Hypertension and Stroke PPT

1. Hypertension and Stroke

2. Introduction
• Hypertension is a chronic condition due to its role
in the causation of coronary heart disease, stroke
and other vascular complications
• Major risk factors for cardiovascular mortality,
which accounts for 20-50 per cent of all deaths

3. Classification
Hypertension is divided into
1. Primary (essential)
2. Secondary

4. Essential hypertension
• Hypertension is classified as "essential" when the
causes are generally unknown
• Essential hypertension is the most prevalent form
of hypertension accounting for 90 per cent of all
cases of hypertension

5. Secondary hypertension
• Some other disease process or abnormality is involved in
causation
• 10 per cent or less of the cases of hypertension
• Causes:
• Kidney diseases: chronic glomerulo-nephritis and chronic
pyelonephritis
• Tumours of the adrenal glands
• Congenital narrowing of the aorta and
• Toxemias of pregnancy

6. "Rule of halves"
• Hypertension is an ''iceberg" disease.
• Only about half of the hypertensive subjects in the general
population of most developed countries were aware of the
condition,
• Only about half of those aware of the problem were being
treated, and
• Only about half of those treated were considered adequately
treated

7. 1. The whole community
2. Normotensive subjects
3. Hypertensive subjects
4. Undiagnosed HTN
5. Diagnosed HTN
6. Diagnosed but untreated
7. Diagnosed and treated
8. Inadequately treated
9. Adequately treated

8. Risk Factors For High Blood Pressure
• Non‐modifiable risk factors
• Modifiable risk factors

9. Risk Factors
Non‐modifiable
• Age
• Sex
• Genetic factors
• Ethnicity
Modifiable
• Obesity
• Diet –Salt, Saturated fat,
Dietary fibres
• Alcohol and Tobacco
• Physical activity
• Stress
• Socio‐Economic Status

10. Symptoms
• Headache
• Shortness of breath
• Dizziness
• Chest pain
• Palpitations
• Nose bleed
• But most people usually
have NO warning signs
or symptoms

11. Prevention of Hypertension
1. Primary Prevention
• Population strategy
• High risk strategy
2. Secondary prevention

12. Population Strategy
• Nutrition
• Weight reduction
• Exercise promotion
• Behavioral changes
• Health education
• Self care

13. High Risk Strategy
• Approach is to prevent the attainment of levels of blood
pressure at which the institution of treatment would be
considered
• Identifying high risk groups- family history, tracking of of
blood pressure from childhood

14. Secondary prevention
1. Early case detection- screening
2. Treatment
3. Patient compliance

15. Life Style Modifications to Manage
Hypertension
MODIFICATION RECOMMENDATION
Weight reduction Maintain normal body weight
reduction (BMI‐18.5‐24.9)
Adopt DASH diet Consume diet rich in fruits, eating plan vegetables
& low‐fat diary
products with reduced content
of saturated fat & total fat
Dietary sodium
reduction
Reduce dietary sodium intake – no more than 100
Meq/D (2.4 g
sodium or 6 g sodium chloride)

16. Life Style Modifications to Manage
Hypertension
MODIFICATION RECOMMENDATION
Physical activity Engage in regular physical activity brisk walking
for at least 30 min/day most days of the week
Moderation of
alcohol consumption
Limit consumption to
•No more than 2 drinks / day in most men
•No more than 1 drink / day in women & lighter
– weight persons.

17. Drug Therapy
1. ACE inhibitors
2. Beta blockers
3. Calcium channel blockers
4. Diuretics
5. Angiotensin II receptor blockers

18. Dietary Approaches to Stop Hypertension
(DASH)
• The National Heart, Lung, and Blood Institute (NHLBI)
• Flexible and balanced eating plan
• Low in saturated fat, cholesterol, and total fat
• Focuses on fruits, vegetables, and fat‐free or low‐fat dairy
products
• Rich in whole grains, fish, poultry, beans, seeds, and nuts
• Contains fewer sweets, added sugars and sugary beverages,
and red meats

19. JNC-8 Algorithm

20. JNC 8 Classification

21. Which is the National health programme
for hypertension?

22. National Programme for Prevention
and Control of Non communicable
Disease

23. Objectives:- NP-NCD
• Health promotion through behaviour change - involvement of
community, civil society, community-based organizations, media
and development partners
• Screening, early diagnosis, management, referral and follow-up at
each level of healthcare delivery to ensure continuum of care
• Build capacity of health care providers at various levels for
prevention, early diagnosis, treatment, follow-up, rehabilitation,
IEC/BCC, monitoring and evaluation, and research

24. Objectives:- NP-NCD
• Strengthen supply chain management for drugs,
equipment and logistics for diagnosis and management at
all health care levels
• Monitoring, supervision and evaluation of programme
through proper implementation of uniform ICT
application across India
• To coordinate and collaborate with other programmes,
departments/ministries, civil societies

25. Stroke

26. Introduction
• Acute severe manifestations of cerebrovascular disease. It
causes both physical and mental crippling.
• WHO defined stroke as “rapidly developed clinical signs of
focal disturbance of cerebral function; lasting more than 24
hours or leading to death, with no apparent cause other
than vascular origin“

27. Introduction
• Caused by three morphological abnormalities –
stenosis, occlusion or rupture of arteries
• Signs and symptoms are related to extend and site of the
area involved and to the underlying causes Coma,
hemiplegia, paraplegia, monoplegia, multiple paralysis,
speech disturbances, nerve paresis, sensory impairement
etc.

28. Aetiology
A. Ischaemic stroke
- Lacunar infarct
- Carotid circulation
obstruction
- Vertebrobasilar
obstruction
B.Hemorrhagic stroke
- Spontaneous
intracerebral hemorrhage
- Subarachnoid
hemorrhage
- Intra cranial aneurysm
- AV malformation

29. Morbidity And Mortality
• Cerebral thrombosis followed by hemorrhagic stroke
is the most common form of stroke
• Worldwide 6.1 million deaths, 10.8% of all deaths
(2008)
• Prevalence rate in India – 1.54/ 1000 population

30. Risk factors
• Hypertension
• Cardiac abnormalities –
LVH, Dilatation
• Diabetes
• Elevated blood lipids
• Obesity
• Smoking
• Glucose intolerance
• Oral contraceptives

31. Transcient Ischaemic Attacks (TIA)
• These are episodes of:
1. Focal
2. Reversible
3. Neurological deficit of sudden onset
4. Of less than 24 hours duration
• They show a tendency to recurrence
• Due to microemboli and are a warning sign of stroke

32. Host factors
• Age - Can occur in any age,
Globally more in age >70 years
• India – strokes in the young
• Sex: M > F
• Personal history : a/w diseases, esp. CVS disease
and diabetes

34. Stroke Control Programme
• Community level effective measures for the prevention
• Control of arterial hypertension
• Early detection and treatment following TIA
• Management of other risk factors (diabetes, smoking)
• Control of complications and follow up of patients
• Reliable knowledge and extend of the problem in the
community