HYPERTENSION SSCENARIO FOR LAYMEN-WORLD HEALTH DAY BY DR.A.P.NAVEEN KUMAR

2. Blood Pressure
• Blood pressure is the force exerted by blood
against the vessel wall.
• BP is measured in millimeters of mercury
( mmHg).
• Normal BP = 120/80 mmHg.

3. Blood Pressure
Systolic BP =pressure or force exerted on the vessel wall by
flow of blood due to contractions of the heart (systole).
Systolic refers to the pressure of the blood when the
heart beats to pump it out.
Diastolic BP = Pressure when the heart is resting
(relaxation/diastole).
Diastolic refers to the pressure of the blood when the
heart rests in between beats

4. Sphygmomanometer

5. HYPERTENSION
• Hypertension is defined as systolic blood
pressure (SBP) of 140 mmHg or greater,
diastolic blood pressure (DBP) of 90 mmHg
or greater.
8 JNC, 2007

6. Classification of BP
BP Classification Systolic BP Diastolic BP
(mmHg) and (mmHg)
Normal <120 <80
Prehypertension 120-139 or 80-89
Stage 1 140-159 or 90-99
Stage 2 > 160 or > 100
Systolic HTN > 160 <90
• Patients with prehypertension, increased risk for progression to
hypertension;
• 130/80 to 139/89 mm Hg BP range, twice the risk to develop
hypertension
The JNC 7 Report: JAMA, 2003; 289: 2560-2572

7. What is high blood pressure?
• A blood pressure reading above 130/80
mmHg is considered high. High blood
pressure is commonly an asymptomatic
condition, often known as “the silent
killer”.
• Blood pressure measurements indicate how
strongly blood presses against arterial walls
as it is pumped around the body by the heart.

8. Key facts on high blood pressure
• Affects one in three adults worldwide
• Affects men more than women
• Affects poorer populations more than others
• Is implicated in 13% of deaths worldwide
• Is identified in WHO’s Health 2020 policy as one of the WHO
European Region’s major contributors to disease

9. Why high blood pressure is a
public health concern
• High blood pressure strains the arteries and heart raising the
probability of heart attack, stroke and kidney disease.
• High blood pressure can lead to hypertension.
• Hypertension is diagnosed if readings on separate occasions
consistently show blood pressure to be 140/90 mmHg or higher.
• Hypertension is identified as the world’s most prevalent preventable
disease in WHO’s Health 2020 policy.

10. HIGH BLOOD PRESSURE
High blood pressure – also known as raised
blood pressure or hypertension – increases the
risk of heart attacks, strokes and kidney failure.
If left uncontrolled, high blood pressure can
also cause blindness, irregularities of the
heartbeat and heart failure.

11. HIGH BLOOD PRESSURE
The risk of developing these complications is higher in the
presence of other cardiovascular risk factors such as
diabetes.
One in three adults worldwide has high blood pressure.
The proportion increases with age, from 1 in 10 people in
their 20s and 30s to 5 in 10 people in their 50s.

12. HIGH BLOOD PRESSURE
Prevalence of high blood
pressure is highest in some low-
income countries in Africa, with
over 40% of adults in many
African countries thought to be
affected.

15. Hypertension is the most prevalent chronic disease in India.
The prevalence of hypertension in India is low compared to
world figures. In India, 23.10 per cent men and 22.60 per
cent women over 25 years old suffer from hypertension,
says the World Health Organisation’s ‘global health statistics
2012’ .
India also fares better than the global average of 29.20 in
men and 24.80 in women.

16. The prevalence of hypertension ranges from 20-40% in
urban adults and 12-17% among rural adults.
The number of people with hypertension is projected
to increase from 118 million in 2000 to 214 million in
2025, with nearly equal numbers of men and women.

17. HTN Prevalence in India
Recent (2012) studies show that for every
known person with hypertension there are
two persons with either undiagnosed
hypertension or prehypertension
Increased blood pressure is a high-risk condition
that causes approximately 51 per cent deaths from
stroke and 45 per cent from coronary artery
disease in India.

18. THE MYTH
• “Patients fear anti-hypertensive medications
due to side effects or getting addicted to
tablets.
• But side effects from anti-hypertensive
medications are rare and often not serious.”
THE REALITY
• On the contrary, if hypertension is not fought,
it can result in serious diseases, some of them
fatal

19. STUDY ANALYSIS
53.30 per cent were aware
of their diagnosis; 42.80
per cent were taking
treatment and only 10.50
per cent had controlled BP.

20. DYSMETABOLIC SYNDROME
• Elevated waist circumference:
Men — greater than 90 cms
Women — greater than 80 cms
• Elevated triglycerides: Equal to or greater than 150 mg/dL
• Reduced HDL ("good") cholesterol:
Men — Less than 40 mg/dL
Women — Less than 50 mg/dL
• Elevated blood pressure: Equal to or greater than 130/85
mm Hg or use of medication for hypertension
• Elevated fasting glucose: Equal to or greater than 100
mg/dL or use of medication for hyperglycemia

21. Risk factors for high blood pressure
• A diet high in saturated fat
• Excessive salt consumption
• Overweight and obesity
• A sedentary lifestyle and lack of exercise
• Excessive alcohol consumption
• Smoking
• Un-managed stress
• A family history of high blood pressure
• Being over 65 years of age
• Co-morbidities such as diabetes

22. Hypertension : Symptoms & Signs
No specific symptoms ( detected on routine
check-up).( SILENT KILLER)
Headache: Morning localised to occipital
region.
Others : Dizziness, Palpitation, Easy fatigability,
epistaxis, haematuria, blurring of vision.

23. Types of hypertension
• Essential / Primary/ Idiopathic
hypertension
– 90%
– No underlying cause
• Secondary hypertension
– Underlying cause

24. Investigations
Basic Tests
CBC
Urine : protein. Microscopic analysis.
LFT : S cholesterol etc
RFT : S creatinine , BUN
ECG
Chest X-ray.
Blood sugar : Fasting/ PP
Ophthalmoscopy
Special Tests ( Sec HT)

25. Hypertension : Complications
• CNS
Stroke – Infarct/ Haemorrhage
• Retina
Hypertensive retinopathy
• Kidney
Renal failure

26. Hypertension : Cardiovascular effects
• Atherosclerosis
• Angina
• Myocardial Infarction
• Heart failure

27. Atherosclerosis

28. Effects of Atherosclerosis

29. Angina

30. Myocardial Infarction

31. ULTIMATE GOAL OF
ANTIHYPERTENSIVE THERAPY
BLOOD
PRESSURE PREVENTION PROLONGED
REDUCTION OF COMPLICATIONS
SURVIVAL

32. Benefits of BP reduction
35% to 40% mean reductions
in stroke incidence
20% to 25% in myocardial
infarction
more than 50% in HF
The JNC 7 Report: JAMA, 2003; 289: 2560-2572

33. Manage high blood pressure by:
eating a healthy diet
reducing salt intake
exercising regularly
stopping smoking
reducing alcohol consumption
managing stress
having regular blood pressure checks

34. Lifestyle Modifications to
Prevent and Manage Hypertension
• Reduce weight • Moderate consumption
of:
• alcohol
• sodium
• saturated fat
• cholesterol
• Maintain adequate intake of
dietary:
• Increa • potassium
se • calcium
physic • magnesium
al
activity • Avoid tobacco
(JNC VI. Arch Intern Med. 1997)

39. LIFESTYLE CHANGES
For some people, lifestyle changes are sufficient to control
blood pressure such as stopping tobacco use, eating healthily,
exercising regularly and avoiding the harmful use of alcohol.
Reduction in salt intake can help.
For others, these changes are insufficient and they need
prescription medication to control blood pressure

42. WEIGHT LOSS
maintaining a normal
weight: every 5 kg of
excess weight lost can
reduce systolic blood
pressure by 2 to 10 points.

44. Drugs used to control hypertension
Drug Class Example
Diuretics Hydrochlorothiazide
-blockers Metoprolol
Ca – Channel Amlodipine
blockers
ACE- inhibitors Benazepril
ARBs Valsartan
α blockers Prazosin

50. The WHO response
The WHO Health 2020 policy identifies high blood pressure
as a major contributor to disease, and hypertension as the
world’s most prevalent preventable disease.
High blood pressure is the theme of World Health Day
2013, with a particular emphasis on reducing dietary salt
intake.

51. WHO’s current European policy
Priority interventions of the action plan for
noncommunicable diseases 2012-2016 include:
• promotion of a healthy diet through marketing and fiscal
measures
• elimination of trans fats
• salt reduction
• cardio-metabolic risk reduction assessment and
management
• promotion of physical activity and mobility

52. Key interventions
• Encourage regular blood pressure checks
• Encourage patients to be aware of their individual risks
• Establish effective tools for early identification,
management and control
• Promote physical activity, dietary improvement and salt
reduction
• Provide low-cost antihypertensive medication
• Set target for mean blood pressure reduction levels
across populations

53. THANK YOU