3. 0 50 000 100 000 150 000 200 000 250 000 300 000 350 000
China
India
UK
USA
Prevalance
Awareness
Treatment
33%
74% 85%
25%
62% 94%
33% 50% 50%
44.7% 44.7% 67%
Hypertension Prevalence, Awareness, Treatment
Millions
78m
12m
230m
300m
China: Age 35-75. Liu J, Lancet. 2017 Dec 9;390(10112):2549-2558
4. Most with Hypertension in India Are Not Aware
and Hence Not treated
Roy A et al. BMJ Open. 2017;7:e015639. Data for Delhi National Capital Region weighted and applied nationally.
0%
20%
40%
60%
80%
100%
Have high blood
pressure
Aware Treated Controlled
<11%
218M
74M
60M
24M
Barely 1 in 10 of the 218 million
adults with hypertension
in India have it under control
5. WHO Guidance on Hypertension
Advocacy
Surveillance
Capacity
Monitoring
Diagnosis
Assess CVD
risk
Innovations
Essential
Medicines and
Technology
Treatment
Protocol
Data System
Best buys, Global
action plan
CVD, risk factors
-STEP survey
-WHS plus
FDC, Blood Pressure Device, Self care
Risk stratification
Technical
package
-Screen
6. Diagnosis
• Confirmation of hypertension:
– after two visits ideally 1 to 4 weeks apart
• Systolic blood pressure on both days is ≥140 mmHg and/or Diastolic
blood pressure on both days is ≥90 mmHg
• Patients with SBP ≥160 mmHg or DBP ≥100 mmHg may be
indicated for immediate treatment based on one assessment
6
7. Essential technology (device and lab)
Blood
pressure
measurement
device,
Stethoscope
Weighing
scales
Measuring
tapes
Urine albumin
strips
Urine ketones
test strips
Glucometer,
blood glucose
test strips
Blood
cholesterol,
electrolyte,
creatinine,
ECG
Challenges at PHC at low resource settings
-Affordable technology blood pressure measuring devices for low resource settings,
WHO 2005
9. Challenges in Diagnosis
9
Three sources of error in the
measurement of blood pressure (AHA)
• Observer bias
• Faulty equipment
• Failure to standardize the technique of
measurement
Diagnosis confirmation
10. 10
Three sources of error in the
measurement of blood pressure (AHA)
• Observer bias
• Faulty equipment
• Failure to standardize the technique of
measurement
11. • Raise the pressure to 30mm above pulse palpation
• Lower at 2mm/sec (faster rate: lower SBP and higher DBP)
• Terminal digit preference: rounding off to the zero: over
estimation
Common errors….
*Office blood pressure measurement practices among community health providers (medical and paramedical) in northern district of India; Bishav
Mohan a,*, Naved Aslam a, Upma Ralhan b, Sarit Sharma et al, India Heart Journal 6 6 ( 2 0 1 4 ) 4 0 1 -4 0 7
12. 12
Three sources of error in the
measurement of blood pressure (AHA)
• Observer bias
• Faulty equipment
• Failure to standardize the technique of
measurement
13. • The best equipment????
• Calibration interval
Common errors….*
14. 14
Three sources of error in the
measurement of blood pressure (AHA)
• Observer bias
• Faulty equipment
• Failure to standardize the
technique of measurement
15. • Supporting the arm: lower SBP/DBP by 11 and 12mm as compared to unsupported arm
• Right cuff sizes: if small (obese people) SBP can rise by 8mm
• Resting the patient: food, cold weather, stress, activity, coffee, tobacco
• Auscultation: 1st appearance of sound: systolic
• Complete disappearance of sound: diastolic
Common errors….
16. Common errors….
• Minimum two readings
• Sitting is better than supine: 3mm SBP raised and 3mm
DBP lowered in supine
• Centre of the bladder: Heart level: Increases if above,
decreases if below that
16
18. Objectives of the workshop
• Present the available guidelines and preliminary progress on guidance
updating
• Solicit practical country-level inputs from representatives on the most
suitable devices for different levels of health care
• Purchasing and maintaining blood pressure devices at different levels
of health care provision
18
Despite the heavy burden of illness and death from hypertension, many countries have been slow to respond. Just over half with HTN know they have it and just 1 in 7 globally have it under control. These proportions are significantly higher in LMICs. Yet HTN is probably the easiest to treat and effective treatment is available and can be relatively inexpensive.
Invest 1 USD on drug therapy and counselling to high CVD risk, return 3.29 USD
High blood pressure, according to the WHO-ISH guidelines, includes both hypertension (defined as 140/90 mmHg or above) and ``high normal'' (between 130/85 mmHg and 140/90 mmHg). The WHO-ISH guidelines class optimal blood pressure as less than 120/80 mmHg, 105/60
BP> From Mercury, to Aneroid, to Electronic. Cost of essential technology, point of care, validation