Hypertension - Contents Introduction Problem statement Epidemiology Complications Diagnosis Prevention and control Treatment protocol

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2. EPIDEMIOLOGY AND CONTROL OF
HYPERTENSION
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3. contents
• Introduction
• Problem statement
• Epidemiology
• Complications
• Diagnosis
• Prevention and control
• Treatment protocol
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4. INTRODUCTION
• Definition
–A systolic BP greater than 140 mm Hg or
–a diastolic BP greater than 90 mm Hg
• Types
–primary and secondary
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5. INTRODUCTION
• Silent killer
• Preventable and can be controlled
• Significant gaps in diagnosis and
treatment
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6. Problem statement
• Large burden- global and India
• Iceberg disease
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7. Global
• Prevalence doubled to 1.28 billion in last 3
decades
• Two- thirds in low and middle income countries
• Kills 8 million every year
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8. India
Overall prevalence – 22.7%
Kerala
Overall prevalence – 32%
[NFHS-5]
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9. Epidemiology
Non-modifiable risk
factors
• Age
• Sex
• Genetic factors
• Ethnicity
Modifiable risk factors
• Obesity
• Salt intake
• Saturated fat
• Dietary fibre
• Alcohol
• Physical activity
• Environmental stress
• Socioeconomic status
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10. COMPLICATIONS
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11. DIAGNOSIS
• BP measurement
– 2 readings
– Take third reading if differ by >5 mm Hg
– Lower reading of SBP and DBP taken
• Measuring BP
– Mercury sphygmomanometer / electronic digital
– Relax for 5 minutes
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JNC 8 Classification

13. Prevention
Primary
prevention
Population
strategy
High-risk
strategy
Secondary
prevention
Early case
detection
Treatment
Tertiary
prevention
Patient
compliance
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Palliative
care

14. 1 3 5
7
2
4 6
8
Whole community
Normotensive
subjects
Hypertensive
subjects
Undiagnosed Hypertension
Diagnosed Hypertension
Diagnosed and treated
Hypertension
Inadequately treated
Hypertension
Diagnosed but untreated Hypertension
Adequately treated
Hypertension
9
Rule of halves
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15. “Tracking” of blood pressure
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16. Primary Prevention
Population-strategy
small reduction in average
BP of a population
large reduction in
incidence of cardiovascular
complications
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Multifactorial
approach
•Nutrition
•Weight reduction
•Exercise promotion
•Behavioural changes
•Health education
•Self care

17. Primary Prevention
Life style Modifications
Modification Recommendation
Weight reduction Maintain normal body weight (BMI 18.5 -24.9)
DASH eating plan
(Dietary Approaches to
Stop Hypertension)
Diet rich in fruits, vegetables
Low sodium and low-fat diary products
Dietary sodium reduction Dietary sodium intake not more than 6 g NaCl
Physical activity Regular aerobic physical activity
Brisk walking atleast 30 minutes per day
Moderation of alcohol
consumption
Not more than two drinks per day
Stop smoking
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18. Primary Prevention
High – risk strategy
• Risk factors - low prevalence in the community
• Family history of hypertension
• “Tracking” of blood pressure
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19. Secondary Prevention
• Early case detection
– Screening
• Treatment
– Target blood pressure less than 140/90
• Patient compliance
– The extent to which patient behaviour
coincides with clinical prescription
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20. Category Systolic Diastolic
Optimal <120 <80
Normal 120 – 129 80 – 84
High normal 130 – 139 85 – 89
Grade 1
hypertension
140 – 159 90 – 99
Grade 2
hypertension
160 – 179 100 – 109
Grade 3
hypertension
≥180 >110
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Refer to
higher centre
ECG, S. Creatinine
Lifestyle modification
Drug treatment
Lifesyle
modification

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22. National Program for Prevention
and Control of Cancer,Diabetes
CVD and Stroke ( NPCDCS)
Objectives
• Prevent and control NCDs
• Early diagnosis and treatment
• Capacity building
• Palliative and rehabilitative care
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23. • NPCDCS renamed as
National Programme for Prevention and
Control of Non Communicable Diseases
NP-NCD
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24. Strategies
– Health promotion
– Population based Screening > 30 years
– Opportunistic screening > 30 years
– Non Communicable Disease (NCD) clinics
– Trained manpower
– Strengthening tertiary level facilities
– Service delivery – public health infrastructure
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26. Indian Hypertension Control Initiative
– WHO, ICMR, MOHFW, State govts
– Target - 25% reduction in prevalence by 2025
– Decentralisation of essential health services
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51
66
0
20
40
60
80
2014 2015
HTN control rate (%),
2 pilot clinics
Protocols
Medication
Supply
Team
care
and
Task
sharing
Patient-
Centered
Care
Information
Systems

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https://www.linkedin.com/in/jazeela-mohamed-siddique-989976248