Insight and opinion from The National’s editorial leadership
April 28, 2022
“If you don’t know your blood pressure, it’s like not knowing the value of your company,” the Turkish-American heart surgeon and TV personality Dr Mehmet Oz once quipped.
One in eight deaths worldwide is thought to be the result of high blood pressure, or hypertension. Left untreated, the condition raises the risk of heart attacks, strokes and other severe health problems, and it condition plagues, on average, a quarter of men and a fifth of women. In certain places, the figures are far higher – in Central and Eastern Europe, it is as many as 40 per cent of men, and in the Sahel, more than a third of women. In the Middle East, hypertension levels are also high, ranging from 20 per cent in Iran to 30 per cent in Oman. Across the GCC, more than a third of adults have hypertension or diabetes, or both, and the average patient with heart disease is almost a decade younger than in the West, according to a recent paper by two Oman-based doctors in the Journal of Human Hypertension (JHH).
n the Middle East, hypertension levels range from 20 per cent in Iran to 30 per cent in Oman
The condition is so prevalent that there is hardly a medical practice in the world where doctors do not start an exam by taking a patient’s blood pressure. Where the condition is chronic, they commonly prescribe daily tablets. The global market for antihypertensive drugs is worth more than $20 billion, and is expected to reach $30 billion by the end of the decade.
This week, doctors in the UK announced trials for a new course of treatment that, if successful, could revolutionise the industry, and transform the lives of people who suffer from chronic hypertension. The answer, doctors from Queen Mary University London and the UK National Health Service believe, could be a twice-yearly injection.
The causes of hypertension are often a mystery, though not always. In some cases, it is thought to be genetic. In most cases, however, lifestyle factors are clearly at play.
In another paper in JHH, published last year, Drs Majd Abboud and Sabine Karam from St George Hospital University Medical Centre in Beirut write that, in the Middle East, “modifiable factors” are a major cause. They include the usual suspects – “excessively high rates of smoking and obesity”.
That these are all “modifiable factors”, by definition, suggests the obvious: that prevention is really the best cure. Individuals can keep their own blood pressure low through diet and exercise, first and foremost, but they can also help their families by ensuring a more healthy environment for their children. Some experts have suggested that suspected genetic causes for hypertension may be down to the fact that families usually have similar lifestyles.
But Drs Abboud and Karam also point to other, more macro causes, including “suboptimal healthcare systems, socio-economic factors and disparities in education, literacy and urbanisation”, all of which affect public awareness and doctors’ ability to prescribe treatments in time. Some studies have also attributed hypertension in adults to environmental factors they experienced as children, such as exposure to lead, air pollution and even noise.
Clearly, tackling this particular problem once and for all will require a society-wide effort that spans ordinary citizens as well as policymakers. That means the battle ahead is a long one. But in the meantime, if the injection trials in the UK show good results, those who struggle with high blood pressure may find their lives become a little easier.
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
Milestones on the road to union
1970
October 26: Bahrain withdraws from a proposal to create a federation of nine with the seven Trucial States and Qatar.
December: Ahmed Al Suwaidi visits New York to discuss potential UN membership.
1971
March 1: Alex Douglas Hume, Conservative foreign secretary confirms that Britain will leave the Gulf and “strongly supports” the creation of a Union of Arab Emirates.
July 12: Historic meeting at which Sheikh Zayed and Sheikh Rashid make a binding agreement to create what will become the UAE.
July 18: It is announced that the UAE will be formed from six emirates, with a proposed constitution signed. RAK is not yet part of the agreement.
August 6: The fifth anniversary of Sheikh Zayed becoming Ruler of Abu Dhabi, with official celebrations deferred until later in the year.
August 15: Bahrain becomes independent.
September 3: Qatar becomes independent.
November 23-25: Meeting with Sheikh Zayed and Sheikh Rashid and senior British officials to fix December 2 as date of creation of the UAE.
November 29: At 5.30pm Iranian forces seize the Greater and Lesser Tunbs by force.
November 30: Despite a power sharing agreement, Tehran takes full control of Abu Musa.
November 31: UK officials visit all six participating Emirates to formally end the Trucial States treaties
December 2: 11am, Dubai. New Supreme Council formally elects Sheikh Zayed as President. Treaty of Friendship signed with the UK. 11.30am. Flag raising ceremony at Union House and Al Manhal Palace in Abu Dhabi witnessed by Sheikh Khalifa, then Crown Prince of Abu Dhabi.
December 6: Arab League formally admits the UAE. The first British Ambassador presents his credentials to Sheikh Zayed.
