;t
HYPERTENSI
ON
DEPARTMENT OF COMMUNITY
MEDICINE
37-48
2K22 BATCH
INTRODUCTION
CLASSIFICATION
MEASUREMENT OF B.P
ICE-BERG PHENOMENON
CONTE RULE OF HALVES
NT TRACKING OF
B.P
RISK FACTORS
OUTLE PREVENTION
T INDIA HYPERTENSION
CONTROL INITIATIVE
INTRODUCTI
ON
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
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
CLASSIFICATION OF HYPERTENSION
PRIMARY/ESSENTIAL
S E C O N DA RY HYPERTENSION
HYPERTENSION
Due to other
It accounts systemic causes
about 90%of Mainly of diseaes
all cases it is of kidney,tumorsof
adrenal
of idiopathic
gland,toxemia of
cause. pregnancy.
CLASSIFICATION OF HYPERTENSION
BASED ON
MEASUREMENT
CLASSIFICATION OF HYPERTENSION
BASED OEXTENT
N OF ORGAN
DAMAGE
STAG 1 No manifestation of
E Atorganic1 of
least chathnegefollowing
STAG 2 manifestations of organ
E Left
involvem e v en tri
c u l
a r
G
hyen
peerr
ta
rl
oi
zpe
hdy & Focal
nt a nr
ate
rrr
oiw in g of th e rena l
Micro
es -albuminuri,proteinuria
of p las m a c
&slight elevation
rea t ini
n e
Both s y m
concentration p
STAG 3 appeared as result of to m(1.
2 s
-2 mg / dl )
E & signs h av e
The pressure at which the sounds
MEASUREMENT Ia)reisfirst
taken as th
(ne systolic pressure.
pressure th he
eard
sou pdhas fie
rst becomes
then disappears Near the
OF BLOOD m u ffl
e
diastolicd (p ha se I
V ) a nd
Er
(phase V) a)Observer errorro
PRESSURE rs
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
ICE BERG
PHENOMENON
some diseases like hypertension,
diabetes, anemia, malnutrition,
CLINICAL &
mental illness, etc., the
DIAGNOSED
unknown morbidity
(corresponding to large ASYMPTOMATIC
submerged portion of ice) is
more than the known morbidity PRE-SYMPTOMATIC
in the community and
constitutes an important, UNDIAGNOSED&
LATENT
undiagnosed reservoirs of
disease in the community. Their
IGNORED DELIBERATELY
detection and control is a
challenge to the modern
technique of community
medicine.
RULE OF
HALVES
Definition:
The "Rule of Halves" explains Public Health
gaps in detection, treatment, Significance:
and control of hypertension in
populations.
Breakdown: Highlights need
Only 50% of hypertensive for population-
individuals are AWARE of their wide BP
condition.
Of those aware, only 50%
screening.
receive TREATMENT. Indicates poor
Of those treated, only 50%
have ADEQUATE BLOOD
follow-up &
PRESSURE CONTROL.
Therefore, only 1 in 8 treatment
INCIDEN
CEOverall prevalence in adults – around 30–40% with a global
Global prevalence – 1.13 billion in 2015
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.
PREVALANCE IN
As per NATIONAL FAMILY HEALTH SURVEY-5 done in the year
INDIA
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
If the blood pressureof an individual
is followed up from the childhood
into adulthood, then those individuals
whose pressures were initially
high in the distribution would probably
TRACKIN continue
i.e., lowin the same
blood
remain low and
track tend
pressure as adultsto
high levels tend
to become higher as individuals grow
G OF older
This knowledge can be applied in
BLOOD identifying
at risk
children and adolescents
of developing hypertension
at a future date
PRESSU
RE
RISK FACTORS
AG
E
NON-
SE
MODIFIABLE X
RISK GENETIC
FACTORS FACTORS
ETHNICITY
OBESITY
SALT INTAKE
SATURATED FAT
DIETARY
MODIFIAB FIBERS
ALCOHOL
LE RISK HEART RATE
PHYSICAL
FACTORS ACTIVITY
ENVIRONMENTAL
STRESS
SOCIO-ECONOMIC
STATUS OTHER FACTORS
oral contraception (most
common)
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.
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
STRA
Directed at TEGY
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
PRIMARY reduction in the incidence of cardiovascular
complications like stroke and CHD.
PREVENTI GOAL – To shift the community
ON 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
PREVENTI lifestyle, yoga and transcendental meditation would be profitable.
> Health
ON 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
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.
SECOND Early detection is a major problem because high bp rarely causes
> Early case detection:
ARY
PREVENTI
symptoms until organ damage has already occurred and our aim
should be to control it before this happens.
Only effective method of diagnosis of hypertension is to
ON 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
Treatment protocols that
control from 10% (20 million HTN
patients) to 30% (60 million
provide quality patient care in
patients) in 25 project districts by primary care facilities.
2022, so as to reduce death and Provision of adequate supply of
disability related to cardio-vascular quality medicines and blood
diseases pressure monitor. Comprehensive
OBJECTIVES: To raise awareness training for health care workers at
about HTN and educate all levels on latest practices in
communities on steps to HTN treatment and
prevent HTN and its Team-based care for counseling
and follow-up of the patients.
complications by undergoing
Strategies to improve
treatment coverage and
blood pressure
Standard control:
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
Q U I Z TIME
1: When is World Hypertension D ay
celebrated?
A) May C)May
15 20
B)May D)May
2. Essential
17 hypertension is25
also
k n ow n a s ?
A. Primary C. Malignant
hypertension hypertension
B. Secondary D. Renal
hypertension hypertension
3. A hyper tensive emergency is
characterized
A) Mild by?
elevation in b.p without C)elevated bp only
symptoms during sleep
B) severeelevation of b.p with D)elevated
bp with
signs od end-organ damage headache only
4. Which of the following complications is
associated with malignant
A. hypertension? C.
Stroke Appendicitis
B. D.
Myopia Asthma
5. W h a t is the primary goa l of
the A)
IHCI?
To reduce the prevalence of diabetes in
India
B)To control hypertension and reduce
cardiovascular diseases
C)To improve healthcare infrastructure in r u r a l
areas
D)To increase awareness about
HARSH SADHVIKA
JOSEPH ABHIGNA
VARSHINI
O UR RAGHAVENDRA
HARSHITHA TEAM KAUSHIK
MONIKA
SRIYA
SRI LAKSHMI SATHWIK
H AN K
T YOU!!
!!!
