Long-Term Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rate in the Middle East and North Africa: A Systematic Review and Meta-Analysis of 178 Population-Based Studies in 2.262 Million Participants

Abstract

Aim: This study investigated and pooled the long-term trends in prevalence, awareness, treatment, and control of hypertension (HTN) in the Middle East and North Africa (MENA) region. Material and Methods: In this systematic review and meta-analysis, we searched MEDLINE/ PubMed, Web of Science, Google Scholar, EMBASE and Scopus between database inception and November, 2020. All cross-sectional studies with the English language that investigated the prevalence of pre-HTN, HTN, awareness, treatment, and control in the MENA counties were included. The selection study, data extraction, and quality assessment were conducted by two investigators independently. Heterogeneity between studies were assessed using Cochran’s Q test and I-squared and due to sever heterogeneity between studies, the random effect model was used to pool the estimates. Sensitivity analysis was performed to estimate the long-term trends in prevalence, awareness, treatment, and control rates of HTN according to definition of HTN as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for HTN. Results: Overall, 178 studies met the inclusion criteria. Studies comprised 2,262,797 participants with a mean age of 45.72±8.84 years. According to random effect model, the pooled prevalence of pre-HTN and HTN were 33% (95% CI: 28, 39) and 26% (25, 27), respectively. Over the past three decades, prevalence of hypertension increased significantly in the region. The pooled awareness, treatment, and control rates were 50% (48, 53), 41% (38, 44) and 19% (17, 21) receptively. The pooled awareness, treatment and control rates of HTN were lower significantly in men than women. According to definition of HTN as blood pressures above 140/90 mm Hg, over the past three decades, although the awareness and treatment rates did not change significantly, the control rates improved significantly in the region. Conclusion: The findings showed that HTN is a significant public health problem in the MENA region. Although there are low levels of pooled awareness, treatment and control rates, the control rates improved over the past three decades in the region. Funding Statement: This study funded by Alborz University of Medical Sciences. Declaration of Interests: The Authors declare that there is no conflict of interest.