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HYPERTENSION: AN OVERVIEW. Prof Ahmed Mandil, Dr Hafsa Raheel KSU Dept of Family & Community Medicine. Objectives. By the end of this session, students should be able to: Understand the basic concepts of hypertension Explain the magnitude of the problem - PowerPoint PPT Presentation
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HYPERTENSION: AN OVERVIEW
Prof Ahmed Mandil, Dr Hafsa RaheelKSU Dept of Family & Community Medicine
Objectives
By the end of this session, students should be able to:
Understand the basic concepts of hypertension Explain the magnitude of the problem Identify important risk factors for hypertension Identify the important complications of
hypertension Explain important concepts of prevention and
control of hypertension
April 21, 2023 Hypertension 2
Headlines
Magnitude of the problem Risk factors Assessment & diagnosis Complications Prevention and control
April 21, 2023 3Hypertension
Magnitude
■ In developed and developing countries alike, essential hypertension affects 25-35% of the adult population. Up to 60-70% of those beyond the seventh decade of life
■ Each increment of 20 mm Hg in systolic blood pressure or 10 mm Hg in diastolic blood pressure doubles the risk of cardiovascular disease events independent of other factors.
April 21, 2023 4Hypertension
Prevalence of Hypertension in Obese and non-Obese Saudis
The study group: 14.805 males: 6225 females: 8580The age: 14 – 70 yearsNon-obese prevalence: 4.8 % males 2.8 % females Obese prevalence: 8 % males 8 % females
El-Hazmi M. Saudi Medical Journal 2001; 22 (1): 44-48
April 21, 2023 5Hypertension
Hypertension among attendants of primary health care centers in Al-Qassim region, Saudi Arabia.
Study sample: 1114 Prevalence: 30 % Higher among: ● Age > 40 years ● Overweight and obese
people ● illiteracy Awareness: 20 % of hypertensive women 25 % of hypertensive menKhalid A et al. Saudi Med J 2001; 22 (11) 960-963
April 21, 2023 6Hypertension
Blood Pressure Measurement and Hypertension Diagnosis
1 in 5 adult Canadians have hypertension
Over 40% of Canadians at aged 56-65 have hypertension
90% of normotensive persons aged 55-65 developed hypertension in the next 20 years in the Framingham study
2010 Canadian Hyprtension Education ProgramApril 21, 2023 7Hypertension
Hypertension in the community- Rule of halves
April 21, 2023 Hypertension 8
Risk Factors Smoking Dyslipidaemia Diabetes Mellitus Obesity Age (older than 55 for men, 65 for women) Gender (men or postmenopausal women) Family History of cardiovascular disease
(men under age 55 or women under age 65)
April 21, 2023 9Hypertension
Modifiable Risk Factors for Developing Hypertension
Obesity Poor dietary habits High sodium intake Sedentary lifestyle High alcohol consumption
April 21, 2023 10Hypertension
Colors of Salt
White Black Red Yellow Green Brown Clear
Table salt Soy sauce Catsup Mustard Pickles Soups & gravies Saline
April 21, 2023 11Hypertension
High Risk Subjects
► ABP ≥ 180 systolic and/or ≥ 110 diastolic
► Systolic BP > 160 with low diastolic <70
► Diabetes mellitus► Metabolic syndrome► ≥ 2 cardiovascular risk factors
(smoking, dyslipidaemia, obesity, …..)April 21, 2023 12Hypertension
Life time Risk of Hypertension in normotensive women and men aged 65 years
Risk of Hypertension %
0 2 4 6 8 10 12 14 16 18 20
Years to Follow-up
Women
Risk of Hypertension %
Years to Follow-up
0 2 4 6 8 10 12 14 16 18 20
Men
JAMA 2002:297:1003-10. Framingham data.
100
80
60
40
20
0
100
80
60
40
20
0
April 21, 2023 13Hypertension
Types & Complications of Hypertension
Types of hypertention, 2007, USA
Essential * 92.0-95.0 %
Secondary
Chronic kidney disease 3.0-6.0 %
Renovascular disease 0.2-1.0 %
Pheochromocytoma 0.1-0.2 %
Aldosteronism 0.1-0.3 %
Cushing’s syndrome 0.1-0.2 %
Coarctation 0.1-0.2 %
Oral contraceptives 0.2-1.0 %
* Onset in 30s and 40s, gradual onset, family history, obesity
April 21, 2023 15Hypertension
TIA = transient ischemic attack; LVH = left ventricular hypertrophy; CHD = coronary heart disease; MI = myocardial infarction; HF = heart failure. Cushman WC. J Clin Hypertens. 2003;5(Suppl):14-22.
RetinopathyRenal failure
Peripheral vascular disease
Complications of Hypertension:
LVH, IHD, MI, HF
TIA, stroke
Hypertension Hypertension is a risk factoris a risk factor
April 21, 2023 16Hypertension
Assessment & Diagnosis
Nokolai Korotkoff, 1905
Auscultatory method of
blood pressure measurement
April 21, 2023 18Hypertension
Noninvasive Blood Pressure Measurement
Methodologies- Auscultatory (K sound)
- Mercury
- Aneroid
- Oscillometric
Locations Situations - Upper arm - Clinic - Wrist - Home - Finger - Ambulatory
The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC), 2007
Systolic Diastolic
Optimal <120 and <80
Normal 120–129 and/or 80–84 High normal 130–139 and/or 85–89Grade 1 HTN 140–159 and/or 90–99 Grade 2 HTN 160–179 and/or 100–109 Grade 3 HTN 180 and/or 110 Isolated Systolic HTN ≥140 and <90
Definitions and Classification of blood pressure
Prevention & Control
◘ Reduce sodium intake
◘ Healthy diet: high in fresh fruits, vegetables, low fat dairy products, dietary and soluble fiber, whole grains and protein from plant sources, low in saturated fat, cholesterol and sodium.
◘ Regular physical activity: 30-60 minutes of moderate intensity cardiorespiratory activity (e.g. a brisk walk); 5-7 days/week
in addition to routine activities of daily living
◘ Low risk alcohol consumption (≤2 standard drinks/day and less than 14/week for men and less than 9/week for women)
Primary Prevention – Population Strategies 1
April 21, 2023 22Hypertension
Primary Prevention – Population Strategies 2
◘ Maintenance of ideal body weight (BMI 18.5-24.9 kg/m2)
Waist Circumference Men Women - EMR, Europe, Sub-Saharan African <94 cm <80 cm - South Asian, Chinese <90 cm <80 cm
◘ Prevention / cessation of tobacco use
Health Education
Behavioral change
April 21, 2023 Hypertension 23
Primary Prevention- High Risk approach
Tracking of blood pressure from childhood, in high risk families
April 21, 2023 Hypertension 24
April 21, 2023 25Hypertension
Secondary prevention
April 21, 2023 Hypertension 26
Timely diagnosis and adequate control of BP
Compliance with treatment
Usual blood pressure threshold values for initiation of pharmacological treatment of hypertension *
Condition Initiation
SBP or DBP mmHg
• Systolic or Diastolic hypertension
140/90
• Diabetes• Chronic Kidney Disease 130/80
Indications for Pharmacotherapy
April 21, 2023 27Hypertension
* Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC 7) EXPRESS
BENEFITS OF LOWERING BLOOD PRESSURE
The Clinical Trials had shown:
Reduction in • STROKE 35 – 40 % • MI 20 – 25 %
• HEART FAILURE > 50%
April 21, 2023 28Hypertension
Conclusion
ASSESS AND MANAGE CV RISK IN HYPERTENSIVES High dietary sodium intake, smoking, dyslipidemia,
dysglycemia, abdominal obesity, unhealthy eating, and physical inactivity.
LIFESTYLE MODIFICATION Sustained lifestyle modification is the cornerstone for
the prevention and control of hypertension and the management of cardiovascular disease. Encourage patients to reduce their sodium intake.
TREATING TO TARGET BP Treat blood pressure to less than <140/90 mmHg. In people with diabetes or chronic kidney disease
target to <130/80 mmHg and more than one drug is usually required including diuretics to achieve BP targets.
April 21, 2023 29Hypertension
Global initiatives:World Health Day 2013
April 21, 2023 Hypertension 30
Local hypertension initiatives
Saudi societies working in the hypertension field: Saudi hypertension management society Saudi heart association
Related databases: HEARTS database: http://www.hearts-
ksa.com/home.html SPACE registry project in Saudi Arabia:
http://www.space-ksa.com/ Saudi Hypertension management guidelines
April 21, 2023 Hypertension 31
References 1
1. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 2003
2. Saudi Hypertension Management Guidelines 3. The British Hypertension Society. NICE Guidelines4. Franklin S. Epidemiology of hypertension. UC
Irvine5. The Canadian Hypertension Education Program:
Recommendations for management of hypertension, 2006
April 21, 2023 32Hypertension
References 2
6. Treatment of hypertension in the prevention and management of Ischemic Heart Disease. American Heart Association, 2007
7. European guidelines for management of arterial hypertension 2007
8. Saad H. Hypertension updates, 20109. International societies: American Heart
Association; Heart & Stroke Foundation of Canada; British Heart Foundation; European Society of Cardiology, World Health Organization (www.who.int); Centers for disease control and prevention. www.cdc.gov April 21, 2023 33Hypertension