A Hypertension and Diabetes Control Among Cardiology Patients in Saudi Arabia: A Quality-Improvement Study Using a Preventive Care Bundle

References

[1] World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization; 2021.

[2] Alhabeeb W, Tash AA, Alshamiri M, Arafat M, Balghith MA, Almasood A, et al. National Heart Center/Saudi Heart Association 2023 Guidelines on the Management of Hypertension. J Saudi Heart Assoc. 2023;35(1):16-39. doi:10.37616/2212-5043.1328.

[3] McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018. doi:10.1093/eurheartj/ehae178.

[4] Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.0000000000003480.

[5] American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Suppl 1): S1-S350. doi:10.2337/dc25-SINT.

[6] American Diabetes Association Professional Practice Committee. Cardiovascular disease and risk management: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Suppl 1): S207-S238. doi:10.2337/dc25-S010.

[7] Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023;44(39):4043-4140. doi:10.1093/eurheartj/ehad192.

[8] Kidney Disease: Improving Global Outcomes Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S): S1-S127.

[9] Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. doi:10.1093/eurheartj/ehab484.

[10] Tash AA, Al-Bawardy RF. Cardiovascular Disease in Saudi Arabia: facts and the way forward. J Saudi Heart Assoc. 2023;35(2):148-162. doi:10.37616/2212-5043.1336.

[11] Alqahtani BA, Alenazi AM. A national perspective on cardiovascular diseases in Saudi Arabia. BMC Cardiovasc Disord. 2024; 24:184. doi:10.1186/s12872-024-03845-8.

[12] AL-Rasheedi M, Alhazmi Y, AlDaiji LA, AlDaiji LA, Mobarki FI, Almuhaysini KM, et al. Status of diabetes mellitus in different regions of KSA and update on its management. Front Clin Diabetes Healthc. 2024; 5:1482090. doi:10.3389/fcdhc.2024.1482090.

[13] Alharbi AA, Alharbi AA, Al-Dubai SA. Inter-relation between diabetes mellitus and hypertension in terms of incidence and prediction in Saudi Arabia: a retrospective cohort study. BMC Public Health. 2024; 24:1956. doi:10.1186/s12889-024-19471-0.

[14] General Authority for Statistics. Health Status Statistics Publication 2024. Riyadh: General Authority for Statistics; 2024.

[15] International Diabetes Federation. Saudi Arabia diabetes report 2024. Brussels: International Diabetes Federation; 2024.

[16] Public Health Authority. High-Impact Interventions to Reduce Non-Communicable Diseases in Saudi Arabia. Riyadh: Public Health Authority; 2024.

[17] Public Health Authority. Saudi Health Promotion and Prevention Guideline for Hypertension. Riyadh: Public Health Authority; 2021.

[18] Public Health Authority. Saudi Health Promotion and Prevention Guideline for Diabetes Mellitus. Riyadh: Public Health Authority; 2025.

[19] Alhabib KF, Batais MA, Almigbal TH, Alshamiri MQ, AlTaradi H, Rangarajan S, et al. Demographic, behavioral, and cardiovascular disease risk factors in the Saudi population: results from the PURE-Saudi study. BMC Public Health. 2020; 20:1213. doi:10.1186/s12889-020-09298-w.

[20] Yagoub U, Saiyed NS, Al Qahtani B, Al Zahrani AM, Birema Y, Al Hariri I. Investigating the incidence and risk factors of hypertension: a multicentre retrospective cohort study in Tabuk, Saudi Arabia. PLoS ONE. 2022;17(1): e0262259. doi: 10.1371/journal.pone.0262259.

[21] Alenazi AM, Alqahtani BA, Alhowimel AS, Alenazi AM, Elnaggar RK. National and regional prevalence rates of hypertension in Saudi Arabia. Front Public Health. 2023; 11:1092905. doi:10.3389/fpubh.2023.1092905.

[22] Alqahtani BA, Elnaggar RK, Alshehri MM, Khunti K, Alenazi AM. National and regional prevalence rates of diabetes in Saudi Arabia: analysis of national survey data. Int J Diabetes Dev Ctries. 2023; 43:363-370. doi:10.1007/s13410-022-01092-1.

[23] NCD Risk Factor Collaboration. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019. Lancet. 2021;398(10304):957-980. doi:10.1016/S0140-6736(21)01330-1.

[24] NCD Risk Factor Collaboration. Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: pooled analysis of 1108 population-representative studies. Lancet. 2024;404(10467):2077-2093. doi:10.1016/S0140-6736(24)02317-1.

[25] Gastens V, Tancredi S, Bonnan D, Kiszio B, Del Giovane C, Tsuyuki RT, et al. Pharmacist interventions to improve hypertension management among patients with diabetes: a systematic review and meta-analysis of randomized controlled trials. BMC Health Serv Res. 2025; 25:1268. doi:10.1186/s12913-025-13461-7.

[26] Rabi DM, McBrien KA, Sapir-Pichhadze R, Nakhla M, Ahmed SB, Dumanski SM, et al. Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2020;36(5):596-624. doi: 10.1016/j.cjca.2020.02.086.

[27] German CA, Baum SJ, Ferdinand KC, Gulati M, Polonsky TS, Toth PP, et al. Defining preventive cardiology: a clinical practice statement from the American Society for Preventive Cardiology. Am J Prev Cardiol. 2022; 12:100432. doi: 10.1016/j.ajpc.2022.100432.

[28] Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18): e895-e1032. doi:10.1161/CIR.0000000000001063.

[29] Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, et al. 2023 AHA/ACC/Multisociety Guideline for the Management of Patients with Chronic Coronary Disease. Circulation. 2023;148(9): e9-e119. doi:10.1161/CIR.0000000000001168.

[30] Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, et al. Life's Essential 8: updating and enhancing the American Heart Association's construct of cardiovascular health. Circulation. 2022;146(5): e18-e43. doi:10.1161/CIR.0000000000001078.

@article{1719123,
      author = {Majid Suleman},
      title = {A Hypertension and Diabetes Control Among Cardiology Patients in Saudi Arabia: A Quality-Improvement Study Using a Preventive Care Bundle},
      journal = {Iconic Research And Engineering Journals},
      year = {2026},
      volume = {9},
      number = {12},
      pages = {2783-2794},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1719123.pdf},
      abstract = {Background: Hypertension and diabetes mellitus converge frequently in cardiology clinics and amplify the risk of coronary events, heart failure, kidney disease and premature mortality. In Saudi Arabia, rapid epidemiological transition, regional variation in cardiometabolic risk and uneven follow-up capacity have made simultaneous control of blood pressure and glycaemia a central quality issue rather than a narrow prescribing problem. Aim: This review develops a publishable quality-improvement framework for a preventive care bundle designed for cardiology patients in Saudi Arabia who have hypertension, diabetes or both. Objectives: The objectives were to synthesise 2020-2025 evidence, define measurable care gaps, specify bundle components, propose a clinic-level implementation model and identify indicators that can be used for audit, feedback and scale-up. Methods: A structured narrative review was undertaken using recent international guidelines, Saudi national guidance, national statistics and peer-reviewed studies relevant to cardiometabolic prevention, cardiology care and quality improvement. Evidence was organised around burden, guideline-concordant practice, implementation barriers, bundle design and measurement. Findings: Contemporary evidence supports accurate blood-pressure measurement, individualised glycaemic targets, kidney and lipid risk assessment, intensification of cardioprotective therapy, lifestyle counselling, medication adherence support, remote monitoring and multidisciplinary follow-up. A bundle model can reduce clinical inertia by converting separate guideline recommendations into a repeated workflow. Conclusion: A Saudi cardiology preventive care bundle should be simple, auditable and adaptable across tertiary, regional and rural services.},
      month = {June},
      doi = {https://doi.org/10.64388/IREV9I12-1719123}
  }