title: Hypertension and its management in countries in Africa and the Middle East, with special reference to the place of β-blockade.
abstract: BACKGROUND
  The prevalence and clinical consequences of hypertension in countries in Africa and the Middle East have not been studied as well as in other regions.
  
  
  METHODS
  We have reviewed the literature on the epidemiology and management of hypertension and related cardiovascular complications in countries within Africa and the Middle East. A PubMed search for countries in the region and 'hypertension' was supplemented by articles identified from reviews, and by literature suggested by the authors.
  
  
  RESULTS
  The prevalence of hypertension is >20% in some countries in the Middle East and Africa, despite an average population age that is some 10-15 years lower than those of developed countries. Hypertension in these countries is associated with an increased risk of cardiovascular risk factors and cardiovascular disease, as elsewhere. Awareness rates of hypertension are low. Hypertension and its complications are undertreated, and mortality rates from cardiovascular disease are higher than in developed countries.
  
  
  CONCLUSIONS
  Available resources should be brought to bear on the management of hypertension in these countries. In particular, a recent downgrading of the importance of β-blockers in hypertension management guidelines needs to be reassessed. These agents are as effective as other antihypertensive classes both on blood pressures and on cardiovascular event rates. General concerns over an increased rate of new-onset diabetes with β-blockers have been overstated, although these agents should be avoided in metabolic syndrome.
authors.affiliation: American University of Beirut Medical Center, Department of Internal Medicine, Division of Cardiology, Beirut, Lebanon. sarnaout@aub.edu.lb
authors.forename: M Samir
authors.initials: MS
authors.lastname: Arnaout
authors.forename: Wael
authors.initials: W
authors.lastname: Almahmeed
authors.forename: Mohsen
authors.initials: M
authors.lastname: Ibrahim
authors.forename: James
authors.initials: J
authors.lastname: Ker
authors.forename: Ma Taher
authors.initials: MT
authors.lastname: Khalil
authors.forename: Corrie T
authors.initials: CT
authors.lastname: Van Wyk
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Eyas
authors.initials: E
authors.lastname: Al Mousa
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000349:Africa / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008877:Middle East / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents