2. INTRODUCTION
Most common cardiovascular disease and a major public
health problem in the developed and developing countries.
Prevalence of hypertension has been exponentially
increasing in India and other countries like USA and China
in the recent decades.
HT is also called as 'Twentieth Century Disease' or 'silent
killer’.
It is affecting about 20% of the adult population.
Hypertension accounts for 20 - 50% of mortality among all
cardiovascular deaths.
3. Over time, if the force of the blood flow is often high, the tissue
of the arterial walls gets stretched beyond its healthy limit and
damage occurs.
If BP rises above 180 systolic or 110 diastolic, emergency
treatment is needed.
Higher the pressure worse is the prognosis
Approximately 70% of people who have their first heart attack
and About 80% of people who have their first stroke have high
blood pressure.
The lifetime risk of developing HTN among those 55 years of
age and older who currently have normal BP is 90%.
4. Historical aspect of hypertension:
The vascular diseases and aetiopathogenesis came from
ancient Indian Medical Text Sushruta Samhita.
Bright in 1827 called attention to the existence of hypertension
in man, his conclusion was based on the post mortem finding of
persons having albunminurea during life, hypertrophied heart
and abnormal kidney finding at death.
Riva-Rocci in 1896 introduced the first clinical acceptable
sphygmomanometer.
Nicolai Sorgeyovith Korrotkoff 1905, described occurence of
auscultatory sounds in relation to systolic and diastolic blood
pressure.
5. PREVALENCE OF HYPERTENSION: WORLD SCINARIO
Worldwide, raised blood pressure is estimated to cause 7.5
million deaths.
12.8 per cent of the total of all annual deaths.
Overall prevalence HBP in adults, aged25 years and over was
around 40 per cent in 2008.
970 million people worldwide have high BP.
The number of people living with hypertension is predicted
to be 1.56 billion worldwide by the year 2025.
6. PREVALENCE OF HYPERTENSION: INDIAN SCINARIO
A community based survey was carried out by ICMR during
2007-08 to identify the risk factors for non-communicable
diseases under state based Integrated Disease Surveillance
Project Phase I.
Survey was carried out in the states of Andhra Pradesh, Kerala,
Madhya Pradesh, Maharashtra,Uttarakhand, Tamil Nadu and
Mizoram.
Prevalence was varying from 17 to 27 per cent in all the states
with marginal rural-urban differences.
Overall pattern of prevalence was found increasing with age
groups in all states.
Hypertension was comparatively more prevalent in executive
and service categories in all the states
7. First Author Year Age Gr. Place
Sample size Prevalence (o/o)
Men Women Men Wome
: Urban:
Gupta R 1995 20-75 Jaipur 1415 797 29.5 33.5
Gupta PC 1999 18-60 Mumbai 4006
7
5952 43.8 44.5
Joseph A 2000 20-89 Trivandru. 76 130 31.0 41.2
Gupta R 2002 20-75 Jaipur 550 573 36.4 37.4
:Rural:
Todkar S S 2007 19-79 Maharashtra 641 656 6.55 7.92
Gupta R 1994 20-75 Rajasthan 1982 1166 23.7 16.9
Malhotra P 1999 16-70 Haryana 2559 - 3.0 5.8
The Recent Indian Hypertension Prevalence studies
According to JNC-8 (BP> 140/90)
8. What is blood pressure?
Force of blood exerted on the walls of blood vessels.
Magnitude of this force depends on the cardiac output and the
resistance of the blood vessels.
When heart beats, it pushes blood through arteries to the rest of the
body.
When the blood pushes harder against the walls of arteries, blood
pressure goes up.
Having higher blood pressure for short amounts of time is normal.
Blood pressure staying high for most of the time can cause serious
health problems.
9. How is blood pressure measured?
Cuff is filled with air to squeeze the artery of upper arm while a
“gauge” records blood pressure as the air is released from cuff.
Has two parts-a top number systolic” and a bottom number
“diastolic” pressure.
Systolic pressure is blood pressure when heart beats and
pumps blood through arteries.
Diastolic pressure is blood pressure in between heartbeats
when heart is not pumping.
10. Based on the average of two or more properly measured,
seated BP readings.
Patient must be properly prepared and positioned and seated
quietly for at least 5 minutes in a chair.
The auscultatory method should be used.
A normal blood pressure is less than 120/80mmhg.
Caffeine, exercise, and smoking should be avoided for at least
30 minutes before BP measurement.
12. Classifications of blood pressure measurements
Sr. no Category SBP in mmHg DBP in mmHg
1 Normal < 120 <80
2 Pre hypertension 120-139 80-89
Hypertension
3 Stage 1 140- 159 90-99
4 Stage 2 ≥160 ≥100
14. TYPES OF HYPERTENSION
Hypertension is a complex multifactorial chronic disease.
Two major types and four less frequently found types.
1.Primary or essential hypertension.
2.Secondary hypertension.
The other types include:
1.Malignant Hypertension.
2.Isolated Systolic Hypertension
3.White Coat Hypertension
4.Resistant Hypertension
16. Primary Hypertension
1911 Frank introduced the term essential Hypertension.
Most common type of hypertension.
Diagnosed in about 90% of cases.
Essential hypertension has no obvious or identifiable cause.
Environmental factors such as stress, obesity, smoking, physical
activity, additional dietary salt intake, have been implicated as
exogenous factors
18. Secondary Hypertension:
Less common affecting only less than 10% of patients.
This may be caused by:
Kidney damage or impaired function (This accounts for most
secondary forms of hypertension.)
Tumours or overactivity of the adrenal gland.
Thyroid dysfunction.
Coarctation of the aorta.
Pregnancy-related conditions.
Sleep Apnea Syndrome.
Medication, recreational drugs, drinks & food.
19. Pulmonary hypertension:
High blood pressure that occurs in the arteries in the lungs.
Reflects the pressure the heart must exert to pump blood from
the heart through the arteries of the lungs.
Normal pulmonary-artery pressure is about 14 mm Hg at rest.
If pulmonary pressure in artery is greater than 25 mmHg at rest
and 30 mmHg during exercise.
Symptoms
Fatigue
Dizziness
Shortness of breath
22. AGE : Blood vessels lose flexibility with age which contribute to
increasing pressure throughout the system.
SEX: Early in life there is little evidence of a difference in blood
pressure between the sexes.
A higher percentage of men than women have HBP until 45
years.
From ages 45 to 54 and 55 to 64, the percentages of men and
women with HBP are similar. After that, a much higher
percentage of women have HBP than men.
23. GENETIC FACTOR: Hypertension is one of most common
complex genetic disorder.
Children of two normotensive parents have 3% possibility of
developing hypertension.
Possibility is 45% in children of two hypertensive parents.
HEREDITY: -Family history of hypertension is one of the
strongest risk factor for development of hypertension.
ETHNICITY : Population studies have consistently revealed
higher blood pressure levels in black communities than other
ethnic groups .
25. OBESITY: Risk of developing HT in overweight/obese is associated
with twofold to sixfold.
SALT INTAKE: Increased salt intake contributes substantially to the
development of essential hypertension.
SATURATED FAT: Raises blood pressure as well as serum
cholesterol.
DIETARY FIBRE: Risk of CHD and HT is inversely related to the
consumption of dietary fibre.
Fibres reduce plasma total and LDL cholesterol.
26. ALCOHOL: Heavy and regular use of can contribute to high
triglycerides, obesity, alcoholism, suicide and accidents.
limited alcohol consumption to no more than two drinks per day
for men and one drink per day for women.
Smoking: Temporarily raises blood pressure and increases risk
of damaged arteries.
Second-hand smoke exposure to other people's smoke
increases the risk of heart disease for nonsmokers.
HEART RATE: The heart rate of the hypertensive is invariably
higher then that of normotensive.
PHYSICAL ACTIVITY: Physical activity by reducing body
27. ENVIRONMENTAL STRESS: Enviromental factors operate
through mental processes, consciously or unconsciously, to
produce hypertension.
OCCUPATION AND HYPERTENSION: Job strain is important
risk factor for development of HT.
Prevalence of HT among labourers and strenuous workers are
reported to be lower as compared with persons having less
strenuous job.
SOCIO-ECONOMIC STATUS: Inverse relation has been noted
with levels of education, income and occupation.
OTHER FACTORS : Commonest present cause of secondary
29. DIABETES AND HYPERTENSION:
Coexistence of hypertension and diabetes possibly point
towards a common genetic and environmental factor.
Growing prevalence of obesity in children predisposes to
diabetes and hypertension.
Increases the risks of coronary heart disease, stroke,
nephropathy and retinopathy.
Risk of CVD is increased by 75%, contributing to the morbidity
and mortality of population.
30. Complications of Prolonged Uncontrolled HTN
CVS
Ventricular hypertrophy, dysfunction and failure.
Coronary artery disease, Acute MI
Arterial aneurysm, dissection, and rupture.
Angina or prior myocardial infarction
Prior coronary revascularization
Heart failure
Arrhithymias
Kidneys
Glomerular sclerosis leading to impaired kidney function and finally
end stage kidney disease.
Ischemic kidney disease especially when renal artery stenosis is the
cause of HTN
31. Nervous System
Stroke, intracerebral and subaracnoid hemorrhage.
Cerebral atrophy and dementia
The Eyes
Retinopathy, retinal hemorrhages and impaired vision.
Vitreous hemorrhage, retinal detachment
Neuropathy of the nerves leading to extraoccular muscle
paralysis and dysfunction
33. PREVENTION OF HYPERTENSION
1. Primary prevention
(a) Population strategy
(b) High-risk strategy
2. Secondary prevention
35. PRIMARY PREVENTION
Defined as "all measures to reduce the incidence of disease in a
population by reducing the risk of onset".
Earlier the prevention starts, more likely it is to be effective.
POPULATION STRATEGY
Population approach directed at the whole population.
Concept 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 CVD.
Goal is to shift the community blood pressure towards lower
levels or "biological normality”.
36. Multifactorial approach
BEHAVIOURAL CHANGES: Reduction of stress and smoking,
modification of personal life-style, yoga.
HEALTH EDUCATION: Preventive advice on all risk factors and
related health behaviour.
SELF-CARE: Patient is taught self-care i.e. to take his own
blood pressure and keep a log-book of his readings.
38. HIGH-RISK STRATEGY
Aim is "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.
The family history of hypertension and "tracking" of blood
pressure from childhood may be used to identify individuals at
risk.
39. SECONDARY PREVENTION
Control of hypertension can be successfully achieved by
medication.
EARLY CASE DETECTION:
A major problem because high blood pressure rarely causes
symptoms until organic damage has already occurred.
The only effective method of diagnosis of hypertension is to
screen the population.
40. TREATMENT :
Aim of treatment is to obtain a BP below 140/90 mmhg, and
ideally a BP of I20/8O mmhg.
Classes of drug available:
1)Diuretics (thiazides, chlorthalidone and indapamide)
2)Beta-blockers & alpha-blockers 3)Calcium-channel blockers
4)Central agonists 5)Peripheral adrenergic inhibitors
6) Angiotensin-converting enzyme (ACE) inhibitors
7) Vasodilators 8)Angiotensin receptor blockers.
Choice of drug depends on the individual and any other
conditions they may have
41. PATIENT COMPLIANCE:
Treatment of high BP must normally be life-long and this
presents problems of patient compliance.
Compliance rates can be improved through education directed
to patient, families and the community.
43. REFRENCES
K.Park, Text book of Preventive and Social Medicine, 23 edition,
Bhanot publication page no365-376.
Dr Sampat Sambhaji Todkar.PREVALANCE AND
EPIDEMIOLOGICAL FACTORS OF HYPERTENSION IN ADULTS
AGED 18 YEARS AND ABOVE AT RURAL HEALTH TRAINING
CENTRE, FIELD PRACTICE AREA OF G M C
AURANGABAD,DISSERTATION 2007.
http://www.medicalnewstoday.com/articles/150109.php?page=3 LAST
VISITED ON 19/06/2016
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/High
-Blood-Pressure-or-Hypertension_UCM_002020_SubHomePage.jsp
LAST VISITED ON 19/06/2016
45. Hypertension: The Silent Killer: Updated JNC-8 Guideline
Recommendations Authors: Kayce Bell, Pharm.D. Candidate
2015 Harrison School of Pharmacy, Auburn University; June
Twiggs, Pharm.D. Candidate 2015 Harrison School of
Pharmacy, Auburn University; Bernie R. Olin, Pharm.D.,
Associate Clinical Professor of Pharmacy Practice, Drug
Information and Learning Resource Center, Harrison School
of Pharmacy, Auburn University
http://www.medicalnewstoday.com/articles/150109.php
LAST VISITED ON 19/06/2016
https://en.wikipedia.org/wiki/Secondary_hypertension
LAST VISITED ON 19/06/2016
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024199/
LAST VISITED ON 19/06/2016