Heat-adapted family medicine: A comprehensive review of climate-related risks, chronic disease management, and primary care preparedness in hot regions

Background: The Arabian Peninsula and other hot regions of the world are warming at nearly twice the global average rate, exposing vulnerable populations to recurrent and prolonged periods of extreme heat. Family physicians sit at the front line of this emerging climate-health interface, yet structured guidance on heat-adapted primary care remains sparse in the medical literature.
Objective: This narrative literature review synthesizes contemporary evidence on the cardiovascular, renal, and metabolic consequences of extreme heat, examines the safety profile of commonly prescribed cardiometabolic medications during heatwaves, and proposes a practical, primary-care-oriented operational framework   the HEAT-FM model to guide clinicians working in hot regions, with particular relevance to the Gulf Cooperation Council (GCC) context.
Methods: A structured literature review of English-language publications (2000–2025) was performed using PubMed, Scopus, and grey-literature sources from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and the Saudi Ministry of Health. Themes were synthesized around hypertension, chronic kidney disease (CKD), diabetes mellitus, medication safety, primary care preparedness, and Gulf-region epidemiology.
Results: Heat exposure aggravates hypertension through impaired diurnal blood pressure rhythm and increased nighttime values; precipitates acute-on-chronic kidney injury via volume depletion and vasopressin-mediated tubular stress; and worsens glycemic stability through dehydration, insulin pharmacokinetic alterations, and cognitive impairment of self-management. Diuretics, renin-angiotensin-aldosterone system (RAAS) blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors, metformin, and anticholinergic agents demand particular attention during heat events. Primary care preparedness remains underdeveloped, especially for the elderly, outdoor labourers, and Hajj pilgrims.
Conclusion: A structured, anticipatory primary-care response is needed. The proposed HEAT-FM framework High-risk identification, Education, Adjustment of medications, Timely follow-up, Family/community prevention, and Monitoring offers a memorable, clinically actionable scaffold for family physicians in hot regions. Embedding such frameworks within national heat-health action plans is essential as climate change accelerates.