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Saudi Journal of Kidney Diseases and Transplantation
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Year : 1999  |  Volume : 10  |  Issue : 3  |  Page : 352-356
Epidemiology of Hypertension in Egypt

Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt

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How to cite this article:
Ibrahim M M. Epidemiology of Hypertension in Egypt. Saudi J Kidney Dis Transpl 1999;10:352-6

How to cite this URL:
Ibrahim M M. Epidemiology of Hypertension in Egypt. Saudi J Kidney Dis Transpl [serial online] 1999 [cited 2022 Jan 26];10:352-6. Available from: https://www.sjkdt.org/text.asp?1999/10/3/352/37243

   Introduction Top

Until a few years ago, there was no adequate information about the epidemiology of hypertension in Egypt. The exact prevalence of hypertension, degree of public awareness, and the prevalence of hypertension risk factors were not known. This information is important both for local health planners and for the international scientific community. The recognition of differences in hypertension prevalence rates between different populations and between different groups in the same population may help in identification of factors such as genetic, behavioral and/or environmental variables that might be related to the development of hypertension.

In Egypt, and other developing countries, there has been a significant change in health profile. Eradication of many infections, nutritional and parasitic diseases, and the decline in infant mortality rate lead to an increase in average life expectancy.

The average life expectancy in Egyptians changed between the years 1960 and 1990. [1] There has been an increase in longevity in both males and females: from 51.6 to 62.8 years in males, and from 53.8 to 66.4 years in females. Aging of the population will contribute to the increasing prevalence of diseases of old age, including hypertension, cardiovascular diseases and diabetes.

Cardiovascular diseases now constitute the main cause of mortality among Egyptians. In 1970, cardiovascular diseases were responsible for only 12.4% of deaths, while infections and gastrointestinal diseases were responsible for 32.8%. Two decades later, cardiovascular diseases caused 42.5% of deaths, while infections and gastrointestinal diseases were responsible for 14.1%. It is expected that this trend will increase, and possibly we will be facing an epidemic of cardiovascular diseases in the coming decades.

Adoption of western life style, increased rates of obesity, cigarette smoking and other cardiovascular risk factors are contributing factors.

The data presented in this communication about the epidemiology of hypertension in Egypt were collected during the Egyptian National Hypertension Project (NHP) survey in the years 1991-1994. [2],[3] This was a joint project between the Egyptian and USA governments; the Ministry of Public Health and the Cairo University from the Egyptian side, and the National (USA) Institute of Health (Lung and Blood) and Johns Hopkins University from the USA side.

In this review, I will discuss the methodology, the population characteristics, blood pressure distribution, hypertension prevalence, degree of public awareness, disease control, and some of the hypertension risk factors.

   Methods Top

The survey was conducted in 21 sampling locations in six Egyptian governorates representing all Egyptian geographic areas and socio-economic groups.

The survey sites were Port Said Governorate and the north end of the Suez Canal representing coastal governorates; El­Sharquia in the middle of Nile Delta representing the Delta governorates; Beni Sweif, 100 miles South of Cairo, representing Northern upper Egypt; Aswan, 800 miles south of Cairo, representing Southern Upper Egypt; El-Wadi El-Gadid, an oasis in the Western Sahara, representing the Frontier Governorates; and Cairo, the capital of Egypt, with the main urban concentration.

After a preparatory stage of ten months, field survey was conducted in two phases during the period of December 1991 to May 1993. During phase I, all households in the sample, 25 years and older were visited by data collection staff who were newly graduated doctors. Questionnaire forms were filled and blood pressure was measured four times according to a standardized protocol. In phase I, hypertensive subjects were identified.

Phase II followed immediately phase I. It was conducted at local health centers in different sampling locations. Hypertensive subjects identified in phase I with gender matched controls were recruited for detailed clinical and laboratory evaluation including standard 12-lead echocardiographic (ECG) studies, optic fundus examination, blood chemistry, 12-hours urine analysis and measuring skin color reflectance.

Data collected in questionnaire forms examined demographic and behavior characteristics and medical history of the population.

Demographic characteristics included: family size and parity, housing conditions, socio-economic status, level of education, marital status, employment, skin color, migration and religion.

Behavior characteristics included: social and dietary habits, occupational stress, drugs and cigarette smoking.

The third set of data collected in questionnaire forms covered medical history, hypertension awareness and treatment, previous blood pressure measurement, hypertension risk factors, hypertension complications and other cardiovascular risk factors.

Persons were considered hypertensive if they met one of the following conditions:

1) Diastolic blood pressure (DBP) greater than or equal to 90 mmHg. Systolic blood pressure (SBP) greater than or equal to 140 mmHg.

Currently taking antihypertensive medications regardless of their recorded blood pressure measurement.

   Results Top

Response rate:

In the sample frame, the target numbers for households were 3600 and for individuals were 7915. Response rate at the household level was 93.3% and at the individual level was 8.5%.

Age and gender distribution:

Age range in the sample was 25-95 years, mean age was 45.6 years. Females constitute 56.5% of the sample.

Housing conditions:

21% of individuals in the sample lived in mud houses, 26.9% had no running water and 2% had no electricity.


73.3% were living in urban areas while 26.7% lived in rural areas.

Education level:

Individuals were categorized into low education group, i.e., illiterate or just read and write (64.7%), and a high education group, i.e., finished high school, college or university graduates (35.3%).

Skin color:

Ninety-three percent of the sample individuals had mixed or dark skin color, while 5% of had black skin and 2% were white or blonde.

Systolic blood pressure frequency distribution: About 50% of sample examined had SBP in the range of 110-129 mmHg. SBP was above 180 mmHg in 2.7% and was less than 110 mmHg in 3.3%.

Diastolic blood pressure frequency distribution:

More than 60% of the sample had DBP in the range of 70-89 mmHg. DBP was above 110 mmHg in 1.5% and less than 60 mmHg in 3.3%.

Age and gender distribution:

There was a progressive increase in SBP level with advancing age; the increase was greater in women than men after the age of 50 years

Hypertension prevalence:

The national estimate of the prevalence of hypertension in Egyptians was 26.3%, slightly more prevalent in women (28.9%) than in men (25.7%).

Prevalence of hypertension increased progressively with age reaching a peak in the age group of 65-74 where more than 50% of individuals have high blood pressure. Before the age of 45 years, hypertension was more prevalent in men, while the reverse was true after age 45 years.

Systolic hypertension was present in 17.2% of the overall sample population and was more common in women than men. There was a sharp increase with age reaching a plateau at age of 65-74 years. Diastolic hypertension was more common in men than in women in all age groups. Its prevalence increased progressively to reach a plateau between ages 45-65 years followed by a sharp decline that was more evident in women than in men.

According to the guidelines of the 5th Joint National Committee's Report, 58.3% of the sample had normal blood pressure and 17.5% had high normal. Thus in the majority of hypertensive subjects hypertension was in the mild to moderate range.

Hypertension prevalence in different Egyptian regions:

The highest rate was in greater Cairo area, 31%, and the lowest rate was in the frontiers 19.9%. These data underscore the role of environmental factors in relation to hypertension.

Awareness, Treatment and Control:

At a national level, 37.5% of the hyper­tensive Egyptians were aware of being hypertensive: 23.9% were receiving treatment but the hypertension was controlled in only 8%

In addition, rates of awareness varied among different Egyptian regions. The highest degree of awareness was in Cairo and Coastal areas (greater than 50%), the lowest in northern Upper Egypt, (about 20%). Hypertension control was the best in Cairo and Coastal regions (15%) and was very low in northern Upper Egypt (2%).

Hypertension Risk Factors

A. Obesity:

Body mass index (BMI) greater than 30 kg/nr was more common in hypertensive subjects than normotensive subjects, 39.8% vs. 26.5%. Obesity was present in 50.3% of hypertensive women.

B. Waist/Hip ratio:

Waist/Hip ratio, as an index of body fat distribution, was greater in hypertensive subjects than normotensive subjects and more in men than women.

C. Social stress:

We examined a number of parameters that might be associated with increased social stress: social isolation, low levels of education and unemployment. In the sample examined, 2.3% of the individuals were living alone. Hypertension was present in 59.7% of those living alone and in 30% of those who were not.

D. Lower levels of education:

Lower levels of education were more common in hypertensive subjects in compa­rison to normotensive subjects; 72% Vs 61 % and more in Egyptian women than men. Unemployment rate was higher in hypertensives than in normotensives; 30.2% Vs 12.9%.

E. Skin color:

High prevalence of hypertension was associated with black skin color in most of the age groups.

Family history:

A family history of hypertension was slightly more common in hypertensive subjects (35%), than normotensive subjects (32%).

Urinary sodium excretion:

12-hour urinary Sodium (Na) excretion was used to represent salt intake. Levels of urinary Na excretion varied in different Egyptian regions; 125 mEq/L in Cairo, 99 mEq/L in Aswan and 56 mEq/L in Oasis. These correlated positively with prevalence of hypertension.

   Comment Top

The Egyptian National Hypertension Project (NHP), provides for the first time data about the magnitude of hypertension problem nationwide in an Arab country. The prevalence of hypertension in Egypt is among the highest in the world with a national estimate of 26.3% in adult population. There is an impressive increase in prevalence rates with age: approximately 60% of individuals above the age of 60 years suffer from hypertension. The study also showed that the rates of hypertension awareness, treatment and control were low. These observations should encourage the development of national campaigns in order to increase public awareness and should alert health planners to start prevention programs and improve physician education and training. The establishment of the Egyptian Hypertension Society was a direct by-product of the results of the Egyptian HNP.

The results of the survey underscore the role of environmental factors in develop­ment of hypertension. The variable prevalence of hypertension between different geographic areas in Egypt, in spite of the similar racial and ethnic backgrounds, should invite investigators to examine the role of environment. Dietary salt intake, expressed in urinary Na excretion, was more than double in the Cairo area, which had the highest prevalence of hypertension, while the Frontiers (Oasis) had the lowest dietary salt intake and the lowest prevalence of hypertension. Racial differences have been shown to affect salt sensitivity. Egyptians seem to belong to the salt sensitive group. Limiting daily salt intake should be encouraged and be part of a nationwide hypertension prevention program.

   References Top

1.The Central Agency for Public Mobilization and Statistics (CAPMAS). The annual health report of the year 1990. Cairo, Egypt: CAPMAS 1990.  Back to cited text no. 1    
2.Ashour Z, Ibrahim MM, Appel LJ, et al. The Egyptian National Hypertension Project (NHP): design and rationale. The NHP Investigative Team. Hypertension 1995;26:880-5.  Back to cited text no. 2    
3.Ibrahim MM, Rizk H, Appel LJ, et al. Hypertension prevalence, awareness, treatment and control in Egypt. Results from the Egyptian National Hypertension Project (NHP). NHP Investigative Team. Hypertension 1995;26:886-90.  Back to cited text no. 3    

Correspondence Address:
M Mohsen Ibrahim
Department of Cardiovascular Medicine, Cairo University Hospitals, Kasr El-Aini, Cairo 11562
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PMID: 18212445

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