Epidemiologic features and management of hypertension in Tunisia, the results from the Hypertension National Registry (NaTuRe HTN)
Authors: Abid Leila , Hammami Rania , Chamtouri 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 , Jribi 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: March 2022

Abstract
Background
Hypertension is the leading cause of morbi-mortality in our country. 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.

Methods
Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg.

Results
Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most 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 a BP target, and only in 18.6% if we consider 130/80 as a target. The independent 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 > 80 bpm (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 that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.