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ANNALS OF CLINICAL AND LABORATORY RESEARCH

The Prevalence of Arterial

Hypertension in Sample of
Algerian population in Oran
city: Inherited Aspect
Abstract
Background: Arterial Hypertension (AH) is considered as a public health
problem due to its high prevalence and difficult control and its also
described as one of the most important risk factors for cardiovascular
diseases.
Objectives: This study aimed to determine the prevalence of AH, as
well as characteristics related to the presence of its inherited aspect
among individuals aging between 24 and 70 years from the urban
region of Oran city in Algeria.
Methods: Transversal study from January 2010 to January 2011, population-based study, of 620 participants with random sampling. For
classification of AH, criteria included blood pressure (BP) 140/90
mmHg or current use of antihypertensive drugs. Individuals were interviewed with standardized questionnaires previously tested.

2013
Vol. 1 No. 1:2
doi: 10.3823/1401

Amrani, Asma1*,
Chawki Lamara,
Sid Ahmed1,
Talebbendieb,
Farida Mesli2,
Baba Hamed,
Mohamed bey1,
Ahmed Fouatih,
Zoubir3
1Biotechnology department, Faculty of
Sciences, University of Es-Snia, Oran,
Algeria.
2Biologydepartment, Faculty of Sciences,
University of Es-Snia, Oran, Algeria.
3 Epidemiology and preventive medicine
service, Faculty of Medecine, University
of Oran, Algeria.

Corresponding author:
Dr. A. Amrani

cardio_gen@yahoo.com

Results: Arterial Hypertension has a prevalence of 51.6 % in this

sample of Algerian population in Oran city, which is composed of
620 individuals. Among hypertensive individuals (n= 320), mean age
was 50.6 years, 73.33% was female hypertensive, 31.25% male hypertensive and 62.5% with a family history of Arterial Hypertension,
among them: 46% with a maternal family history (FH), 31% with a
fraternal FH, 20% with a paternal FH and 4% with a dead fraternal
FH, 41% had a family history of cardiovascular disease where those
with a stroke family history: 36.58% had a maternal FH, 12.19% with
a paternal FH and 7.31% with a fraternal FH, 13.41% with a dead

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ANNALS OF CLINICAL AND LABORATORY RESEARCH

2013
Vol. 1 No. 1:2
doi: 10.3823/1401

fraternal FH. Those with a family history of myocardial infarction (MI)

were: 9.75% with a maternal FH of MI, 14.63% with a paternal FH,
4.86% with a fraternal FH, 2.43% with dead fraternal FH. Another
characteristic of this hypertensive population is that 75% had AH associated with Type 2 Diabetes.
Conclusions: This study showed that AH represents an important public health problem with its high prevalence within this population. This
result points the major role of family history of arterial hypertension
and cardiovascular disease; these findings will constitute a data base
for genetic studies in order to a better understanding of the gene
contribution in the heritability of blood pressure.
Key words: Arterial Hypertension, therapy, epidemiology, control,
prevalence, family history, cardiovascular disease, Oran population.

Introduction
Arterial hypertension (AH) is the most frequent disease in Algeria [1]. The role played by AH in the development of cardiovascular diseases (CVD) stresses
the importance of knowing its distribution in different Algerian regions, where around 35% of the
Algerian population is hypertensive [2]. Blood pressure (BP) is a linear and continuous variable which
presents a positive association with the risk for
cardiovascular diseases [3], so that the relationship
between cerebrovascular disease and BP is also continuous, increasing and significant in levels higher
than 115-75 mmHg, for all age groups [4].
According to the WHO (World Health Organization) guidelines for arterial hypertension, adult individuals are classified as hypertensive when the
systolic blood pressure (SBP) reaches values equal
to or higher than 140 mmHg, and/or when the
diastolic blood pressure (DBP) is equal to or higher

than 90 mmHg, in two or more occasions and in

the absence of anti-hypertensive treatment. Blood
pressure was considered as normal when lower
than 130/85 mmHg, and optimal when lower than
120/80 mmHg [5].
Arterial hypertension is considered as a syndrome,
for its frequent association to a number of metabolic disorders, such as obesity, increased insulin resistance, diabetes mellitus and dyslipidemia, among
others. The existence of these risk factors and of
lesions in target organs, when present, is important and must be considered for the stratification
of individual risks, so that prognosis and therapeutic
decisions may be correctly conducted [5].
Although blood pressure displays substantial heritability, typically reported at 30 to 60%, hypertension
is likely to be heterogeneous phenotype trait [6].
The family history of AH is largely associated with
AH [7, 8].

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ANNALS OF CLINICAL AND LABORATORY RESEARCH

The present study analyzed and interpreted some

epidemiological aspects of arterial hypertension in
a sample of Algerian population with a main focus
on the family history of AH.

Materials and methods

Transversal study, which was population-based, with
random sampling, in three health centers (two in a
peripheral area and one in the Cardiology Unit). This
work is part of the Arterial Hypertension Project.
This collaborative study aimed to investigate the occurrence of arterial hypertension and cardiovascular
disease and their relationship with the family history
of each disease in the city of Oran, Algeria. Information on social-demographic variables and life habits
and family history of AH and CVD of adult and aged
individuals (24 to 70 years old), living in the city of
Oran, were collected during the period between
January 2010 and January 2011 by the use of a
standardized questionnaire answered at the health
centers.
The sample was estimated in 620 individuals, the
participants included were those coming for examination and their family members or friends who
were with them. They were initially informed on
objectives and procedures and were then invited
to voluntarily participate to the study. Consenting
individuals signed an informed consent form.
The inclusion criteria were: people aged from 24 to 70,
the hypertensive were defined as having an elevated
systolic blood pressure SBD140mmHg and sustained
diastolic blood pressure DBP90mmHg, or who
were currently receiving antihypertensive therapy.
Any Subjects with possibility of a secondary hypertension were excluded. Hypertensive subjects whose
parents both had hypertension were considered to
have a positive family history of hypertension. Normotensive was defined as those with a blood pressure of less than 140/90mmHg, both groups with
Under License of Creative Commons Attribution 3.0 License

2013
Vol. 1 No. 1:2
doi: 10.3823/1401

subjects under the influence of estrogen, thyroid,

and cortisol hormones were excluded.
This research was conducted by the members of
the project and doctors of the health Centers; they
applied the standardized, pretested questionnaires
and measured blood pressure variables. Measurements included blood pressure with a Sphygmomanometer (KDM CE 0123).
Blood pressure was measured with the person in
sitting position, feet placed on the floor, left arm
relaxed and placed on the table at heart level and
hand palm up. The person should have an empty
bladder and should not have had moderate or intensive physical activity, smoked or drank alcohol
during the previous 30 minutes. For analysis, the
last BP measurement was considered, as long as
the difference between them was not larger than
5 mmHg. In case of larger differences, BP was measured two further times, with 3-minute intervals,
and the last measurement was considered.
The outcome was considered was presence or the
absence of arterial hypertension, defined according
to the WHO guidelines, the following independent
variables were considered:
1.Independent sociodemographic variables: a) age
- in completed years, b) gender - male or female;
c) marital status.
2.Life-habit independent variables.
3.The family history of arterial hypertension: Maternal, Paternal, Fraternal, Dead Fraternal.
4.The family history of cardiovascular diseases
(CVD) such as stroke and myocardial infarction.
Information was recorded twice, with the establishment of two databases which were compared for
correction of eventual inconsistencies. Data were
analyzed with the EPI INFO-2000 software and SPSS
software.

ANNALS OF CLINICAL AND LABORATORY RESEARCH

Results

2013
Vol. 1 No. 1:2
doi: 10.3823/1401

this population of hypertensive, 87% were treated

and 75% had Type 2 diabetes (Table 2).

Our population was composed of 620 persons

where 51.61% male and 48.38% female with a sex
ratio of 1.06. The prevalence of arterial hypertension among this sample was 51.61% with a female
predominance (Table 1).
Among hypertensive population, the mean age
was 50.6 years, with a mean systolic blood pressure (SBP) of 139.56 and a mean of diastolic blood
pressure (DBP) of 89.22. We have noticed within

The specificity of this population is the presence of

62.5% of a family history of arterial hypertension
among the hypertensive; we found that 46% had a
maternal history, 31% with a fraternal history, 20%
with a paternal history and 4%with a dead fraternal
history (Table 3).
This population with a family history of arterial hypertension was characterized also with the presence

Table 1. Distribution of hypertensives according to the sex.

Classification

Hypertensives
n%

Normotensives
n%

Total

Male

100 31.25%

220 68.75%

320

Female

220 73.33%

80 26.66%

300

Total

320 51.61%

300 48.37%

620

n-Number of individuals.

Table2. Clinical characteristics of normotensive and hypertensive participants.

Characteristics
n=320n=300

HT
P Value

NT

50.6 8.92

53.75 7.96

0.85

Male/ Female

100/220

220/80

NS

SBP (mmHg)

152.4412.37

116.2113.24

p<0,0001

DBP (mmHg)

92.49 6.72

73.55 6.13

p<0,0001

BMI (kg/m2)

28.53,9

25,1 3,1

p<0,0001

152 (47.5%)

84(28%)

p< .001

240(75%)

36 (12%)

p< .001

200 (62.5%)

54(18%)

p<0,001

82(41%)

57(28,5%)

p<0,05

20,5%

16,5%

NS

Age (years)

Smoking habit
Diabetes mellitus
Family history of HTN
Family history of CVD and HTN
Family history of Diabetes mellitus

All the data were presented as mean SD. EH: essential hypertensive patients; NT: normotensive subjects; BMI: body mass index; SBP:
systolic blood pressure; DBP: diastolic blood pressure; CVD: Cardiovascular disease; HTN: Hypertension.

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ANNALS OF CLINICAL AND LABORATORY RESEARCH

of a family history of cardiovascular disease (41%),

such as stroke and myocardial infarction.
Among this latter sample, those with a family history of stroke were 36.58% with a maternal family
history, 12.19% with a paternal family history and
7.31% with a fraternal family history, 13.41% with
a dead fraternal family history (Table 4).
Those with a family history of myocardial infarction
(MI) were: 9.75% with a maternal family history of
MI, 14.63% with a paternal family history, 4.86%
a fraternal family history, and 2.43% with dead fraternal family history (Table 5).

2013
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doi: 10.3823/1401

Discussion
The present study is the first report in the investigation on the prevalence and up to now there is no
study on the family history of Arterial hypertension
in the population of Oran in Algeria, which is a second big city after the capital and in the whole country. We found a high prevalence of Arterial Hypertension with 51.6%, and its increasing alarmingly in
the whole Algerian population and other developing nations [9, 10]. This high prevalence may be only
noticed in urban area [11]. This hypertensive population is characterized with a female predominance of
Arterial hypertension with 73.33%, comparing to
the male where we found only 31.25% hypertensive one, this is due to the early menopause noticed

Table 3. Distribution of hypertensives according to the origin of the family history of arterial hypertension.
Hypertensives with a Family History of AH (n=200)
n
%
Maternalfamiliarhistory

92

Paternalfamiliarhistory

40 (20%)

Fraternalfamiliarhistory

62 (31%)

Dead Fraternalfamiliarhistory

(46%)

8 (4%)

n-Number of individuals.

Table 4. Distribution of hypertensives according to the origin of their family history of cardiovascular
disease (Stroke).
Hypertensives with family history of CVD (stroke)
n
%
Maternalfamiliarhistory

30 36.58%

Paternalfamiliarhistory

10 12.19%

Fraternalfamiliarhistory

Dead Fraternalfamiliarhistory

11 13.41%

7.31%

n-Number of individuals.
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ANNALS OF CLINICAL AND LABORATORY RESEARCH

2013
Vol. 1 No. 1:2
doi: 10.3823/1401

Table 5. Distribution of hypertensives according to the origin of their family history of cardiovascular
disease (Myocardial Infarction).
Hypertensives with family history of CVD (MI)
n
%
Maternalfamiliarhistory

Paternalfamiliarhistory

(9.75%)
12 (14.63%)

Fraternalfamiliarhistory

(4.87%)

Dead Fraternalfamiliarhistory

(2.43%)

n-Number of individuals.

which may play a major role in their high prevalence

of Arterial hypertension [12]. According to the WHO
(World Health Organization), women are highly
protected from AH before menopause [13]. Other
studies in Algeria have confirmed these findings
(www.who.int/chp/steps/STEPS_Algeria_Data.pdf).
Although the high prevalence of AH, 87.5% were
under treatment which points the major role that
play the health services, among this studied sample
of hypertensive, 75% had Type 2 Diabetes associated with AH, which may enhance the risk of developing a coronary diseases, end stage renal diseases,
and peripheral vascular diseases [14, 15]. This result
has also been confirmed in West Algerian Population [16]. Nevertheless, essential arterial hypertension and type 2 diabetes are under interplay between genetics and environmental factors [17, 18].
The strength and the originality of this study is the
focus on the family history of Arterial hypertension
and cardiovascular disease, we found that nearly
62.5% of the hypertensivehave a family history of
Arterial hypertension, this joins the fact that genetic
factors are responsible of the two thirds of the familial aggregation of blood pressure and with the
transmission of cultural factors which are responsible for the remaining third [19]. Thus, the family

history of AH are highly associated with the increasing risk of developing arterial hypertension.
However, among this population with a family history of AH, the maternal family history is the most
prevalent with 46%, followed by the Fraternal family history with 31%, these observations are in line
with earlier report providing evidence that when
one parent is hypertensive, almost 28.3% of their
children will be hypertensive, and 45%, for those
with two hypertensive parents [20].
Therefore the heritable factors in combination with
a number of recognized environmental risk factors
are important determinants of the pathogenesis of
natural history of essential hypertension [21].
Another important aspect of this study is the presence of family history of cardiovascular disease
among hypertensive with family history of AH, with
exclusive inclusion of patients having a family history of CVD before 65 years, which increase the
probability that genetic factors are involved to a
significant degree in the onset of MI. we noticed
that 14.63% have a paternal family history of myocardial infarction vs. 9.75% with a maternal history
of MI, It is well known that women develop CVD
about 10 years later than men, probably due to
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ANNALS OF CLINICAL AND LABORATORY RESEARCH

the protective effects of female sex hormones but

also due to the different frequency of classical risk
factors such as diabetes, hypertension and smoking
habits [22, 23]. Where 36.5% of this population has
a maternal family history of stroke.
So can we attribute the heritability of stroke and
myocardial infarction to the gender? Until now,
there is no evidence of this aspect since the complexity of these pathologies.
In recent years, genome-wide association studies
(GWAS) have displayed an effective approach to
localize genomic regions predisposing to common,
polygenetic disorders, including cardiovascular disorders [24, 25].

Conclusions
Our study points the high prevalence of arterial hypertension among this population and need more
accurate studies focusing on other risk factors of
arterial hypertension. However, our original findings about family history of arterial hypertension
and CVD diseases will constitute a data base and a
long road to take in the determination of the heritability of blood pressure by doing linkage studies
in order to a better understanding of the gene contribution in Arterial Hypertension and cardiovascular
diseases.

Acknowledgements
Special thanks to the Health Centers (Cardiology
unit, CHUO, Algeria) and to the patients for their
contribution.

Under License of Creative Commons Attribution 3.0 License

2013
Vol. 1 No. 1:2
doi: 10.3823/1401

Conflict of Interest
None declared.

References
1. TAHINA (Transition Health Impact In NorthAfrica): Transition
pidmiologique et systme de sant. Enqute nationale sant.
Institut National de la Sant Publique, Alger, Novembre 2007.
http://www.Doc_ENS_07_Resume_final_tahina.pdf.
2. Temmar, M., Labat, C., Benkhedda, S., Charifi, M., Thomas,
F., Bouafia, MT., Bean, K., Darne, B., Sfar, ME., Benetos, A.
Prevalence and determinants of hypertension in the Algerian
Sahara. J Hypertens 2007; 25: 2218-2226.
3. Lewington, S., Clarke, R., Oizilbash, N., Peto, R., Colllin, R. For
the prospective study collaboration. Age-specific relevance of
usual blood pressure to vascular mortality: A meta-analysis of
individual data for one million adults in 61 prospective studies.
Lancet 2002; 360: 1903-13.
4. Drea, EL., Lotufo, PA. Epidemiologia da hipertenso arterial
sistmica. Hipertens. 2004; 7 (3 : 86-9.
5. Sociedade Brasileira de Cardiologia. V diretrizesbrasileiras de
hipertensoarterial. Ar Bras Cardiol. 2007; 89 (3): e24-e79.
6. Kupper, N., Ge, D., Treiber, FA., Snieder, H. Emergence of
novel genetic effects on blood pressure and hemodynamics
in adolescenc : The Georgia Cardiovascular Twin Study.
Hypertension 2006; 47: 948-954]
7. Van der Sande, MA., Walraven, GE., Milligan, PJ., Banya, WA.,
Ceesay, SM., Nyan, OA., McAdam, KP. Family history: An
opportunity for early interventions and improved control of
hypertension, obesity and diabetes. Bull World Health Organ
2001; 79(4): 321-323.
8. Galderisi, M., Celentano, A., Tammaro, P., Mureddu, GF.,
Garofalo, M. Ambulatory blood pressure monitoring in offspring
of hypertensive patients. Relation to left ventricular structure
and function. Am J Hypertens 1993; 6: 114-20.
9. www.who.int/chp/steps/STEPS_Algeria_Data.pdf)./.
10. Wang, TJ., Vasan, RS. Epidemiology of uncontrolled hypertension
in United States. Circulation 2005; 112: 1651-2.
11. Duprez, D., Van Helshoecht, P., Van den Eynde, W., Leeman, M.
Prevalence of hypertension in the adult population of Belgium:
Report of a worksite study, Attention Hypertension. J Hum
Hypertens 2002; 16: 47-52.
12. Hajjar, MI., Clarence, E., Grim, MD., Varghese, G., Kotchen, T.
Impact of diet on blood pressure and age-related changes in
blood pressure in the US population. Analysis of NHANESIII.
Arch Intern Med. 2001; 161: 589-593.
13. WHO. La lutte contre lhypertensio: Rapport dun comit OMS
dexperts. Srie de rapports technique,. Genv: 1996.
14. Flack, JM., Shafi, T. et al, Prevention of Hypertension and its
complication: Theorical basis and guidlines for treatment. J Am
Soc Nephrol. 200; 1: 92-8.5
15. Kurtz, TW., Spence, MA. Genetics of essential hypertension.
Am J Med. 199; 9: 77-84.

ANNALS OF CLINICAL AND LABORATORY RESEARCH

16. Kourta, D. 34% des Algriens sont hypertendus. El Watan

Archives 26.12.2004. Disponible sur le sit : www.elwatan.com/
IMG_article_PDF/article_14318.pdf. Kourta, D. 5 000 dcs par
an causs par les maladies.
17. Barnett, AH., Eff, C., Leslie, RD., Pyke, DA. Diabets in identical
Twins. A study of 200 pairs. Diabetologia 1981; 20: 87-93.
18. Swales, JD., Dzau, VJ. Angiotensin-converting enzyme inhibition:
Research advances and clinical implications. J Am Heart 1992;
123: 1412-1413.
19. Ward, .H., Brenner, BM. Rin Hypertensio : Patho-physiology,
Diagnonsis, and Managment. Laragh 1990; 81-100.
20. Lauer, RM., Clarke, WR. Childhood risk factors for high adult
blood pressure: The Muscatine Study. Pediatrics 1989; 84: 63341.
21. Bhavani, BA., Padma, T., Shastry, BKS., Reddy, NKS. Gender
specific association on insertion/deletion polymorphisms of
the human angiotensin converting enzyme gene with essential
hypertensio . Int J Hum Genet 2004; 4: 207-13.
22. Anand, SS., Islam, S., Rosengren, A., Franzosi, MG., Steyn, K.,
Yusufali, AH., Keltai, M., Diaz, R., Rangarajan, S., Yusuf, S: Risk
factors for myocardial infarction in women and men: Insights
from the INTERHEART study. Eur Heart J. 200 ; 29 (7): 932-940.
23. Kannel, WB., Hjortland, MC., McNamara, PM., Gordon, T:
Menopause and risk of cardiovascular disease: The Framingham
study. Ann Intern Med. 197 ; 85 (4): 447-452.
24. Hirschhorn, JN., Daly, M . Genome-wide association studies for
common diseases and complex traits. Nat Rev Genet 200 ; 6 (2):
95-108.
25. Genome-wide association study of 14,000 cases of seven
common diseases and 3,000 shared controls. Nature 200 ; 447
(7145): 661-678.

2013
Vol. 1 No. 1:2
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