Epidemiology , Prevention and

Control of NCDs
Dr Praveer Kumar
Associate Professor
"Measure Your Blood Pressure Accurately,
Control It, Live Longer!"
 RISK FACTORS FOR Hypertension

Non Modifiable
Modifiable
Obesity
AGE
Salt Intake
SEX
Saturated Fats
Genetic Factors
Dietary Fibres
Ethnicity
Alcohol
Heart Rate
Stress
Physical Activity
 Non-modifiable Risk Factors
1. Age - Blood pressure rises with age in both sexes
and the rise is greater in those with higher initial
blood pressure.
2. SEX – Higher in young and middle aged male
adults. But increases in women after menopause .

Estrogen supplementation protects against the

relative rise of blood pressure in post menopausal
women.
3. Genetic Factors –
Family studies have shown that the children of
two normotensive parents have 3 per cent
possibility of developing hypertension, whereas
45 percent possibility in children with two
hypertensive parents .
 Modifiable Risk Factors
1. Obesity - Greater the weight gain, the greater the
risk of high blood pressure . "Central obesity"
indicated by an increased waist to hip ratio, has
been positively correlated with high blood
pressure
2. SALT INTAKE - high salt intake (i.e., 7-8 g per day)
increases blood pressure proportionately.
Potassium reduces blood pressure.
3. SATURATED FAT - Saturated fat raises blood
pressure .
4. DIETARY FIBRE – Risk of CHD and hypertension is
inversely related to the consumption of dietary fibre.
5. ALCOHOL : High alcohol intake is associated with an
increased risk of high blood pressure.
6. Heart Rate - Heart rate of the hypertensive group is
invariably higher. This may reflect a resetting of
sympathetic activity at a higher level.
7. PHYSICAL ACTIVITY : Physical activity have reducing
effect on blood pressure.
(8) ENVIRONMENTAL STRESS :
• Psychosocial factors operate through mental
processes, consciously or unconsciously, to produce
hypertension.
• Catecholamine levels in young people revealed
higher noradrenaline levels in hypertensives than in
normotensives.
• Over-activity of the sympathetic nervous system has
an important part to play in the pathogenesis of
hypertension.
9. SOCIO-ECONOMIC STATUS -
Post transitional stage of society - Lower socio-
economic groups.
Transitional or Pre-transitional Society - Upper socio-
economic groups.
• The commonest cause of secondary
hypertension is oral contraception, because of
the oestrogen component in combined
preparations.
 Prevention of Hypertension
1. Primary prevention
(a) Population strategy
(b) High-risk strategy
2. Secondary prevention
 Primary Prevention

(a) NUTRITION –
(i) Reduction of salt intake to an average of not more
than 5 g per day
(ii) Moderate fat intake
(iii) The avoidance of a high alcohol intake
(iv) Restriction of energy intake appropriate to body
needs.
(v) Intake of fruits and green leafy vegetables
• b) WEIGHT REDUCTION :
The prevention and correction of over weight/ obesity
(Body Mass Index should be <23) is a prudent way of
reducing the risk of hypertension and indirectly CHD.
 EXERCISE PROMOTION
c) The evidence that regular physical activity leads to
a fall in body weight, blood lipids and blood pressure
goes to suggest that regular physical activity should
be encouraged as part of the strategy for risk-factor
control .
As per WHO , Physical Activity more than 150-300 mts
Moderate Intensity or > 75-150 mts Vigorous
Intensity/week) is Inversely related with
Hypertension, Type 2 Diabetes, Stress, Depression
(d) BEHAVIOURAL CHANGES :
• Reduction of - Stress, Alcohol and Smoking,

• Modification of personal life-style, yoga, Music

listening and meditation should be included.
• Avoidance of fried , Oily & Junk foods
(e) SELF-CARE -
The patient is taught self-care, i.e., to take his
own blood pressure and keep a log-book of his
readings.
Logbooks can also be useful for statistical
purposes and for the long-term follow-up of
cases
(F) Health Education –Provide preventive advice on
all risk factors and related health behavior to public
 SECONDARY PREVENTION
• EARLY CASE DETECTION : Early detection is a
major Problem but very cost effective. The
only effective method of diagnosis of
hypertension is to screen the population.
Screening should be linked with follow up and
care.
 TREATMENT
• The aim of treatment should be to obtain a
blood pressure below 140/90, and ideally a
blood pressure of 120/80.

• Control of hypertension has been shown to

reduce the incidence of stroke and other
complications.
JNC-8 :TREATMENT CHOICES

41
 PATIENT COMPLIANCE
• The treatment of high blood pressure must
normally be life-long
• The compliance rates can be improved
through education directed to patients,
families and the community
 Stroke or CVA
• Manifest by abrupt onset , non-convulsive Focal
Neurological Deficit caused by either occlusion of
artery (Infarction) or rupture of artery
(Hemorrhage).
• WHO defined stroke as "rapidly developed clinical
signs of focal disturbance of cerebral function;
lasting more than 24 hours or leading to death, with
no apparent cause other than vascular origin“.
 RISK FACTORS

a. Age – Incidence rise steeply with age. 20 % of strokes occur in

population less than 40 year of age.
b. Sex : The incidence rates are higher in males than
females at all ages.
c. Personal history : Nearly three-quarters of all registered stroke
patients had associated diseases, mostly in the cardiovascular
system or of diabetes.
d. Hypertension - Main risk factor for cerebral thrombosis as well as
cerebral hemorrhage. For every 20 mmHg systolic or10 mmHg
diastolic increase in BP, there is doubling of mortality from stroke.
e. Diabetes
f. Elevated blood lipids – Total LDL, HDL, VLDL, Triglyceride Level
 RISK FACTORS

g.Obesity
h. Smoking
i. Glucose Intolerance
j. Elevated blood clotting factors
k. Oral Contraceptives
l. Male Sex
m. Family History
n. Physical Inactivity - Increases risk of heart disease
and stroke by 50%.
o. Unhealthy Diet - : Low fruit and vegetable
intake is estimated to cause about 11% of
stroke worldwide.
 Preventive Measures
• Regular screening of Hypertensive patients. Those
are hypertensive should be placed on treatment
and their BP level should be adequately controlled.
• At least moderate exercise 30 mts daily for five days
in a week, Pranayam, Yoga.
• Diet should be balanced and included enough fruits.
WHO recommends a population salt intake of less
than 5 grams/person/day to help the prevention of
hypertension.
• Proper care of diabetes and raised cholesterol level
• Smoking, high alcohol intake should be curtailed.

• STRESS MANAGEMENT IS CORNERSTONE.

PRANAYAM IS MOST IMPORTANT.

• Govt. of India has launched “National Programme

For Prevention & Control of Cancer, Diabetes,
Cardio-Vascular Diseases & Stroke” (NPCDCS).
 Obesity
• Types –
• Hypertrophic obesity - Abnormal growth of the
adipose tissue due to an enlargement of fat cell
size.
• Hyperplastic obesity -An increase in fat cell
number .
• or a combination of both.
Prevention and Control
• Weight control is widely defined as
approaches to maintaining weight within the
'healthy' (i.e. 'normal' or acceptable') range of
body mass index of 18.5 to 24.9 kg/m 2
throughout adulthood
• The diet should be increased –
• Consumption of common un-refined foods i.e.
fruits, green leafy vegetables.
• Adequate levels of essential nutrients in the low
energy diets should be ensured
• Reducing diets should be as close as possible to
existing nutritional patterns.
 EXERCISE PROMOTION
Regular physical activity leads to a fall in body weight,
lipid levels.
Regular physical activity should be encouraged as part
of the strategy for weight control .
As per WHO , Physical Activity more than 150-300 mts
Moderate Intensity or > 75-150 mts Vigorous
Intensity/week) is Inversely related with obesity
Hypertension, Type 2 Diabetes, Stress, Depression
Thank You