Hypertension prevalence incidence in india types of hypertension rule of halves Tracking of blood pressure

1. HYPERTENSION

2. Hypertension is the most commonest cardiovascular
disorder, posing a major public health challenge to
population in socio-economic and epidemiological
Transition .It is a major condition of concern due to its
role in causation coronary heart disease, stroke and
other vascular complications

3. CATEGORY SYSTOLIC BLOOD PRESSURE
(mm of Hg)
DIASTOLIC BLOOD PRESSURE
(mm of Hg)
BP
OPTIMAL
NORMAL
HIGH NORMAL
<120
120-129
130 – 139
<80
80-84
85 – 89
HYPERTENSION
GRADE 1(MILD)
GRADE 2(MODERATE)
GRADE 3(SEVERE)
140-159
160-179
>=180
90-99
100-109
>110
ISOLATED SYSTOLIC
HYPERTENSION
GRADE 1
GRADE 2
140-159
>=160
<90
<90
 When systolic and diastolic blood pressure fall in different categories, the higher category should be
selected
 Isolated systolic hypertension is defined as a systolic pressure of 140 mm of Hg or more and
a diastolic pressure less than 90mm of Hg

4. CLASSIFICATION
OF
HYPERTENSION
BASEDON
EXTENTOF
ORGAN DAMAGE
 STAGE 1 No manifestation of organic change
 STAGE 2 At least one of the following manifestations of organ
involvement:
Left ventricular hypertrophy
Generalized and focal narrowing of the renal arteries
Micro-albuminuria, proteinuria and slight elevation
. of the plasma creatinine concentration(1.2-2 mg/dL)
 STAGE 3 Both symptoms and signs have appeared as result of
. organ damage

5. MEASUREMENT OF
BLOOD PRESSURE

6. • WHO study group recommended that blood pressure should me
measured in
sitting position than in the supine position
• An uniform policy of measurement should be adopted in a clinic
• The systolic and diastolic pressure should me measured at least
3 times over a period of at least 3 minute and the lowest
reading recorded
The pressure at which the sound are first heard (phase I) is taken as the systolic pressure
Near the diastolic pressure the sound first become muffled (phase IV) and then disappear
(phase V)
Errors
a)Observer error
b)Instrumental error
c)Subject error

7. HYPERTENSION
PRIMARY
(ESSESNTIAL)
SECONDARY

8. PRIMARY HYPERTENSION
 Cause generally unknown
 It is the most prevalent form of hypertension >90
SECONDARY HYPERTENSION
 When some other disease process or abnormalities is involved in
it causation
 About 10%
 Some of the prominent diseases that leads to hypertension are
a) Disease of the kidney(chronic glomerulonephritis and
chronic pyelonephritis)
a) Tumours of adrenal glands
b) Congenital narrowing of the aorta

9. What the patient
sees
Complications

10. Rule Of Halves
The whole communityNormotensive
subjectsHypertensive
subjectsUndiagnosed
hypertension
Diagnosed hypertension
Diagnosed but untreated
Diagnosed and treated
Inadequately
treated
Adequately treated

11. INCIDENCE
 Global prevalence - 1.13 billion in 2015
 Overall prevalence in adults – around 30-40% with a global standard prevalence
of 24 and 20% in men and women respectively.
 This high prevalence around the world is irrespective of income status.
 It becomes progressively more common with advancing age, with a prevalence
of >60% in people aged >60 years (due to increase in body weight and adoption
of sedentary lifestyle).
 Elevated blood pressure is a leading cause of premature death in 2015,
accounting to almost 10 million deaths and over 200 million DALYs.
 Systolic BP of >=140 mm Hg accounts for most of the mortality and disability
burden.

12. PREVALENCE IN INDIA
As per NATIONAL FAMILY HEALTH SURVEY-4 done in the year 2015-2016,
11% of women- with hypertension: 7% - stage 1
1% - each of with stage 2 and stage 3
61%- normal blood pressure
30%-prehypertensive
1%- taking anti-hypertensives
15% of men-hypertensive: 10%-stage 1
2%-stage 2
1%-stage 3
43%-normal BP
43%-prehypertensive
1%- taking anti-hypertensives

13. Tracking Of
Blood
Pressure
If the blood pressure of an individual is
followed up from the childhood into
adulthood, then those individuals whose
pressures were initially high in the
distribution would probably continue in the
same track as adults
ie., low blood pressure tend to remain low
and high levels tend to become higher as
individuals grow older
This knowledge can be applied in identifying
children and adolescents at risk of
developing hypertension at a future date

14. 0
0.2
0.4
0.6
0.8
1
1.2
0 0.2 0.4 0.6 0.8 1 1.2
Time
BloodPressure

15. RiskFactors
Risk Factors For Hypertension
Modifiable
Non-Modifiable

16. NON
MODIFIABLE
RISK
FACTORS
AGE
SEX
GENETIC FACTORS
ETHNICITY

17. AGE
BP increases with age in both sexes
and the rise is greater in those with
higher initial blood pressure.
Age represents an accumulation of
environmental influences and the
genetically programmed senescence in
body systems

18. SEX
 At adolescence, men display a higher
average level.
 Most evident in the young and the middle
aged adults.
 Late in life, the difference narrows and the
pattern even reverses,
Genetic Factors • Their inheritance is polygenic
• The evidences are based on twin and family studi
• Attempt to find the genetic markers associated with
hypertension are unsuccessful

19. Ethnicity
 Population studies has consistently revealed
higher blood pressure in levels in black
communities compared to other groups
 Average difference in blood pressure
between two groups vary from slightly less
than 5 mm Hg during second decade of life
to 20 mm Hg during the sixth

20. MODIFIABLE
RISK
FACTORS
 OBESITY
 SALT INTAKE
 SATURATED FAT
 DIETARY FIBERS
 ALCOHOL
 HEART RATE
 PHYSICAL ACTIVITY
 ENIVRONMENTAL STRESS
 SOCIO-ECONOMIC STATUS
 OTHER FACTORS
-oral contraception(most common)
noise, vibration, temperature(require further investiga

21. Prevention
Of
Hypertension
Primary prevention
Secondary prevention
a) Population strategy
b) High-risk strategy
The low prevalence of hypertension in some communities
indicate that the hypertension is potentially preventable
The WHO has recommended the following approaches in
the prevention of hypertension :

22. Primary
prevention
Population strategy
 Directed at the whole population irrespective of the
individual risk levels.
 The concept of population approach is based on the
fact that even a small reduction in the average
blood pressure of a population would produce a
large reduction in the incidence of cardiovascular
complications like stroke and CHD.
 GOAL-To shift the community distribution of
blood pressure towards the lower levels of
“biological normality”.

23.  It involves multifactorial approach based on the following interventions:
Nutrition:
a. reduction of salt intake to an average of not more than 5 gm per
day
b. moderate fat intake
c. avoidance of a high alcohol intake
d. restriction of energy intake appropriate to body needs
Weight reduction:
Prevention and correction of over weight / obesity(BMI > 25)
Exercise promotion:
Regular physical activity leads to a fall in body weight, blood lipids and blood
pressure.
Behavioural changes:
Reduction of stress and smoking, modification of personal lifestyle, yoga and
transcendental medication would be profitable.
Health education
Self care

24. HIGH RISK STRATEGY
AIM:To prevent the attainment of levels of blood pressure at
which the institution of treatment would be considered.
This approach is appropriate if the risk factors occur with very
low prevalence in the community.
Detection of high risk subjects should be encouraged by the
optimum use of clinical methods

25. Secondary
Prevention
 GOAL: To detect and control high blood pressure in affected
individuals
Modern hypertensive drug therapy can effectively reduce high
blood pressure and consequently the excess risk of morbidity and
and mortility from coronary, cerebrovascular and kidney diseases
diseases
Early case detection:
 Early detection is a major problem because high bp rarely causes
symptoms until organ damage has already occurred and our aim
should be to control it before this happens
 Only effective method of diagnosis of hypertension is to screen the
population and should be linked with follow up and sustained
care.
Treatment:
 Aim: to obtain a bp below 140/90 and ideally a BP of 120/80.
 In essential hypertension, we cannot treat the cause as the cause is
unknown

26. Patient compliance:
It is the extent to which patient behaviour(in terms of taking
medicines ,following diets or following other lifestyle changes)
coincides with clinical prescription.
The compliance rates can be improved through education
directed to patients, families and the community.