2. Screening for Hypertension
Outline of lecture
• Definition of Hypertension
• Why do we need to screen?
• Risk factors
• How do we screen?
• Who and when do we screen?
• How to lower BP / prevent hypertension
3. Hypertension
Definition
• Hypertension is defined as persistent elevation of systolic BP of
140mmHg or greater and/or diastolic BP of 90 mmHg or greater.
• This definition is based on the average of two or more properly
measured, seated, BP readings on each of two or more clinic visits.
CPG MOH 2013
4. Classification of elevated BP
Classification SBP (mmHg) DBP (mmHg)
Optimal <120 and <80
Prehypertension 120-139 or 80-89
Hypertension
Stage I 140-159 and/or 90-99
Stage II 160-179 and/or 100-109
Stage III ≥180 and/or ≥110
5. Why is it important to screen
for hypertension?
6. What is screening?
• Identification of previously undiagnosed diseases by application
of tests, examinations or other procedures
• Among… apparently healthy populations OR people at high risk
of developing a disease
• Aims to detect early disease before it becomes symptomatic
7. Hypertension in Malaysia
• In 2011, prevalence in adults ≥ 18 years old increased from 32.2% in 2006
to 32.7% (NHMS 2011)
• Men vs Women : 26.3% vs 25%
• 1 in 4 adults aged 25 – 64 years old has hypertension
• 61% of total hypertensive were “undiagnosed”.
• Hypertension is the number one cardiovascular risk factor in Malaysia
(42.6%)
8. Complications of Hypertension
• Heart
• Kidney
• Brain
• Peripheral vasculature
• Eyes
Higher BP Higher chance of complications
10. Classification of Hypertension
Primary (Essential) Hypertension
• Elevated BP with unknown cause
• 90%-95% of all cases
Secondary Hypertension
• Elevated BP with a specific cause
• 5%-10% in adults
11. Primary (Essential) Hypertension
Multifactorial
• Genetics ; family history
• Age (>55 in men, >65 for women)
• Ethnicity (Bumiputera 36.4%,
Malays 34.0%, Chinese 32.3%,
Indians 30.6%)
• Cigarette smoking
• Alcohol
• Excess salt intake
22. Who and when should you
screen for hypertension?
23. Screen…
• Opportunistic – adult patients aged 18 and above
• Screening program – campaigns, awareness
• Patients who are at increased risk for hypertension
• Intervals :
• Yearly for:
• persons with systolic blood pressure of 120 to 139 mmHg or diastolic BP
of 80 to 90 mmHg (pre-hypertension)
• Aged 40 and above
• Every 3 years for:
• Adults between 18 and 39 years whose latest blood pressure
was <130/80 mmHg and have no risk factors for hypertension should be
screened at least every three years.
24. If BP found to be elevated:
• Take complete history:
• Duration and level of elevated BP if known
• Symptoms of secondary causes of hypertension
• Symptoms of target organ complications: heart failure, etc
• Symptoms of CVD : chest pain, dyspnea, etc
• Family history : HPT, CHD, stroke, DM, renal disease, dyslipidaemia
• Diet history
• Drug history
• Lifestyle and environmental factors
31. How to lower your BP
Dietary changes (DASH diet) :Dietary Approaches to Stop
Hypertension
• restrict salt intake (less than 6g of salt = 1 teaspoonfuls of salt)
32. How to lower your BP
DASH diet
• Emphasizes on vegetables, fruit and low-fat dairy foods — and
moderate amounts of whole grains, fish, poultry and nuts
34. How to lower your BP
• Ideally, refrain from alcohol
• Restrict alcohol intake : no more than 21 units for men and 14
units for women per week (1 unit = ½ pint of beer = 100mls of
wine = 20mls of whisky)
35. How to lower your BP
• Stop cigarette smoking
• Reduce CVD risk
