Hypertension in Moroccan adults: sociodemographic, lifestyle, and dietary risk factors
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Submitted
November 1, 2024
Published
April 10, 2025
Abstract
Background: Hypertension constitutes a principal etiological factor in cardiovascular morbidity and premature mortality worldwide, however, the epidemiological profile of its risk determinants within the Moroccan population remains inadequately characterized.
Aims: This investigation aimed to estimate the prevalence of prehypertension and hypertension and elucidate their association with various sociodemographic, behavioral, and metabolic factors among adult Moroccans.
Patients and Methods: Data were derived from the inaugural nationwide cross-sectional survey on non-communicable diseases risk factors, conducted between 2017 and 2018. Data collection adhered to the World Health Organization’s STEPwise approach to surveillance (STEPS). The analytical cohort comprised 4580 adults, aged 18 years and above.
Results: The observed prevalence rates for prehypertension and hypertension were 42.4% and 34.5%, respectively. Individuals aged 45 years or older demonstrated a significantly elevated propensity for both prehypertension and hypertension relative to younger cohorts. Participants with university-level education exhibited a statistically significant elevated risk of hypertension compared to those with lower educational attainment. Overweight and obese individuals presented a significantly increased risk for both prehypertension and hypertension than their non-overweight peers (Adjusted Odds Ratio [AOR] = 1.83; 95% Confidence Interval [CI]: 1.58–2.13; p < 0.001; and AOR=3.06; 95% CI: 2.60–3 .60; p < 0.001, respectively). Hyperglycemia and dyslipidemia were associated with higher odds of hypertension, albeit marginally (AOR = 1.19; 95% CI: 0.99–1.41; p = 0.055; and AOR = 1.16; 95% CI: 0.99–1.37; p = 0.069, respectively). Current tobacco smokers exhibited a significantly higher risk of hypertension than non-smokers (AOR = 1.47; 95% CI: 1.09–1.98; p = 0.013).
Conclusions: The prevalence of prehypertension and hypertension was substantial within the studied population. Advanced age, elevated educational attainment, obesity, hyperglycemia, dyslipidemia, and tobacco smoking were associated with an elevated risk of both prehypertension and hypertension. Consequently, the implementation of urgent public health interventions is imperative to address the health burden associated with hypertension and to prevent the progression of prehypertension to hypertension and subsequent cardiovascular diseases.
Keywords: Age, Dyslipidemia, Education level, Hyperglycemia, Hypertension, Obesity, Overweight, Prehypertension.
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References
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Bays, H. E., Kulkarni, A., German, C., Satish, P., Iluyomade, A., Dudum, R., Thakkar, A., Rifai, M. A., Mehta, A., Thobani, A., Al-Saiegh, Y., Nelson, A. J., Sheth, S., & Toth, P. P. (2022). Ten things to know about ten cardiovascular disease risk factors - 2022. American Journal of Preventive Cardiology, 10, 100342. https://doi.org/10.1016/j.ajpc.2022.100342
Boujnah, R., Nazek, L., Maalej, M., Achhab, Y. E., & Nejjari, C. (2018). Hypertension in Tunisian adults attending primary care physicians (ETHNA-Tunisia). Indian Heart Journal, 70(4), 544–547. https://doi.org/10.1016/j.ihj.2017.11.005
Chow, C. K., Teo, K. K., Rangarajan, S., Islam, S., Gupta, R., Avezum, A., Bahonar, A., Chifamba, J., Dagenais, G., Diaz, R., Kazmi, K., Lanas, F., Wei, L., Lopez-Jaramillo, P., Fanghong, L., Ismail, N. H., Puoane, T., Rosengren, A., Szuba, A., Temizhan, A., … PURE (Prospective Urban Rural Epidemiology) Study investigators (2013). Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA, 310(9), 959–968. https://doi.org/10.1001/jama.2013.184182
Cifkova, R., Fodor, G., & Wohlfahrt, P. (2016). Changes in Hypertension Prevalence, Awareness, Treatment, and Control in High-, Middle-, and Low-Income Countries: An Update. Current Hypertension Reports, 18(8), 62. https://doi.org/10.1007/s11906-016-0669-y
Daştan, İ., Erem, A., & Çetinkaya, V. (2017). Urban and rural differences in hypertension risk factors in Turkey. Anatolian Journal of Cardiology, 18(1), 39–47. https://doi.org/10.14744/AnatolJCardiol.2017.7452
De Backer, G., Ambrosioni, E., Borch-Johnsen, K., Brotons, C., Cifkova, R., Dallongeville, J., Ebrahim, S., Faergeman, O., Graham, I., Mancia, G., Manger Cats, V., Orth-Gomér, K., Perk, J., Pyörälä, K., Rodicio, J. L., Sans, S., Sansoy, V., Sechtem, U., Silber, S., Thomsen, T., … Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (2003). European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Heart Journal, 24(17), 1601–1610. https://doi.org/10.1016/s0195-668x(03)00347-6
El Hendaoui, H., Mziwira, M., & Belahsen, R. (2023). Prevalence of obesity and hypertension in the region of Khouribga (Morocco): Effects of socio-demographic and lifestyle factors. E3S Web of Conferences, 452, 07008. https://doi.org/10.1051/e3sconf/202345207008
Forget, P. (2016). Faculty Opinions recommendation of Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 Data set. In Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. Faculty Opinions Ltd. https://doi.org/10.3410/f.726827339.793524296
Gamage, A. U., & Seneviratne, R. A. (2021). Physical inactivity, and its association with hypertension among employees in the district of Colombo. BMC Public Health, 21(1), 2186. https://doi.org/10.1186/s12889-021-12013-y
Ghose, B., & Yaya, S. (2018). Blood pressure‐controlling behavior in relation to educational level and economic status among hypertensive women in Ghana. Family Medicine and Community Health, 6(3), 115–123. https://doi.org/10.15212/fmch.2018.0112
Hussain, M. A., Al Mamun, A., Peters, S. A., Woodward, M., & Huxley, R. R. (2016). The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia. Journal of Epidemiology, 26(10), 515–521. https://doi.org/10.2188/jea.JE20150178
Joffres, M., Falaschetti, E., Gillespie, C., Robitaille, C., Loustalot, F., Poulter, N., McAlister, F. A., Johansen, H., Baclic, O., & Campbell, N. (2013). Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open, 3(8), e003423. https://doi.org/10.1136/bmjopen-2013-003423
Kearney, P. M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P. K., & He, J. (2005). Global burden of hypertension: analysis of worldwide data. Lancet (London, England), 365(9455), 217–223. https://doi.org/10.1016/S0140-6736(05)17741-1
Khdour, M. R., Hallak, H. O., Shaeen, M., Jarab, A. S., & Al-Shahed, Q. N. (2013). Prevalence, awareness, treatment and control of hypertension in the Palestinian population. Journal of Human Hypertension, 27(10), 623–628. https://doi.org/10.1038/jhh.2013.26
Kuwabara, M., & Hisatome, I. (2019). The Relationship Between Fasting Blood Glucose and Hypertension. American Journal of Hypertension, 32(12), 1143–1145. https://doi.org/10.1093/ajh/hpz147
Lenfant, C., Chobanian, A. V., Jones, D. W., Roccella, E. J., & Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails. Hypertension (Dallas, Tex.: 1979), 41(6), 1178–1179. https://doi.org/10.1161/01.HYP.0000075790.33892.AE
Leng, B., Jin, Y., Li, G., Chen, L., & Jin, N. (2015). Socioeconomic status and hypertension: a meta-analysis. Journal of hypertension, 33(2), 221–229. https://doi.org/10.1097/HJH.0000000000000428
Li, H., Meng, Q., Sun, X., Salter, A., Briggs, N. E., & Hiller, J. E. (2010). Prevalence, awareness, treatment, and control of hypertension in rural China: results from Shandong Province. Journal of Hypertension, 28(3), 432–438. https://doi.org/10.1097/HJH.0b013e328334b39e
Liu, J., Bu, X., Wei, L., Wang, X., Lai, L., Dong, C., Ma, A., & Wang, T. (2021). Global burden of cardiovascular diseases attributable to hypertension in young adults from 1990 to 2019. Journal of Hypertension, 39(12), 2488–2496. https://doi.org/10.1097/HJH.0000000000002958
Liu, M. W., Yu, H. J., Yuan, S., Song, Y., Tang, B. W., Cao, Z. K., Yang, X. H., Towne, S. D., Jr, & He, Q. Q. (2018). Association between fruit and vegetable intake and the risk of hypertension among Chinese adults: a longitudinal study. European Journal of Nutrition, 57(7), 2639–2647. https://doi.org/10.1007/s00394-018-1687-0
Lloyd-Sherlock, P., Ebrahim, S., & Grosskurth, H. (2014). Is hypertension the new HIV epidemic?. International Journal of Epidemiology, 43(1), 8–10. https://doi.org/10.1093/ije/dyu019
Matar, D., Frangieh, A. H., Abouassi, S., Bteich, F., Saleh, A., Salame, E., Kassab, R., & Azar, R. R. (2015). Prevalence, awareness, treatment, and control of hypertension in Lebanon. Journal of Clinical Hypertension (Greenwich, Conn.), 17(5), 381–388. https://doi.org/10.1111/jch.12485
Mharchi, S., & Maamri, A. (2024). Physical Activity, and Their Impact on Chronic Diseases (Hypertension and T2DM) among North-Eastern Morocco’s Population. Medicina Moderna, 31. https://doi.org/10.31689/rmm.2024.31.1.37
Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J. (2016). Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation, 134(6), 441–450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912
Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
Ministère de la Santé. Enquête Nationale sur les Facteurs de Risque communs des Maladies Non Transmissibles, STEPS, 2017-2018: Rapport. 2019. Retrieved from https://www.sante.gov.ma/Documents/2019/05/Rapport%20de%20l%20enquête%20Stepwise.pdf
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Authors
Lahmam, H., Auajjar, N., Mehdad, S., Mekkaoui, B., El Berri, H., Belakhel, L., Attarassi, B., Saeid, N., Mounach, S., El Kari, K., & Aguenaou, H. (2025). Hypertension in Moroccan adults: sociodemographic, lifestyle, and dietary risk factors. The North African Journal of Food and Nutrition Research, 9(19), 151–162. https://doi.org/10.51745/najfnr.9.19.151-162
Copyright (c) 2025 Houria Lahmam, Nabila Auajjar, Slimane Mehdad, Bouchra Mekkaoui, Hicham El Berri, Latifa Belakhel, Benaissa Attarassi, Naima Saeid, Samir Mounach, Khalid El Kari, Hassan Aguenaou
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