Determinants Affecting the Awareness of Hypertension Complications within the General Population in Saudi Arabia.

BACKGROUND: Hypertension imposes a significant public health burden. An increased awareness of hypertension complications within a population can positively impact patient care and prevent complications. This study seeks to assess the awareness of hypertension complications among the population of Bisha in Saudi Arabia in 2020. METHODS: A cross-sectional study was conducted in 2020. A validated self-administered online-based questionnaire was sent to a sample of the adult population of Bisha to measure their awareness of hypertension complications. RESULTS: Almost three-quarters of the population (72.2%) were aware of hypertension complications. The awareness level was significantly higher among male participants (p < 0.001), those aged 31-40 years, those who were married, those working as police officers or in civilian jobs, those living in urban areas (p = 0.04), those with a university-level education (p = 0.03), those with a medium family income (SAR 5000-14,999) (p = 0.001), and those with a history of hospitalization because of causes other than hypertension (p = 0.05). Marital status was independently predictive of awareness (B = 0.851, Wald test = 12.179, p = 0.000) among the respondents. CONCLUSION: The study concludes that the awareness of hypertension complications among the Bisha population in Saudi Arabia was deemed acceptable. Factors such as marital status, age, gender, a family history of hypertension, the duration of hypertension, and medication adherence positively influenced this awareness and served as predictors of hypertensive awareness. The findings highlight the importance of health authorities in ensuring the widespread awareness of hypertension complications, particularly among hypertensive individuals.

Echocardiographic Changes in Saudi Patients with Type 2 Diabetes Mellitus.

Background and Objectives: Cardiovascular disease is one of the leading causes of morbidity and mortality among the diabetic population. Given the high prevalence of diabetes mellitus (DM) in Saudi Arabia and the high prevalence of heart failure in the diabetic population, this study assesses the echocardiographic changes in Saudi patients with type 2 DM (T2DM) compared with healthy controls. Materials and Methods: In this retrospective case-control study, 80 patients with diabetes (45 males, age: 58.78 ± 10.2 years) were compared with 80 controls (45 males, age: 58.6 ± 10 years) who underwent an echocardiographic study in the King Saud University Medical City, Riyadh, Saudi Arabia. Results: There were no significant differences between the patients with diabetes and controls in terms of aortic root diameter, left atrium diameter, posterior wall, interventricular wall thickness, left ventricular diameters and ejection fraction. However, diastolic dysfunction was statistically significantly higher in the diabetic group than in the control group (p < 0.05). Conclusions: This is the first case-control study in Saudi Arabia that assesses echocardiographic parameters in T2DM patients. DM is an independent risk factor for diastolic dysfunction regardless of its association with hypertension and dyslipidemia.

Physicians' perceptions and beliefs on the current dyslipidemia management practices within Saudi Arabia.

Background: Limited reports addressing physicians' understanding of the various low-density lipoprotein cholesterol (LDL-C) targets/statin intensity required for treating the various dyslipidemia patient populations in Saudi Arabia are available. Therefore, the current study assessed the perceptions and beliefs of practicing clinicians in Saudi Arabia regarding the current practice for management of dyslipidemia and potential perceived barriers to adherence to lipid guidelines encountered in their regular clinical practice. Knowledge of different clinical practices and beliefs could have a positive impact on improving the quality of future care provided by physicians. Methods: A survey questionnaire was designed to assess physicians' familiarity, usage, and adherence to seven different international guidelines and used to evaluate the management of dyslipidemia, practice of patient treatment, and perceived obstacles to adhering to lipid guidelines related to specific patients, doctors, and practice issues. Results: A total of 467 physicians were recruited for the study: (1) 57.2% were primary care physicians (PCPs) and (2) 42.8% were specialists. About 90.8% of them followed lipid guidelines of which the most common set were based on those by the American College of Cardiology/American Heart Association. The most utilized risk assessment tool was the atherosclerotic cardiovascular disease (ASCVD) risk calculator. About 60% of the physicians set an LDL-C target for their patients based on a combination of patients' risk factors and lipid profiles. In all, 42.1% of the physicians chose not to change existing therapy among patients with dyslipidemia to attain a non-high-density lipoprotein goal with controlled LDL-C level. Atorvastatin accounted for the greatest percentage of primary and secondary prevention choices (71.9% and 69.6%, respectively). Rosuvastatin was mostly preferred by physicians for patients with familial hypercholesterolemia. About two-thirds of the physicians (77.9%) prescribed statins to diabetic patients aged 40-75 years. Statin intolerance was encountered by 62.9% of the physicians in ≤ 10% of patients by 62.9%. Therapeutic strategies included switching to an alternative statin (40.1%) followed by reducing the statin dose (35.3%). Ezetimibe was prescribed by most physicians (77.9%) as an add-on to statin if the LDL-C target was not achieved. Fibrate was most preferred by physicians (62.7%) for hypertriglyceremia treatment followed by statins (28.7% of the physicians). Sixty-six percent reported not using proprotein convertase subtilisin/kexin type 9 serine protease inhibitors in their clinical practice due to unavailability at their institute (51.8%), high costs (26.3%), and/or lack of knowledge (20.6%). Perceived barriers to guideline adherence identified by physicians were lack of familiarity and knowledge of the guidelines, patient non-adherence, medication costs, and lack of timely follow-up appointments and educational tools. Multiple similarities and differences were observed after comparisons were made between specialists and PCPs in terms of guideline preference, clinical practice, and perceived barriers. Conclusion: Different perceptions and attitudes among physicians in Saudi Arabia were found due to variable recommendations by international lipid guidelines. Perceived barriers that included the patient, physician, and practice were identified by physicians at multiple levels. Multiple challenges and different action gaps were observed when comparing specialists to PCPs. It is recommended that standardized practices be followed by clinicians in Saudi Arabia, and actions to address the outlined barriers are essential for optimizing health outcomes and ASCVD prevention.

The Effect of Laparoscopic Sleeve Gastrectomy on Serum Thyroid-Stimulating Hormone Levels in Obese Patients with Overt and Subclinical Hypothyroidism: a 7-Year Retrospective Study.

BACKGROUND: Inconsistent results were reported by several studies that evaluated the effect of weight loss induced by bariatric surgery on thyroid function panel. This study is aimed at evaluating this effect on thyroid-stimulating hormone (TSH) and thyroid hormone replacement dosages in obese population with overt and subclinical hypothyroidism (SH). METHODS: A retrospective study was performed on all morbidly obese patients with previous diagnosis of overt and subclinical hypothyroidism who underwent laparoscopic sleeve gastrectomy from October 2009 to January 2017. The correlation between TSH and body mass index (BMI) and the effect of weight loss induced by bariatric surgery on TSH were investigated. RESULTS: The prevalence of overt and SH in morbidly obese patients was 10.8% and 7.2%, respectively. Thirty-six hypothyroid patients and 67 subclinically hypothyroid patients were included in the study. Hypothyroidism improved in 44.5% of patients and completely resolved in 22.2%, and 33.3% experienced no change. Ninety-one percent of SH patients completely resolved, 6% improved, but 3% worsened, with one patient developed hypothyroidism. Both groups achieved a significant decrease in postoperative BMI. A positively statistically significant association was found between BMI and TSH (p < 0.005). CONCLUSIONS: Our results favor the effect of laparoscopic sleeve gastrectomy in the obese population with overt and SH as shown by the majority of SH resolution and overt hypothyroidism improvement.