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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