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Hypertension Community Medicine Presentation
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- 2. Hypertension is themost commonest cardiovascular disorder, posing a major public health challenge to population in socio-economic and epidemiological Transition .It is a major condition of concern due to its role in causation coronary heart disease, stroke and other vascular complications
- 3. CATEGORY SYSTOLIC BLOODPRESSURE (mm of Hg) DIASTOLIC BLOOD PRESSURE (mm of Hg) BP OPTIMAL NORMAL HIGH NORMAL <120 120-129 130 – 139 <80 80-84 85 – 89 HYPERTENSION GRADE 1(MILD) GRADE 2(MODERATE) GRADE 3(SEVERE) 140-159 160-179 >=180 90-99 100-109 >110 ISOLATED SYSTOLIC HYPERTENSION GRADE 1 GRADE 2 140-159 >=160 <90 <90 When systolic and diastolic blood pressure fall in different categories, the higher category should be selected Isolated systolic hypertension is defined as a systolic pressure of 140 mm of Hg or more and a diastolic pressure less than 90mm of Hg
- 4. CLASSIFICATION OF HYPERTENSION BASEDON EXTENTOF ORGAN DAMAGE STAGE1 No manifestation of organic change STAGE 2 At least one of the following manifestations of organ involvement: Left ventricular hypertrophy Generalized and focal narrowing of the renal arteries Micro-albuminuria, proteinuria and slight elevation . of the plasma creatinine concentration(1.2-2 mg/dL) STAGE 3 Both symptoms and signs have appeared as result of . organ damage
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- 6. • WHO studygroup recommended that blood pressure should me measured in sitting position than in the supine position • An uniform policy of measurement should be adopted in a clinic • The systolic and diastolic pressure should me measured at least 3 times over a period of at least 3 minute and the lowest reading recorded The pressure at which the sound are first heard (phase I) is taken as the systolic pressure Near the diastolic pressure the sound first become muffled (phase IV) and then disappear (phase V) Errors a)Observer error b)Instrumental error c)Subject error
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- 8. PRIMARY HYPERTENSION Causegenerally unknown It is the most prevalent form of hypertension >90 SECONDARY HYPERTENSION When some other disease process or abnormalities is involved in it causation About 10% Some of the prominent diseases that leads to hypertension are a) Disease of the kidney(chronic glomerulonephritis and chronic pyelonephritis) a) Tumours of adrenal glands b) Congenital narrowing of the aorta
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- 10. Rule Of Halves Thewhole communityNormotensive subjectsHypertensive subjectsUndiagnosed hypertension Diagnosed hypertension Diagnosed but untreated Diagnosed and treated Inadequately treated Adequately treated
- 11. 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.
- 12. PREVALENCE IN INDIA Asper NATIONAL FAMILY HEALTH SURVEY-4 done in the year 2015-2016, 11% of women- with hypertension: 7% - stage 1 1% - each of with stage 2 and stage 3 61%- normal blood pressure 30%-prehypertensive 1%- taking anti-hypertensives 15% of men-hypertensive: 10%-stage 1 2%-stage 2 1%-stage 3 43%-normal BP 43%-prehypertensive 1%- taking anti-hypertensives
- 13. Tracking Of Blood Pressure If theblood 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 ie., 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 and adolescents at risk of developing hypertension at a future date
- 14. 0 0.2 0.4 0.6 0.8 1 1.2 0 0.2 0.40.6 0.8 1 1.2 Time BloodPressure
- 15. RiskFactors Risk Factors ForHypertension Modifiable Non-Modifiable
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- 17. AGE BP increases withage in both sexes and the rise is greater in those with higher initial blood pressure. Age represents an accumulation of environmental influences and the genetically programmed senescence in body systems
- 18. SEX At adolescence,men display a higher average level. Most evident in the young and the middle aged adults. Late in life, the difference narrows and the pattern even reverses, Genetic Factors • Their inheritance is polygenic • The evidences are based on twin and family studi • Attempt to find the genetic markers associated with hypertension are unsuccessful
- 19. Ethnicity Population studieshas consistently revealed higher blood pressure in levels in black communities compared to other groups Average difference in blood pressure between two groups vary from slightly less than 5 mm Hg during second decade of life to 20 mm Hg during the sixth
- 20. MODIFIABLE RISK FACTORS OBESITY SALTINTAKE SATURATED FAT DIETARY FIBERS ALCOHOL HEART RATE PHYSICAL ACTIVITY ENIVRONMENTAL STRESS SOCIO-ECONOMIC STATUS OTHER FACTORS -oral contraception(most common) noise, vibration, temperature(require further investiga
- 21. Prevention Of Hypertension Primary prevention Secondary prevention a)Population strategy b) High-risk strategy 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 :
- 22. Primary prevention Population strategy Directedat 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 complications like stroke and CHD. GOAL-To shift the community distribution of blood pressure towards the lower levels of “biological normality”.
- 23. It involvesmultifactorial 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 over weight / obesity(BMI > 25) Exercise promotion: Regular physical activity leads to a fall in body weight, blood lipids and blood pressure. Behavioural changes: Reduction of stress and smoking, modification of personal lifestyle, yoga and transcendental medication would be profitable. Health education Self care
- 24. HIGH RISK STRATEGY AIM:Toprevent 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
- 25. Secondary Prevention GOAL: Todetect 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 and mortility from coronary, cerebrovascular and kidney diseases diseases Early case detection: Early detection is a major problem because high bp rarely causes 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 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
- 26. Patient compliance: It isthe extent to which patient behaviour(in terms of taking medicines ,following diets or following other lifestyle changes) coincides with clinical prescription. The compliance rates can be improved through education directed to patients, families and the community.