globally , there are four million people who die annually as a direct result of high blood pressure6 and it is estimated there would be an increase of hypertensives to 1.2 billion by 2010.7 in the eastern mediterranean regional office ( emro ) , hypertension has reached 26%.8 in saudi arabia , hypertension has become an increasingly important health problem affecting a large number of saudi people,9 which has necessitated early detection and management as a priority through screening programs . the potential benefit of early intervention for high blood pressure supports the importance of screening and follow - up of abnormal screening results . several studies have demonstrated the rule of halves , whereby half of those affected are detected , half of those detected are treated and half of those treated are adequately controlled,10 although it is questionable whether this works.11 because hypertension is asymptomatic most of the time , the benefit of early detection and treatment is proven,12 and it is cost effective.13 accordingly , the general directorate of health affairs in the eastern province , in collaboration with the directorate of primary health centers , organized a community - based screening campaign program aimed at studying and improving the care of hypertensive patients through the primary health care system , through identification of undiagnosed cases , and the offer of effective management as one of its objectives . this study was conducted to measure the prevalence of hypertension through a screening campaign in the eastern province of saudi arabia , and examine the associations with socio - demographic factors . the study was part of a screening campaign for diabetes and hypertension conducted between 28 august 2004 and 18 february 2005 . details of the methodology used were described previously.14 a scientific committee formulated the detailed process to carry out this campaign . this included the determination of the standards for running the campaign , accreditations of instruments and health education materials to be used , besides training , financial , supervision and health education committees , data processing and entry committees . a media campaign was organized in each sector using written materials and audiovisual media , as well as posters that were put on billboards along the streets and in other public places in the eastern province . all saudi residents in the eastern province of saudi arabia , aged 30 years and above were invited to participate in a screening campaign for the early detection of diabetes mellitus ( dm ) and hypertension at more than 300 examination posts , data collection centers , set up in all primary health care centers , governmental , and most private hospitals and dispensaries , in addition to mobile teams , and other venues . the eastern province was divided into 15 sectors as follows : dammam , khobar , qatif , ras tanura , abqaiq , safwa , jubail , khafji , oraiera , nuaeria , sarar , qaria olaya , rafia , hassa , and hafr al - baten . a structured questionnaire developed through a focused group , and validated by experts in the fields of dm and hypertension , was used by pre - trained health teams , who had attended a training course for the conduct of the campaign , to obtain information on health status and lifestyle . based on the recommendations of the seventh report of the joint national committee on prevention , detection , evaluation , and treatment of high blood pressure ( jnc - vii)15 blood pressure was measured twice for each participants at rest , in the sitting position , at an interval of 1 - 2 minutes . if the difference between the two readings was greater than 5 mmhg , measurements were retaken until the reading were stable . blood pressure measurement was taken , using a standardized mercury sphygmomanometer , with an appropriate - size cuff inflated to a pressure approximately 30 mmhg greater than systolic . the systolic pressure was considered as equal to the pressure at which the pulse is first heard by auscultation ( korotkoff phase i ) , and the diastolic pressure as equal to phase v ( the point of disappearance of the sound ) . the screening test was considered positive if the systolic and diastolic blood pressure was  140 and /or  90 mmhg , respectively . the diagnosis of hypertension was made if a positive screening was confirmed on a subsequent day , or if there was a history of previous diagnosis , irrespective of the blood pressure reading . pre - hypertension was defined as systolic and diastolic of 120 - 139 , and /or 80 - 89mmhg , respectively . co - coordinators were assigned for each sector to supervise the examination posts , ensure the continuity of work and calibration of equipment and resolve issues such as absence of health workers , equipment breakdown , shortage of forms , proper completion of all forms , reminders to defaulters , ensure the follow - up of campaign letters and cooperation with coordinators in other sectors and main supervision committees . the forms were collected from each sector , where they were double - checked for completeness . non - eligible people were excluded , and forms with incomplete data , or unconfirmed results were sent back to the sectors with a covering letter asking for corrections to be made . the significance of univariate difference analysis was assessed using chi - squared test for categorical variables , and t - test , anova for systolic and diastolic variable with gender and categorical age respectively . those variables found to be significantly associated with hypertension were included in multiple regression analysis , using men and women , separately , with bp as the dependent variable , and age , sector , marital status , education , occupation as independent variables . the odds ratio and 95% confidence interval were calculated , and a p value < 0.05 was considered as indicative of statistical significance . of the 650.000 eligible individuals targeted by this campaign , 214,381 participated forming 33% . data on 197,681 were available . the mean systolic blood pressure ( sbp ) and diastolic blood pressure ( dbp ) of the participants was ( mean  standard deviation ) 121.0415.84 and 77.599.20 mmhg , respectively . the mean sbp and dbp of the second reading after confirmation of the screened positive was 127.7116.75 and 80.97 9.67mmhg . the screened mean systolic and diastolic bp was significantly higher in men than women 12214 and 788.7 and 119.817 and 76.69.5 mm hg , respectively ; ( p<0.001 ) . on the other hand , it was also significantly higher in males than females after confirmation of screened positive individuals 128 + 15.0 and 82 + 9.0 and 126.9 + 17.0 and 80 + 9.5 mmhg , respectively ( p<0.001 ) . both the mean systolic bp and diastolic bp increased with age , reaching their peak in the age group , 50 - 59 in both genders ( p<0.0001 ) . this pattern was seen in the screening and in the confirmation of screened positive ( p<0.0001 ) . regarding individuals who had not been diagnosed previously , 15,390 ( 9% ) were screened positive for hypertension , 7,308 ( 47.5% ) of whom had the confirmation test for blood pressure . the rest refused to return , failed to attend the referral , or could not be traced . the overall prevalence of hypertension , from screening , was 41,584 ( 21% ) which dropped to 30,706 ( 15.6% ) in the second reading . newly diagnosed hypertension was 4,330 ( 2.8% ) hypertension was more prevalent in women ( 18.1% ) than in men ( 13.1% ) with p - value < 0.0001 ( table 1 ) . prevalence of hypertension and pre - hypertension table 2 displays the prevalence of hypertension in relation to demographic characteristics . prevalence of hypertension in relation to age and marital status regarding marital status , hypertension was significantly more prevalent among widowed males and females ( 29.9% , 44.7% ) , followed by divorced males and females ( 16.9% , 21.5% ) , respectively , and was lowest among single individuals ( p<0.0001 ) . the prevalence of hypertension was significantly higher with lower income , and low educational level ( p < 0.0001 ) . among females , the highest rate of hypertension was in housewives ( 20.6% ) and the lowest among professionals ( 6.8% ) ( p<0.0001 ) . among men , the highest rate was in the unemployed ( 30.4% ) and the lowest was in military personnel ( 7% ) with p - value < 0.0001 ( table 3 ) . prevalence of hypertension in relation to socioeconomic variables regarding geographical distribution , the prevalence of hypertension , among men , was higher in subjects living in oraiera ( 26.3% ) and lowest was in jubail 6.5% ( p<0.005 ) . among the women , the highest rate of hypertension was in al - hassa ( 22.8% ) and was lowest in jubail with 11.3% ( table 4 ) . prevalence of hypertension in relation to geographical distribution logistic regression analysis was used to quantify the effect of socioeconomic factors with hypertension as a dependent factor ( table 5 ) . the analysis indicated that increasing age , being married , widowed , or divorced , were significant predictors of hypertension in men and women ; whereas being in the military service , being a professional , technical , non - technical , employed in administration , and those with higher education starting from secondary school were conversely associated with hypertension in men . in women , there was negative association with education . but being professional , technical , an employee in the administrative sector , housewives , and unemployed were significant predictors of hypertension . having a higher income a comparison of the different surveys of blood pressure distribution in saudi arabia91617 is difficult as the cut - off point ( ranging from systolic bp of 140 to 160 mmhg ) , and characteristics of population varied substantially . a study done within a comparable time cited a prevalence similar to ours.17 however , our figure is more realistic since it was obtained after the confirmation of positive screening . for example , in our study , confirmation of the bp reading reduced the prevalence figure from 21% to 15.6% , and the drop was statistically different even in sectors with almost 100% follow - up of screened positive results like oraiera and hafr - al - baten . this variability may be attributable to a  white - coat  effect causing a temporary increase in bp.18 hypertension is a complex multi - factorial and polygenic disorder that is thought to result from an interaction between an individual 's genetic make - up and various environmental factors,19 which may explain the variability of hypertension among sub - populations within the eastern province . the current study showed that the prevalence rates of hypertension in oraiera were higher than those in other sectors , while it was lowest in jubail . jubail is an industrial city with a dominant young working population , which may explain the relatively lower prevalence of hypertension those in comparison with other sectors . an apparently higher prevalence of hypertension was found in women than men in univariate analysis , although the average sbp and dbp was higher in men than women . this finding was consistent in sub - classification of all age groups , marital status , in most sectors , except oraiera , but showed a low prevalence with high education , higher income , and professional occupations in women than men . the rate of age - related blood pressure increase and sbp was observed with increasing age , whereas dbp peaked at the age group 50 - 59 years . this observation , documented previously , was explained by a wide pulse pressure in the elderly.20 in such a large campaign , there could be bias from different response rates in different sectors.14 however , the strength of this study is that the large sample sizes was able to provide a nationally fair representative estimate of hypertension in the eastern province of saudi arabia . besides , the percentage of our participants was consistent with the latest census on age and gender done in the eastern province of saudi arabia.21 generally , the overall yield of screened individuals with newly diagnosed hypertension was high , which indicates a strong recommendation for blood pressure screening to detect undiagnosed cases . lack of follow - up was associated with both health team factors ( failure of referral ) , and patient factors ( failure to keep scheduled follow - up ) . on other hand , psychological factors may have played a role since the newly screened positive subjects could have been in a state of denial with regard to their high blood pressure . the yield of this screening campaign has proved that the prevalence of hypertension may be higher than it appears , which is an indication that it is vital for more screening campaigns to be carried out and as systematic follow - up conducted for subjects with abnormal screening results .
objective : to estimate the prevalence of hypertension through a screening campaign in the eastern province of saudi arabia , and examine its association with lifestyle factors.research design and methods : in 2004 , all saudi residents in the eastern province , aged 30 years and above were invited to participate in a screening campaign for the early detection of diabetes and hypertension . 
 blood pressure was recorded by trained nurses using a mercury sphygmomanometer , based on the recommendations of ( jnc- vii ) . 
 a positive screening test for hypertension was defined as systolic and/or diastolic blood pressure of  140 and 90 mm hg , respectively . 
 subjects who had positive screening tests were asked to come on the following day for a confirmation of the reading . 
 hypertension was considered if there was a persistent reading of systolic and/or diastolic blood pressure of  140 and 90 mmhg after confirmation , or when there was history of a previous diagnosis.results:21% of the sample was positive from previous history or screening . 
 after confirmation , the prevalence of hypertension dropped to 15.6% , pre - hypertension was 3.7% , whereas the prevalence of undiagnosed hypertension was 2.8% . 
 the prevalence rose with age . 
 it was higher in women than in men of all age groups and in all sectors of the eastern province , although the mean systolic and diastolic bp was higher in men than women . 
 it was higher with lower education , in widows and divorcees than others ( p<0.0001).conclusion : the yield of the screening for abnormal blood pressure was high . 
 systematic follow - up of subjects with abnormal screening results is vital .