Egyptians score high on blood pressure

BMJ 1994; 308 doi: (Published 05 February 1994) Cite this as: BMJ 1994;308:360
  1. M Gulens

    Early results from the Egyptian national hypertension project show that about a third of the population in urban areas has high blood pressure. “Egypt suffers from one of the highest prevalences of hypertension in the world,” said Dr Mohsen Ibrahim, professor of cardiology at Cairo University. “Unless serious measures are taken to control this disease we will be facing a serious cardiovascular epidemic in the coming two decades.”

    The national hypertension project, undertaken in conjunction with the American Heart, Blood, and Lung Institute and Johns. Hopkins University, is the first study of its kind in a developing country. From November 1991 to April 1993 the prevalence of hypertension was surveyed in 600 households in six of Egypt's 24 provinces. Only subjects over 25 years old were included, and hypertension was defined as blood pressure equal to or greater than 140/90 mm Hg.

    Dr Ibrahim, the principal investigator of the project, said that most of the 6733 subjects were aged between 35 and 45. Weighted national estimates presented at the first pan-Arab conference on hypertension at the end of last year suggested that about 59% of Egyptians had blood pressure in the normal range and 17% in the high-normal category, and the remaining 24% had varying stages of hypertension.

    Half of the people studied in urban Cairo had hypertension, compared with 31% in Beni Suef (upper Egypt), 36% in Port Said (a coastal town), 24% in Sharkeya (in the delta), 30% in Aswan (upper Egypt), and 19% in Wadi Gedida (a frontier oasis). “There is a definite difference in the prevalence of hypertension among different Egyptian provinces,” said Dr Ibrahim. Three quarters of the hypertensive subjects studied lived in urban areas. For the whole of Egypt the researchers estimate that 32% of the urban population has hypertension, compared with only 25% of the rural population.

    * Smoking is likely to push up hypertension rates in Egypt

    (Fig Omitted)

    The full results of the project are still awaited, but Dr Ibrahim said that “just plain guessing” points to overcrowding, cigarette smoking, pollution, social stresses, and diet as factors contributing to the higher prevalence of hypertension in urban areas. But Dr Yasser Sharaf, a member of the project, added that “preliminary results point towards excessive salt intake and obesity as the most important risk factors for hypertension in Egypt.”

    Egypt's population of 56 million is expected to surpass 73 million by the year 2000. Although morbidity from virus infections and diseases has decreased over the past three decades, deaths due to cardiovascular disease have increased from 12.4% to 42.5% of all deaths. “On the basis of data from the project we expect to have 10 million hypertensive subjects in Egypt by the year 2000,” Dr Ibrahim said.

    Dr Paul Whelton, professor of epidemiology and medicine at Johns Hopkins University, told the pan-Arab conference that the Egyptian data were reminiscent of data in the US two decades ago, before the instigation of awareness programmes about high blood pressure led to a 57% decrease in age adjusted mortality from stroke and a 50% decrease in coronary deaths. Similar programmes to raise awareness among doctors, patients, and the public are planned for Egypt.

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