Prevalence and Risk Factors of Hypertension in Saudi Arabia: A Systematic Review

Abstract

Abstract
Background:
Hypertension is a major health problem; it affects more than 1.39 billion people worldwide and is responsible for cardiovascular diseases and early mortality in most of the cases. However, in Saudi Arabia, hypertension is a critical public health challenge, and the prevalence differs significantly across the regions. From available literature, modifiable risk factors for hypertension that have been strongly associated include obesity, physical inactivity, smoking, and dietary habit, which again underscore the imperatives for appropriate public health strategies.

Objective:
The systemic review aims to synthesize evidence on the prevalence of hypertension, associated risk factors, and regional disparities in Saudi Arabia to inform targeted public health interventions and policy strategies.

Methods:
An extensive search of the literature was carried out in PubMed and Google Scholar, in addition to looking into regional databases, using a time frame from 1996 to the end of 2023. It includes all research articles that report on studies related to the prevalence of high blood pressure or associated risk factors among adults, defined as participants aged ≥15 years residing within the borders of Saudi Arabia. Publications in the form of systematized reviews or as meta-analyses, and other studies dealing with expatriates, were excluded. Only entitled studies were critically analyzed and qualitively synthesized.

Results:
Prevalences on hypertension vary highly across different studies of Saudi Arabia, including very huge differences, between 11.1% and 36.2%, with serious region-wide inequalities in prevalence estimates. The available national-level studies showed prevalence rates in the studies of El Bcheraoui et al. (2014), based on urbanization and altered lifestyle, were 15.2%, while prevalence from Al-Nozha et al. (2007) is 26.1%, strongly connected to obesity and aging in their populations. Regionally, the Eastern Region exhibited prevalence ranging from 15.6% to 16%, influenced by sedentary behavior and dietary transitions. The Western Region including Al-Taif had the highest prevalence of 36.2%, reflecting the impact of urbanization, smoking and high salt intake. The lowest prevalence rate, 11.1%, was registered in the Southern Region of Saudi Arabia. The main contributory factors here are the maintenance of a traditional diet with minimal exposure to fast food, as well as active lifestyles of people residing in this part of Saudi Arabia. The Northern Region did not give specific prevalence rates but identified major risk factors like smoking, obesity, and sedentary behavior. Al-Kharj, a semi-urban region, showed a very high prehypertension prevalence of 54.9% and hypertension prevalence of 4.9%, mainly due to obesity and low educational attainment. These results further underscore the urgent need for region-specific public health strategies in order to address hypertension and its associated risk factors effectively.

Conclusions
This review represents a call to action for region-specific public health interventions in response to the rising burden of hypertension in Saudi Arabia. The interventions should focus on reducing modifiable risk factors through the promotion of lifestyle modifications, increasing screening programs, and ensuring equity in access to health care. Future studies should pay greater attention to the use of standardized diagnostic criteria and longitudinal assessment of the outcomes of interventions in order to limit regional disparities and improve management of hypertension.