EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY ACCORDING TO WHO AND ACC/AHA GUIDELINES AMONG HYPERTENSIVE PATIENTS ATTENDING OUTPATIENT CLINICS IN ADEN, YEMEN

Abstract

Hypertension remains a major global health challenge and is the leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. Despite significant advances in pharmacological treatment, lifestyle-related factors such as physical inactivity, obesity, excessive dietary sodium intake, and tobacco or alcohol use continue to play a major role in the increasing burden of hypertension. Regular physical activity, including structured exercise programs, has been shown to improve vascular function and promote better blood pressure control. However, the optimal role and dose–response relationship of resistance training in the management of hypertension are not yet fully defined. Improved understanding of these relationships is essential for developing effective non-pharmacological interventions that complement pharmacological therapies. An analytical cross-sectional study was conducted between April and May 2025 among hypertensive outpatients attending randomly selected clinics in Aden, Yemen. A total of 422 patients were recruited using simple random sampling from clinic registration lists. Eligible participants were adults aged 18 years or older who had been receiving antihypertensive therapy for at least one year. Pregnant women and patients with irregular medication adherence were excluded. Data were collected using a structured, pretested, and validated Arabic questionnaire adapted from prior studies. Statistical analysis was performed using SPSS version 25. Descriptive analysis and chi-square tests were used for categorical variables, and a P-value of less than 0.05 was considered statistically significant. A total of 422 hypertensive patients were included in the analysis. The median age was 57 years, and males constituted 53.8% of participants. The prevalence of overweight and obesity was high (35.8% and 32.9%, respectively). Cigarette smoking was reported by 25.2% of patients, while 40.1% reported qat chewing, and only 9.7% engaged in regular physical exercise. Diabetes mellitus (37.9%) and heart disease (27.7%) were the most common comorbidities, followed by dyslipidemia (23.5%) and chronic kidney disease (9.2%). Calcium channel blockers (34.1%) and diuretics (30.8%) were the most commonly prescribed antihypertensive drug classes, followed by angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (each 24.4%). According to both WHO and ACC/AHA guidelines, no antihypertensive class demonstrated statistically significant superiority in achieving blood pressure control (P > 0.05). Blood pressure control among hypertensive outpatients in Aden, Yemen, remains suboptimal. Although calcium channel blockers and diuretics were the most frequently prescribed medications, no single antihypertensive drug class was superior in achieving optimal blood pressure control. Lifestyle-related risk factors, particularly smoking, physical inactivity, and excess body weight, were highly prevalent, and comorbid conditions such as diabetes and cardiovascular disease further compounded the disease burden. These findings underscore the importance of integrating comprehensive lifestyle modification programs, smoking cessation interventions, and patient education into routine hypertension management strategies to improve clinical outcomes.