title: Undiagnosed hypertension in a rural community in Sudan and association with some features of the metabolic syndrome: how serious is the situation?
abstract: BACKGROUND
  Hypertension is the leading risk factor for death and disability globally. Its prevalence is increasing worldwide especially in low and middle income countries. It is considered a silent killer because it has no specific symptoms and thus can go unnoticed for many years, only presenting for the first time with serious complications. The situation of undiagnosed hypertension in Sudan has not been fully investigated before.
  
  
  OBJECTIVE
  To determine the prevalence of undiagnosed hypertension in the rural communities of River Nile State (RNS), Sudan and to assess the associated risk factors.
  
  
  METHODS
  A cross-sectional community-based study, in which 1099 volunteer adult participants from the rural communities in RNS, not known to be hypertensive, were included. Blood pressure was measured as well as anthropometric measurements. The WHO stepwise approach for non-communicable diseases surveillance was used for data collection. A p value below 0.05 was considered statistically significant.
  
  
  RESULTS
  There were 461 males (41.9%) and 683 females (58.1%). The male to female ratio was 1:1.4. The age range was 18-90 years, with a mean age of 39.6 (STD ± 15.9). The prevalence of undiagnosed hypertension was 38.2%, with a prevalence of 36.7% among males and 39.3% among females. There were significant associations between undiagnosed hypertension and increasing age, obesity, illiteracy and diabetes mellitus (p < 0.05).
  
  
  CONCLUSIONS
  This study uncovers a hidden epidemic of a silent killer in the rural communities of RNS. Urgent interventions are required to address this serious health epidemic.
authors.affiliation: a Department of Medicine , Nile Valley University , Atabara , Sudan .
authors.forename: Sarra O
authors.initials: SO
authors.lastname: Bushara
authors.affiliation: a Department of Medicine , Nile Valley University , Atabara , Sudan .
authors.forename: Sufian K
authors.initials: SK
authors.lastname: Noor
authors.affiliation: b Department of Pathology , Nile Valley University , Atabara , Sudan .
authors.forename: Wadie M
authors.initials: WM
authors.lastname: Elmadhoun
authors.affiliation: c Department of Community Medicine , Nile Valley University , Atabara , Sudan , and.
authors.forename: Amel A
authors.initials: AA
authors.lastname: Sulaiman
authors.affiliation: d Department of Medicine , Milton Keynes University Hospital NHS Foundation Trust , Eaglestone, Milton Keynes, Buckinghamshire , UK.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001795:Blood Pressure Determination; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D017678:Sex Distribution; D013397:Sudan / Q000453:epidemiology; D015996:Survival Rate; D055815:Young Adult
keywords: River Nile State; Sudan; undiagnosed hypertension