Under- treatment and under diagnosis of hypertension: a serious problem in the United Arab Emirates

BACKGROUND: Hypertension, notably untreated or uncontrolled, is a major risk factor for cardiovascular diseases (CVD) morbidity and mortality. In countries in transition, little is known about the epidemiology of hypertension, and its biochemical correlates. This study was carried out in Al Ain, United Arab Emirates, to characterize self-reported (SR) normotensives and hypertensives in terms of actual hypertension status, demographic variables, CVD risk factors, treatment, and sequalae. METHODS: A sample, stratified by SR hypertensive status, of 349 SR hypertensives (Mean age ± SD; 50.8 ± 9.2 yrs; Male: 226) and 640 SR normotensives (42.9 ± 9.3 yrs, Male: 444) among nationals and expatriates was used. Hypertensives and normotensive subjects were recruited from various outpatient clinics and government organizations in Al-Ain city, United Arab Emirates (UAE) respectively. Anthropometric and demographic variables were measured by conventional methods. RESULTS: Both under-diagnosis of hypertension (33%) and under-treatment (76%) were common. Characteristics of undiagnosed hypertensives were intermediate between normotensives and SR hypertensives. Under-diagnosis of hypertension was more common among foreigners than among nationals. Risk factors for CVD were more prevalent among SR hypertensives. Obesity, lack of exercise and smoking were found as major risk factors for CVD among hypertensives in this population. CONCLUSION: Hypertension, even severe, is commonly under-diagnosed and under-treated in the UAE. Preventive strategies, better diagnosis and proper treatment compliance should be emphasized to reduce incidence of CVD in this population

Prevalence and determinants of microalbuminuria among diabetic patients in the United Arab Emirates

Abstract Background Microalbuminuria (MA) represents the earliest clinical evidence of diabetic nephropathy and is a predictor of increased cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of MA among diabetic patients in the Al-Ain district of the United Arab Emirates (UAE). Methods The study was part of a general cross-sectional survey carried out to assess the prevalence of diabetes mellitus (DM) complications in Al-Ain district, UAE and was the first to assess the prevalence of MA among diabetic patients. A sample of 513 diabetic patients with a mean age of 53 years (SD: ± 13) was randomly selected during 2003/2004. All patients completed an interviewer-administered questionnaire and underwent medical assessment. First morning urine collections were obtained and were tested for clinical proteinuria using urine dipsticks and for MA using the single Micral-Test II strips. Results MA was found in 61% (95% CI: 56.7–65.7) of the sample and the rate was significantly higher among males, positively related to body mass index (BMI), type 2 DM and presence of other DM complications such as diabetic retinopathy and neuropathy. Of the total sample population, 12.5% (95% CI: 8.1-14.1) had clinical proteinuria. Conclusion The prevalence rate of MA was considerably high ( 61%) among diabetic patients in the UAE. Therefore, regular screening for MA is recommended for all diabetic patients, as early treatment is critical for reducing cardiovascular risks and slowing the progression to late stages of diabetic nephropathy (overt proteinuria and end-stage renal disease).</p

Evaluation of Plasma Beta-2-microglobulin in Patients with the Nephrotic Syndrome

In patients with the nephrotic syndrome, it is often desirable to assess the disease process, not only by proteinuria but also by indices of glomerular inflammatory process. We investigated the importance of &#946;-microglobulin (&#946;M) as a means of assessing renal function in patients with the nephrotic syndrome with normal or abnormal values of creatinine clearance. There were 46 patients (mean age, 42.2 &#x002B; 10.4 years; male/female (M/F) ratio = 31/15) and 35 healthy controls (mean age 39 &#x002B; 4.5 years, M/F ratio 25/10). We subdivided the study patients into group A (n = 18, mean age 39.6 &#x002B; 10.6 years, M/F ratio 8/10) and group B patients (n = 28, mean age 45.6 &#x002B; 8.9 years, M/F ratio 23/5) who had normal and abnormal values of creatinine clearance respectively. An enzyme-linked-immunosorbent assay (ELISA) was used to quantitate plasma &#946;2M in the study patients and controls. The median 132M levels of the study patients and controls were 44.0 and 1.7 mg/l respectively (p &lt; 0.0001). Beta-2-M levels correlated significantly with serum creatinine (r = 0.56, p &lt; 0.0001), and creatinine clearance (r = -0.6, p &lt; 0.0001). In group A patients, the median &#946;2M level was significantly higher than normal (4.1 vs. 1.7 mg/1, p &lt; 0.01). Plasma &#946;2M levels did not correlate well with any other parameter measured in group A patients. When groups A and B were compared, the median plasma &#946;2M level in group B was significantly higher than group A (20.3 vs. 4.1 mg/1, p &lt; 0.0001). The urinary &#946;2M (expressed per mg urine creatinine) was also higher in group B than group A patients (6.8 vs. 0.7 p &lt; 0.05). We conclude that elevation of &#946;2M-microglobulin in patients with the nephrotic syndrome who have normal creatinine clearance suggests early abnormal renal function in these patients. It may be used to assess the rate of normalisation of renal function or progression to chronic renal failure

Circulating levels of endothelin-1 in a homogenous Gulf Arab population with untreated essential hypertension

<b>Background: </b> Racial variations are reported in the natural history of hypertension. For example, hypertension is significantly more prevalent in blacks than whites. Endothelial cells are important regulators of vas-cular tone and homeostasis, in part through secretions of vasoactive substances including endothelin-1 (ET-1), a small peptide with potentva-sopressor actions. In black hypertensives, ET-1 levels are higher than in normotensive blacks and in both hypertensive and normotensive whites. Since ET-1 might play a significant role in the development and severity of hypertension in the indigenous Arab population of the United Arab Emirates, we investigated the circulating levels of ET-1 in this homog-enous population. <b> Patients and Methods: </b> ET-1 levels were measured in plasma sam-ples from 60 untreated hypertensive Arabs and compared with 60 age-and sex-matched normotensive controls. <b> Results: </b> ET-1 levels were significantly higher in hypertensives (mean 10.1&#x00B1;1 pmol/L) than normotensives (mean 2.2&#x00B1;0.5 pmol/L). Body mass index (BMI) was slightly higher among the hypertensives. For all sub-jects these levels significantly (P&#60; 0.001) correlated with systolic blood pressure and less significantly (P&#60; 0.05) with diastolic blood pressure and body weight. The correlation between ET-1 and both systolic and diastolic blood pressure was persistently significant after adjusting for BMI. <b> Conclusion: </b> Plasma concentrations of ET-1 are significantly higher in hypertensive Gulf Arabs as compared with reported levels in white hy-pertensives and ET-1 could be a risk factor for cardiovascular diseases in this population. The endothelial system might be particularly impor-tant with respect to hypertension in this racial group and merits further study