A brief Presentation on the topic "Hypertension" filled with research based on North East India.

1. Hypertension
20068 & 20069

2. What is Hypertension?
Hypertension, or high blood pressure (above 129mmHg Systolic &
84mmHg Diastolic), is a medical condition characterized by elevated
blood pressure in the arteries, increasing the risk of heart disease and
stroke.

3. Classification of Hypertension
Hypertension is classified based on the severity of blood pressure readings:
Normal
120-129 mmHg Systolic
89-89 mmHg Diastolic
High Normal
130-139 mmHg Systolic
85-89mmHg Diastolic
Hypertension Grade 1
140-159 mmHg Systolic
90-99 mmHg Diastolic
Hypertension Grade 2
160-179 mmHg Systolic
100-109 mmHg Diastolic
Hypertension Grade 3
>180 mmHg Systolic
>110 mmHg Diastolic
Isolated Systolic Hypertension
>140 mmHg Systolic
< 90 mmHg Diastolic
Optimal
<120 mmHg Systolic
<80 mmHg Diastolic

4. Classification of Hypertension
Hypertension is classified as
1. Primary Hypertension
• It is the most common form of hypertension and is not caused by any specific underlying medical
condition. It is believed to develop gradually over time due to a combination of genetic, lifestyle,
and environmental factors.
• Primary hypertension accounts for about 90-95% of all hypertension cases. Some of the risk
factors associated with primary hypertension include age, family history, obesity, sedentary
lifestyle, excessive alcohol consumption, and high salt intake.
2. Secondary Hypertension
• Secondary hypertension accounts for the remaining 5-10% of hypertension cases and is a result
of an underlying medical condition such as kidney disease, thyroid disorders, or sleep apnea.
• Proper diagnosis and treatment of the underlying condition often leads to improved blood
pressure control.

5. Causes of Hypertension
Hypertension can be caused by several factors

6. Primary Hypertension
• Genes
• Physical Changes
• Environment

7. Secondary hypertension
• Kidney diseases
• Obstructive sleep apnea
• Congenital heart defects
• Side effects of medication
• Use of illegal drugs or alcohol abuse
• Adrenal gland problem

8. Prevalence of Hypertension
in India
Hypertension is a major health concern in India, affecting more than 200
million adults. It is more prevalent in urban areas and increases with age

9. Prevalence of Hypertension In India 2019
-2023 (Gender wise)

10. Prevalence of Hypertension In India
2015-2016 (State wise)

11. Pattern of Hypertension among different
religions
(Based on National Family Health Survey - 5 (2020-2021))

12. Prevalence of Hypertension in Mizoram
• Mizoram has one of the highest rates of hypertension in the country, primarily attributed to
changing lifestyle, stress, and genetic predisposition.
• According to a research published in 2018 a data was taken from 12,313 subjects (male: 5707,
female: 6606) from urban (n = 5853) and rural (n = 6460) localities.
• Prevalence of HTN was 15.9% with significant urban–rural (18.9% versus 13.2%) and gender
variation (18.2% versus 13.9%).
• Logistic regression** analysis in the overall (rural and urban) model was carried out, which
revealed that age, extra salt (salt as a side dish), tuibur, high BMI and sedentary lifestyle were
independently associated with HTN
**Logistic regression is a statistical analysis method to predict a binary outcome, such as yes or no,
based on prior observations of a data set.

13. Risk Factors

14. Non-modifiable Risk Factor
The non-modifiable risk factors for hypertension include age, family history of hypertension, and ethnicity.
Age
Age is a significant non-modifiable risk factor
for hypertension, as the risk tends to increase
with age. The older a person gets, the more
likely they are to develop high blood pressure.
It is important for individuals of all ages to
monitor and maintain healthy blood pressure
levels.
Sex
Sex is another non-modifiable risk factor for
hypertension. Generally, men are more likely
to develop high blood pressure compared to
women until women reach menopause. After
menopause, the risk becomes similar for both
sexes.
Genetic Factors
Genetic factors also play a role in the
development of hypertension. People with a
family history of high blood pressure are more
likely to develop the condition themselves.
Understanding your family history and
discussing it with your healthcare provider can
help identify potential risk factors and enable
appropriate preventive measures to be taken.
Ethnicity
Ethnicity is another non-modifiable risk factor
for hypertension. Studies have found that
certain ethnic groups, such as African
Americans and Hispanic Americans, have a
higher prevalence of hypertension compared
to Caucasian Americans. Therefore, it is
important for individuals to be aware of their
ethnicity and take appropriate steps to monitor
and control their blood pressure.

15. Modifiable Risk Factors
In addition to non-modifiable risk factors, there are also several modifiable risk factors that can contribute
to the development of hypertension. These include lifestyle choices such as smoking, excessive alcohol
consumption, poor diet high in sodium and low in potassium, sedentary behavior, and obesity. Addressing
these modifiable risk factors through lifestyle modifications can significantly reduce the risk of developing
hypertension and its complications.

16. Modifiable Risk Factors
• Obesity
Excess body weight places an
additional strain on the heart
and blood vessels, leading to
elevated blood pressure.
Losing as little as 5 to 10
percent of one's body weight
can lead to significant
reductions in blood pressure
and improve overall
cardiovascular health.
• Salt Intake
High sodium intake can also
have a negative impact on
blood pressure. It is
recommended to limit sodium
intake to less than 2,300 mg
per day, which can be achieved
by reducing the amount of
processed and packaged foods
consumed and increasing
intake of fresh fruits and
vegetables.
• Saturated Fat
Eating less saturated
fat can improve heart
health. Choose lean
proteins like fish and
chicken, and limit red
meats and full-fat dairy.

17. Modifiable Risk Factors
• Alcohol
Excessive alcohol
consumption is associated
with high blood pressure. It
is recommended to limit
alcohol intake to moderate
levels, which is defined as
up to one drink per day for
women and up to two drinks
per day for men. By
reducing alcohol
consumption, individuals can
significantly lower their risk
of developing hypertension
and its complications.
• Heart Rate
Another modifiable risk factor
for heart health is heart rate. A
high resting heart rate is often
associated with an increased
risk of cardiovascular
diseases. Engaging in regular
aerobic exercise can help
lower resting heart rate and
improve overall heart health.
• Environmental Stress
Creating a supportive and
calm environment can help
reduce environmental
stress and positively impact
heart health. This can be
achieved through practices
such as creating a peaceful
living space, engaging in
stress-relief activities like
meditation or yoga, and
ensuring sufficient sleep
and relaxation. By
managing environmental
stress, individuals can
promote a healthier heart
and overall well-being.

18. Modifiable Risk Factors
• Socio-economic Status
Socio-economic status is
another modifiable risk factor
that can influence heart health.
Lower socio-economic status
is often associated with limited
access to healthcare,
unhealthy lifestyle behaviors,
and increased stress levels, all
of which can contribute to an
increased risk of heart
disease. By addressing social
and economic inequalities and
improving access to resources
and opportunities, we can
work towards reducing the
impact of socio-economic
status on heart health.
• Dietary Fibres
Dietary fibers play an
important role in maintaining
heart health. They have
been shown to help lower
cholesterol levels, regulate
blood sugar levels, and
support a healthy weight, all
of which contribute to a
reduced risk of heart
disease. Including foods rich
in dietary fibers such as
whole grains, fruits,
vegetables, and legumes
can greatly benefit heart
health and overall well-
being.
• Saturated Fat
Another modifiable risk
factor that can impact heart
health is saturated fat in the
diet. Consuming a diet high
in saturated fat can lead to
high cholesterol, which is a
major risk factor for heart
disease. By choosing foods
low in saturated fat, such
as lean proteins, fruits, and
vegetables, individuals can
improve their heart health
and reduce their risk of
developing heart disease.

19. Symptoms
Hypertension is often called the "silent killer" as it rarely causes noticeable symptoms.
However, uncontrolled hypertension can lead to serious complications such as heart attacks, strokes,
heart failure, and kidney disease.
These can include
• Severe headaches
• Shortness of breath
• Nosebleeds
• Visual disturbances

20. Diagnosis of Hypertension
Diagnosing hypertension involves measuring blood pressure using a
sphygmomanometer and looking for consistent high readings. Additional
tests may be performed to determine the cause and assess organ
damage.

21. "Rule of Halves"
The "rule of halves" is a term used to describe the fact that only half of those with hypertension are aware
of their condition. Of those who are aware, only half receive treatment. And of those who are treated, only
half have their blood pressure under control. It is important for individuals to regularly monitor their blood
pressure and seek medical attention if needed to prevent complications.

22. Pictorial description of rule of halves as
applied to urban adult population of
Boileauganj, Shimla

23. Laboratory Examinations
• Electrocardiogram
• Serum Potassium, Creatinine and Calcium
• Lipid Profile
• Blood Glucose

24. Sources of errors in measuring
Hypertension
1. Observers error
1. Hearing acuity
2. Interpretation of Korotkoff sounds*
2. Instrumental error
1. Leaking valve
2. Cuff that do not encircle the arm
3. Size of cuff
3. Subject error
1. Circumstances of examination
2. Position of subject
3. External stimuli such as fear, anxiety, etc.
*Korotkoff sounds are generated when a blood pressure cuff changes the flow of blood through the artery.

25. Preventive Measures
Preventing hypertension involves implementing healthy
lifestyle habits, such as maintaining a balanced diet,
engaging in regular physical activity, reducing stress,
avoiding tobacco and excessive alcohol consumption, and
regular check-ups.

26. Preventive Measures
1. Primary Prevention
It has been defined as "all measures to reduce the incidence of disease in a population by reducing the
risk of onset"
Primary Prevention efforts for hypertension include educating the public about the importance of
maintaining a healthy lifestyle, promoting awareness of risk factors, and implementing programs that
promote early detection and management of the condition.
(a) Population Strategy
Population strategy involves targeting the entire population and educating them about the healthy
behaviors that can reduce the risk of developing hypertension. This approach may involve public health
education campaigns, regulating food and beverage labeling, and creating smoke-free environments.
(b) High-Risk Strategy
High-Risk Strategy, on the other hand, involves identifying individuals who are at an increased risk of
developing hypertension due to pre-existing health conditions or lifestyle factors, and taking appropriate
measures to manage their risk. This approach may involve regular blood pressure monitoring, lifestyle
counseling, and medication when necessary.

27. Preventive Measures
2. Secondary Prevention
Secondary Prevention focuses on early detection and intervention for individuals who already have high
blood pressure. This includes regular screenings, lifestyle modifications such as exercise and diet
changes, and medication management to prevent further complications and control blood pressure
levels. Additionally, promoting regular follow-ups and adherence to treatment plans are crucial in this
preventive measure.

28. Preventive Measures
i. EARLY CASE DETECTION
• Early Case Detection is vital in Secondary Prevention of hypertension.
• It is crucial to conduct regular screenings and tests for individuals who are at risk of developing high blood pressure.
• This measure helps detect hypertension at an early stage, which can lead to timely interventions and reduced risk of
complications.
ii. TREATMENT
• Treatment in Secondary Prevention involves a combination of lifestyle modifications and medication management.
• Lifestyle modifications may include regular exercise, a healthy diet low in sodium and high in fruits and vegetables, and
stress management techniques.
• Medication management may involve the use of antihypertensive drugs to help control blood pressure and reduce the risk
of further complications.
iii. PATIENT COMPLIANCE
• Patient compliance is crucial in the success of secondary prevention efforts for hypertension.
• It is essential for patients to adhere to their prescribed treatment plans, including taking medication as directed and
making lifestyle modifications.
• Regular communication and education about the importance of compliance can help ensure that patients are actively
involved in their own care and are maximizing the benefits of secondary prevention measures.

29. Treatment Options for Hypertension
Treatment aims to lower blood pressure and manage the underlying causes. It may include lifestyle
modifications, such as a healthy diet, regular exercise, stress management, and medication if necessary.
In some cases, lifestyle changes alone may be sufficient to manage hypertension.
However, if blood pressure remains elevated despite these modifications, medication may be necessary.
There are various types of antihypertensive drugs available, including diuretics, beta-blockers, ACE
inhibitors, and calcium channel blockers.
These medications work by different mechanisms to relax blood vessels, reduce the volume of blood, or
decrease the force of the heart's contraction, ultimately helping to lower blood pressure.

30. Complications
Some complications of Hypertension are:
• Coronary Heart Disease
• Left Ventricular Hypertrophy
• Stroke
• Retinal Damage
• Dissection of Aorta
• Organ Damage

31. National Programs on
Hypertension
The Government of India has implemented various programs to tackle
hypertension, including the National Programme for Prevention & Control
of Non-Communicable Diseases (NP-NCD) and the National Salt
Reduction Program.

32. National Programme for
Prevention and Control of
Non Communicable
Diseases (NP-NCD)

33. NP-NCD
• The National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) was
launched in India in 2010 to tackle non-communicable diseases, including hypertension.
• The program aims to improve prevention, management, and control of diseases like hypertension through
increased awareness, early detection, and better treatment options.
• The NP-NCD also focuses on promoting healthy lifestyles and reducing risk factors for hypertension.
• The program includes initiatives such as creating awareness campaigns, educating healthcare
professionals, and implementing strategies for salt reduction in processed foods.
• Additionally, the NP-NCD provides training for healthcare providers to improve their capacity in diagnosing
and managing hypertension effectively.
• Through these measures, the government of India aims to reduce the burden of hypertension and its
associated complications on the population.

34. National Salt Reduction Program
Implementing the National Salt Reduction Program is a key strategy in reducing dietary salt intake, which
is a major risk factor for hypertension.
This program aims to create awareness about the dangers of high salt consumption and promote the use
of low-sodium alternatives.
By encouraging individuals to make healthier food choices, the National Salt Reduction Program can
contribute to the prevention and control of hypertension in India.
Furthermore, the program will also collaborate with food manufacturers and industries to develop and
promote low-salt products.
This will provide individuals with more options to choose from and make it easier for them to reduce their
sodium intake.
Overall, the National Salt Reduction Program is a comprehensive approach that addresses both
individual behavior change and systemic changes in the food industry to combat hypertension.

35. Conclusion and
Recommendations
• Hypertension is a serious health condition with far-reaching
consequences.
• It is essential to raise awareness, prioritize prevention, and ensure
timely diagnosis and management to reduce the burden of
hypertension-related complications.

36. Reference
1. Park's Textbook of Preventive and Social Medicine - 27th Edition
2. Statistica (https://www.statista.com/statistics/1336587/india-prevalence-of-hypertension-by-age-
and-gender/)
3. Prevalence and risk factors of hypertension among Mizo population (Prasanta K. Borah,
Suman K. Paine, Hem Ch Kalita, Dipankar Biswas, Dilip Hazarika, Chandra K. Bhattacharjee
and Jagadish
Mahanta)https://www.jstor.org/stable/26978527#:~:text=Prevalence%20of%20HTN%20was%201
5.9%25%2C%20which%20showed%20significant%20gender%20variation,in%20urban%20than%
20rural%20subjects
4. Hypertension: Muslims suffer the least whereas Sikhs suffer the most; know its causes and
preventions (https://www.indiatvnews.com/health/hypertension-muslims-suffer-least-whereas-
sikhs-suffer-the-most-know-causes-and-prevention-2022-05-17-777163)
5. Application of "rule of halves" in an urban adult population, Himachal Pradesh: A study
from North India (Kanica Kaushal, Anjali Mahajan, S. R. Mazta, Department of Community
Medicine, IG Medical College, Shimla, Himachal Pradesh,
India)https://www.researchgate.net/publication/290789690_Application_of_rule_of_halves_i
n_an_urban_adult_population_Himachal_Pradesh_A_study_from_North_India )

37. Thank You