Saudi Cultural Missions Theses & Dissertations
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Item Restricted Investigating the potential of using mHealth apps to support DASH diet self-management among individuals with high blood pressure in Saudi Arabia(University of Sheffield, 2024-09) Alnooh, Ghadah; Williams, Elizabeth; Hawley, MarkBackground: Hypertension is a significant risk factor for cardiovascular disease and stroke, affecting 1.28 billion adults worldwide. Saudi Arabia has a high prevalence of hypertension, with 48.2% of adults aged 40 to 64 living with high blood pressure (BP) in 2018. Lifestyle management is crucial in addressing this issue. Strategies for preventing and controlling hypertension include maintaining a healthy body weight, increasing physical activity levels, and adopting the Dietary Approaches to Stop Hypertension (DASH) diet as the front-line strategy. Effective dietary self-management can enhance adherence to the DASH diet and help control BP. In this context, mobile health (mHealth) apps are increasingly considered valuable resources for managing individuals’ diets. Smartphone apps may provide new opportunities to improve nutrition interventions and change behaviour. Nevertheless, despite these advantages, patients and health-care professionals can face difficulties in identifying and selecting the most suitable apps. Further research is needed to determine whether mHealth apps can support DASH diet self-management and improve adherence among individuals with high BP in Saudi Arabia. Aims: The overall aim of this thesis is to investigate the potential of using mHealth apps to support DASH diet self-management among individuals with high BP in Saudi Arabia. Methods: Four studies were conducted in two phases. Phase one aimed to identify the most suitable DASH diet self-management apps. An exploratory approach was used to gather information on relevant apps, including their effectiveness, theoretical basis, quality, safety, security, characteristics, and functions. This phase consisted of two studies: 1) a systematic review of existing literature and 2) an app store review. Phase two aimed to select the most suitable DASH diet app for the Saudi Arabian context and to evaluate its feasibility and acceptability within this context. This exploratory phase involved two studies: a qualitative study and a feasibility study. The qualitative study sought to gain insights into the experiences and perspectives of individuals with high BP and healthcare professionals who have used the DASH diet self-management apps identified in phase one as high-quality, secure, and potentially effective (Noom and DASH To Ten). This information was crucial in selecting the most appropriate app for the Saudi context. The feasibility study evaluated the feasibility and acceptability of using the Noom app to support DASH diet self-management among individuals with high BP in Saudi Arabia. Results: The first phase identified two high-quality, secure, and potentially effective DASH diet apps: DASH To TEN and Noom. In the second phase, the participants in the qualitative study selected the Noom app as the most suitable for the Saudi context. While during the feasibility study, the participants found the Noom app to be feasible and acceptable, they also suggested improvements for greater accessibility to the Saudi population, including translating it into Arabic and simplifying the food logging process. Conclusion: The contributions of this thesis are significant in addressing a crucial gap in current research: the need for more studies exploring the use of smartphone apps to enhance adherence to the DASH diet to control BP. The research employed a systematic staged approach to identify and select commercial dietary smartphone applications, enabling researchers to make well-informed decisions when selecting dietary apps. This approach provided a solid basis for developing a high-quality RCT of a widely available DASH diet app since this research carefully identified and selected a commercial DASH diet app and evaluated its feasibility, usability, and acceptability among individuals with high BP in Saudi Arabia. However, conducting an RCT in Saudi Arabia may face challenges if the app is not adapted to address participants' recommendations, particularly concerning the need to enhance its educational content to better align with the needs of Saudi users. In addition, dietitians can leverage these findings to recommend two high-quality, potentially effective, and secure apps to their patients, aiding in DASH diet self-management. This research also offers critical insights into the interactive features of these dietary apps, informed by feedback from both patients and health professionals. These insights are instrumental for researchers and developers aiming to design more effective and user-friendly dietary applications. This research’s exploration of the feasibility and acceptability of commercial dietary apps among Saudis can inform further studies in the mHealth field.15 0Item Restricted Factors Associated with Antihypertensive Adherence in Patients Attending A Specialist Hypertension Service(University of Galway, 2024-07) Alhayrani, Hassan; Dennedy, MichaelAbstract This investigation explores the factors affecting antihypertensive medication adherence and focuses more on ADRs in patients receiving care at a dedicated hypertension clinic. Hypertension is a widespread health concern associated with significant cardiovascular implications, often necessitating pharmacological intervention. However, ADRs frequently compromise adherence to antihypertensive medications. This study is designed as a piece of secondary data analysis based on a cross-sectional study completed in 2021. The study utilized a quantitative research design. Data were collected by examining patient records, clinical assessments, and adherence monitoring, involving analysing pharmacy refill data and high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) analysis of urine samples. The study population comprised adults aged 18 and older who were diagnosed with hypertension and undergoing treatment at University College Hospital in Galway, Ireland. The study found no statistically significant overall impact of ADRs on medication adherence, although the use of diuretics approached statistical significance with a p- value of 0.084. Approximately 75% of patients reported adherence, while only 27% were confirmed adherent through mass spectrometry, indicating a significant discrepancy between self-reported adherence and objective measures. The findings underscore the necessity for robust methods to monitor and enhance adherence, particularly through minimizing ADRs and providing patient support tailored to demographic characteristics. Healthcare providers can develop more effective strategies to manage hypertension and improve patient outcomes by understanding the specific factors that influence adherence. The study aims to inform targeted interventions to optimize adherence and ultimately enhance the efficacy of hypertension management. This research highlights the critical need for personalized approaches in managing antihypertensive therapy, considering the varied impact of ADRs across different patient groups. The insights gained from this study could guide future research and clinical practices to better support patients in adhering to their prescribed medication regimens, thereby reducing the burden of hypertension-related complications.28 0Item Restricted The Modulation Effect of Inflammatory Cytokines on T cell Proliferation in Hypertension(University of Glasgow, 2024-05) Alsheikh, Eman; Marta, Czesnikiewicz-Guzik; Tomasz, GuzikHypertension is a common medical condition with very serious target organ consequences, increasing the risk of heart disease, stroke, and severe health complications. Despite the identification of various mechanisms (vascular, renal, and central mechanism) contributing to the pathogenesis of hypertension, the majority of cases lack a clear aetiology. Emerging evidence has established a significant association between hypertension and immune responses, particularly involving adaptive immune cells and inflammatory cytokines. Immunosuppressive drugs and cytokine inhibitors have shown potential in mitigating hypertension, suggesting a crucial role of the immune system in this condition. Given the central role of T lymphocytes in the adaptive immune response, this study hypothesises that, in the context of hypertension, inflammatory cytokines can modulate T cell activation independently of antigen stimulation. To test this hypothesis, total T cells were isolated from the spleens and PBMCs of normotensive and hypertensive mice and exposed to a range of cytokines, including TNF-α, IL-6, IL-15, IFN-γ, IL-7, IL-1β, IL-17A, IL-2, and IL-12, using different stimulation protocols. Aiming to understand the effects of these cytokines on T cell proliferation, differentiation, and the expression of activation markers such as CD69. Our findings highlight the varying abilities of cytokines to sustain T cell viability, with IL 7, IL-15, and IL-6 demonstrating a tendency for greater efficacy compared to other cytokines. In addition, IL-7 and IL-15 significantly impact T cell proliferation, notably affecting the CD8+ T cell population. However, despite these effects, no significant difference was detected between normotensive and hypertensive T cells in response to IL-7 and IL-15. This suggests that while these cytokines are potent in driving T cell proliferation, their influence is not specifically heightened in the context of hypertension. In GSEA and KEGG analyses, the Ca2+ signalling pathway was distinctively activated in response to IL-7 and IL-15 in Ang II induced hypertension. Conclusion: These data imply that most studied cytokines linked to hypertension pathology do not substantially affect normotensive or hypertensive T cells in a murine model. However, T cell proliferation was elevated in both Sham and Ang II mice in response to IL-15 and IL-7. Together, the data presented in this thesis warrant further investigations into the role of cytokines in hypertension and may point to IL-15 or IL-7 as biological targets for antihypertension therapy.43 0Item Restricted Enhancing Chemical Adherence Testing through Pharmacokinetics and Pharmacogenetics Insights and Mass Spectrometry Advancements.(University of Leicester, 0024-05-18) Alghamdi, Randah; Gupta, PankajThis thesis addresses the pressing issue of medication non-adherence with a focus on hypertension. Non-adherence is common and significantly elevates the risk of hospitalisation and mortality. The study investigates chemical adherence tests to assess medication adherence, employing liquid chromatography with tandem mass spectrometry (LC-MS/MS) as a robust method. The introduction highlights the complexities of adherence measurement and outlines potential limitations, including the influence of pharmacokinetics (PK) and pharmacogenetics on medication detection and the time-consuming nature of chemical adherence testing (CAT) processes. The central hypothesis underpinning this research is that the pharmacokinetics and pharmacogenetics of antihypertensive medications do not significantly affect medication detection or, consequently, the results of CAT by LC-MS/MS. This hypothesis is explored through a series of specific aims, including establishing PK parameters for the 20 most commonly prescribed antihypertensive medications through a comprehensive literature review. Additionally, the study aims to determine whether these PK parameters have any bearing on the outcomes of CAT using LC-MS/MS. A systematic review is conducted to identify genetic polymorphisms related to the effects of cardiovascular medications within the Biology Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) cohort, and the subsequent investigation focuses on the association between genetic polymorphisms and medication detection rates in the same cohort. Furthermore, the study strives to develop and partial validate an improved and more efficient CAT method for quantitating various cardiometabolic medications using LC-QQTO MS, a crucial step in ensuring accurate adherence assessments. The findings of this research reveal several critical insights. Chapter 3, which reviews the PK parameters of commonly prescribed antihypertensive medications, demonstrates no significant correlation between these parameters and adherence scores. This observation holds for multiple parameters, including bioavailability, urine excretion, clearance, volume of distribution (VD), half-life, peak time, and peak concentrations. Logistic regression analysis confirms that PK parameters do not predict non-adherence, even when considering additional factors such as age, sex, the number of medications, and creatinine levels. In Chapter 4, the systematic review uncovers various genetic polymorphisms associated with cardiovascular medication effects in the BIOSTAT-CHF cohort. However, these genetic variations do not exhibit a substantial correlation with non-adherence to prescribed cardiovascular drugs and encompass a wide range of effects, including PK influences, adverse drug reactions, metabolic responses, therapeutic outcomes, and risk-related impacts. Additionally, a non-directed genome wide association study (GWAS) showed weak associations with some potential polymorphisms, but none met the usual threshold of significance. Chapter 5 focuses on the development and partial validation of LC-QTOF-MS methods for the quantitation of cardiometabolic medications. Due to the distinct challenges posed by the COVID-19 pandemic, the objective was modified to conduct a partial validation assessment. The analysis time was reduced by 10 times from the previous method. The optimization of conditions for both positive and negative modes of LC-QTOF-MS is detailed, covering parameters such as capillary voltage, energy settings, and mobile phase selection. The validation results underscore the importance of tailored approaches for different pharmaceutical compounds, emphasising the significance of meticulous method development and validation in pharmaceutical analysis. In conclusion, this thesis proves the central hypothesis that the pharmacokinetics and pharmacogenetics of antihypertensive medications do not significantly affect medication detection and, therefore, do not influence the outcomes of CAT by LC-MS/MS. These findings offer valuable insights into improving medication adherence assessment and management in cardiometabolic diseases, highlighting the need for a multifaceted approach that considers pharmacokinetics and pharmacogenetics. Notably, my thesis had to adapt to the challenges posed by the COVID-19 crisis. The research shifted its focus from the initial plan of conducting PK profiles of antihypertensive medications in healthy volunteers to the plan of undertaking a systematic review of genetic polymorphisms associated with various effects of cardiovascular medications within the BIOSTAT-CHF cohort study.10 0Item Restricted The Association Between Lifestyle Behaviour, including Physical Activity and Dietary Habits, and their relationship with Hypertension in a UK Population Sample(Saudi Digital Library, 2023-08-14) Fakeeh, Mohammed; Nicholl, BarbaraBackground: high blood pressure is a crucial contributor to the development of cardiovascular disease and a significant public health concern that affects millions of people globally. There has been growing discussion about hypertension among adults and the role that lifestyle factors play in this condition. There is a high level of physical inactivity and poor dietary choices in the United Kingdom (UK), both of which might contribute to hypertension. Objective: This study aimed to investigate the association between lifestyle factors – including physical activity and dietary habits – and sociodemographic factors and their associations with high blood pressure using a UK Biobank sample. Methods: Participants from the UK Biobank were included (N = 230,087) who had self- reported hypertension. The chi-squared test was utilised for categorical variables and the Mann–Whitney U test was utilised for continuous variables to compare dietary, sociodemographic and physical activity-related variables between groups with and without hypertension. Multivariable logistic regression analysis was used to establish whether there was an association between hypertension (the dependent variable) and physical activity and dietary habits, including the consumption of tea, coffee, beef, salt added to food, raw salad and vegetables (the independent variables). We then adjusted for a wide range of potential covariates (age, sex, Townsend scale score, body mass index (BMI), smoking status and alcohol consumption). The analysis was carried out using R software (v. 4.2.1). Results: The findings indicate an association between hypertension and physically active individuals compared to those reporting low physical activity levels (odds ratio (OR): 1.13, 95% confidence interval (CI) (1.10–1.16), p < 0.001). In contrast, dietary habits varied. Tea and beef consumption were found to have significant associations with hypertension ((OR tea – light to moderate: 1.05, 95% CI (1.02–1.09), p = 0.002); OR beef – once a week: 1.10, 95% CI (1.06– 1.14), p < 0.001), while consumption of coffee and salt added to food had negative associations with hypertension ((OR coffee – light to moderate: 0.90, 95% CI (0.88–0.93), p < 0.001); OR salt –usually: 0.82, 95% CI (0.80–0.84), p < 0.001). The analysis of sociodemographic factors revealed that older people and males were likelier to experience hypertension than younger people and females, respectively ((OR age – 60–71 years: 4.09, 95% CI (3.96–4.22) p < 0.001); (OR sex – male: 1.34, 95% CI (1.32–1.37), p < 0.001). On the Townsend scale, those in quintiles Q3–Q5 had greater exposure to hypertension than those in quintile Q1-Q2 (OR: 1.09, 95% CI (1.04–1.14), p = 0.001). Overweight and obese people and smokers were significantly likelier to experience hypertension than those with a healthy weight ((OR BMI – overweight: 1.91, 95% CI (1.86–1.97), p < 0.001); OR BMI – obese: 4.14, 95% CI (4.02–4.26), p < 0.001) and those who never smoked (OR smoking – previous: 1.11, 95% CI (1.09–1.14), p < 0.001). Finally, the consumption of raw salad, vegetables and alcohol demonstrated no significant associations with hypertension. Conclusion: This study highlights the associations between lifestyle behaviours, including physical activity and dietary habits, and their relationships with hypertension in a sample from the UK Biobank. Evidently, lifestyle behaviours are crucial to hypertension. However, some associations emerged in unexpected directions, suggesting that further research in this area should be conducted using longitudinal data.15 0