We determined the prevalence of hypertension and the level of awareness, treatment and control of hypertension among Palestinian adults in a population-based cross-sectional survey. Two-stage stratified sampling method was used to select 2077 participants from the general population aged 25 years and over. Trained observers obtained two blood pressure (BP) measurements from each individual by the use of a standardized mercury sphygmomanometer after a 5-min sitting rest. Information on sociogeographical factors and antihypertensive medications was obtained using a standard questionnaire. Hypertension was defined as a mean systolic BP (SBP) 140 mm Hg, diastolic BP (DBP) 90 mm Hg, and/or use of antihypertensive medications. The overall prevalence of hypertension was 27.6%, with a higher percentage among men (29.2 vs 26.4%; P=0.04). Hypertension increased with age in both men and women. Among hypertensive patients, 51.0% were aware of their elevated BP, 40.2% had treatment and only 9.5% achieved targeted BP control (<140/90 mm Hg). Patients under antihypertensive treatment showed SBP and DBP that were only 3.1 mm Hg and 2.5 mm Hg lower than individuals without antihypertensive treatment, respectively. The data show that hypertension prevalence among Palestinian adults is high, whereas the proportions of awareness treatment and control of hypertension were low. Concerted public health effort is urgently required to improve the detection, treatment and control of hypertension in Palestine.
The out-patient pharmacies in Ramallah and Bethlehem, central Palestine, were evaluated for NSAIDs utilization and pattern of prescribing and dispensing of these commonly used medications across the whole country. In our study for this area that accounts for almost 25% of the inhabitants of all Palestine (459, 761 inhabitants according to 2011 census), we analyzed the use of NSAIDs whether were prescribed for the patient or were obtained without a prescription in the period of Sept 1(st) to Nov. 30, 2011. The number of defined daily doses, DDD/1000 inh/day, and the percentage utilization from total were determined and analyzed using the simple ATC/DDD model which was developed by WHO for assessment of quality prescribing of medications. From these data we calculated DU 90% for the drugs described in this study. Using a scale for GI toxicity and risk determination from a meta- analysis of controlled epidemiological studies, we determined the GI risk of the drugs in the study. Ketoprofen and piroxicam were found to be associated with the highest risk, on the other hand ibuprofen and diclofenac were associated with low risk of GI toxicity. The average Price/DDD was also determined for the purpose of comparison with the prices in other European countries. Our findings were both exciting and interesting with the total consumption of NSAIDs over the period of study was 31.26 DDD/1000 inh/day comparing to 51.02 DDD/1000 inh/day in the European countries included in the study. Only 5 drugs fell within DU 90% which are respectively along with their percentage NSAIDs consumption: (ibuprofen; 26.48%, diclofenac; 23.38%, etoricoxib; 21.24%, meloxiocam; 12.19%, and celecoxib; 7.16%). The drugs were obtained mostly by prescription except for the first 2 agents (ibuprofen and diclofenac) which were almost exclusively bought without a prescription as OTC with the pharmacist greatly influence their use and dispensing. The price of purchasing for the top DU 90% agents was almost twice the price in Europe for the same drugs taking into consideration the limitations of our study in determining the equipotency or the equivalency of the DDD doses in Palestine and Europe.
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