HYPERTENSION MANAGEMENT DURING RAMADAN: RESULTS FROM THE NATIONAL TUNISIAN REGISTRY OF HYPERTENSION (NATURE HTN)

Abstract

Objective: Ramadan fasting is a religious obligation practiced by Muslim population. No clear consensus and a paucity of evidence are published to guide patients and clinicians in management of hypertension during fasting Ramadan as well as fasting effects are not well studied. This study was performed to assess the impact of Ramadan fasting on hypertensive patients. Design and method: We performed a prospective multi centric Tunisian study from April, 15th to Mai, 15th 2019. We compared hypertensive patients who fasted Ramadan to those who did not fast. Life style, adherence to treatment and impact of fasting Ramadan were compared between two groups. Results: We analyzed 25609 patients with hypertension. Mean age was 64.4 ± 12.5 years old. More than 48% of patients were aged more than 65 years old. Female gender represented 54.7%. Prevalence of diabetes, obesity and coronary artery diseases were 39.5%, 27% and 18.5% respectively. Mean of systolic blood pressure (SBP) was 138.87 ± 19.62 mmHg. Prevalence of stroke, atrial fibrillation and hypertensive nephropathy were 6.6%, 7.4% and 33% respectively. Sixty four percent of patients fasted during Ramadan. In comparison to patients who did not fast during Ramadan, eating salty food was significantly lower in patients who fasted during Ramadan (42.1%vs. 60.1%; p < 0.001). There was an obvious change in the lifestyle activities and a significant increase of sport practice in patients who fasted Ramadan (19% vs. 7.5% p < 0.001). Anti-hypertensive drug adherence was significantly higher in patients who fasted Ramadan. A significant difference in blood pressure target was reported in hypertensive patients who fasted Ramadan (32.4% vs. 17.4%; p < 0.001). Conclusions: Ramadan Fasting could be beneficial in hypertensive patients to reach target blood pressure level provided that they should be carefully monitored during fasting and adhere to treatment and diet. Physician should adopt an educational program and avoid therapeutic inertia to prevent complications during fasting Ramadan.