|Year : 2016 | Volume
| Issue : 2 | Page : 61-66
Hypertension and employee's health: A cross-sectional analysis in private sector at Eastern province, Saudi Arabia
Shaea A Alkahtani1, Mohammed T Al-Hariri2
1 Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia
2 Department of Physiology, College of Medicine, University of Dammam, Dammam, Saudi Arabia
|Date of Web Publication||25-Oct-2016|
Mohammed T Al-Hariri
Department of Physiology, College of Medicine, University of Dammam, 2114, Dammam 31451
Source of Support: None, Conflict of Interest: None
Background: Cardiovascular disease has become the main cause of mortality and morbidity worldwide. Aims: This study was aimed to explore the association between the prevalence of hypertension among employees population and its associated risk factors in private sectors. Settings and Design: The study was cross-sectional screening campaigns by visiting every company. Materials and Methods: The sample size was 915 male employees aged 20-64 years, who voluntarily participated in the screening program. Weight, random blood glucose, and blood pressure (BP) were collected. Statistical Analysis Used: Data were analyzed using SPSS version 20 for windows. A descriptive statistics, t-test, and simple linear regression were used between the variables. Results: Forty-four percent of the participants were prehypertensive and 34% were hypertensive. There were significant differences between participants based on glucose levels, age, and body weight in systolic BP (P < 0.001), and between participants based on their age and body weight in diastolic BP (DBP) (P < 0.001). There were statistically significant differences between groups classified by occupational status (supervisor, skilled, and unskilled jobs) in age and weight (P < 0.001), as well as DBP (P = 0.049). Exercise and smoking did not affect BP. Conclusion: The findings provided limited proof that the prevalence of prehypertension and hypertension were high in male employees in the private sector in the Eastern Province of Saudi Arabia. Age, body weight, and diabetes were risk factors of hypertension.
Keywords: Hypertension, random blood glucose and blood pressure, weight
|How to cite this article:|
Alkahtani SA, Al-Hariri MT. Hypertension and employee's health: A cross-sectional analysis in private sector at Eastern province, Saudi Arabia. Saudi J Health Sci 2016;5:61-6
|How to cite this URL:|
Alkahtani SA, Al-Hariri MT. Hypertension and employee's health: A cross-sectional analysis in private sector at Eastern province, Saudi Arabia. Saudi J Health Sci [serial online] 2016 [cited 2021 Jan 18];5:61-6. Available from: https://www.saudijhealthsci.org/text.asp?2016/5/2/61/192999
| Introduction|| |
An extensive review concluded that work-related conditions and many behavioral and biological factors are related to the incidence and prevalence of cardiovascular diseases (CVDs) due to chronic physiological arousal. ,
Many papers have been reported a cause-effect relation between work-related conditions and hypertension. However, the studies have not been completely consistent.
Age, educational level, and occupational status may determine levels of blood pressure (BP) independently or together from work conditions. ,
In this regards, evidences from private sector in Saudi Arabia have been very limited.
CVD has become the main cause of mortality and morbidity worldwide. Individuals in developing countries are beginning to reflect the shift toward globalization and urbanization that is associated with poor diet, physical inactivity, and obesity, which exposes populations to a major risk of increased CVD.  The incidence of metabolic syndrome and CVD has been rapidly increasing in some developing countries, including Saudi Arabia, mostly because of an economic boom in these countries.  Hypertension is one of the main factors that lead to an increased incidence of CVD in Saudi Arabia and has been associated with other metabolic syndrome diseases such as diabetes mellitus, hypercholesterolemia, and obesity. For example, the coronary artery disease in Saudi Study, a national study that observed 17,230 adults over the period between 1995 and 2000, showed that the prevalence of hypertension in Saudi Arabia was 28.6% for males and 23.9% for females, and the prevalence of CVD among hypertensive patients was twice the prevalence among their normotensive peers.  In the last decade, the prevalence of hypertension increased from 30% to 32.6% in Saudi Arabia.  The most recent national survey showed that 15.2% and 40.6% of Saudis were hypertensive and prehypertensive, respectively.  This rapid increase in hypertension in Saudi Arabia should also increase our awareness of the likelihood of further associated health complications.
The work force system in Saudi Arabia consists of governmental and private sectors, and the private sector has several different aspects compared to the governmental sector, including the rate of foreign labor and the types of jobs.  Although private companies in Saudi Arabia are obligated to arrange appropriate healthcare coverage for their employees,  challenging issues face the health system's attempt to provide cost-effective healthcare services. , Noncommunicable diseases such as diabetes and hypertension increase the cost of healthcare, and reduce the productivity of employees. This may compromise the private sector's contribution to gross domestic product in Saudi Arabia, which was 58.9% in 2013.  While most Saudi epidemiological studies are based on Saudi citizens, specific studies recruiting different ethnicities would be more representative of the private sector in Saudi Arabia. The risk of hypertension and many CVDs is affected by genes, environment, and the gene-environment interactions,  and specific BP-associated genes have been identified among different ethnic populations. 
Industrial companies account for the majority of the private sector, and they are mainly located in the Eastern Province of Saudi Arabia. The health screening program is a local health campaign by the Saudi Diabetes and Endocrinology Association (SDEA) that targets private companies in the Eastern Province of Saudi Arabia. The first aim of the current study was to describe the prevalence of hypertension in male in the private sector in the Eastern Province of Saudi Arabia and to investigate its associated risk factors. The second aim was to investigate possible differences in BP among different nationalities of the current male employees. These data should help health care providers and educators provide suitable preventative interventions to treat hypertension.
| Materials and methods|| |
Investigations were carryout by the SDEA in the Eastern Province of Saudi Arabia. It included nine industrial companies (pressing, electricity, construction, and paper, metal, and ladder factories) located in Dammam and Al-Khobar, and commenced in April 2014. The health team of the SDEA conducted cross-sectional screening campaigns by visiting every company. Measurements included body weight, BP, and random blood glucose. Campaign permission was arranged by the Office of the General Secretary, and Ethical Approval was obtained.
The sample size was 915 male employees aged 20-64 years, who voluntarily participated in the screening program. All participants, who reported to the main hall, understood the benefits and risks of their participation. The selection criteria included all employees who appeared to be healthy. Undiagnosed and untreated diagnosed diabetic and hypertensive individuals were included, whereas employees who had been diagnosed and were being treated, either with medication or a restricted diet, were excluded.
All participants were seated in an air-conditioned hall and had 10 min for interview and rest preceding the measurements. Body weight was measured to the nearest 0.1 kg using a digital scale. Random blood glucose was measured using a glucose meter, with strips and a lancing device to collect a capillary drop of blood. BP was measured using an electronic sphygmomanometer and an appropriately sized cuff with each participant in a sitting position with the arm supported at heart level. The cuff was wrapped around the upper arm loosely enough to allow two fingers to be easily placed under the cuff. Systolic BP (SBP) and diastolic BP (DBP) were recorded digitally, and the values appeared on the screen.
BP was classified as follows: Normal (SBP <120 and DBP <80 mmHg), prehypertension (SBP 120-139 and/or DBP 80-89 mmHg), hypertension Stage I (SBP 140-159 and/or DBP 90-99 mmHg), hypertension Stage II (SBP 160-179 and/or DBP 100-109 mmHg), and hypertension Stage III (SBP ≥180 and/or DBP ≥110 mmHg). The random blood glucose levels were classified as follows: Normal (glucose <140 mg/dL), prediabetes (glucose 140-199 mg/dL), and diabetes (glucose ≥200 mg/dL). Occupational status was divided into three categories: Unskilled workers, who usually had low incomes, physical jobs, and low qualifications; skilled workers, who usually had middle-range incomes, technical/office jobs, and high qualification; and supervisors, who had high incomes, senior management jobs, and high-level qualifications.
Further analysis was performed using data from 536 participants to explore the role of ethnicity on BP. Six nationalities representing three groups. The Middle Eastern ethnicity was represented by two nationality groups: Saudis and Yemenis and Jordanians. The South Asian ethnicity was represented by three nationality groups: Indians, Bangladeshis, and Nepalese. The East Asian ethnicity was represented by one nationality group: Filipinos.
Data were analyzed using IBM SPSS version 20 for windows and are presented as the means with standard deviation.
| Results|| |
[Table 1] shows the descriptive socioeconomic and metabolic data from the participants. The table includes the total valid values of each factor, and the percentages are relative to the total sample size (n = 915).
|Table 1: Descriptive socioeconomic and metabolic data from male employees in the private sector in Saudi Arabia|
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[Figure 1] shows significant differences in age and weight (P < 0.001) as well as DBP (P = 0.049) between groups classified by occupational state, whereas the differences in SBP tended to be significant (P = 0.06). Post hoc comparison showed that DBP for supervisors was significantly higher than for unskilled employees (P < 0.05). Supervisors were significantly older than skilled and unskilled employees (P < 0.001). Body weight for supervisors was significantly the highest, and body weight for skilled employees was significantly greater than that of the unskilled employees (P < 0.001). The interaction between occupational state*age on SBP was significant (P < 0.05), but the interaction between occupational state*age on DBP was not significant. Exercise and smoking had no significant effect on SBP and DBP. In addition, there was no significant difference in SBP based on family history of diseases, but the difference in DBP was significant (P < 0.01).
|Figure 1: Differences in systolic blood pressure, diastolic blood pressure, weight, and age between male employees in the private sector in Saudi Arabia classified by occupational status. ɫSupervisor is significantly higher than skilled employees group ( P ≤ 0.05). ǂSupervisors or skilled employees' groups are higher than unskilled employees group ( P ≤ 0.05). SBP: Systolic blood pressure; DBP: Diastolic blood pressure|
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[Table 2] and [Table 3] show the differences between the participants classified by the nationality in physiological and behavioral factors. One-way ANOVA analysis showed a significant difference between nationality groups in SBP (P ≤ 0.05), and post hoc analysis using Scheffe test showed that SBP for Filipinos was significantly greater than Saudis. Differences in SBP between Filipinos and other nationality groups apart from Saudis were small and insignificant. Although Filipinos were older than Saudis, Filipinos engaged in regular exercise more than Saudis, and the body mass for Saudis was significantly higher than Filipinos (P ≤ 0.05).
|Table 2: Differences in age, weight, blood pressure, and glucose between male employees in the private sector in Saudi Arabia classified by nationality|
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|Table 3: Differences in behavioral and biological factors between male employees in the private sector in Saudi Arabia classified by nationality|
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A simple regression model was developed with hypertension as the outcome variable. Only age blood glucose and weight variables that were correlated with hypertension in the analyses were included as independent variables [Figure 2].
|Figure 2: The main hypertension associated risk factors. (a) Simple linear regression between hypertension and age (r02 = 0.16; P = 0.000); (b) simple linear regression between hypertension and blood glucose (r2 = 0.052; P = 0.000); (c) simple linear regression between hypertension and body weight (r2 = 0.038; P = 0.000)|
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| Discussion|| |
The first aim of the current study was to describe the hypertension among male employee in the private sector and its associated risk factors. The prevalence of prehypertension was 44.6%, and hypertension was present in 34% of the participants. Risk factors associated with hypertension among employees of the private sector in Saudi Arabia were age, diabetes, and obesity. The second aim of the current study was to explore nationality's BP differences and to investigate the role of behavioral and physiological factors. The incidence of hypertension was the lowest in Saudis and highest in Filipinos. Although age, obesity, and diabetes explained the differences in BP, these integrated behavioral and physiological factors did not explain the ethnicity-induced BP differences in male employees in the private sector in Saudi Arabia.
The prevalence of hypertension in the current study was comparable with other studies conducted on older age groups. For example, the prevalence of hypertension in Saudi men and women aged 46-60 years was 40.7%, and 58.2% for those age ≥61-year-old, but the prevalence was 14% in the 18-45 years age group.  A recent study reported that the prevalence of prehypertension in men was 40.4% for ages 15-24 and 86.6% for ages 55-64; prevalence of hypertension was between 4.2% for ages 15-24 and 48% for ages 55-64 years. 
In a regression model analysis, hypertension was significantly associated with age, blood glucose, and body weight. Several previous studies on Saudi populations proved an increase in the prevalence of hypertension with age, which was dramatically increased in elderly populations, ,, and this was similar to other populations.  Hypertension was the highest cardiovascular risk factor among Saudi retired attendees of primary care clinics.  Abnormalities in cardiac structure and function may explain the increased midlife BP.  The BP increases with increased levels of diabetes is consistent with previous studies.  Diabetic people are predisposed to be hypertensive, such that the target BP for diabetic people is <130/80 mmHg.  The prevalence of diabetes and prediabetes in the current study was lower than the prevalence of diabetes in Saudi adults.  It should be noted that the current participants were mostly unskilled active workers in the private sector, who had a body weight <73 kg. Obesity is known to affect diabetes, and prolonged sitting time causes an increased incidence of hyperglycemia, independent of average daily physical activity.  Obesity was associated with hypertension in the current study. In a recent survey that recruited more than 10,000 Saudi adults, obesity was strongly associated with hypertension, diabetes, and hypercholesterolemia. 
Higher occupational status tended to increase SBP, and this could be partially explained by age. Occupational status and family history were associated with increased DBP. Exercise and smoking were not associated with hypertension. These data are comparable with a recent national survey that found that age, sex, obesity, diabetes, and cholesterol are risk factors associated with hypertension, whereas marital status, smoking, education, amount of time spent sedentary, and level of physical activity were not associated with the risk of hypertension.  Smoking up to 30 pack-years was associated with hypertension, whereas current smoking did not correlate with hypertension.  The cessation of smoking may result in increases in BP.  The number of cigarettes smoked daily can also affect BP.  Thus, current smoking may not have a dose-response effect on BP. It should also be noted that the majority of current participants were nonsmokers, and their average age was 36-year-old. Occupational status that promotes standing, carrying, and moving is, in the current study, associated with lower body weight and DBP, and tended to affect SBP. It was reported that daily physical activity, or nonexercise activity thermogenesis, was associated with lower BP in patients with Type 2 diabetes.  Individuals spent more sedentary time during work hours than during leisure time, such that active work can help increase daily energy expenditure.  Spontaneous regular exercise was not associated with lowering BP in the current study. It should be noted that the majority of participants did not engage in regular exercise, which may reduce the variation among the participants. In addition, the levels of physical activity categorized as low, moderate, and high, were not determined in the present study. A meta-analysis study suggested that high and moderate levels of recreational physical activity were associated with decreased risks of hypertension.  Physical activity can be described as sports-like exercise that is usually performed in leisure time, and nonexercise activity thermogenesis includes all daily activity except energy-induced sleeping and eating.  Investigating the effect of these parallel patterns of activity on pladienolide B is warranted.
The present behavioral and physiological factors did not explain nationality-induced BP differences, suggesting that East Asian individuals represented by Filipinos are more predisposed to elevate BP to a greater extent than South Asian and Middle Eastern males. The progressive increase in hypertension and some other related metabolic diseases were found among Filipinos who live in the US compared with some other ethnic groups.  Several complex factors explained the increased undiagnosed BP in Asia Pacific individuals, including gene mutations.  Differences in BP-associated gene loci have been reported in different ethnic groups from Europe, East Asia, and South Asia.  For example, the dopamine receptor Type 1 was associated with essential hypertension in Japanese subjects not in Caucasians.  The interactions between genetic, physiological, social, and behavioral factors related to BP are affected by ethnicity. For example, the association between the presence of BP-associated genes, physical activity, perceived racial discrimination, and body fat percentage differ between African American, European American, and Hispanic American children.  Furthermore, although body weight and body mass index (BMI) were greater for Saudis than Filipinos, it was reported that metabolic syndrome is associated with lower levels of BMI for East Asians than other ethnicities.  Asian American women have significantly higher excess visceral adipose tissue, compared with European American women, but this difference was not found in men.  Whether visceral fat predisposition in Filipinos explains the elevated BP requires further investigation. The current outcomes support the recommendation of tailored public health prevention programs to eliminate disparities in incident hypertension among different ethnic groups. 
One of the limitations of the study was restricted privacy of the companies, which did not allow the collection of some important socioeconomic data that might better explain the variations in BP. Data on the prevalence of noncommunicable diseases in the private sector in Saudi Arabia are limited. Further studies investigating the risk factors of hypertension among Filipinos are needed. These studies should consider involving participants from different geographical areas in Saudi Arabia and from different hierarchal occupational positions to better understand the role of behavioral and socioeconomic status in BP.
| Conclusion|| |
The prevalence of prehypertension and hypertension was high in male employees in the private sector in the Eastern Province of Saudi Arabia. Age, body weight, and diabetes were the risk factors of hypertension. Active occupational jobs were associated with lower body weight and tended to be associated with lower BP. These behavioral and physiological risk factors of hypertension did not explain the elevated levels of BP in Filipinos compared with Saudis, a definitive conclusion must await further studies.
The authors would like to thank Chairman and all the members of SDEA for their assistance and support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kristensen T. The demand-control-support model: Methodological challenges for future research. Stress Med 1995;11:17-26.
Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annu Rev Public Health 1994;15:381-411.
Albright CL, Winkleby MA, Ragland DR, Fisher J, Syme SL. Job strain and prevalence of hypertension in a biracial population of urban bus drivers. Am J Public Health 1992;82:984-9.
Kelly JT. Evaluating employee health risks due to hypertension and obesity: Self-testing workplace health stations. Postgrad Med 2009;121:152-8.
Fuster V. Top 10 cardiovascular therapies and interventions for the next decade. Nat Rev Cardiol 2014;11:671-83.
Mabry RM, Reeves MM, Eakin EG, Owen N. Gender differences in prevalence of the metabolic syndrome in Gulf Cooperation Council Countries: A systematic review. Diabet Med 2010;27:593-7.
Al-Nozha MM, Abdullah M, Arafah MR, Khalil MZ, Khan NB, Al-Mazrou YY, et al.
Hypertension in Saudi Arabia. Saudi Med J 2007;28:77-84.
Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Yousef M, Sabico SL, et al.
Diabetes mellitus Type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): A decade of an epidemic. BMC Med 2011;9:76.
El Bcheraoui C, Memish ZA, Tuffaha M, Daoud F, Robinson M, Jaber S, et al.
Hypertension and its associated risk factors in the kingdom of Saudi Arabia, 2013: A national survey. Int J Hypertens 2014;2014:564679.
Al-Asmari MG. Saudi labor force: Challenges and ambitions. J King Abdulazziz Univ Arts Humanit 2008;16:19-59.
Khaliq AA. The Saudi health care system: A view from the minaret. World Health Popul 2012;13:52-64.
Walston S, Al-Harbi Y, Al-Omar B. The changing face of healthcare in Saudi Arabia. Ann Saudi Med 2008;28:243-50.
Bawazir SA, Alkudsi MA, Al Humaidan AS, Al Jaser MA, Sasich LD. Pharmaceutical policies used by private health insurance companies in Saudi Arabia. Saudi Pharm J 2013;21:267-76.
Population Census. Population Estimates by Province and Administrative Area 2010-2025. Central Department of Statistics & Information; 2010.
Kato N. Ethnic differences in genetic predisposition to hypertension. Hypertens Res 2012;35:574-81.
Franceschini N, Reiner AP, Heiss G. Recent findings in the genetics of blood pressure and hypertension traits. Am J Hypertens 2011;24:392-400.
Daskalopoulou SS, Khan NA, Quinn RR, Ruzicka M, McKay DW, Hackam DG, et al.
The 2012 Canadian hypertension education program recommendations for the management of hypertension: Blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol 2012;28:270-87.
Al Turki YA. Cardiovascular risk factors among retired attendees visiting primary care clinics. Pak J Med Sci 2014;30:515-8.
Ghosh AK, Hardy RJ, Francis DP, Chaturvedi N, Pellerin D, Deanfield J, et al.
Midlife blood pressure change and left ventricular mass and remodelling in older age in the 1946 British Birth Cohort Study. Eur Heart J 2014;35:3287-95.
Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: An update. Hypertension 2001;37:1053-9.
Peddie MC, Bone JL, Rehrer NJ, Skeaff CM, Gray AR, Perry TL. Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: A randomized crossover trial. Am J Clin Nutr 2013;98:358-66.
Memish ZA, El Bcheraoui C, Tuffaha M, Robinson M, Daoud F, Jaber S, et al.
Obesity and associated factors - Kingdom of Saudi Arabia, 2013. Prev Chronic Dis 2014;11:E174.
Thuy AB, Blizzard L, Schmidt MD, Luc PH, Granger RH, Dwyer T. The association between smoking and hypertension in a population-based sample of Vietnamese men. J Hypertens 2010;28:245-50.
Lee DH, Ha MH, Kim JR, Jacobs DR Jr. Effects of smoking cessation on changes in blood pressure and incidence of hypertension: A 4-year follow-up study. Hypertension 2001;37:194-8.
Bowman TS, Gaziano JM, Buring JE, Sesso HD. A prospective study of cigarette smoking and risk of incident hypertension in women. J Am Coll Cardiol 2007;50:2085-92.
Hamasaki H, Yanai H, Mishima S, Mineyama T, Yamamoto-Honda R, Kakei M, et al.
Correlations of non-exercise activity thermogenesis to metabolic parameters in Japanese patients with Type 2 diabetes. Diabetol Metab Syndr 2013;5:26.
McCrady SK, Levine JA. Sedentariness at work: How much do we really sit? Obesity (Silver Spring) 2009;17:2103-5.
Huai P, Xun H, Reilly KH, Wang Y, Ma W, Xi B. Physical activity and risk of hypertension: A meta-analysis of prospective cohort studies. Hypertension 2013;62:1021-6.
Levine JA. Non-exercise activity thermogenesis. Proc Nutr Soc 2003;62:667-79.
Ryan C, Shaw RE. Perspectives on the crisis and challenge of cardiovascular disease in the diverse Asian populations of California. Hawaii Med J 2010;69 5 Suppl 2:25-7.
Watson RE, Karnchanasorn R, Gossain VV. Hypertension in Asian/Pacific Island Americans. J Clin Hypertens (Greenwich) 2009;11:148-52.
Beige J, Bellmann A, Sharma AM, Gessner R. Ethnic origin determines the impact of genetic variants in dopamine receptor gene (DRD1) concerning essential hypertension. Am J Hypertens 2004;17:1184-7.
Klimentidis YC, Dulin-Keita A, Casazza K, Willig AL, Allison DB, Fernandez JR. Genetic admixture, social-behavioural factors and body composition are associated with blood pressure differently by racial-ethnic group among children. J Hum Hypertens 2012;26:98-107.
Palaniappan LP, Wong EC, Shin JJ, Fortmann SP, Lauderdale DS. Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index. Int J Obes (Lond) 2011;35:393-400.
Park YW, Allison DB, Heymsfield SB, Gallagher D. Larger amounts of visceral adipose tissue in Asian Americans. Obes Res 2001;9:381-7.
Carson AP, Howard G, Burke GL, Shea S, Levitan EB, Muntner P. Ethnic differences in hypertension incidence among middle-aged and older adults: The multi-ethnic study of atherosclerosis. Hypertension 2011;57:1101-7.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]