Hypertension the Silent Killer
Epidemiology
Prof Faisal A Alnasir FRCGP, MICGP, FFPH, PhD
President, Family & Community Me...
2
Hypertension
• Common
• Non Communicable disease
• Inevitable
• Preventable
• Serious complication
3
WHO estimated that high blood pressure
causes one in every eight deaths, making
hypertension the third leading killer in...
4
5
Size of the problem
1-World wide
• In 2010, 1.2 billion people were expected to be suffering from
hypertension worldwide...
6
Size of the problem
2-In the Eastern Mediterranean Region
• The average prevalence of hypertension 26% and it affects
ap...
7
Size of the problem
In Bahrain
National Non-communicable Diseases Risk Factors Survey 2007
8
Size of the problem
In Bahrain
National Non-communicable Diseases Risk Factors Survey 2007
In Lebanon
•23.1% are hypertensive
•Prevalence increases with age
•Occurs more in the less educated and unemployed
•Preval...
10
Size of the problem
In Saudi Arabia:
The prevalence range from 4% to 15%.
Abolfotouh MA et al.
It may reach as high as ...
In Sudan
 of 6-12y children:
4.9% were pre-hypertensive and
4.9% were hypertensive
Salman Z, et al 2010
12
Size of the problem
It has been estimated that individuals who are
normotensive at the age 55 years have a 90%
lifetime...
13
Awareness of Hypertension
Although the prevalence of high blood pressure is high,
there is a low awareness rate (Up To ...
Awareness of Hypertension
Faisal Alnasir, 2004
15
Awareness of Hypertension
In Egypt only 37.5% of hypertensives were aware of
Having it.
In United States, Chile, and Cu...
16
Advantage of Controlling Hypertension
•A 5-6 mmHg reduction in diastolic BP reduces stroke by 40%.
Joint National Commi...
17
Economic Impact
The economic burden of chronic NCDs can
be analyzed on two levels.
•First, the effects of macroeconomic...
18
Economic Impact
Direct Cost:
Including prescribing medicines, inpatient visits,
outpatient visits, emergency room visit...
19
Economic Impact
•Poor are disproportionately affected
•more vulnerable
•Prevalence 6 time more in uneducated
•Medicatio...
20
Economic Impact
In Alkhobar the total direct cost of hypertension
care for patients registered in the primary health
ca...
21
Prevention
Primary prevention is the most cost-effective
approach to containing the emerging
hypertension epidemic.
Hus...
22
Prevention
Incidence of hypertension was reduced by 20% to
50% if primary prevention were implemented
Stamler 1991
For ...
23
Prevention
Life style Modification:
•perform aerobic exercise
•maintain a healthy body weight
•follow a healthy diet
•r...
24
Modification Recommendation Approximate systolic BP
reduction
Weight reduction Maintenance of normal body weight 5–20 m...
25
Life style Modification
• Weight reduction
Every 1 kilogram of weight loss lower blood pressure by
1.6/1.1 mmHg
Khatib ...
26
Prevalence of overweight and obesity among
some countries of the Eastern Mediterranean
Region (WHO.2004)
Country Overwe...
In Bahrain
National Non-communicable Diseases Risk Factors Survey 2007
In Sudan
 of 6-12y children:
45 (14.8%) were overweight; 32 (10.5%)
were obese
Salman Z et al 2010
29
30
Life style Modification
• Eating habits
31
32
Life style Modification
• Physical activity
Exercise lowers systolic and diastolic blood pressure
by 5-10 mmHg
Arakawa
33
Life style Modification
• Physical activity
National Non-communicable Diseases Risk Factors Survey 2007
34
Life style Modification
• Sodium moderation
Reducing dietary sodium intake to no more than 100 mEq/L
)2.4g sodium or 6 ...
35
Life style Modification
• Diabetes
(In Bahrain)
National Non-communicable Diseases Risk Factors Survey 2007
36
Life style Modification
• Diabetes
(In Bahrain)
37
Life style Modification
• Tobacco
)In Bahrain)
National Non-communicable Diseases Risk Factors Survey 20
-Lipids
39
Life style Modification
• Lipids
(In Bahrain)
National Non-communicable Diseases Risk Factors Survey 20
40
Life style Modification
• Cocoa ingestion
100g/day of chocolate
drink reduces the systolic BP and
diastolic BP
Taubert ...
41
Blood Pressure Pooled Change (mm Hg) P
Cocoa
Systolic -4.7 .002
Diastolic -2.8 .006
Tea
Systolic 0.4 .63
Diastolic -0.6...
42
Change in Blood Pressure reduction
between cocoa & Tea
Taubert et al 2007
“The magnitude of the hypotensive effects of ...
Chocolate and Coronary Heart Disease: A Systematic Review
This article reviews current evidence on the effects of cocoa/ch...
44
Measurement of Blood Pressure
The "white-coat" effect
Prevalence of white coat hypertension
was 3.6% overall and 12.8% ...
45
Measurement of Blood Pressure
The "white-coat" effect
Prevalence of white coat hypertension
was 3.6% overall and 12.8% ...
46
Measurement of Blood Pressure
The "white-coat" effect
Prevalence of white coat hypertension
was 3.6% overall and 12.8% ...
47
Hypertension Control
Very poor control of hypertension world wide
•In Egypt 23.9% were receiving treatment & 8%
control...
48
Measurement of Blood Pressure
•Seated in a quiet room
•Arm muscles relaxed
•Cubital fossa at heart level
•Avoid tight s...
49
Management
Good management of hypertension is central to any
strategy formulated to control hypertension at the
communi...
50
Management
2 mmHg reduction in systolic blood pressure
is likely to reduce the annual mortality from
stroke, coronary h...
51
Conclusion
Hypertension is a serious problem that could
be called "the silent killer". Its prevalence is
very high espe...
52
Conclusion
Hypertension is a serious problem that could
be called "the silent killer". Its prevalence is
very high espe...
53
Conclusion
Hypertension is a serious problem that could
be called "the silent killer". Its prevalence is
very high espe...
54
Thank
you
55
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د فيصل الناصر

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د فيصل الناصر - Faisal Alnasir is a Professor and Chairman at Dept Of Family & Community Medicine at Arabian Gulf University.
http://www.faisalalnasir.com

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د فيصل الناصر

  1. 1. Hypertension the Silent Killer Epidemiology Prof Faisal A Alnasir FRCGP, MICGP, FFPH, PhD President, Family & Community Medicine Council Arab Board Chairman, Department of Family & Community Medicine Arabian Gulf University
  2. 2. 2 Hypertension • Common • Non Communicable disease • Inevitable • Preventable • Serious complication
  3. 3. 3 WHO estimated that high blood pressure causes one in every eight deaths, making hypertension the third leading killer in the world. Globally, there are one billion hypertensives and four million people die annually as a direct result of it. Hussein A. Gezairy Regional Director for the Eastern Mediterranean
  4. 4. 4
  5. 5. 5 Size of the problem 1-World wide • In 2010, 1.2 billion people were expected to be suffering from hypertension worldwide Sixth report of the Joint National Committee on prevention,1997 • Expected to increase to 1.56 billion by 2025 International 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 untreated hypertension (68.6%), and only 15.8% had blood pressure treated and controlled.
  6. 6. 6 Size of the problem 2-In the Eastern Mediterranean Region • The average prevalence of hypertension 26% and it affects approximately 125 million individuals. • Each year, there are several million new cases of hypertension and more of pre-hypertension Report on the regional consultation on hypertension UAE, 2003
  7. 7. 7 Size of the problem In Bahrain National Non-communicable Diseases Risk Factors Survey 2007
  8. 8. 8 Size of the problem In Bahrain National 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 in body mass index particularly in female patients •Only14.7% exercised daily R A Tohme, A R Jurjus, A Estephan 2005
  10. 10. 10 Size of the problem In Saudi Arabia: The prevalence range from 4% to 15%. Abolfotouh MA et al. It may reach as high as 20.4% for systolic hypertension and 25.9% 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.2011 In the UAE: Hypertension has become one of the leading public health problems
  11. 11. In Sudan  of 6-12y children: 4.9% were pre-hypertensive and 4.9% were hypertensive Salman Z, et al 2010
  12. 12. 12 Size of the problem It has been estimated that individuals who are normotensive at the age 55 years have a 90% lifetime risk for developing hypertension. EMR0 Technical Publications Blood pressure is under control in less than 20% of patients with hypertension in many countries A joint CINDI/EuroPharm Forum project WHO
  13. 13. 13 Awareness of Hypertension Although 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 Hypertension Faisal Alnasir, 2004
  15. 15. 15 Awareness of Hypertension In Egypt only 37.5% of hypertensives were aware of Having it. In United States, Chile, and Cub, 32%, 37%, and 39% of the people were not aware. Pan American Health
  16. 16. 16 Advantage 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 cerebrovascular disease 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 mortality from 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 people when taking anti hypertensive medications is decreased by 34%. MacMahon, 1993
  17. 17. 17 Economic Impact The economic burden of chronic NCDs can be analyzed on two levels. •First, the effects of macroeconomic policies on opportunities for prevention in different population groups •Second, the cost and overall efficiency of interventions must be evaluated in terms of effectiveness and health gains for the population at large.
  18. 18. 18 Economic Impact Direct Cost: Including prescribing medicines, inpatient visits, outpatient visits, emergency room visits, office- based medical provider visits, home health visits, and other medical expenses Sanjeev Balu, 2001 Indirect Cost: Productivity loss ($300 per eligible employee per year) absence & short term disability Goetzel (2004), the only study in the U.S.
  19. 19. 19 Economic Impact •Poor are disproportionately affected •more vulnerable •Prevalence 6 time more in uneducated •Medication cost up to US$ 100 per month •further poverty •Cost to Health Services •USA total cost of CVD is 2% of the gross domestic product • direct medical costs estimated at nearly $55.0 billion for the year 2001 Sanjeev Balu, 2001 •Canada 21% of all diseases costs are due to CVD (US$12 billion/Year) direct cost is $3,072 per person per year, and indirect cost is $854 Guijing Wang,2008
  20. 20. 20 Economic Impact In Alkhobar the total direct cost of hypertension care for patients registered in the primary health care represented 6.32% of the estimated cost of treating the expected number of patients. Al-Shahri 1998
  21. 21. 21 Prevention Primary prevention is the most cost-effective approach to containing the emerging hypertension epidemic. Hussein AlGezairy Regional Director for WHO
  22. 22. 22 Prevention Incidence of hypertension was reduced by 20% to 50% if primary prevention were implemented Stamler 1991 For the developing countries prevention of hypertension should be the goal.
  23. 23. 23 Prevention Life style Modification: •perform aerobic exercise •maintain a healthy body weight •follow a healthy diet •restrict salt intake •stress management •limit alcohol consumption
  24. 24. 24 Modification Recommendation Approximate systolic BP reduction Weight reduction Maintenance of normal body weight 5–20 mmHg/10 kg healthy eating plan Consumption a diet rich in vegetables, fruits, and low-fat dairy products with a reduced content of saturated and total fat 8–14 mm Hg Dietary sodium Reduction dietary sodium intake to no more than 2.4 g sodium 2–8 mmHg Physical activity Engagement in regular aerobic physical activity at least 30 minutes daily, most days of the week 4–9mmHg Recommended lifestyle modifications
  25. 25. 25 Life style Modification • Weight reduction Every 1 kilogram of weight loss lower blood pressure by 1.6/1.1 mmHg Khatib et al. EMR0 Technical Publications
  26. 26. 26 Prevalence of overweight and obesity among some countries of the Eastern Mediterranean Region (WHO.2004) Country Overweight/obesity (%) Males Females Saudi Arabia 64.0 70.0 Lebanon 60.0 53.0 Islamic Republic of Iran 57.0 67.7 Bahrain 56.4 79.0 Jordan 46.0 43.7 Egypt 43.8 41.0 Libyan Arab Jamahiriya 42.5 74.9 Oman 40.5 43.5 Morocco 37.2 21.7 United Arab Emirates 25.5 39.9 Tunisia 13.1 41.9 Kuwait 79 56
  27. 27. In Bahrain National Non-communicable Diseases Risk Factors Survey 2007
  28. 28. In Sudan  of 6-12y children: 45 (14.8%) were overweight; 32 (10.5%) were obese Salman Z et al 2010
  29. 29. 29
  30. 30. 30 Life style Modification • Eating habits
  31. 31. 31
  32. 32. 32 Life style Modification • Physical activity Exercise lowers systolic and diastolic blood pressure by 5-10 mmHg Arakawa
  33. 33. 33 Life style Modification • Physical activity National Non-communicable Diseases Risk Factors Survey 2007
  34. 34. 34 Life style Modification • Sodium moderation Reducing dietary sodium intake to no more than 100 mEq/L )2.4g sodium or 6 g sodium chloride), reduces the blood pressure by an average of 4–6 mmHg. Khatib et al. EMR0 Technical Publications
  35. 35. 35 Life style Modification • Diabetes (In Bahrain) National Non-communicable Diseases Risk Factors Survey 2007
  36. 36. 36 Life style Modification • Diabetes (In Bahrain)
  37. 37. 37 Life style Modification • Tobacco )In Bahrain) National Non-communicable Diseases Risk Factors Survey 20
  38. 38. -Lipids
  39. 39. 39 Life style Modification • Lipids (In Bahrain) National Non-communicable Diseases Risk Factors Survey 20
  40. 40. 40 Life style Modification • Cocoa ingestion 100g/day of chocolate drink reduces the systolic BP and diastolic BP Taubert et al 2007
  41. 41. 41 Blood Pressure Pooled Change (mm Hg) P Cocoa Systolic -4.7 .002 Diastolic -2.8 .006 Tea Systolic 0.4 .63 Diastolic -0.6 .38 Change in Blood Pressure reduction between cocoa & Tea Taubert et al 2007
  42. 42. 42 Change in Blood Pressure reduction between cocoa & Tea Taubert et al 2007 “The magnitude of the hypotensive effects of cocoa is in the range that is usually achieved with monotherapy of β-blockers or angiotensin- converting enzyme inhibitors”
  43. 43. Chocolate and Coronary Heart Disease: A Systematic Review This article reviews current evidence on the effects of cocoa/chocolate on clinical and subclinical coronary heart disease (CHD), CHD risk factors, and potential biologic mechanisms.  The high content of polyphenols and flavonoids present in cocoa has been reported to play an important protective role in the development of CHD.  Although studies have demonstrated beneficial effects of chocolate on endothelial function, blood pressure, serum lipids, insulin resistance, and platelet function, it is unclear whether chocolate consumption influences the risk of CHD. Khawaja O et al Current Atherosclerosis Reports, Volume 13 / September 2011
  44. 44. 44 Measurement of Blood Pressure The "white-coat" effect Prevalence of white coat hypertension was 3.6% overall and 12.8% in hypertensive patients. Marquez Contreras et al. 2006
  45. 45. 45 Measurement of Blood Pressure The "white-coat" effect Prevalence of white coat hypertension was 3.6% overall and 12.8% in hypertensive patients. Marquez Contreras et al. 2006
  46. 46. 46 Measurement of Blood Pressure The "white-coat" effect Prevalence of white coat hypertension was 3.6% overall and 12.8% in hypertensive patients. Marquez Contreras et al. 2006
  47. 47. 47 Hypertension Control Very poor control of hypertension world wide •In Egypt 23.9% were receiving treatment & 8% controlled Ibrahim et al. •In Canada 15.8% had blood pressure treated and controlled Petrella et al, 2007 •In Saudi Arabia, 76 % were receiving treatment, but only 20% were found controlled Abolfotouh et al,
  48. 48. 48 Measurement 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 reliable Goodman and Gilman's1993
  49. 49. 49 Management Good management of hypertension is central to any strategy formulated to control hypertension at the community level. Randomized trials of drugs that lower and control blood pressure clearly show a reduction in mortality and morbidity. Hussein A. Gezairy Regional Director for the Eastern Mediterranean
  50. 50. 50 Management 2 mmHg reduction in systolic blood pressure is likely to reduce the annual mortality from stroke, coronary heart disease and all other causes by 6%, 4% and 3%, respectively
  51. 51. 51 Conclusion Hypertension is a serious problem that could be called "the silent killer". Its prevalence is very high especially in the GCC countries. Effective efforts ought to be taken in order to prevent, prevent, prevent, prevent then diagnose and treat it.
  52. 52. 52 Conclusion Hypertension is a serious problem that could be called "the silent killer". Its prevalence is very high especially in the GCC countries. Effective efforts ought to be taken in order to prevent, prevent, prevent, prevent then diagnose and treat it.
  53. 53. 53 Conclusion Hypertension is a serious problem that could be called "the silent killer". Its prevalence is very high especially in the GCC countries. Effective efforts ought to be taken in order to prevent, prevent, prevent, prevent then diagnose and treat it.
  54. 54. 54 Thank you
  55. 55. 55

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