The prevalence of metabolic syndrome among hypertensive patients in Hadramout: A hospital-based study

Rasheed Mohammed Bamekhlah; Mohammed Rasheed Bamekhlah; Hussain Saeed Alghazali; Abdulrahman Rasheed Bamekhlah

doi:10.4103/HMJ.HMJ_20_19

ORIGINAL ARTICLE

Year : 2019 | Volume : 12 | Issue : 4 | Page : 200-203

The prevalence of metabolic syndrome among hypertensive patients in Hadramout: A hospital-based study

Rasheed Mohammed Bamekhlah¹, Mohammed Rasheed Bamekhlah², Hussain Saeed Alghazali³, Abdulrahman Rasheed Bamekhlah⁴
¹ Department of Medicine, College of Medicine and Medical Sciences (HUCOM), Hadramout University; Department of Medicine, Ibnseena Teaching Hospital; Department of Medicine, Al-Riyan Specialized Hospital, Mukalla, Hadramout, Republic of Yemen
² Department of Medicine, Ibnseena Teaching Hospital; Department of Medicine, Al-Riyan Specialized Hospital, Mukalla, Hadramout, Republic of Yemen
³ Department of Medicine, College of Medicine and Medical Sciences (HUCOM), Hadramout University; Department of Medicine, Al-Riyan Specialized Hospital, Mukalla, Hadramout, Republic of Yemen
⁴ Department of Medicine, College of Medicine and Medical Sciences (HUCOM), Hadramout University, Mukalla, Hadramout, Republic of Yemen

Date of Submission	02-Mar-2019
Date of Acceptance	28-Jul-2019
Date of Web Publication	11-Nov-2019

Correspondence Address:
Rasheed Mohammed Bamekhlah
P.O. Box No. 8892, Mukalla, Hadramout
Republic of Yemen

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/HMJ.HMJ_20_19

Abstract

Background and Objectives: Hypertension (HTN) is one of the most common medical diseases worldwide, and it is one component of metabolic syndrome (MetS). The aim was to determine the prevalence of MetS among hypertensive patients. Subjects and Methods: A prospective hospital-based cross-sectional study conducted at Al-Rayan Specialized Hospital, Mukalla, Hadramout, Republic of Yemen, from February 2015 to April 2016. MetS was estimated according to the National Cholesterol Education Program-Adult Treatment Panel criteria. Results: From 345 patients, 207 were diagnosed as MetS (60%), whose age was 57.9 ± 9.2 years and significantly higher than that of patients without the syndrome (44.7 ± 6.6) years (P < 0.0001). Males with the syndrome were significantly less than females (32.4% and 67.6%, respectively) compared with patients without, (odds ratio 0.28 95% confidence interval [0.18–0.44], P < 0.0001). As HTN was present in all studied patients, diabetes was more common MetS component in patients with the syndrome (79.2%), followed by the high waist circumference (76.3%), then high triglycerides (66.2%) and the least was low high-density lipoprotein (59.9%). There was 58% of patients with MetS had four MetS components, 32.8% with five and only 7.2% had only three components. Conclusion: The prevalence of MetS among hypertensive patients was high. It was more common in females and older age. Diabetes and central obesity were the most frequent syndrome components. More than half of the patients had >3 components, but a considerable number of patients were with the all 5 components.

Keywords: Diabetes, Hadramout, hypertension, metabolic syndrome

How to cite this article:
Bamekhlah RM, Bamekhlah MR, Alghazali HS, Bamekhlah AR. The prevalence of metabolic syndrome among hypertensive patients in Hadramout: A hospital-based study. Hamdan Med J 2019;12:200-3

How to cite this URL:
Bamekhlah RM, Bamekhlah MR, Alghazali HS, Bamekhlah AR. The prevalence of metabolic syndrome among hypertensive patients in Hadramout: A hospital-based study. Hamdan Med J [serial online] 2019 [cited 2022 Aug 19];12:200-3. Available from: http://www.hamdanjournal.org/text.asp?2019/12/4/200/270672

Introduction

Hypertension (HTN) and metabolic syndrome (MetS) are highly prevalent diseases that present a global challenge.^[1],[2] In 2000, approximately 1 billion people worldwide (26.4% of the adult population) were estimated to have HTN, and this is likely to increase to over 1.5 billion by 2025 as a result of ageing population in many developed countries, and an increasing incidence of HTN in developing countries.^[2] It is estimated that around 20%–25% of the world's adult population has MetS and they are twice as likely to die from it; moreover, they are three times more likely to have a heart attack or stroke compared with people without the syndrome.^[3] When HTN and MetS components coexist in an individual, they potentiate one another leading to synergism that increase the total risk.^[4] HTN is one of the major manifestations of the group of clinical abnormalities that characterise MetS.^[5] The use of some antihypertensive agents such as diuretics or beta-adrenergic blocking agents may worsen insulin resistance and increase the risk of developing cardiovascular disease.^[6]

Even though there are different studies done on the prevalence of MetS in different parts of the world,^[6],[7],[8] and in neighbour countries;^{[9],[10],[11],[12]} few reports on MetS in the area were specifically performed among hypertensive individuals.^[13] In the Republic of Yemen, only three published studies were performed on MetS,^{[14],[15],[16]} and the fourth was our work in Hadramout.^[17] Hence, the aim of this study was to determine the prevalence of MetS among hypertensive patients in Hadramout.

Subjects and Methods

Study design and source

A prospective cross-sectional hospital-based study conducted at the Medical Department and Outpatient Clinics of Al-Rayan Specialized Hospital, Mukalla, Hadramout, Republic of Yemen, from February 2015 to April 2016. Previously diagnosed hypertensive patients were submitted to the study after inclusion and exclusion criteria had been applied.

Inclusion criteria

Patients ageing 25 years or more with a diagnosis of HTN either previously or recently at the period of data collection.

Exclusion criteria

Patients who refused consent, and those who had Type 1 diabetes mellitus (DM), secondary DM and HTN, any evidence of non-diabetic or non-hypertensive renal disease, severe renal disease, severe heart failure (New York Heart Association Class III or more), liver disease or pregnancy.

Metabolic syndrome definition

MetS was diagnosed, according to the National Cholesterol Education Program, Adult Treatment Panel III (ATP-III), in patients fulfilling three or more of the following:^[18]

Abdominal obesity (waist circumference [WC] >102 cm in men and > 88 cm in women)
Triglycerides (TGs) >1.7 mmol/l (150 mg/dl)
High-density lipoprotein (HDL) <1.04 mmol/l (40 mg/dl) for men and <1.30 mmol/l (50 mg/dl) for women
High fasting plasma glucose (FPG) ≥6.1 mmol/l (≥110 mg/dl) or taking anti-hyperglycaemic drugs
High blood pressure (systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg or taking antihypertensive drugs.

Sample size and selection

The sample size was estimated using the formula for descriptive study (n = Zα² × p × q/d ²),^[19] where n is the sample desirable, Zα is the confidence level at 95% (1.96), d is the desirable precision at 5% (0.05), P is the previous prevalence of MetS in hypertensive patients in Kuwait - (34%)^[13] and q is 1-p which is equal to 0.66. Based on the above formula, the minimal sample size was 345. Then, systematic sampling was applied, and every second, the participant was selected using the systematic random sampling technique.

Data collection

All patients underwent detailed history taking and clinical examination, including measurements of height, weight, WC and blood pressure. Fasting venous blood was sampled from an antecubital vein from all patients for the measurement of plasma glucose (FPG), HDL, TGs, urea and creatinine.

Ethical clearance was obtained from the college ethical committee then a written consent from each patient or his/her guardian was taken as an agreement to participate in the study.

Statistical analysis

Data were processed by The Statistical Package for Social Sciences (SPSS) software version 20.0 (IBM Corporation., Armonk, NY, USA). 't' test was applied to compare means and Pearson's Chi-square test to compare gender and MetS components. Furthermore, we estimated odds ratio (OR) and the resulting confidence interval (95% CI) for all categorical variables. All statistical hypothesis tests were two-sided, and P < 0.05 was considered statistically significant. Microsoft office Excel 2010 spreadsheet was used to form the figure.

Results

On the basis of ATP-III criteria,^[18] 60% (207 out of 345) patients fulfilled the criteria for MetS and 138 (40%) without MetS. The mean age of MetS patients (57.9 ± 9.2 years) was highly significant compared with patients without the syndrome (44.7 ± 6.6 years). All means of the five components of MetS were significantly higher in MetS patients than those of non-MetS ones [Table 1].

Table 1: Parameters of hypertensive patients with and without metabolic syndrome

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Males with MetS (67, 32.4%) were significantly lower than MetS females (140, 67.5%), (OR 0.28, 95% CI [0.18–0.44], P < 0.0001). After HTN, diabetes was the most common MetS component in MetS patients, followed by high WC, high TGs and low HDL was the least frequent MetS component. All these components were higher in frequency among MetS patients comparing non-MetS patients with statistical significance [Table 2].

Table 2: Frequency of gender and components of metabolic syndrome

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Regarding the distribution of MetS patients, (120, 58%) had 4 components (criteria) of MetS, 72 (34.8%) had 5 components and only 15 (7.2%) were with 3 components [Figure 1].

Figure 1: Distribution of metabolic syndrome components

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Discussion

Although many studies worldwide were in the range of 30%–50%,^{[20],[21],[22],[23]} higher figures were reported.^[24],[25] This variation also recorded in the same region, in the Middle East, Yasein et al., in Jordan reported about twice than Sorkhou et al., in Kuwait (65% and 34%, respectively).^[13],[26] In India, Govindula et al., Thakur et al. and Salagre et al.^{[25],[27],[28]} found that the prevalence of MetS was 82.5%, 68.6% and 49%, respectively. The possible explanations for the variation could be genetic disparities between populations, ethnicity, sociodemographic characteristics, lifestyle, duration of HTN and experiences of antihypertensive treatment. Recently, Tadewos et al. found that the prevalence of MetS in urban inhabitants was 82.8%;^[29] therefore, it calls for a critical attention to create awareness for individuals living in an urban situation concerning how to modify their lifestyle to limit/prevent MetS risks.

This study revealed that MetS patients were older than the non-MetS, with female predominance, and this was supported by many studies.^[30],[31] The syndrome affected <10% of people in their 20s and 40% of people in their 60s,^[32] Nolan et al., in a pooled analysis reported only 5%–7% among young adult.^[33]

After HTN, diabetes was the second most frequent MetS component, followed by WC, TGs and the least frequent one was HDL; Selagre et al, in India ^[28] was very similar to our findings except that WC and TGs replaced their arrangements, However, in most studies around the globe, WC was the most frequent, and diabetes was the least.^{[26],[27],[34],[35]} More than 90% of our MetS patients had >3 components (58% with 4 components and 34.8% with all the 5 components) while only 7.2% were with three components, but many studied showed that more patients were with three components, and the least were with five components (10.2%–17%),^{[25],[28],[29],[35]} this may be attributed partially to lifestyle changes during stressful situation of the war and economy. Genetic factors may have a role and need further studies. Our people have a higher risk for coronary artery diseases and stroke, and primary and secondary prevention must be more effective; through early diagnosis and control of HTN, DM and dyslipidaemia, as well as exercise, ideal weight and minimise stress as possible.

Conclusion

The prevalence of MetS among hypertensive patients was 60%. It was more common in females and older age. Diabetes is the most common component followed by high WC, high serum TGs and least frequent one was the serum low HDL. Most patients had >3 components of the syndrome.

Acknowledgement

We would like to thank the workers of the Department of Medicine in Al-Rayan Specialized Hospital for their help to obtain data of patients and workers of laboratory workers of the hospital, for processing and carrying out the investigation results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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