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DR SHASHIKANT. R. PAWAR JR II
P G Guide: DR.S. S. TODKAR
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.
 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%.
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.
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.
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
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)
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.
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.
 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.
Follow-up based on initial BP measurements for adults
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
Hypertension
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
Hypertension
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
Hypertension
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.
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
Hypertension
NON-MODIFIABLE RISK FACTORS
 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.
 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 .
MODIFIABLE RISK FACTORS
 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.
 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
 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
Hypertension
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.
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
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
Hypertension
PREVENTION OF HYPERTENSION
1. Primary prevention
(a) Population strategy
(b) High-risk strategy
2. Secondary prevention
Hypertension
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”.
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.
Lifestyle modifications
www.nhlbi.nih.gov
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.
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.
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
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.
THANK YOU
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
 https://www.google.co.in/search?q=types+of+hypertension&rlz=
1C1EODB_enIN535IN535&oq=types+of+hyp&aqs=chrome.2.69
i57j0l5.11708j0j7&sourceid=chrome&ie=UTF-8#q=hypertension
LAST VISITED ON 19/06/2016
 http://www.health24.com/Medical/Hypertension/Types-of-blood-
pressure/Types-of-hypertension-20120721 LAST VISITED ON
19/06/2016
 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

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Hypertension

  • 1. DR SHASHIKANT. R. PAWAR JR II P G Guide: DR.S. S. TODKAR
  • 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.
  • 11. Follow-up based on initial BP measurements for adults
  • 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
  • 44.  https://www.google.co.in/search?q=types+of+hypertension&rlz= 1C1EODB_enIN535IN535&oq=types+of+hyp&aqs=chrome.2.69 i57j0l5.11708j0j7&sourceid=chrome&ie=UTF-8#q=hypertension LAST VISITED ON 19/06/2016  http://www.health24.com/Medical/Hypertension/Types-of-blood- pressure/Types-of-hypertension-20120721 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