Hypertension

(1)

Hypertension

Lecture

2

(2)

OBJECTIVES

TO KNOW what is blood pressure mean?

What are the normal and abnormal values?

How to control HTN?

(3)

Hypertension Definition

Hypertension is sustained elevation of BP

•

Systolic blood pressure  140 mm Hg or

•

Diastolic blood pressure  90 mm Hg

(4)

Hypertension is defined as:

A. Systolic blood pressure  140 and diastolic blood pressure  90

B. Systolic blood pressure  120 and diastolic blood pressure  80

C. Diastolic blood pressure  140 and systolic blood pressure  90

D. Diastolic blood pressure  120 and systolic blood

pressure  80

(5)

Classification of Hypertension

•

Primary (Essential) Hypertension

•

Elevated BP with unknown cause

•

90% to 95% of all cases

•

Secondary Hypertension

•

Elevated BP with a specific cause e.g.:

•

Renal diseases

•

Congenital narrowing of the aorta

•

Endocrine disorders

•

5% to 10% in adults

(6)

The cause of primary (Essential) Hypertension is:

A.

Renal diseases

B.

Congenital narrowing of the aorta

C.

Endocrine disorders

D.

Unknown cause

(7)

Blood Pressure Classification

BP

Classification

SBP mmHg

DBP mmHg

Normal < 120 and < 80

Pre-

Hypertension 120 -139 or 80-89

Stage 1

Hypertension 140-159 or 90-99 Stage 2

Hypertension > 160 or > 100

(8)

In Stage 2 Hypertension the diastolic Blood pressure is ______

A.

^{> 120}

B.

^{> 140}

C.

^{> 160}

D.

^{> 180}

(9)

Risk Factors Non Modifiable

1.

Age: Blood pressure rises with age

2.

Family history

3.

Race: higher blood pressure levels in black communities than other ethnic groups

4.

Gender. Before menopause hypertension is more common in males

(10)

Risk Factors Modifiable

1.

Being overweight or obese

2.

Being physically inactive

3.

Too much salt (sodium) in diet

4.

Too little potassium in diet

5.

Low intake of dietary fibres

6.

High alcohol intake

7.

ENVIRONMENTAL STRESS

(11)

Modifiable risk factors for Hypertension include

A.

High potassium intake

B.

High intake of dietary fibers

C.

Being Physically active

D.

High intake of sodium

(12)

BP Measurement

•

Sitting on comfortable chair with back supported

•

Legs uncrossed

•

Waiting about 5 minutes before taking a measurement

•

No talking while measuring BP

•

No caffeine or smoking for 30 minutes before BP measurement

(13)

BP Measurement

•

Appropriate size cuff

•

Arm with the cuff on a table at chest height

•

BP measurement in both

•

armsUse arm with higher reading for subsequent measurements

(14)

Hypertension in Community:

Rule of halves

•

Of the total population, 50% have hypertension.

•

Only 50% out of all hypertensive cases know about the condition.

•

Of the total 50% of diagnosed cases, 50% take medicine and 50% do not.

•

Of the 50% who take medicine, only 50% are adeuately treated and the rest 50 % are not.

(15)

(16)

Hypertension: Complications

• Complications are primarily related to development of

atherosclerosis (“hardening of

arteries”), or fatty

deposits that harden

with age

(17)

Complications of Hypertension

•

The common complications target these organs:

•

^Heart

•

^Brain

•

^Kidney

•

^Eyes

(18)

Hypertension Complications

1.

Hypertensive Heart Disease

•

Coronary artery disease

•

Left ventricular hypertrophy

•

Heart failure

(19)

Complications

1. Cerebrovascular Disease

•

^Stroke

2. Peripheral Vascular Disease

3. Retinal Damage

(20)

Left Ventricular Hypertrophy

Fig. 32-3

(21)

Primary Prevention

• Primary prevention is concerned with

preventing the onset of disease; it aims to reduce the incidence of disease.

• Primary prevention has been defined as “all

measures to reduce the incidence of disease in a

population by reducing the risk of onset”

(22)

Primary Prevention

1.

^NUTRITION

•

Reduction of salt intake to an average of less than 5 g per day.

•

Moderate fat intake.

•

The avoidance of a high alcohol intake.

•

Restriction of energy (calorie) intake appropriate to body needs.

(23)

POPULATION STRATEGY

2.

WEIGHT REDUCTION

3.

EXERCISE PROMOTION

4.

HEALTH EDUCATION

5.

^SELF-CARE:

The patient is taught self-care, i.e., to take his own blood pressure and keep a log-book of his readings.

(24)

Short Notes

A. Enumerate 5 primary prevention measures for

hypertension

(25)

Secondary Prevention

•

The goal of secondary prevention is to detect and control high blood pressure in affected individuals.

•

Secondary prevention includes:

•

Early case detection

•

^Treatment

•

Improving compliance

(26)

Detection and control high blood pressure in affected individuals is considered _______?

A. Primary Prevention

B. Secondary Prevention

C. Tertiary Prevention

D. None of the above

(27)

Measures to reduce the incidence of hypertension disease in a population is

considered ________?

A. Primary Prevention

B. Secondary Prevention

C. Tertiary Prevention

D. None of the above

(28)

1. EARLY CASE DETECTION

•

Major problem because high blood pressure rarely causes symptoms until organic damage has already occurred.

•

The only effective method of diagnosis of hypertension is to screen the population.

(29)

2. Treatment

• The aim of treatment should be to obtain a blood pressure below 140/90.

• Control of hypertension has been shown to

reduce the incidence of complications.

(30)

3. Improving Patient compliance

•

Treatment of hypertension is life-long.

•

This presents problems of patient compliance.

•

Compliance is the extent to which patient behavior (e.g.

taking medicines, following diets) coincides with clinical prescription.

•

The compliance rates can be improved through education directed to patients, families and the community.

(31)

The extent to which patient behavior (e.g.

taking medicines) coincides with clinical prescription is called _______?

A. Compliance B. Consent

C. Regimen

D. Drug Abuse

(32)

(33)

Benefits of Lowering BP

Average Percent Reduction

Stroke incidence 35–40%

Myocardial infarction 20–25%

Heart failure 50%

(34)