Incidence of Triple Whammy Phenomena among Hypertensive Patients in Saudi Arabia and Awareness Among Healthcare Professionals

Mohammad Bonyan Alsobaie ^1* Lubna Alsheikh ²

• ¹ University of Arizona, Tucson, United States
• ² King Abdulaziz University, Jeddah, Makkah, Saudi Arabia

Cardiovascular diseases are a leading cause of mortality in Saudi Arabia, accounting for approximately 42% of deaths. The Triple Whammy phenomenon—combining angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, diuretics, and non-steroidal anti-inflammatory drugs—increases acute kidney injury risk, particularly in hypertensive patients. This study, conducted in a small-scale hospital in Jeddah from 2017 to 2022, assessed Triple Whammy incidence and healthcare professionals’ awareness. Of 5,654 patient records, 1,899 met inclusion criteria, with 2.7% experiencing the Triple Whammy. A survey of 56 professionals revealed 75% unawareness, with pharmacists and dentists most affected. Over-the-counter non-steroidal anti-inflammatory drug access and training gaps likely drive incidence and awareness deficits. The phenomenon can lead to acute kidney injury with mortality rates as high as 50–80% in critically ill patients and imposes significant costs, representing 5% of hospital budgets and 1% of overall health expenditure. Interventions like education, pharmacist roles, and non-steroidal anti-inflammatory drug regulation are proposed. Limitations include the small-scale focus and low survey sample, necessitating national studies to measure incidence accurately and improve patient safety.