.8-83.6])
Multivariate analysis identified five independent factors significantly associated with hypertension: male sex (ORa=1.55 [1.18-2.03]), age over 40
years (ORa=6.54[4.70-9.11]), low level of schooling (ORa=1.80 [1.36-2.38]), low physical activity (ORa=1.42[1.07-1.88]) and high socio-economic
level (ORa=1 .84 [1.30-2.63]).

Conclusion: The HSHS study confirmed the high prevalence of hypertension, and the extent of its low detection and control. Hence the need for
a universal approach to health promotion, oriented towards the general population, piloted by its local organizations, based on the adoption of a
healthy lifestyle, and centered on physical activity.

##plugins.themes.academic_pro.article.details##

References

  1. Organisation Mondiale de la Santé. Hypertension Internet . 2021 Consulté le 28 janvier 2022 . Disponible: https://www. who.int/fr/news-room/fact-sheets/detail/hypertension
  2. Liu J, Bu X, Wei L, Wang X, Lai L, Dong C, et al. Global burden of cardiovascular diseases attributable to hypertension in young adults from 1990 to 2019. J Hypertension. 2021;39(12):2488–96.
  3. Monique R. Hypertension artérielle de l’adulte Internet .Elsevier Connect. 2019 Consulté le 2 février 2022 . Disponible: https://www.elsevier.com/fr-fr/connect/etudesde-medecine/item-221-hypertension-arterielle-de-ladulte
  4. Kamdem F, Djomou FA, Hamadou B, Nsala SN, Jingi AM, Biholong C, et al. Connaissance des Facteurs de Risque Cardiovasculaires et Attitudes de Prévention par la Population du District de Santé de Deido-Cameroun. Health Sci Dis Internet . 2018 Consulté le 2 février 2022 ;19(1 (Suppl)). Disponible: https://www.hsd-fmsb.org/index.php/ hsd/article/view/950
  5. Mzoughi K, Zairi I, Jemai A, Ben Kilani M, Ben Daamar H, Ben Gaied Hassine E, et al. Etude des facteurs de mauvaise observance médicamenteuse chez les hypertendus. Tunis Med. 2018;96(06):385–90.
  6. Ben Mansour N, Skhiri H, Aounallah Skhiri H, Hsairi M, Hajjem S. Causes of death in Tunisia: estimates of years of life lost. East Mediterr Health J. 2014;20(04):257–64.
  7. Ferguson TS, Younger NO, Tulloch-Reid MK, Wright MB, Ward EM, Ashley DE, et al. Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in Jamaica: analysis from a cross-sectional survey. BMC Cardiovasc Disord. 2008;8:20.
  8. Institut National de la Statistique. Résultats du Recensement 2004 Internet . 2004. Disponible: http://www.ins.nat.tn/ indexfr.php.
  9. Reignier A, Sacchetto É, Hardouin J-B, Orsonneau J-L, Carrer DL, Delaroche O, et al. Comparison of calculated LDL cholesterol (LDL-C) versus measured LDL cholesterol (LDL-M) and potential impact in terms of therapeutic management. Ann Biol Clin. 2014;72(5):593–8.
  10. National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2004 p. 86. Report No.: 04–5230.
  11. American Diabetes Association. Standards of Medical Care in Diabetes Abridged for Primary Care Providers. Clin Diabetes. 2021;39(1):14–43.
  12. American Heart Association. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. 2002 p. 280. Report No.: 02–5215.
  13. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation Internet . 2014 Consulté le 2 février 2022 ;129(25_suppl_2). Disponible : https://www. ahajournals.org/doi/10.1161/01.cir.0000437739.71477.ee
  14. Organisation Mondiale de la Santé. Obésité et surpoids Internet . 2020 Consulté le 2 février 2022 . Disponible: https://www.who. int/fr/news-room/fact-sheets/detail/obesity-and-overweight
  15. Organisation Mondiale de la Santé. Questionnaire mondial sur la pratique d’activités physiques (GPAQ). Guide pour l’analyse Internet . Disponible: http://www.who.int/chp/ steps/GPAQ_Analysis_Guide_FR.pdf.
  16. Tesfaye F, Byass P, Wall S. Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovasc Disord. 2009;9:39.
  17. Organisation Mondiale de la Santé. Stratégie de Coopération: Mauritanie Internet . 2009. Disponible: http://www.who.int/ countryfocus/cooperation_strategy/ccsbrief_mrt_fr.pdf.
  18. Ghannem H, Limam K, Ben Abdelaziz A, Mtiraoui A, Hadj Fredj A, Marzouki M. Facteurs de risque des maladies cardiovasculaires dans une communauté semi urbaine du Sahel Tunisien. Rev Epidemiol Sante Publique. 1992;40(2):108–12.
  19. Ghannem H, Hadj Fredj A. Prevalence of cardiovascular risk factors in the urban population of Soussa in Tunisia. J Public Health Med. 1997;19(4):392–6.
  20. Mhenni N. Epidémiologie du diabète sucré dans la commune de Ksar Hellel (Tunisie) Thèse de Doctorat en Médecine . Sousse ; 2008.
  21. 21. Ben Romdhane H, Skhiri H, Bougatef S, Ennigrou S, Gharbi D, Chahed MK, et al. Prévalence, connaissance, traitement et contrôle de l’hypertension artérielle: résultats d’une enquête populationnelle. Tunis Med. 2005;83 Suppl 5:41–6.
  22. Elasmi M, Feki M, Sanhaji H, Jemaa R, Haj Taeib S, Omar S, et al. Prévalence des facteurs de risque cardiovasculaires conventionnels dans la population du Grand Tunis. Rev Epidemiol Sante Publique. 2009;57(2):87–92.
  23. Mesure des facteurs de risque des maladies non transmissibles dans deux wilayas pilotes en Algérie (Approche « Step wise » de l’OMS). Algérie: République Algérienne Démocratique et populaire Ministère de la Santé, de la Population et de la Réforme Hospitalière. Direction de la Prévention; 2005 p. 227.
  24. Yahia-Berrouiguet A, Benyoucef M, Meguenni K, Brouri M. Enquête sur la prévalence des facteurs de risque de maladies cardiovasculaires à Tlemcen (Algérie). Med Maladies Metabol. 2009;3:313–9.
  25. Temmar M, Labat C, Benkhedda S, Charifi M, Thomas F, Bouafia MT, et al. Prevalence and determinants of hypertension in the Algerian Sahara. J Hypertens. 2007;25(11):2218–26.
  26. Hamida F, Temmar M, Chibane A, Guendouz N, Bouamra A, Bouafia MT. Prévalence de l’HTA et les autres facteurs de risque cardiovasculaires : Etude El-Menia. 2010.
  27. Recommandations de Bonnes Pratiques Médicales. Affection Longue Durée. L’hypertension artérielle de l’adulte Internet . 2010. Disponible: http://www.assurancemaladie. ma/upload/document/hypertension-resume.pdf
  28. Erem C, Hacihasanoglu A, Kocak M, Deger O, Topbas M. Prevalence of prehypertension and hypertension and associated risk factors among Turkish adults: Trabzon Hypertension Study. J Public Health. 2009;31(1):47–58.
  29. Wilkins K, Campbell NR, Joffres MR, McAlister FA, Nichol M, Quach S, et al. Blood pressure in Canadian adults. Health Rep. 2010;21(1):37–46.
  30. Bersamin A, Stafford RS, Winkleby MA. Predictors of hypertension awareness, treatment, and control among Mexican American women and men. J Gen Intern Med. 2009;24 Suppl 3:521–7.
  31. Miandrisoa RM, Ramilitiana B, Rakotonoel RR, Rasamoelina W, Ravaoavy H, Ralamboson SA, et al. Connaissances de l’hypertension artérielle et de ses complications au Centre Hospitalier de Soavinandriana. J Current Med Research Opinion. 2020;3(01):415–21.
  32. Godet-Thobie H, Vernay M, Noukpoape A, Salanave B, Malon A, Castetbon K, et al. Niveau tensionnel moyen et prévalence de l’hypertension artérielle chez les adultes de 18 à 74 ans, ENNS 2006-2007. Bull Euro Hebd. 2008;49:478–83.
  33. HTA: observance thérapeutique réduite chez les patients de moins de 60 ans Internet . Consulté le 1 février 2022 . Disponible: https://www.cardio-online.fr/Actualites/ Depeches/HTA-observance-therapeutique-reduite-patientsmoins-de-60-ans
  34. Coccina F, Pierdomenico AM, Cuccurullo C, Pizzicannella J, Madonna R, Trubiani O, et al. Prognostic Value of Masked Uncontrolled Hypertension Defined by Different Ambulatory Blood Pressure Criteria. Am J Hypertension. 2020;33(8):726–33.
  35. Persell SD, Peprah YA, Lipiszko D, Lee JY, Li JJ, Ciolino JD, et al. Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension: A Randomized Clinical Trial. JAMA Network Open. 2020;3(3):e200255.
  36. Laouani Kechrid C, Hmouda H, Ben Naceur MH, Ghannem H, Toumi S, Ajmi F. Hypertension artérielle du sujet de plus de 60 ans: Enquête épidémiologique dans la région de Sousse (Tunisie). Tunis Med. 2004;82(11):1001–5.
  37. Ghozzi H, Kassis M, Hakim A, Sahnoun Z, Abderrahmen A, Abbes R, et al. Observance médicamenteuse chez un échantillon d’hypertendus dans la région de Sfax (Tunisie). Ann Cardiol Angeiol (Paris). 2010;59(3):131–7.
  38. Masson F, Pouponneau A, Gaillard T, Remy A. L’activité physique au service de la prévention cardio-vasculaire. Actualites Pharmaceutiques. 2021;60(610):34–8.
  39. Amoretti R, Bigard X, Monod H, Rivière D, Rochcongar P, Rodineau J. Médecine du sport: Pour le Praticien. Elsevier Health Sciences; 2020. 749 p.
  40. Nocon M, Hiemann T, Muller-Riemenschneider F, Thalau F, Roll S, Willich SN. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil.Jun;15(3):239–46.
  41. Sardeli AV, Griffth GJ, Dos Santos MVMA, Ito MSR, Chacon-Mikahil MPT. The effects of exercise training on hypertensive older adults: an umbrella meta-analysis. Hypertens Res. 2021;44(11):1434–43.
  42. Myles P, Swenshon S, Haase K, Szeles T, Jung C, Jacobi F, et al. A comparative analysis of psychological trauma experienced by children and young adults in two scenarios: evacuation after a natural disaster vs forced migration to escape armed conflict. Public Health. 2018 May;158:163–75.
  43. Rêgo ML, Cabral DA, Costa EC, Fontes EB. Physical Exercise for Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and Cognition. Clin Med Insights Cardiol. 2019;13:1179546819839411.
  44. Chanudet X, Lambert de Cremeur G, Bonnevie L. L’activite physique dans le traitement de l’hypertension artérielle. Presse Med. 2006;35(6 Pt 2):1081–7.
  45. Comité régional de l’Afrique 70. Cadre de mise en œuvre du plan d’action mondial pour l’activité physique 2018-2030 dans la Région africaine de l’OMS : rapport du Secrétariat Internet . Organisation Mondiale de la Santé. Bureau régional de l’Afrique; 2020 Consulté le 2 février 2022 . Report No.: AFR/RC70/10. Disponible: https://apps.who.int/ iris/handle/10665/333745
  46. Organisation Mondiale de la Santé. Plan d’action mondial de l’OMS pour promouvoir l’activité physique 2018-2030 : des personnes plus actives pour un monde plus sain Internet . Genève: Organisation Mondiale de la Santé; 2019 Consulté le 2 février 2022 . 101 p. Disponible: https://apps.who.int/iris/ handle/10665/327168
  47. Haute Autorité de Santé. Activité : adapter la prescription à la situation du patient Internet . Haute Autorité de Santé. 2019 Consulté le 2 février 2022 . Disponible: https://www.hassante.fr/jcms/p_3111658/fr/activite-adapter-la-prescriptiona-la-situation-du-patient
  48. OCDE. Réunion ministérielle de l’OCDE sur la santé: Les priorités des systèmes de santé au lendemain de la crise Internet . 2010. Disponible: http://www.oecd.org/