Download hypertension

HYPERTENSION
Dr. Pracheth R,
MBBS, MD
Assistant Professor, Community Medicine,
Yenepoya Medical College
One way to get high blood pressure is to go
mountain climbing over molehills.
Outline
• Introduction
• Classification
• Magnitude
• Risk factors
• Clinical features, measurement
• Treatment
• Prevention
Specific Learning Objectives
• To enlist the classification of Hypertension
• To explain the risk factors in Hypertension
• To demonstrate the measurement of Blood
Pressure
• To enumerate the treatment strategies for
Hypertension
• To enlist preventive measures for Hypertension.
Introduction
• Coronary heart disease, stroke
• 20-50% all deaths
Introduction
• Force of blood pushing against walls of arteries,
as it flows through them
• Diastolic BP: occurs near beginning of cardiac
cycle. Minimum pressure in arteries when
ventricles fill blood
• Systolic BP: near end of cardiac cycle when
ventricles contract.
Grades –Blood Pressure
Category
Normal
Prehypertension
Hypertension
Stage 1
Stage 2
Stage 3
Systolic BP
<120
120-139
Diastolic BP
<80
80-90
140-159
160-179
≥180
90-99
100- 109
≥110
Classification
• Primary (essential)
• Secondary:
Kidney, tumours –adrenal gland, congenital
narrowing of aorta, toxaemias of pregnancy.
(10%).
Magnitude
• Worldwide health disorder
• Rule of halves:
 Iceberg disease
Half-hypertensive : aware, treated, adequately
treated
World
• Worldwide: 7.5 million deaths, 12.8% all annual
deaths.
• Major risk-coronary heart disease, stroke
• Heart failure, peripheral vascular disease, renal,
retinal haemorrhage, visual impairment.
• > 25 years: 40%
India
• 17 to 21%
• Uttarkhand, Mizoram, MP
• High socioeconomic status.
Tracking
Risk factors- Non modifiable
• Age
• Gender
• Genetic factors: twin studies
Children- normal : 3%, Hypertensive: 45%
• Ethnicity: Black Americans
Modifiable risk factors
• Obesity
• Salt intake : 7-8gram/day
• Saturated fat: cholesterol
• Dietary fibre: inversely related-reduce Total
Cholesterol, LDL.
• Alcohol: Systolic Blood Pressure
• Sedentary lifestyle
Modifiable risk factors
• Environmental stress
• Socio-economic status
• Other factors:
Oral Contraceptives
Noise, vibration, temperature.
Prevention of Hypertension
• Primary prevention
oPopulation strategy:
Nutrition:
Reduce salt intake
Alcohol
Restrict energy
DASH diet
Prevention of Hypertension
Weight reduction
Exercise
Behavioural changes: stress, smoking, yoga
Health education
Self-care
Prevention of Hypertension
High risk strategy:
 Family history
Tracking
Prevention of Hypertension
• Secondary prevention:
Early detection
Treatment:
≥60 years: SBP<150 mm Hg, DBP<90 mm Hg
<60 years: SBP <140 mm Hg, DBP<90 mm Hg
Diabetes/ Chronic Kidney Disease : SBP <140
mm Hg, DBP<90 mm Hg
Patient compliance
JNC VIII Criteria
JNC VIII Criteria
Case study
Raju is a 48-year-old who sees you occasionally
for a recurrent cough and upper respiratory tract
infections. He:
• Has no significant past medical history
• Is taking no medicines
• Has no known allergies
• Is a regular smoker and has been since his teens
• Drinks a couple of stubbies a night and a bit
more on the weekend .
Case study
On examination:
• Temperature 37°C
• Pulse rate 78, regular
• Blood pressure (BP) 148/94 mmHg
• Repeat BP 144/92 mmHg.
Case study
• Does he have Hypertension ?
• Does he need Anti-hypertensive treatment ?
• What is the first choice drug ?
• What should be his ideal BP ?
Main parts:
Sphygmomanometer
Parts: stethoscope
Procedure
• Sitting: flex arm
• Check pulse
• Properly sized blood pressure cuff: 80% of the
circumference of the upper arm.
• Wrap the cuff around the upper arm with the
cuff's lower edge one inch above the antecubital
fossa.
Procedure
• Lightly press the stethoscope over the brachial
artery just below the cuff's edge.
• Rapidly inflate the cuff to 180mmHg. Release air
from the cuff at a moderate rate
• Listen with the stethoscope ,simultaneously
observe the sphygmomanometer.
Procedure
• The first knocking sound (Korotkoff) :systolic
pressure.
• When the knocking sound disappears: diastolic
pressure (such as 120/80).
• If high, measure again at least after 1 minute.
National Programme for Prevention
and Control for Cancer, Diabetes,
Cardiovascular disease and Stroke
(NPCDCS)
Background
• India: health transition: increase Non
Communicable Diseases
• Diabetes, Cardiovascular Disease and Stroke
component
• Cancer component
Diabetes Cardiovascular Disease
and Stroke Component
• Objectives:
Prevent, control: lifestyle changes, behaviour
Early diagnosis, treatment
Capacity building
Train human resource
Develop Palliative Care
Activities
• At Sub-Centre level:
Health promotion
Screening > 30 years
Suspected : referred
• At Community Health Centre level:
Required investigations
Home visits
Complicated cases: refer
Activities
• At District Hospital
 Screen people above 30 years
Investigation
Management
Home based Palliative Care: chronically ill
Urban check-up scheme
• Screen urban slum: diabetes, high blood
pressure
• Create database
• Create awareness
• All people above 30 years
Additional Points
• World Health Day 2013: Hypertension
• World Hypertension Day : 17th May: Know Your
Numbers
Summary
THANKS