Blood Pressure

• Blood pressure is the force exerted by blood against the vessel wall.

• BP is measured in millimeters of mercury ( mmHg).

• Normal BP = 120/80 mmHg.

Blood Pressure Systolic BP =pressure or force exerted on the vessel wall

by flow of blood due to contractions of the heart (systole).

Systolic refers to the pressure of the blood when the heart beats to pump it out.

Diastolic BP = Pressure when the heart is resting (relaxation/diastole).

Diastolic refers to the pressure of the blood when the heart rests in between beats

Sphygmomanometer

HYPERTENSION

• Hypertension is defined as systolic blood

pressure (SBP) of 140 mmHg or greater,

diastolic blood pressure (DBP) of 90 mmHg

or greater.

8 JNC, 2007

Classification of BP

BP Classification Systolic BP Diastolic BP(mmHg) and (mmHg)

Normal <120 <80Prehypertension 120-139 or 80-89Stage 1 140-159 or 90-99Stage 2 > 160 or > 100Systolic HTN > 160 <90

• Patients with prehypertension, increased risk for progression to hypertension;

• 130/80 to 139/89 mm Hg BP range, twice the risk to develop hypertension

The JNC 7 Report: JAMA, 2003; 289: 2560-2572

What is high blood pressure?

• A blood pressure reading above 130/80 mmHg is considered high. High blood pressure is commonly an asymptomatic condition, often known as “the silent killer”.

• Blood pressure measurements indicate how strongly blood presses against arterial walls as it is pumped around the body by the heart.

Key facts on high blood pressure

• Affects one in three adults worldwide

• Affects men more than women

• Affects poorer populations more than others

• Is implicated in 13% of deaths worldwide

• Is identified in WHO’s Health 2020 policy as one of the WHO European Region’s major contributors to disease

Why high blood pressure is apublic health concern

• High blood pressure strains the arteries and heart raising the probability of heart attack, stroke and kidney disease.

• High blood pressure can lead to hypertension.

• Hypertension is diagnosed if readings on separate occasions consistently show blood pressure to be 140/90 mmHg or higher.

• Hypertension is identified as the world’s most prevalent preventable disease in WHO’s Health 2020 policy.

HIGH BLOOD PRESSURE

High blood pressure – also known as raised blood pressure or hypertension – increases the risk of heart attacks, strokes and kidney failure.

If left uncontrolled, high blood pressure can also cause blindness, irregularities of the heartbeat and heart failure.

HIGH BLOOD PRESSURE

The risk of developing these complications is higher in the presence of other cardiovascular risk factors such as diabetes.

One in three adults worldwide has high blood pressure.

The proportion increases with age, from 1 in 10 people in their 20s and 30s to 5 in 10 people in their 50s.

HIGH BLOOD PRESSURE

Prevalence of high blood pressure is highest in some low-income countries in Africa, with over 40% of adults in many African countries thought to be affected.

Hypertension is the most prevalent chronic disease in

India.

The prevalence of hypertension in India is low compared to world

figures. In India, 23.10 per cent men and 22.60 per cent women over 25 years old suffer from hypertension,

says the World Health Organisation’s ‘global health

statistics 2012’ .

India also fares better than the global

average of 29.20 in men and 24.80 in

women.

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HTN Prevalence in India

Recent (2012) studies show that for every known person with hypertension there are two persons

with either undiagnosed hypertension or prehypertension

Increased blood pressure is a high-risk condition that causes approximately 51 per cent deaths

from stroke and 45 per cent from coronary artery disease in India.

THE MYTH• “Patients fear anti-hypertensive medications

due to side effects or getting addicted to tablets.

• But side effects from anti-hypertensive medications are rare and often not serious.”

THE REALITY• On the contrary, if hypertension is not fought,

it can result in serious diseases, some of them fatal

STUDY ANALYSIS

53.30 per cent were aware of their diagnosis; 42.80 per cent were taking treatment and only 10.50 per cent had controlled BP.

DYSMETABOLIC SYNDROME• Elevated waist circumference: Men — greater than 90 cms Women — greater than 80 cms• Elevated triglycerides: Equal to or greater than 150 mg/dL• Reduced HDL ("good") cholesterol: Men — Less than 40 mg/dL Women — Less than 50 mg/dL• Elevated blood pressure: Equal to or greater than 130/85

mm Hg or use of medication for hypertension• Elevated fasting glucose: Equal to or greater than 100

mg/dL or use of medication for hyperglycemia

Risk factors for high blood pressure

• A diet high in saturated fat• Excessive salt consumption• Overweight and obesity• A sedentary lifestyle and lack of exercise• Excessive alcohol consumption• Smoking• Un-managed stress• A family history of high blood pressure• Being over 65 years of age• Co-morbidities such as diabetes

Hypertension : Symptoms & Signs

No specific symptoms ( detected on routine

check-up).( SILENT KILLER)

Headache: Morning localised to occipital region.

Others : Dizziness, Palpitation, Easy fatigability,

epistaxis, haematuria, blurring of vision.

Types of hypertension

• Essential / Primary/ Idiopathic

hypertension

– 90%

– No underlying cause

• Secondary hypertension

– Underlying cause

InvestigationsBasic Tests

CBCUrine : protein. Microscopic analysis.

LFT : S cholesterol etc

RFT : S creatinine , BUN

ECG

Chest X-ray.Blood sugar : Fasting/ PP

Ophthalmoscopy

Special Tests ( Sec HT)

Hypertension : Complications

• CNS Stroke – Infarct/ Haemorrhage

• Retina Hypertensive retinopathy

• Kidney Renal failure

Hypertension : Cardiovascular effects

• Atherosclerosis• Angina• Myocardial Infarction• Heart failure

Atherosclerosis

Effects of Atherosclerosis

Angina

Myocardial Infarction

ULTIMATE GOAL OF ANTIHYPERTENSIVE THERAPY

PROLONGED SURVIVAL

BLOODPRESSURE

REDUCTIONPREVENTION

OF COMPLICATIONS

Benefits of BP reduction

35% to 40% mean reductions in stroke incidence

20% to 25% in myocardial infarction

more than 50% in HF

The JNC 7 Report: JAMA, 2003; 289: 2560-2572

Manage high blood pressure by:

eating a healthy diet

reducing salt intake

exercising regularly

stopping smoking

reducing alcohol consumption

managing stress

having regular blood pressure checks

Lifestyle Modifications to Prevent and Manage Hypertension

• Avoid tobacco

(JNC VI. Arch Intern Med. 1997)

• Reduce weight • Moderate consumption of:

• alcohol • sodium• saturated fat• cholesterol

• Increase physical activity

• Maintain adequate intake of dietary:

• potassium• calcium • magnesium

LIFESTYLE CHANGES

For some people, lifestyle changes are sufficient to control blood pressure such as stopping tobacco use, eating healthily, exercising regularly and avoiding the harmful use of alcohol.

Reduction in salt intake can help.

For others, these changes are insufficient and they need prescription medication to control blood pressure

WEIGHT LOSS

maintaining a normal weight: every 5 kg of excess weight lost can reduce systolic blood pressure by 2 to 10 points.

Drugs used to control hypertension

Drug Class ExampleDiuretics Hydrochlorothiazide-blockers MetoprololCa – Channel blockers

Amlodipine

ACE- inhibitors BenazeprilARBs Valsartanα blockers Prazosin

The WHO response

The WHO Health 2020 policy identifies high blood pressure as a major contributor to disease, and hypertension as the world’s most prevalent preventable disease.

High blood pressure is the theme of World Health Day 2013, with a particular emphasis on reducing dietary salt intake.

WHO’s current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include:

• promotion of a healthy diet through marketing and fiscal measures

• elimination of trans fats• salt reduction• cardio-metabolic risk reduction assessment and

management• promotion of physical activity and mobility

Key interventions

• Encourage regular blood pressure checks• Encourage patients to be aware of their individual

risks• Establish effective tools for early identification,

management and control• Promote physical activity, dietary improvement

and salt reduction• Provide low-cost antihypertensive medication• Set target for mean blood pressure reduction

levels across populations

THANK YOU