Dr. mahmoud.hamada :: Publications:

Hypertension is a worldwide public health concern, because of its high prevalence and because it is one of the leading causes of burden of disease and death (Czernichow et al., 2011). Hypertension is confirmed to be a major health problem in Egypt with a prevalence rate of 26.3% among the adult population (>25 years)(Ibrahim et al., 1995), with the highest prevalence in greater Cairo (31%) and Northern Upper Egypt (30.7%) and the lowest rate in the frontiers governorates (19.9%). Almost two-thirds (62.5%) of those who could be classified as hypertensive are not aware that they have high blood pressure (BP). At national level, the estimated percentage of hypertensive individuals receiving pharmacological treatment in Egypt was 23.9%, but the hypertension was controlled in only 8% (Ibrahim, 1999). Hypertension presents a major area of intervention because it is a frequent condition and is amenable to control through both nonpharmacological lifestyle factors and pharmacological treatment. Pharmacological treatment for hypertension has been shown to be effective in decreasing BP and subsequently cardiovascular events(Chen, 2012) although BP levels achieved in treated patients may still be considerably higher than those in truly normotensive persons. Lifestyle measures for lowering BP include reduced alcohol intake, reduced sodium chloride intake, increased physical activity, and control of overweight (Trovato et al., 2010). Lifestyle interventions also have the potential to reduce the need for or the amount of medications in hypertensives and prevent high BP from developing in nonhypertensives. Furthermore, lifestyle interventions are instrumental in controlling other concomitant cardiovascular risk factors not necessarily related to hypertension, such as smoking, raised cholesterol level, or diabetes, hence the importance of a multifactorial approach to effective risk reduction in hypertensives (Becton et al., 2012). The worldwide rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal disease (ESRD) necessitating renal replacement therapy (RRT) and attendant cardiovascular disease (CVD) is threatening to reach epidemic proportions over the next decade, and only a small number of countries have robust economies able to meet the challenges posed (Xue et al., 2001,Lysaght, 2002, and El-Nahas M., 2005). In Egypt, one of the developing countries, poverty has emerged as one of the most challenging socio-economic problems, with 22.9% of the total populations within the national poverty line (Wassili and Baradaeus, 2012). A change in global approach to CKD from treatment of ESRD to much more aggressive primary and secondary prevention is therefore imperative (El-Nahas M., 2005). A number of population-based studies are conducted on CKD and its determinants in many parts of the World. Such studies are limited in the Middle East and Arab World. The Egypt Information, Prevention, and Treatment of Chronic Kidney Diseases (EGIPT-CKD) programme is a community-based mass screening program carried out among a population group at high-risk for the development of CKD and CVD such as diabetics, hypertensives and subjects with family history of diabetes, hypertension, CVD and CKD in Damanhour city and the surroundding towns in Al-Buhayrah governorate, in Lower Egypt (Gouda et al., 2011). The relationship between elevated blood pressure and end-stage renal disease (ESRD) is well established (Eberly et al., 2004). High levels of treated blood pressure are positively and significantly related to an early decline in kidney function among hypertensive men (Vupputuri et al., 2003), and hypertensive nephrosclerosis is recognized as a major cause of ESRD (Allen and Sanders, 2013). The prevalence of chronic kidney disease (CKD) in essential hypertension has been considered to be low (