فيصل الناصر - Prof faisal hypertension presentation1 4

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د فيصل الناصر - Faisal Alnasir is a Professor and Chairman at Dept Of Family & Community Medicine at Arabian Gulf University.

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فيصل الناصر - Prof faisal hypertension presentation1 4

  1. 1. Hypertension the Silent KillerEpidemiologyProf Faisal A Alnasir FRCGP, MICGP, FFPH, PhDPresident, Family & Community Medicine Council Arab BoardChairman, Department of Family & Community MedicineArabian Gulf University
  2. 2. 2Hypertension• Common• Non Communicable disease• Inevitable• Preventable• Serious complication
  3. 3. 3WHO estimated that high blood pressurecauses one in every eight deaths, makinghypertension the third leading killer in the world.Globally, there are one billion hypertensives andfour million people die annually as a direct resultof it.Hussein A. GezairyRegional Director for the Eastern Mediterranean
  4. 4. 4
  5. 5. 5Size of the problem1-World wide• In 2010, 1.2 billion people were expected to be suffering fromhypertension worldwideSixth report of the Joint National Committee on prevention,1997• Expected to increase to 1.56 billion by 2025International Society of Hypertension• Its prevalence from 20% to 30% of the adult population.Alwan A 1993• Incidence In USA between 14% to 40% in 35 to 64 years.WHO 2002• Prevalence in Canada 17.3%. Most patients had untreatedhypertension (68.6%), and only 15.8% had blood pressuretreated and controlled.
  6. 6. 6Size of the problem2-In the Eastern Mediterranean Region• The average prevalence of hypertension 26% and it affectsapproximately 125 million individuals.• Each year, there are several million new cases ofhypertension and more of pre-hypertensionReport on the regional consultation on hypertensionUAE, 2003
  7. 7. 7Size of the problemIn BahrainNational Non-communicable Diseases Risk Factors Survey 2007
  8. 8. 8Size of the problemIn BahrainNational Non-communicable Diseases Risk Factors Survey 2007
  9. 9. In Lebanon•23.1% are hypertensive•Prevalence increases with age•Occurs more in the less educated and unemployed•Prevalence increases significantly with an increase inbody mass index particularly in female patients•Only14.7% exercised dailyR A Tohme, A R Jurjus, A Estephan 2005
  10. 10. 10Size of the problemIn Saudi Arabia:The prevalence range from 4% to 15%.Abolfotouh MA et al.It may reach as high as 20.4% for systolic hypertension and25.9% for diastolic hypertension.Al-Nozha MM et al.In south-western 11.1%.Abolfotouh MA et al.In Jeddah, the hypertensive were 22.6%.Elkalifa Am et al.2011In the UAE:Hypertension has become one of the leading public healthproblems
  11. 11. In Sudan of 6-12y children:4.9% were pre-hypertensive and4.9% were hypertensiveSalman Z, et al 2010
  12. 12. 12Size of the problemIt has been estimated that individuals who arenormotensive at the age 55 years have a 90%lifetime risk for developing hypertension.EMR0 Technical PublicationsBlood pressure is under control in less than 20% ofpatients with hypertension in many countriesA joint CINDI/EuroPharm Forum project WHO
  13. 13. 13Awareness of HypertensionAlthough the prevalence of high blood pressure is high,there is a low awareness rate (Up To 70% are unaware)Alwan A1993
  14. 14. Awareness of HypertensionFaisal Alnasir, 2004
  15. 15. 15Awareness of HypertensionIn Egypt only 37.5% of hypertensives were aware ofHaving it.In United States, Chile, and Cub, 32%, 37%, and 39%of the people were not aware.Pan American Health
  16. 16. 16Advantage of Controlling Hypertension•A 5-6 mmHg reduction in diastolic BP reduces stroke by 40%.Joint National Committee on Detection, 1992•lowering by 5-6mmHg can reduce mortality from cerebrovasculardisease by 35%-40%, from ischemic heart disease by 15% 20%and reduction in all deaths from cardiovascular causes by 23%.Psaty, et al 1997• 3 mmHg decrease in systolic BP reduces annual mortalityfrom stroke, coronary heart diseases and all other causes by 8%,5% and 4%.Whelton PK, 1994•The chances of mortality from CVD in old hypertensive peoplewhen taking anti hypertensive medications is decreased by 34%.MacMahon, 1993
  17. 17. Advantage of Controlling HypertensionThe first long-term data from a high-blood-pressure study, the Systolic Hypertension in theElderly Program (SHEP), show that each monthof chlorthalidone-based therapy was associatedwith approximately one day of extension in life,free from cardiovascular death.The main findings are that after 22 years offollow-up, when about 60% of the participants inSHEP were dead, we saw a prolonged lifeexpectancy in those who took the activetreatment for 4.5 years.Dr John B Kostis Journal of the American Medical Association 2011
  18. 18. 18Economic ImpactThe economic burden of chronic NCDs canbe analyzed on two levels.•First, the effects of macroeconomic policies onopportunities for prevention in differentpopulation groups•Second, the cost and overall efficiency ofinterventions must be evaluated in terms ofeffectiveness and health gains for thepopulation at large.
  19. 19. 19Economic ImpactDirect Cost:Including prescribing medicines, inpatient visits,outpatient visits, emergency room visits, office-based medical provider visits, home healthvisits, and other medical expensesSanjeev Balu, 2001Indirect Cost:Productivity loss ($300 per eligible employee per year)absence & short term disabilityGoetzel (2004), the only study in the U.S.
  20. 20. 20Economic Impact•Poor are disproportionately affected•more vulnerable•Prevalence 6 time more in uneducated•Medication cost up to US$ 100 per month•further poverty•Cost to Health Services•USA total cost of CVD is 2% of the grossdomestic product• direct medical costs estimated at nearly $55.0billion for the year 2001Sanjeev Balu, 2001•Canada 21% of all diseases costs are due toCVD (US$12 billion/Year) direct cost is $3,072per person per year, and indirect cost is $854Guijing Wang,2008
  21. 21. 21Economic ImpactIn Alkhobar the total direct cost of hypertensioncare for patients registered in the primary healthcare represented 6.32% of the estimated cost oftreating the expected number of patients.Al-Shahri 1998
  22. 22. 22PreventionPrimary prevention is the most cost-effectiveapproach to containing the emerginghypertension epidemic.Hussein AlGezairyRegional Director for WHO
  23. 23. 23PreventionIncidence of hypertension was reduced by 20% to50% if primary prevention were implementedStamler 1991For the developing countries prevention ofhypertension should be the goal.
  24. 24. 24PreventionLife style Modification:•perform aerobic exercise•maintain a healthy body weight•follow a healthy diet•restrict salt intake•stress management•limit alcohol consumption
  25. 25. 25Modification Recommendation Approximate systolic BPreductionWeight reduction Maintenance of normal body weight 5–20 mmHg/10 kghealthy eating plan Consumption a diet rich invegetables, fruits, andlow-fat dairy products with areduced content of saturated andtotal fat8–14 mm HgDietary sodium Reduction dietary sodium intake tono more than2.4 g sodium2–8 mmHgPhysical activity Engagement in regular aerobicphysical activity at least 30minutes daily, most days of theweek4–9mmHgRecommended lifestyle modifications
  26. 26. 26Life style Modification• Weight reductionEvery 1 kilogram of weight loss lower blood pressure by1.6/1.1 mmHgKhatib et al. EMR0 Technical Publications
  27. 27. 27Prevalence of overweight and obesity amongsome countries of the Eastern MediterraneanRegion (WHO.2004)Country Overweight/obesity (%)Males FemalesSaudi Arabia 64.0 70.0Lebanon 60.0 53.0Islamic Republic of Iran 57.0 67.7Bahrain 56.4 79.0Jordan 46.0 43.7Egypt 43.8 41.0Libyan Arab Jamahiriya 42.5 74.9Oman 40.5 43.5Morocco 37.2 21.7United Arab Emirates 25.5 39.9Tunisia 13.1 41.9Kuwait 79 56
  28. 28. In BahrainNational Non-communicable Diseases Risk Factors Survey 2007
  29. 29. In Sudan of 6-12y children:45 (14.8%) were overweight; 32 (10.5%)were obeseSalman Z et al 2010
  30. 30. 30
  31. 31. 31Life style Modification• Eating habits
  32. 32. 32
  33. 33. 33Life style Modification• Physical activityExercise lowers systolic and diastolic blood pressure by 5-10mmHgArakawa
  34. 34. 34Life style Modification• Physical activityNational Non-communicable Diseases Risk Factors Survey 2007
  35. 35. 35Life style Modification• Sodium moderationReducing dietary sodium intake to no more than 100 mEq/L(2.4g sodium or 6 g sodium chloride), reduces the bloodpressure by an average of 4–6 mmHg.Khatib et al. EMR0 Technical Publications
  36. 36. 36Life style Modification• Diabetes(In Bahrain)National Non-communicable Diseases Risk Factors Survey 2007
  37. 37. 37Life style Modification• Diabetes(In Bahrain)
  38. 38. 38Life style Modification• Tobacco(In Bahrain)National Non-communicable Diseases Risk Factors Survey 2007
  39. 39. -Lipids
  40. 40. 40Life style Modification• Lipids(In Bahrain)National Non-communicable Diseases Risk Factors Survey 2007
  41. 41. 41Life style Modification• Cocoa ingestion100g/day of chocolatedrink reduces the systolic BP anddiastolic BPTaubert et al 2007
  42. 42. 42Blood Pressure Pooled Change (mm Hg) PCocoaSystolic -4.7 .002Diastolic -2.8 .006TeaSystolic 0.4 .63Diastolic -0.6 .38Change in Blood Pressure reductionbetween cocoa & TeaTaubert et al 2007
  43. 43. 43Change in Blood Pressure reductionbetween cocoa & TeaTaubert et al 2007“The magnitude of the hypotensive effects ofcocoa is in the range that is usually achievedwith monotherapy of β-blockers orangiotensin-converting enzyme inhibitors”
  44. 44. Chocolate and Coronary Heart Disease: A Systematic ReviewThis article reviews current evidence on the effects of cocoa/chocolate onclinical and subclinical coronary heart disease (CHD), CHD risk factors,and potential biologic mechanisms. The high content of polyphenols and flavonoids present in cocoa hasbeen reported to play an important protective role in the development ofCHD. Although studies have demonstrated beneficial effects of chocolate onendothelial function, blood pressure, serum lipids, insulin resistance, andplatelet function, it is unclear whether chocolate consumption influencesthe risk of CHD.Khawaja O et al Current Atherosclerosis Reports, Volume 13 / September 2011
  45. 45. 46Measurement of Blood PressureThe "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8% inhypertensive patients.Marquez Contreras et al. 2006
  46. 46. 47Measurement of Blood PressureThe "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8% inhypertensive patients.Marquez Contreras et al. 2006
  47. 47. 48Measurement of Blood PressureThe "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8% inhypertensive patients.Marquez Contreras et al. 2006
  48. 48. 51Hypertension ControlVery poor control of hypertension world wide•In Egypt 23.9% were receiving treatment & 8%controlledIbrahim et al.•In Canada 15.8% had blood pressure treated andcontrolledPetrella et al, 2007•In Saudi Arabia, 76 % were receiving treatment, but only20% were found controlledAbolfotouh et al,
  49. 49. 52Measurement of Blood Pressure•Seated in a quiet room•Arm muscles relaxed•Cubital fossa at heart level•Avoid tight sleeves•Suitable size Cuff to be used•Repeat if BP > 140/90•Measurement on both arms•Mercury sphygmomanometers are most reliableGoodman and Gilmans1993
  50. 50. 53ManagementGood management of hypertension is central to anystrategy formulated to control hypertension at thecommunity level. Randomized trials of drugs thatlower and control blood pressure clearly show areduction in mortality and morbidity.Hussein A. GezairyRegional Director for the Eastern Mediterranean
  51. 51. 54Management2 mmHg reduction in systolic blood pressureis likely to reduce the annual mortality fromstroke, coronary heart disease and all othercauses by 6%, 4% and 3%, respectively
  52. 52. 55ConclusionHypertension is a serious problem that couldbe called "the silent killer". Its prevalence isvery high especially in the GCC countries.Effective efforts ought to be taken in order toprevent, prevent, prevent, preventthen diagnose and treat it.
  53. 53. A Wife is a Wife,no matter whoTHE HELLyou are!!
  54. 54. 58
  55. 55. 59Thankyou
  56. 56. 60Recommended Classification of Hypertension
  57. 57. 61Classification of HypertensionNormal blood pressure for adults is defined assystolic blood pressure below 140 mmHg anddiastolic blood pressure below 90 mmHgProtocol and Guidelines A joint CINDI/EuroPharm Forum project WHO• Mild• Moderate• Severe
  58. 58. 62Category Systolic BP (mmHg) Diastolic BP (mmHg)Optimal < 120 < 80Normal < 130 < 85High-normal 130–139 85–89Grade 1 hypertension (mild) 140–159 90–99Subgroup: borderline 140–149 90–94Grade 2 hypertension (moderate) 160–179 100–109Grade 3 hypertension (severe) ≥ 180 ≥ 110Isolated systolic hypertension ≥ 140 < 90Subgroup: borderline 140–149 < 90Operational classification ofhypertension by blood pressure levelEuropean Society of Hypertension 2003
  59. 59. 63EMR0 Technical Publications Series 29 Clinical guidelinesBPclassificationSystolic BP(mmHg)Diastolic BP(mmHg)Normal <120 and <80Prehypertension 120–139 or 80–89Stage 1hypertension140–159 or 90–99Stage 2hypertension≥160 or ≥100classification that is suggested by theEMRO for adult aged > 18 years
  60. 60. 64Classification according to the extent oforgan damage•hypertension with no other cardiovascular riskfactors and no target organ damage•hypertension with other cardiovascular riskfactors•hypertension with evidence of target organdamage•hypertension with other cardiovascular riskfactors and evidence of target organ damage.Ala Din Alwan WHO, 1996, CINDI/EUROPHARM Forum WHO
  61. 61. 65Clinical assessment of people with hypertensionObjectives•to confirm a persistent elevation of blood pressure•to assess the overall cardiovascular risk•to evaluate existing organ damage or concomitantdisease•to search for possible causes of the hypertension
  62. 62. 66Causes of hypertension•Primary hypertension (95% of cases)•Secondary hypertension*Renal*Drugs*Endocrine*Coarctation of the aorta and aortitis*Pregnancy-induced hypertension
  63. 63. 67The possibility of secondaryhypertension•young age•family history of renal disease•evidence of renal disease•hypertension due to drugs•episodes of sweating, headache, anxiety(phaeochromocytoma)•episodes of muscle weakness and tetany(hyperaldosteronism(
  64. 64. 68Laboratory investigations•urine analysis•plasma creatinine and/or blood urea nitrogen•plasma potassium•random blood glucose•serum cholesterol•heamatocrit•electrocardiogram.•lipidslipoprotein cholesterol•plasma uric acid•chest X-ray•echocardiography.
  65. 65. 69High BP: DBP≥90 and/orSBP≥ 140 mmHgHypertension confirmed Hypertension not confirmedSBP 140-180 mmHg DBP 90-105 mmHgBP <140/90Low CV riskHigh CV riskDBP 90-95 mm HgSBP 140-160 mmHgDBP ≥95 mmHgSBP ≥160 mmHgRepeated measurementsGeneral assessment and evaluation of Check again inCV risk and nonpharmacological six monthsTherapy for 4 weeks*Reinforce nonpharmacologicalTherapy for 3-6 monthsFollow up Follow up Start drug therapy Start drug therapyGuidelines for the diagnosis and management of hypertension
  66. 66. 70
  67. 67. 71Life style Modification• Physical activityExercise lowers systolic and diastolic blood pressure by 5-10mmHgArakawa
  68. 68. 72Measurement of Blood PressureThe "white-coat" effectOf course being a doctor
  69. 69. 73Economic Impact“Since hypertension is associated withcardiovascular disease and diabetes, itsmanagement and control is potentiallycostly".Dr Hussein AlGezairy regional director, WHO
  70. 70. 74Hypertension the Silent KillerProf Faisal A Alnasir FRCGP,MICGP,PhdPresident, Family & Community Medicine Council Arab BoardArabian Gulf UniversityQatar Primary Health Care-20081st International Conference, in Partnership with the WHO
  71. 71. 75Change in Blood Pressure reductionbetween cocoa & Tea

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