Epidemiologic features and Management of Hypertension in Tunisia, the results from the NAtional TUnisian REgistry of HyperTensioN (NaTuRe HTN) about 25890 patients
Authors: Abid Leila , Hammami Rania , Chatmouri Ikram , Drissa Meriam , Boudiche Selim , Bahloul MohamedAmine , BenSlima Hedi , Sayahi Khaled , Charfeddine Selma , Allouche Emna , Rais Lamia , Kaab Badr , IbnHadjamor Hassen , BenFatma Lilia , Garbaa Riadh , Boukhris Sabrine , Halima Manel Ben , Amdouni Nesrine , Ghorbel Chaima , Soudani Sabrine , Khaled Imen , Triki Syrine , Bouazizi Feten , Jemai Imen , Abdeljalil Ouday , Ammar Yemna , Farah Amani , Neji Adnen , Oumayma Zeineb , Seghaier Sana , Mokrani Samir , Thawaba Hamza , Sarray Hela , Ouaghlani Khalil , Thabet Houssem , Mnif Zeineb , Boujelban Fatma , Sghaier Mohamed , Khalifa Roueida , Fourati Sami , Kammoun Yasmin , Abid Syrine , Hamza Chihab , Jeddou Syrine Ben , Sabbah Lassaad , Lakhdhar Rim , Dammak Najla , Sellami Tarek , Herbegue Basma , Koubaa Alia , Triki Faten , Ellouz Tarek , Hmoudi Aicha , BenAmeur Ikhlas , Boukhchina MohamedMongi , Abid Neila , Wachtati Wejdene , Nasrallah Nizar , Houidi Yousra , Meghaieth Fathia , Ghodhbane Elhem , Chayeb Mounira , Chenik Sarra , Kaabachi Samira , Saadaoui Nizar , BenAmeur Ines , Affes Moufida , Ouali Sana , Chaker Mouna , Naanaa Hela , Dghim Meriem , Jarrar Mourad , Mnif Jihene , Turki Ahmed , Zairi Ihsen , Langar Jamel , Dardouri Safa , Hchaichi Imen , Chettaoui Rafik , Essmat Wajih , Chakroun Amel , Mzoughi Khadija , Mechmeche Rachid , BenHalima Afef , BenKhala Sahar , Chtourou Slim , Maalej Abdelkader , Ayari Mohsen , Hadrich Moufid , Tlili Rami , Azaiez Fares , Bouhlel Imen , Sahnoun Samira , Jerbi Habib , BenMrad Imtinene , Riahi Leila , Sahnoun Mohamed , BenJemaa Abdelhamid , BenSalem Amel , Rekik Bassem , BenDoudou Maroua , Boujneh Rachid , Joulak Anissa , Mejdoub Yosra , gtif Imen , Jr Gouider , Naffeti Elyes , Gamra Habib , BenYousef Soraya , Sdiri Wissem , BenHalima Najeh , BenAmeur Youssef , Kachboura Salem , Kraiem Sondes , Fehri Wafa , Bazdeh Leila , Mourali MohamedSami , Milouchi Sami , Drissa Habiba , Maatouk Faouzi , Zakhama Lilia , Addad Faouzi , Kammoun Samir , Abdesselem Salem 
Published: September 2021

Abstract
BackgroundHypertension is the leading cause of morbi-moratlity in low, middle as well as high incomes countries. Tunisia is a developing country with a high cardiovascular profile and the prevalence of hypertension has widely increased during the last decades. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. MethodsNature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90mmHg. Our objective is to assess the predictors of uncontrolled hypertension in our population. Results Three hundred twenty one investigators from all the Tunisian governorates participated in the study. We enrolled 25890 patients with a female predominance (Sex ratio 1.21) and an average age 64.4±12.2 year-old. Most of individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as BP target and only in 18.6% if we consider 130/80 as a target. The independents predictors of uncontrolled blood pressure were male sex (OR=1.09, 95%CI [1.02-1.16]), age> 65 year-old (OR=1.07, 95% CI[1.01-1.13], diabetes (OR=1.18, 95% CI [1.11-1.25], Smoking (OR=1.15, 95% CI [1.05-1.25]), Obesity (OR=1.14, 95% CI[1.07-1.21]), management in public sector (OR=1.25, 95% CI [1.16-1.34]) and Heart rate >80bpm (OR=1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR=0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR=0.86, 95% CI [0.8-0.93]), salt restriction (OR=0.48, 95% CI [0.45-0.51]), drug compliance (OR=0.57, 95% CI[0.52-0.61]) and regular physical activity (OR=0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. Conclusion Nature HTN showed a remarkable improvement of blood pressure control amongst Tunisian people. The control remains low in patients with high cardiovascular profile and those treated in the public sector. A national health program based on therapeutic education, regular control and continuous giving much support to the public institutions is needed to decrease the hypertension burden affection rate in our population.