Front. Cardiovasc. Med.Frontiers in Cardiovascular MedicineFront. Cardiovasc. Med.2297-055XFrontiers Media S.A.10.3389/fcvm.2025.1621750Cardiovascular MedicineOriginal ResearchA cross-sectional study of risk factors associated with hypertension in heart and kidney disease patients in Sana'a, YemenMuafaHussein Mussa12*BalkamMalika Abdu3Department of Internal Medicine, 21 September University for Medical and Applied Sciences, Sana'a, YemenDepartment of Internal Medicine, Ibn Mussa International Hospital, Al Hodaidah, YemenDepartment of Medicine, College of Medicine and Health Sciences, Sana’a University, Sana'a, Yemen
Edited by:Chengxing Shen, Shanghai Jiao Tong University, China
Reviewed by:Yaman Walid Kassab, National University of Science and Technology (Muscat), Oman
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Background
Hypertension is a major contributor to cardiovascular and renal disease worldwide, particularly in low-resource settings such as Yemen.
Objective
To identify demographic, clinical, and lifestyle-related factors associated with hypertension among heart disease (HD) and kidney disease (KD) patients in Sana'a.
Methods
A cross-sectional study was conducted on 300 patients (200 men, 100 women; aged 35–70 years) between March and August 2024. Data on age, sex, weight, smoking, Qat chewing, diabetes, and antihypertensive medication adherence were collected. Blood pressure was measured using a standardized sphygmomanometer. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Results
Hypertension was significantly associated with age (OR: 1.08; 95% CI: 1.02–1.11), obesity (OR: 2.42; 95% CI: 1.23–4.75), smoking (OR: 1.88; 95% CI: 1.05–3.35), type 2 diabetes (OR: 2.87; 95% CI: 1.56–4.55), and irregular medication use (OR: 3.21; 95% CI: 1.45–7.11). All participants reported Qat chewing (100%).
Conclusion
Age, obesity, smoking, diabetes, and poor medication adherence are major predictors of hypertension in Yemeni HD and KD patients. The universal irregularity in medication use highlights systemic healthcare gaps. Strategies to improve adherence, promote lifestyle modification, and strengthen healthcare systems are urgently needed.
Hypertension is one of the most significant risk factors for cardiovascular and renal diseases. In LMICs, including Yemen, limited healthcare infrastructure exacerbates the burden of hypertension. The disease accelerates progression to myocardial infarction, stroke, and end-stage kidney failure, particularly in individuals already suffering from HD or KD (1, 2).
Regional studies have identified obesity, smoking, diabetes, and poor adherence to therapy as key drivers of hypertension (1, 2). In Yemen, widespread Qat chewing further complicates the risk profile, though its precise contribution remains unclear (3).
This study investigates demographic, clinical, and behavioral risk factors for hypertension among Yemeni HD and KD patients (1, 3–5), aiming to inform culturally appropriate prevention and management strategies (6).
MethodsStudy design and setting
A cross-sectional study was carried out in hospitals and outpatient clinics in Sana'a, Yemen, between March and August 2024.
Study population
300 patients with HD, KD, or both were recruited via convenience sampling.
Inclusion criteria:
Age 35–70 years
Diagnosed with HD or KD
Provided informed consent
Data collection
Structured interviews and medical records were used.
Demographics: age, sex, marital status
Clinical data: weight, diabetes, blood pressure
Lifestyle: smoking, Qat chewing
Medication adherence: self-reported regular vs. irregular
Blood pressure measurement: Conducted with a calibrated sphygmomanometer, two readings averaged after 5 min rest. Hypertension defined as ≥130/80 mmHg (ACC/AHA 2017).
Statistical analysis
SPSS v25 was used. Logistic regression assessed associations between risk factors and hypertension. Significance: p < 0.05.
ResultsBaseline characteristics
Table 1.
Baseline characteristics of participants (N = 300).
Variable
Frequency (n)
Percentage (%)
Age (35–70 years)
300
100.0
Male
200
66.7
Female
100
33.3
Married
300
100.0
Weight 70–90 kg
250
83.3
Weight 90–120 kg (Obese)
50
16.7
Qat chewing
300
100.0
Smoking
250
83.3
Type 2 diabetes mellitus
150
50.0
Irregular antihypertensive use
300
100.0
Logistic regression analysis
Table 2.
Logistic regression analysis of risk factors for hypertension.
Risk factor
Odds ratio (OR)
95% CI
p-value
Male gender
1.35
0.92–1.99
0.11
Age (per year increase)
1.08
1.02–1.11
0.004*
Obesity (90–120 kg)
2.42
1.23–4.75
0.01*
Smoking
1.88
1.05–3.35
0.03*
Type 2 diabetes mellitus
2.87
1.56–4.55
0.001*
Irregular medication use
3.21
1.45–7.11
0.004*
Significant at p < 0.05.
Discussion
This study demonstrated that age, obesity, smoking, diabetes, and irregular antihypertensive drug use were significant predictors of hypertension (7–9). The 100% prevalence of irregular drug adherence reflects systemic issues in the Yemeni healthcare system (1, 2).
Key findings:
Age: Vascular stiffening and cumulative exposure to risk factors explain the increased risk.
Obesity: Strong predictor of hypertension via increased cardiac output and vascular resistance.
Smoking: Nicotine contributes to endothelial dysfunction and sympathetic activation.
Diabetes: Insulin resistance and arterial stiffness exacerbate BP rise.
Medication adherence: The strongest predictor, highlighting systemic deficiencies (9, 10).
Qat chewing: Could not be analyzed statistically due to uniform exposure but remains a critical cultural factor requiring future comparative studies.
Strengths: First study in Yemen on this specific patient population; robust statistical analysis.
Limitations: Cross-sectional design; convenience sampling; lack of control group; inability to analyze Qat chewing due to uniformity.
Implications:
Improve medication access and adherence programs (10).
Strengthen public education on lifestyle modification.
Develop system-level policies for better hypertension management.
Conclusion
Hypertension among Yemeni HD and KD patients is significantly associated with age, obesity, smoking, diabetes, and poor medication adherence (11, 12). Addressing these factors through systemic reforms and culturally tailored interventions is essential to reduce the growing cardiovascular and renal burden in Yemen.
Data availability statement
The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.
Ethics statement
The studies involving humans were approved by Ibn Mussa International Hospital. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions
HM: Writing – original draft, Writing – review & editing. MB: Conceptualization, Data curation, Analysis, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
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