ABSTRACT
Background:
Hypertension is a common health issue that affects over one billion adults around the world. In Saudi Arabia, its rise is linked to lifestyle changes, such as unhealthy eating and reduced physical activity. Although many people are affected, knowledge about hypertension and how to manage it remains limited. The aim of this study was to assess the public’s understanding and attitudes toward hypertension in Saudi Arabia.
Methods:
The study was done using an online survey from May to August 2024, which was distributed through social media. Participants answered questions about their demographics, knowledge of hypertension, attitudes toward the condition, and awareness of prevention. A total of 2,113 people aged 18 years and older took part. The data were analyzed to find links between demographic factors and levels of knowledge using a significance level of P ≤ 0.05.
Results:
Nearly all respondents (98.2%) had heard of hypertension, and 78.4% thought it was a common condition. In addition, most participants (64.1%) had a good level of knowledge about hypertension, while 35.9% had a poor level. The most recognized causes were high salt intake (80.5%) and cholesterol (67.0%), while headaches (80.7%) and dizziness (59.7%) were the most commonly known symptoms. Higher education and knowing someone with hypertension were linked to having better knowledge. More than half of respondents (54.2%) were willing to participate in campaigns to raise awareness.
Conclusion:
Although most people are aware of hypertension, there are still gaps in understanding about its risk factors and prevention methods. Educational programs focusing on these areas are needed.
Keywords: Attitude, hypertension, knowledge
Introduction
Hypertension is a condition where blood pressure consistently exceeds normal levels, increasing the risk of heart disease, heart attack, and stroke.[1,2] It affects an estimated 1.28 billion adults aged 30–79 worldwide, with 46% unaware of their condition.[2] Risk factors for hypertension include poor diet, lack of physical activity, and being overweight. While most people with hypertension show no symptoms, those with very high blood pressure may experience headaches, blurred vision, and chest pain.[2] Blood pressure is measured by systolic and diastolic levels, with normal being below 120/80 mmHg. Elevated blood pressure is 120–129 systolic and over 80 diastolic, Stage 1 hypertension is 130–139/80–89 mmHg, Stage 2 is 140+/90+, and a hypertensive crisis occurs when blood pressure exceeds 180/120 mmHg, requiring immediate medical attention.[3]
A study on hypertension helps practitioners identify knowledge gaps and improve patient education, leading to better prevention, treatment, and compliance, ultimately benefiting both healthcare providers and patients. This study assessed knowledge, awareness, and attitudes toward hypertension in Saudi Arabia to inform future public health initiatives.
Methods
Survey instrument. A survey was designed and piloted based on established questionnaires used in previous studies assessing public knowledge and attitudes toward hypertension. It was structured into four key sections. The sociodemographic section collected data on participants’ gender, age, marital status, educational attainment, occupation, nationality, and geographic location.
The knowledge section included nine multiple-choice questions related to the causes, symptoms, and risk factors of hypertension. Participants had the option to select an answer or choose “I don’t know.” The attitudes section asked about attitudes toward hypertension, including perceptions of living with the condition and willingness to engage with individuals who have it. The section on awareness and preventive measures explored participants’ understanding of hypertension-related symptoms, screening practices, and preventive measures.
Data collection and ethical considerations. The survey was disseminated via social media and instant messaging platforms to maximize reach and encourage participation across different regions. To enhance the reliability of the findings, only participants aged 18 years and above were included in the final analysis. Data collection took place between May and August 2024, during which a total of 2,113 eligible participants completed the survey. Ethical approval was obtained from the Institutional Review Board (IRB) of Imam Mohammad Ibn Saud Islamic University (approval number: 645/2024). All writing was collected in accordance with the ethical principles of the Declaration of Helsinki. The survey link included a brief study description and a more detailed explanation on the front page.
Results
A total of 2113 eligible participants completed the study questionnaire. There were 809 participants (38.3%) from the central region and 594 participants (28.1%) from the western region, while the remainder were from other regions. Participants’ ages ranged from 18 to more than 60 years with a mean age of 27.3 ± 11.6 years. A total of 1588 (75.2%) were single, and 481 (22.8%) were married.
Regarding educational level, 1170 (55.4%) had a bachelor’s degree, 777 (36.8%) had a high school education, and 110 (5.2%) had a postgraduate degree. The vast majority of the respondents were Saudi (81%). A total of 1299 (61.5%) were students, 407 (19.3%) were employed, and 337 (15.9%) were unemployed. A total of 1676 (79.3%) said they knew someone who suffers from hypertension, and 640 (30.3%) knew anyone with hypertension who is not receiving any treatment [Table 1].
Table 1.
Sociodemographic characteristics of study participants (n=2113)
| Sociodemographic data | No | % |
|---|---|---|
| Region | ||
| Central region | 809 | 38.3% |
| Northern region | 159 | 7.5% |
| Eastern region | 270 | 12.8% |
| Western region | 594 | 28.1% |
| Northern region | 281 | 13.3% |
| Age in years | ||
| 18–30 | 1544 | 73.1% |
| 31–45 | 358 | 16.9% |
| 46–60 | 172 | 8.1% |
| >60 | 39 | 1.8% |
| Marital status | ||
| Single | 1588 | 75.2% |
| Married | 481 | 22.8% |
| Divorced/widow | 44 | 2.1% |
| Nationality | ||
| Saudi | 1711 | 81.0% |
| Non-Saudi | 402 | 19.0% |
| Educational level | ||
| Below high school | 56 | 2.7% |
| High school | 777 | 36.8% |
| Bachelor degree | 1170 | 55.4% |
| Postgraduate degree | 110 | 5.2% |
| Employment | ||
| Unemployed | 337 | 15.9% |
| Student | 1299 | 61.5% |
| Employed | 407 | 19.3% |
| Retired | 70 | 3.3% |
| Do you know someone who suffers from hypertension? | ||
| Yes | 1676 | 79.3% |
| No | 310 | 14.7% |
| I don’t know | 127 | 6.0% |
| Do you know anyone with hypertension who is not receiving any treatment? | ||
| Yes | 640 | 30.3% |
| No | 1473 | 69.7% |
Knowledge and awareness of hypertension. Among the study participants, 98.2% had heard the term hypertension, and 78.4% thought that it is a common condition. The most reported causes included salty food (80.5%), high cholesterol (67%), and obesity (18%). The most known symptoms were headache (80.7%), dizziness (59.7%), loss of vision (40.2%), and nasal bleeding (26.5%). The most reported preventive measures included regular exercise (85.5%), healthy eating with low amounts of fat (83.6%), avoiding stress (80.9%), peaceful work environments (69.9%), and not smoking (62.1%).
Furthermore, 96% knew that hypertension is not a contagious disease, and 45% indicated that people with hypertension did not suffer discrimination in the workplace. Exactly 57.5% indicated that hypertension is a heart disease, and 90.4% thought that high blood pressure can be dangerous, but 74.4% did not believe that hypertension is a burden on society. As for risk factors that necessitate visiting a doctor, the most reported were a family history of hypertension (87.2%), older age (79.5%), obesity (64.5%), and smoking (60.7%). The most known phenomena that appear in hypertension were heart attack (66.4%) and convulsions/fits (46.4%). A total of 75.3% said that a person should go to the doctor for high blood pressure as soon as possible, and 50.1% said that for the treatment of hypertension, a person should go to a cardiologist, but 41.8% reported that they should go to a family physician [Table 2].
Table 2.
Study participants’ knowledge and awareness of hypertension
| Knowledge items | No | % | |
|---|---|---|---|
| Have you ever heard the term “hypertension”? | Yes | 2074 | 98.2% |
| No | 29 | 1.4% | |
| I don’t know | 10 | 0.5% | |
| Do you think hypertension is a common condition? | Yes | 1647 | 78.4% |
| No | 271 | 12.9% | |
| I don’t know | 183 | 8.7% | |
| Causes of hypertension | Salty food | 1647 | 80.5% |
| High cholesterol | 1371 | 67.0% | |
| Obesity | 368 | 18.0% | |
| Stress | 48 | 2.3% | |
| Fatty food | 28 | 1.4% | |
| Smoking | 23 | 1.1% | |
| Others | 128 | 6.3% | |
| I don’t know | 149 | 7.3% | |
| Symptoms of hypertension | Headache | 1706 | 80.7% |
| Dizziness | 1262 | 59.7% | |
| Loss of vision | 850 | 40.2% | |
| Nose bleeding | 560 | 26.5% | |
| Weakness | 471 | 22.3% | |
| Red face or flushing | 456 | 21.6% | |
| I don’t know | 261 | 12.4% | |
| Preventive measures of hypertension | Regular exercise | 1807 | 85.5% |
| Healthy eating with low amounts of fat | 1766 | 83.6% | |
| Keep away from stress | 1709 | 80.9% | |
| Peaceful work environment | 1476 | 69.9% | |
| Stop smoking | 1312 | 62.1% | |
| Healthy diet with low salt and fat | 43 | 2.0% | |
| I don’t know | 94 | 4.4% | |
| Does “hypertension” suffer from discrimination in the workplace? | Yes | 326 | 15.4% |
| No | 950 | 45.0% | |
| I don’t know | 837 | 39.6% | |
| Hypertension is a contagious disease. | Yes | 21 | 1.0% |
| No | 2029 | 96.0% | |
| I don’t know | 63 | 3.0% | |
| Type of hypertension | Heart disorder | 1214 | 57.5% |
| Family disorder | 725 | 34.3% | |
| Spiritual disorder | 174 | 8.2% | |
| Do you think “high blood pressure” can be dangerous for patients? | Yes | 1911 | 90.4% |
| No | 112 | 5.3% | |
| I don’t know | 90 | 4.3% | |
| Do you think “hypertension” will be a burden on society? | Yes | 351 | 16.6% |
| No | 1572 | 74.4% | |
| I don’t know | 190 | 9.0% | |
| Who should go to the doctor for a high blood pressure check? | People with family history | 1842 | 87.2% |
| Elderly | 1679 | 79.5% | |
| Obese people | 1362 | 64.5% | |
| Smokers | 1283 | 60.7% | |
| People who do not exercise | 1062 | 50.3% | |
| No one | 157 | 7.4% | |
| Stressful people | 42 | 2.0% | |
| I don’t know | 1 | 0.0% | |
| Knowledge items | No | % | |
| What phenomena do you think appear in “hypertension”? | Heart attack | 1320 | 66.4% |
| Convulsions or fits | 923 | 46.4% | |
| Bleeding from nose | 23 | 1.2% | |
| Paralysis | 6 | 0.3% | |
| I don’t know | 465 | 23.4% | |
| When should a person go to the doctor because of high blood pressure? | As soon as possible | 1592 | 75.3% |
| No need to go to the doctor immediately | 382 | 18.1% | |
| I don’t know | 139 | 6.6% | |
| Where should a person go for treatment for hypertension? | Heart doctor/cardiologist | 1058 | 50.1% |
| Family physician | 883 | 41.8% | |
| Home remedies like salt-free diet are enough | 105 | 5.0% | |
| Get medicine from a drugstore | 33 | 1.6% | |
| Herbal doctor | 30 | 1.4% | |
| No need for treatment | 4 | 0.2% | |
The overall knowledge level about hypertension. Most participants (64.1%) demonstrated a good knowledge level of hypertension, while 35.9% displayed a poor level [Figure 1].
Figure 1.
The overall knowledge level about hypertension among study participants in Saudi Arabia. A total of 1354 (64.1%) participants had good overall knowledge of hypertension, while 759 (35.9%) had poor knowledge
Attitudes and perceptions toward hypertension. A total of 78.9% of participants thought that people with high hypertension can live a normal life, 88% said they treat people with hypertension as normal, and 60.1% would not object to their son or daughter marrying someone who suffers from hypertension. Exactly 78.5% thought people should check their blood pressure regularly, and 54.2% would like to participate in a campaign or event to raise awareness about hypertension [Table 3].
Table 3.
Attitudes and perceptions toward hypertension
| Attitude | No | % |
|---|---|---|
| Do you think people with high hypertension can live a normal life? | ||
| Yes | 1667 | 78.9% |
| No | 244 | 11.5% |
| I don’t know | 202 | 9.6% |
| Your behavior toward a case with hypertension | ||
| I would treat him/her as before | 1860 | 88.0% |
| I would feel very awkward, and afraid, and I would stop contacting him/her | 79 | 3.7% |
| I prefer not to answer | 174 | 8.2% |
| Would you object to your son or daughter marrying someone who suffers from hypertension? | ||
| Yes | 305 | 14.4% |
| No | 1269 | 60.1% |
| I don’t know | 539 | 25.5% |
| Do you think a person should check their blood pressure regularly? | ||
| Yes | 1659 | 78.5% |
| No | 75 | 3.5% |
| Maybe | 379 | 17.9% |
| Would you like to participate in a campaign or event to raise awareness of “Hypertension”? | ||
| Yes | 1146 | 54.2% |
| No | 297 | 14.1% |
| Maybe | 670 | 31.7% |
Factors associated with public knowledge of hypertension. Only educational level and knowing someone who suffers from hypertension were significantly associated with knowledge levels. A total of 66% of participants with a bachelor’s degree had good overall knowledge of hypertension versus 48.2% of those with a low knowledge level (P = 0.009). Also, 66.9% of those who knew someone who suffers from hypertension had good knowledge about the disease versus 54.8% of those who did not (P = 0.001) [Table 4].
Table 4.
Factors associated with public knowledge of hypertension
| Factors | Overall knowledge level | P | |||
|---|---|---|---|---|---|
|
| |||||
| Poor | Good | ||||
|
|
|
||||
| No | % | No | % | ||
| Region | 0.228 | ||||
| Central region | 303 | 37.5% | 506 | 62.5% | |
| Northern region | 67 | 42.1% | 92 | 57.9% | |
| Eastern region | 91 | 33.7% | 179 | 66.3% | |
| Western region | 199 | 33.5% | 395 | 66.5% | |
| Northern region | 99 | 35.2% | 182 | 64.8% | |
| Age in years | 0.125^ | ||||
| 18–30 | 536 | 34.7% | 1008 | 65.3% | |
| 31–45 | 148 | 41.3% | 210 | 58.7% | |
| 46–60 | 60 | 34.9% | 112 | 65.1% | |
| >60 | 15 | 38.5% | 24 | 61.5% | |
| Gender | 0.199 | ||||
| Male | 199 | 38.3% | 321 | 61.7% | |
| Female | 560 | 35.2% | 1033 | 64.8% | |
| Marital status | 0.226^ | ||||
| Single | 554 | 34.9% | 1034 | 65.1% | |
| Married | 188 | 39.1% | 293 | 60.9% | |
| Divorced/widow | 17 | 38.6% | 27 | 61.4% | |
| Nationality | 0.188 | ||||
| Saudi | 626 | 36.6% | 1085 | 63.4% | |
| Non-Saudi | 133 | 33.1% | 269 | 66.9% | |
| Educational level | 0.009* | ||||
| Below high school | 29 | 51.8% | 27 | 48.2% | |
| High school | 283 | 36.4% | 494 | 63.6% | |
| Bachelor degree | 398 | 34.0% | 772 | 66.0% | |
| Postgraduate degree | 49 | 44.5% | 61 | 55.5% | |
| Do you know someone who suffers from hypertension? | 0.001* | ||||
| Yes | 555 | 33.1% | 1121 | 66.9% | |
| No | 140 | 45.2% | 170 | 54.8% | |
| I don’t know | 64 | 50.4% | 63 | 49.6% | |
P: Pearson χ2 tests, ^Exact probability test. *P<0.05 (significant)
Relation between knowledge and attitude towards hypertension. A total of 82.3% of those with good knowledge thought people with high hypertension can live a normal life versus 72.9% of those with poor knowledge (P = 0.001), and 91.6% of participants with good knowledge would treat people with hypertension as ordinary compared to 81.7% of those with poor knowledge (P = 0.001). Likewise, 63.2% of those with good knowledge would not object to their son or daughter marrying someone who suffers from hypertension compared to 54.4% of those with poor knowledge, while 84.6% of those with good knowledge said that a person should check their blood pressure regularly versus 67.6% of those with poor knowledge (P = 0.001). Additionally, 57.5% of participants with good knowledge would like to participate in a campaign or event to raise awareness about hypertension in comparison with 48.4% of those with poor knowledge level (P = 0.001) [Table 5]. The most reported reasons for not seeking medical consultation for hypertension [Figure 2] included being very busy with work (34.3%), preferring lifestyle change (28.8%), not knowing where to go (21.9%), and expensive treatment (7.9%).
Table 5.
Relation between participants’ knowledge and their attitude toward hypertension
| Attitude | Overall knowledge level | P | |||
|---|---|---|---|---|---|
|
| |||||
| Poor | Good | ||||
|
|
|
||||
| No | % | No | % | ||
| Do you think people with high hypertension can live a normal life? | 0.001* | ||||
| Yes | 553 | 72.9% | 1114 | 82.3% | |
| No | 93 | 12.3% | 151 | 11.2% | |
| I don’t know | 113 | 14.9% | 89 | 6.6% | |
| Your behavior toward a case with hypertension | 0.001*^ | ||||
| I would treat him/her as before | 620 | 81.7% | 1240 | 91.6% | |
| I would feel very awkward, afraid, and I would stop contacting him/her | 49 | 6.5% | 30 | 2.2% | |
| I prefer not to answer | 90 | 11.9% | 84 | 6.2% | |
| Would you object to your son or daughter marrying someone who suffers from hypertension? | 0.001* | ||||
| Yes | 129 | 17.0% | 176 | 13.0% | |
| No | 413 | 54.4% | 856 | 63.2% | |
| I don’t know | 217 | 28.6% | 322 | 23.8% | |
| Do you think a person should check their blood pressure regularly? | 0.001*^ | ||||
| Yes | 513 | 67.6% | 1146 | 84.6% | |
| No | 44 | 5.8% | 31 | 2.3% | |
| Maybe | 202 | 26.6% | 177 | 13.1% | |
| Would you like to participate in a campaign or event to raise awareness of “Hypertension”? | 0.001* | ||||
| Yes | 367 | 48.4% | 779 | 57.5% | |
| No | 123 | 16.2% | 174 | 12.9% | |
| Maybe | 269 | 35.4% | 401 | 29.6% | |
P: Pearson χ2 tests, ^Exact probability test. *P<0.05 (significant)
Figure 2.
Reasons for not seeking medical consultation for hypertension among study participants
Discussion
Hypertension is a significant issue in developing countries, particularly as they transition from dealing with communicable diseases to managing chronic noncommunicable conditions.[4,5,6] Additionally, hypertension and its related complications, such as heart failure, stroke, and renal failure, are becoming more prevalent as populations age.[7,8] In developed countries, one out of every four people aged 18 years or older has hypertension.[9,10]
Most respondents were students, young, and highly educated, and most of them knew someone who suffers from hypertension. Concerning public knowledge, about two-thirds of the participants had a good knowledge level. Nearly all of them had heard about hypertension, and more than two-fourths said it is a common problem. Participants’ knowledge about hypertension’s causes, symptoms, preventive measures, and risk factors that warrant medical consultation was more than satisfactory. Similarly, good public knowledge about hypertension in a Saudi population was reported by Alshammari et al.[11] and by Alshammari et al.[12] in Riyadh.
The vast majority of respondents knew that hypertension is not a contagious disease but is dangerous. Participants had average knowledge and awareness about the burden and treatment responsibility. Similarly, high knowledge and awareness (75%) were reported by Sabouhi et al.[13] In China, Pan et al.[14] revealed that about half of the respondents had a low level of knowledge about hypertension. In Pakistan, the level of awareness among participants was average. About one-third of the respondents did not understand the importance of continuously taking medication, and due to this, they were found to be nonadherent.[15]
In contrast to the current study findings, Wolde et al.[16] found that most people in Ethiopia (55.3%) had a low level of knowledge about hypertension, while 17.9% had a moderate level, and 26.8% had a high level of knowledge. According to a study conducted in the USA, around 22% of participants had poor knowledge about hypertension.[17] In Brazil, nonadherence to antihypertensive therapy was substantially correlated with the 17.7% of participants who had a poor understanding of hypertension.[18] Similarly, a Turkish study revealed that a third of the participants had insufficient awareness regarding hypertension and lacked sufficient information.[19]
Another study from Pakistan indicated that knowledge about hypertension was limited among patients with hypertension, especially those with uncontrolled blood pressure.[20] Similarly, a study from Iran showed that only 25.2% had good knowledge about hypertension.[21] Poor knowledge about hypertension was also assessed in Cameroon[22] and Zimbabwe.[23] In Saudi Arabia, Saeed et al.[24] conducted a national survey and found that many hypertensive patients are unaware of their disease, and the majority of those who were aware are not receiving treatment. A lack of knowledge about hypertension can lead to a greater burden on the healthcare system in Saudi Arabia with increased prevalence.[25,26] Higher awareness was reported among younger participants with high education and those who knew someone with the disease, which is consistent with many other study findings.[27,28]
Regarding public attitude, the current study revealed a positive attitude toward the disease, people with hypertension, and the importance of periodic checkups. This can be attributed to the high knowledge level about the disorder and its community burden. Oliveira et al.[29] found that less than 50% of hypertensive patients did not consider it to be a serious health problem and believed it to be unavoidable. Almost half of them were not aware of their blood pressure levels and were unable to accurately classify high blood pressure. Victor et al.[30] concluded that the majority of patients thought that prescription drugs were a successful form of treatment, and that vitamins, garlic, and herbs were also helpful. There was also a higher chance of HTN awareness and treatment but not illness control among patients with diabetes mellitus, which drew attention to medication.
Conclusion
In conclusion, the current study revealed a high level of public knowledge about hypertension and a positive attitude toward the disease and affected people. Higher education was associated with a higher knowledge level. To improve blood pressure control, more should be done to raise the level of knowledge in Saudi Arabia, particularly about medication compliance and medical care. Collaboration between the Saudi Hypertension Management Society, the Saudi Ministry of Health, and regional health authorities would support such an initiative.
Author contributions
All authors participated in the concept, design, analysis, interpretation of data, writing, and manuscript review. They have seen and approved the final version of the manuscript.
Ethical approval
The study was conducted by the Declaration of Helsinki, and approved by Imam Muhammad bin Saud Islamic University’s Institutional Review Board (IRB) committee (project digit 645-2024, validated on May 20, 2024).
Informed consent
Written informed consent was obtained from all participants included in the study.
Data and materials availability
All datasets collected during this study are available upon reasonable request from the corresponding author.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors would like to thank all who participated in the survey.
Funding Statement
There was no financial support.
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