There are numerous factors that affect blood pressure in a healthy state such as: Cardiac output, total blood volume, Compliance and Elasticity of blood vessels.
Source WHO, “Global health risks: Mortality and burden of disease attributable to selected major risks.,” World Health Organization, Geneva, Switzerland, 2009 At young ages, hypertension is more prevalent in males compared to females; and in older ages, it is more prevalent amongst women compared to men Men’s greater exposure to risk factors comes from: tobacco and harmful use of alcohol; their lower use of preventative health care; and weaker social ties relative to women – however women are becoming increasingly exposed to such factorsThe poorest people in low- and middle-income countries are affected most. At the household level, sufficient evidence is emerging to prove that CVDs and other non-communicable diseases contribute to poverty due to catastrophic health spending and high out-of-pocket expenditure.
Causes 7.5 million deaths each year, or 13% of all deaths, globally. The World Health Report 2002 estimates that over 50% of coronary heart disease and almost 75% of stroke in developed countries is due to systolic blood pressure levels over the theoretical minimum (115mmHg).
Prevalence of hypertension increases across all age groups throughout all regions. 29.2% of adults are projected to have hypertension by 2025 (29.0% of men and 29.5% of women respectively).
Men are more affected than women(29.0% of men and 29.5% of women respectively have hypertension).
A wide range of factors contribute to raised blood pressure Diet high in saturated fatExcessive salt consumptionOverweight and obesitySedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressFamily history of raised blood pressureBeing over 65 years oldCo-morbidities such as diabetes
A healthy diet entails reducing salt intake to less than 5g/person/day, replacing trans fats with polyunsaturated fats in processed foods, and reduce fat consumption.In addition, promoting increased physical activity through daily activities and improved support or health in the school and workplace setting contribute to lowering blood pressure in the population.It should be a public health policy aim to increase the identification and treatment of at risk raised blood pressure patients.
In high-income countries, widespread diagnosis and treatment with low-cost medication have significantly reduced mean blood pressure across populations – and this has contributed to a reduction in deaths from heart disease. With populations aware of their blood pressure measurement and the steps which can reduce it, significant advances can be made at low cost to reduce blood pressure across populations.
BLOOD PRESSURE- WORLD HEALTH DAY 2013
Blood Pressure• Blood pressure is the force exerted by blood against the vessel wall.• BP is measured in millimeters of mercury ( mmHg).• Normal BP = 120/80 mmHg.
Blood PressureSystolic BP =pressure or force exerted on the vessel wall byflow of blood due to contractions of the heart (systole).Systolic refers to the pressure of the blood when theheart beats to pump it out.Diastolic BP = Pressure when the heart is resting(relaxation/diastole).Diastolic refers to the pressure of the blood when theheart rests in between beats
HYPERTENSION• Hypertension is defined as systolic blood pressure (SBP) of 140 mmHg or greater, diastolic blood pressure (DBP) of 90 mmHg or greater. 8 JNC, 2007
Classification of BPBP Classification Systolic BP Diastolic BP (mmHg) and (mmHg)Normal <120 <80Prehypertension 120-139 or 80-89Stage 1 140-159 or 90-99Stage 2 > 160 or > 100Systolic HTN > 160 <90• Patients with prehypertension, increased risk for progression to hypertension;• 130/80 to 139/89 mm Hg BP range, twice the risk to develop hypertensionThe JNC 7 Report: JAMA, 2003; 289: 2560-2572
What is high blood pressure?• A blood pressure reading above 130/80 mmHg is considered high. High blood pressure is commonly an asymptomatic condition, often known as “the silent killer”.• Blood pressure measurements indicate how strongly blood presses against arterial walls as it is pumped around the body by the heart.
Key facts on high blood pressure• Affects one in three adults worldwide• Affects men more than women• Affects poorer populations more than others• Is implicated in 13% of deaths worldwide• Is identified in WHO’s Health 2020 policy as one of the WHO European Region’s major contributors to disease
Why high blood pressure is a public health concern• High blood pressure strains the arteries and heart raising the probability of heart attack, stroke and kidney disease.• High blood pressure can lead to hypertension.• Hypertension is diagnosed if readings on separate occasions consistently show blood pressure to be 140/90 mmHg or higher.• Hypertension is identified as the world’s most prevalent preventable disease in WHO’s Health 2020 policy.
HIGH BLOOD PRESSUREHigh blood pressure – also known as raisedblood pressure or hypertension – increases therisk of heart attacks, strokes and kidney failure.If left uncontrolled, high blood pressure canalso cause blindness, irregularities of theheartbeat and heart failure.
HIGH BLOOD PRESSUREThe risk of developing these complications is higher in thepresence of other cardiovascular risk factors such asdiabetes.One in three adults worldwide has high blood pressure.The proportion increases with age, from 1 in 10 people intheir 20s and 30s to 5 in 10 people in their 50s.
HIGH BLOOD PRESSUREPrevalence of high bloodpressure is highest in some low-income countries in Africa, withover 40% of adults in manyAfrican countries thought to beaffected.
Hypertension is the most prevalent chronic disease in India.The prevalence of hypertension in India is low compared to world figures. In India, 23.10 per cent men and 22.60 per cent women over 25 years old suffer from hypertension,says the World Health Organisation’s ‘global health statistics 2012’ . India also fares better than the global average of 29.20 in men and 24.80 in women.
The prevalence of hypertension ranges from 20-40% in urban adults and 12-17% among rural adults.The number of people with hypertension is projectedto increase from 118 million in 2000 to 214 million in2025, with nearly equal numbers of men and women.
HTN Prevalence in India Recent (2012) studies show that for every known person with hypertension there are two persons with either undiagnosed hypertension or prehypertension Increased blood pressure is a high-risk conditionthat causes approximately 51 per cent deaths from stroke and 45 per cent from coronary artery disease in India.
THE MYTH• “Patients fear anti-hypertensive medications due to side effects or getting addicted to tablets.• But side effects from anti-hypertensive medications are rare and often not serious.” THE REALITY• On the contrary, if hypertension is not fought, it can result in serious diseases, some of them fatal
STUDY ANALYSIS53.30 per cent were awareof their diagnosis; 42.80per cent were takingtreatment and only 10.50per cent had controlled BP.
DYSMETABOLIC SYNDROME• Elevated waist circumference: Men — greater than 90 cms Women — greater than 80 cms• Elevated triglycerides: Equal to or greater than 150 mg/dL• Reduced HDL ("good") cholesterol: Men — Less than 40 mg/dL Women — Less than 50 mg/dL• Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension• Elevated fasting glucose: Equal to or greater than 100 mg/dL or use of medication for hyperglycemia
Risk factors for high blood pressure• A diet high in saturated fat• Excessive salt consumption• Overweight and obesity• A sedentary lifestyle and lack of exercise• Excessive alcohol consumption• Smoking• Un-managed stress• A family history of high blood pressure• Being over 65 years of age• Co-morbidities such as diabetes
Hypertension : Symptoms & Signs No specific symptoms ( detected on routine check-up).( SILENT KILLER) Headache: Morning localised to occipital region.Others : Dizziness, Palpitation, Easy fatigability, epistaxis, haematuria, blurring of vision.
Types of hypertension• Essential / Primary/ Idiopathic hypertension – 90% – No underlying cause• Secondary hypertension – Underlying cause
InvestigationsBasic Tests CBC Urine : protein. Microscopic analysis. LFT : S cholesterol etc RFT : S creatinine , BUN ECG Chest X-ray. Blood sugar : Fasting/ PP Ophthalmoscopy Special Tests ( Sec HT)
Benefits of BP reduction 35% to 40% mean reductions in stroke incidence 20% to 25% in myocardial infarction more than 50% in HFThe JNC 7 Report: JAMA, 2003; 289: 2560-2572
Manage high blood pressure by: eating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumption managing stress having regular blood pressure checks
Lifestyle Modifications to Prevent and Manage Hypertension• Reduce weight • Moderate consumption of: • alcohol • sodium • saturated fat • cholesterol • Maintain adequate intake of dietary: • Increa • potassium se • calcium physic • magnesium al activity • Avoid tobacco(JNC VI. Arch Intern Med. 1997)
LIFESTYLE CHANGESFor some people, lifestyle changes are sufficient to controlblood pressure such as stopping tobacco use, eating healthily,exercising regularly and avoiding the harmful use of alcohol.Reduction in salt intake can help.For others, these changes are insufficient and they needprescription medication to control blood pressure
WEIGHT LOSSmaintaining a normalweight: every 5 kg ofexcess weight lost canreduce systolic bloodpressure by 2 to 10 points.
Drugs used to control hypertensionDrug Class ExampleDiuretics Hydrochlorothiazide-blockers MetoprololCa – Channel AmlodipineblockersACE- inhibitors BenazeprilARBs Valsartanα blockers Prazosin
The WHO responseThe WHO Health 2020 policy identifies high blood pressureas a major contributor to disease, and hypertension as theworld’s most prevalent preventable disease.High blood pressure is the theme of World Health Day2013, with a particular emphasis on reducing dietary saltintake.
WHO’s current European policyPriority interventions of the action plan fornoncommunicable diseases 2012-2016 include:• promotion of a healthy diet through marketing and fiscal measures• elimination of trans fats• salt reduction• cardio-metabolic risk reduction assessment and management• promotion of physical activity and mobility
Key interventions• Encourage regular blood pressure checks• Encourage patients to be aware of their individual risks• Establish effective tools for early identification, management and control• Promote physical activity, dietary improvement and salt reduction• Provide low-cost antihypertensive medication• Set target for mean blood pressure reduction levels across populations