HYPERTENSION

Dr.A.KRISHNAVENI
• A chronic condition of concern due to its role
in the causation of coronary heart disease,
stroke and other vascular complications.
• Major public health challenge to the population
in socio-economic and epidemiological
transition.

• One of the major risk factors for cardiovascular

mortality, which accounts for 20-50 percent of
all deaths.
 CLASSIFICATION
CLASSIFICATION SYSTOLIC BP (mmHg) DIASTOLIC BP
(mmHg)

NORMAL < 120 AND <80

PRE HYPERTENSION 120 - 139 OR 80 -89

HYPERTENSION

STAGE I 140 -159 OR 90 -99

STAGE II >= 160 OR > = 100

Joint National Committee (JNC 8) Classification

• When systolic and diastolic blood pressure
falls into different categories, the higher
category should be selected and classify the
individual's blood pressure.

• "lsolated systolic hypertension" is defined as

a systolic blood pressure 140 mm of Hg or
more and a diastolic blood pressure of less
than 90 mm of Hg.
 CLASSIFICATION
HYPERTENSION

PRIMARY /ESSENTIAL SECONDARY

(prevalence 90%) (prevalence 10%)

CAUSE – SOME OTHER

CAUSE –UNKNOWN DISEASES (eg - Chronic Kidney
Disease,adrenal tumor etc )
 RULES OF HALVES
• Only about half of the hypertensive subjects in
the general population of most developed
countries were aware of the condition, only
about half of those aware of the problem
were being treated and only about half of
those treated were considered adequately
treated.
 In simple terms
All hypertensives

50% aware 50% unaware

50% treated 50% untreated

50% completely 50% not completely

treated treated
 Tracking of blood pressure
• If blood pressure levels of individuals were followed
up over a period of years from early childhood into
adult life, then those individuals whose pressures
were initially high in the distribution, would probably
continue in the same "track" as adults.

• In other words, low blood pressure levels tend to

remain low, and high levels tend to become higher as
individuals grows older.
• This phenomenon of persistence of rank order
of blood pressure has been described as
"tracking" .
• Application
This knowledge can be applied in
identifying children and adolescents "at risk“
of developing hypertension at a future date.
Tracking
RISK FACTORS FOR HYPERTENSION
• Non Modifiable Risk Factors
• Modifiable Risk Factors
 Non modifiable factors
• 1.Age – BP raises with age in both sexes
cause – Accumulation of environmental
influences and effects of genetically
programmed senescence in body system.

• 2.Ethenicity
Black Communities Have Higher BP
• 3.sex

Early life Little difference between

sexes

Adolescence Men > female

Late life Female > male (due to

postmenopausal changes )
4.Genetic factors
• Twin studies confirmed genetic factors
•
Parents Hypertensive Chance of getting
status hypertension in children

Two normotensive parents 3%

Two hypertensive parents 45 %

 2.Modifiable risk factors
Risk factor Relationship to BP

1.Obesity Weight gain directly proportional to BP

2.Salt intake
Sodium directly proportional to BP
Potassium Inversely proportional to BP
Calcium,cadmium,magnesium Inversely proportional to BP

3.Saturated fat,serum cholesterol directly proportional to BP

4.Dietary fiber Inversely proportional to BP

5.Alcohol directly proportional to BP

6.Physical activity Inversely proportional to BP

7.Socio Economic Status,Stress directly proportional to BP

 PREVENTION OF HYPERTENSION

• 1. Primary prevention
(a) Population strategy
(b) High-risk strategy
• 2. Secondary prevention
 PRIMARY PREVENTION
• “All measures to reduce the incidence of
disease in a population by reducing the risk of
onset"
 POPULATION STARTEGY
• It is directed at the whole population, irrespective of
individual risk levels.
• Concept
Even a small reduction in the average blood
pressure of a population would produce a large
reduction in the incidence of cardiovascular
complications such as stroke and CHD .
• Goal
To shift the community distribution of blood
pressure towards lower levels or "biological normality"
 Nonpharmacotherapeutic interventions

• (a) NUTRITION
 Reduction of salt intake - not more than 5 g
per day
 Moderate fat intake
 Avoidance of a high alcohol intake
 Restriction of energy intake appropriate to body
needs.
• (b) WEIGHT REDUCTION
• (c) EXERCISE PROMOTION
• (d) BEHAVIOURAL CHANGES
Reduction of stress and smoking,
modification of Personal life-style, yoga and
transcendental meditation.

• (e) HEALTH EDUCATION

• (f)SELF-CARE
 High risk strategy
• This approach is appropriate if the risk factors
occur with very low prevalence in the community
• STRATEGY :
Detection of high-risk subjects and optimum
use of clinical methods.
• Method used to identify high risk individuals
1.Identify family history of hypertension
2. “Tracking" of blood pressure from childhood.
 SECONDARY PREVENTION
• Early case detection
• Appropriate treatment
• Adhere compliance to treatment