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HYPERTENSION
DEPARTMENT OF COMMUNITY MEDICINE
37-48
2K22 BATCH
 INTRODUCTION
CLASSIFICATION
MEASUREMENT OF B.P
ICE-BERG PHENOMENON
CONTENT RULE OF HALVES
OUTLET TRACKING OF B.P
RISK FACTORS
PREVENTION
INDIA HYPERTENSION
CONTROL INITIATIVE
 INTRODUCTION
Hypertension
Hypertension is the persistant increase of
blood pressure on the wall of the blood
vessels. High blood pressure is one of the
important factors which plays an important
role in the development of various metabolic,
cardiovascular, renal diseases among others.
 Hypertension is a chronic condition of
concern due to its role in the causation of
coronary heart disease, stroke and other
vascular complications.
It is one of the major risk factors for
Cardiovascular mortality, which accounts for 20-50
per one of all deaths
 CLASSIFICATION OF HYPERTENSION

PRIMARY/ESSENTIAL
SECONDARY HYPERTENSION
HYPERTENSION

Due to other systemic

It accounts about causes
90%of all cases Mainly of diseaes of
it is of idiopathic kidney,tumorsof
adrenal gland,toxemia
cause.
of pregnancy.
CLASSIFICATION OF HYPERTENSION BASED ON
MEASUREMENT
CLASSIFICATION OF HYPERTENSION BASED ON
EXTENT OF ORGAN DAMAGE

STAGE 1 No manifestation of organic change

At least 1 of the following manifestations of organ
STAGE 2 involvement
Left ventricular hypertrophy
Generalized & Focal narrowing of the renal
arteries
Micro-albuminuri,proteinuria &slight elevation
of plasma creatinine concentration(1.2-2mg/dl)
Both symptoms &signs have
STAGE 3
appeared as result of organ damage
 The pressure at which the sounds are first heard (phase
MEASUREMENT OF I) is taken as the systolic pressure. Near the diastolic
pressure the sound first becomes muffled (phase IV) and
BLOOD PRESSURE then disappears (phase V)
Errors
a) Observer error
b) Instrumental error
c) Subject error
• WHO study group recommended that blood pressure
should be measured in sitting position than in the supine
position
• A uniform policy of measurement should be adopted in
a clinic
• The systolic and diastolic pressure should be measured
at least 3 times over a period of at least 3 minutes and
the lowest reading recorded
 ICE BERG PHENOMENON
some diseases like hypertension,
diabetes, anemia, malnutrition, mental
CLINICAL &
illness, etc., the unknown morbidity
DIAGNOSED
(corresponding to large submerged
portion of ice) is more than the known ASYMPTOMATIC
morbidity in the community and
constitutes an important, undiagnosed PRE-SYMPTOMATIC
reservoirs of disease in the
community. Their detection and UNDIAGNOSED&
LATENT
control is a challenge to the modern
technique of community medicine. IGNORED DELIBERATELY
 RULE OF HALVES
Definition:
The "Rule of Halves" explains gaps in Public Health Significance:
detection, treatment, and control of
hypertension in populations.
Breakdown: Highlights need for
Only 50% of hypertensive individuals population-wide BP
are AWARE of their condition. screening.
Of those aware, only 50% receive
TREATMENT. Indicates poor follow-up &
Of those treated, only 50% have
ADEQUATE BLOOD PRESSURE treatment adherence
CONTROL.
Therefore, only 1 in 8 (12.5%)
hypertensives are effectively controlled.
INCIDENCE
Global prevalence – 1.13 billion in 2015
Overall prevalence in adults – around 30–40% with a global standard
prevalence of 24% and 20% in men and women respectively.
This high prevalence around the world is irrespective of income status.

It becomes progressively more common with advancing age, with a

prevalence of >60% in people aged >60 years (due to increase in body
weight and adoption of sedentary lifestyle).

Elevated blood pressure is a leading cause of premature death in 2015,

accounting to almost 10 million deaths and over 200 million DALYs.

Systolic BP of ≥140 mm Hg accounts for most of the mortality and

disability burden.
PREVALANCE IN INDIA
As per NATIONAL FAMILY HEALTH SURVEY-5 done in the year 2019–
2020:
21% of Women with hypertension:

12% – stage 1
4% – each of with stage 2 and stage 3
44% – normal blood pressure
39% – prehypertensive
1% – taking anti-hypertensives

24% of Men hypertensive:

16% – stage 1
4% – stage 2
2% – stage 3
30% – normal BP
 If the blood pressure of an individual is followed up
from the childhood into adulthood, then those
individuals whose pressures were initially high in the
distribution would probably continue in the same
track as adults

TRACKING i.e., low blood pressure tend to remain low and high
levels tend to become higher as individuals grow older
This knowledge can be applied in identifying children
OF BLOOD and adolescents at risk of developing hypertension at
a future date

PRESSURE
 RISK FACTORS

AGE
NON- SEX
GENETIC
MODIFIABLE FACTORS
RISK FACTORS ETHNICITY
 OBESITY
SALT INTAKE
SATURATED FAT
DIETARY FIBERS
MODIFIABLE ALCOHOL
HEART RATE
RISK PHYSICAL ACTIVITY
ENVIRONMENTAL STRESS
FACTORS SOCIO-ECONOMIC STATUS
OTHER FACTORS
oral contraception (most common)
noise, vibration, temperature (require
further investigation)
 CLINICAL MANIFESTATIONS
The most consistent symptom is headache. It is
early morning, suboccipital pulsating headache. It
is often associated with the stiffness of the neck,
awakening the patient from sleep, and gives relief
after vomiting. Other features are dizziness,
palpitation, easy fatigability, epistaxis, blurring of
vision, breathlessness, and personality changes
COMPLICATIONS : Angina pectoris
Myocardial infarction,
Stroke (cerebral thrombosis and
hemiplegia, cerebral hemorrhage),
Renal failure.
Ocular manifestations are blurring vision, scotoma (unilateral or
bilateral), papilledema, and exudates on the retina.
PREVENTION OF HYPERTENSION

The low prevalence of hypertension in some communities

indicate that the hypertension is potentially preventable.
The WHO has recommended the following approaches in the
prevention of hypertension:

PRIMARY PREVENTION
a) Population strategy
b) High-risk strategy

SECONDARY PREVENTION
 POPULATION STRATEGY
Directed at the whole population irrespective of
the individual risk levels.
The concept of population approach is based on the
fact that even a small reduction in the average
blood pressure of a population would produce a
large reduction in the incidence of cardiovascular
PRIMARY complications like stroke and CHD.
PREVENTION
GOAL – To shift the community distribution of
blood pressure towards the lower levels of
“biological normality”.
 It involves multifactorial approach based on the following interventions:
➤ NUTRITION
a. reduction of salt intake to an average of not more than 5 gm per day
b. moderate fat intake
c. avoidance of a high alcohol intake
d. restriction of energy intake appropriate to body needs
➤ WEIGHT REDUCTION
Prevention and correction of overweight / obesity (BMI > 25)
➤ Exercise promotion
Regular physical activity leads to a fall in body weight, blood lipids and blood
pressure.
PRIMARY ➤ BEHAVIOURAL CHANGES
Reduction of stress and smoking, modification of personal lifestyle, yoga and

PREVENTION transcendental meditation would be profitable.

➤ Health education
➤ Self care
 HIGH RISK STRATEGY

AIM: To prevent the attainment of levels of

blood pressure at which the institution of
treatment would be considered.
This approach is appropriate if the risk
factors occur with very low prevalence in
the community.
Detection of high risk subjects should be
encouraged by the optimum use of clinical
methods.
 GOAL: To detect and control high blood pressure in
affected individuals.

Modern hypertensive drug therapy can effectively reduce high blood

pressure and consequently the excess risk of morbidity and
mortality from coronary, cerebrovascular and kidney diseases.

SECONDARY Early detection is a major problem because high bp rarely causes symptoms
➤ Early case detection:

until organ damage has already occurred and our aim should be to control it
PREVENTION before this happens.
Only effective method of diagnosis of hypertension is to screen the
population and should be linked with follow-up and sustained care.

➤ Treatment:
Aim to obtain a bp below 140/90 and ideally a BP of 120/80.
In essential hypertension, we cannot treat the cause as the cause is unknown.
 INDIA HYPERTENSION CONTROL INITIATIVE
Hypertension Control Initiative (IHCI) is an initiative launched by Indian
Council of Medical Research (ICMR), in November 2017, to improve heart
health of the people by controlling high blood pressure in the country,

KEY FEATURES OF THE INITIATIVE

AIM: To increase blood pressure control
Treatment protocols that provide
from 10% (20 million HTN patients) to
30% (60 million patients) in 25 project
quality patient care in primary care
districts by 2022, so as to reduce death facilities.
and disability related to cardio-vascular Provision of adequate supply of quality
diseases medicines and blood pressure monitor.
OBJECTIVES: To raise awareness Comprehensive training for health care
about HTN and educate communities workers at all levels on latest practices
on steps to prevent HTN and its in HTN treatment and
complications by undergoing periodical Team-based care for counseling and
follow-up of the patients.
check-up of their blood pressure.
 Strategies to improve treatment

coverage and blood pressure control:

Standard treatment algorithm

Capacity building at all levels
Availability of protocol drugs
Patient cohort monitoring-robust
monitoring and evaluation
Decentralization for blood pressure
measurement and drug dispensing at
subcenter level.
Strength the HTN treatment component
of NPCDCS
MAY MEASUREMENT MONTH (MMM)
It is a global awareness campaign undertaken in the month of May,
led by International Society of HTN.
Launched in May 2017, MMM put the
spotlight on increasing access to blood
pressure screening as potentially the
most effective way to reduce HTN's
adverse toll on health
Out of 8 countries launched HCI in 2017,
India is the first country to setup a new
mechanism aimed at delivery of services
for the control of HTN at the primary
care level
 QUIZ TIME
1: When is World Hypertension Day celebrated?

A) May 15 C) May 20
B) May 17 D) May 25

2. Essential hypertension is also known as?

A. Primary hypertension C. Malignant hypertension

B. Secondary hypertension D. Renal hypertension

 3. A hyper tensive emergency is characterized by?
A) Mild elevation in b.p without symptoms C) elevated bp only during
sleep
B) severe elevation of b.p with signs od D)elevated bp with headache
end-organ damage only
4. Which of the following complications is associated with
malignant hypertension?
A. Stroke C. Appendicitis

B. Myopia D. Asthma
5. What is the primary goal of the IHCI?
A) To reduce the prevalence of diabetes in India

B) To control hypertension and reduce cardiovascular

diseases

C) To improve healthcare infrastructure in rural areas

D) To increase awareness about hypertension

HARSH SADHVIKA

JOSEPH ABHIGNA

VARSHINI
‌ R‌ ‌
OU RAGHAVENDRA

HARSHITHA TEAM KAUSHIK

MONIKA
SRIYA

SRI LAKSHMI SATHWIK

 ‌
H ‌
A N
‌ K‌
TYOU!!!!!‌ ‌