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Hypertension
Dr. Indranil Das
PGT(Final year)Department of
Community Medicine
Burdwan Medical College
• Hypertension is the commonest cardiovascular
disorder posing a major public health challenge.
• Sir George Pickering first formulated a concept
that blood pressure is distributed continuously in
a bell shaped curve with no real separation
between normotension and hypertension
Prevalence: Prevalence is increasing day by
day.
Tracking of Blood pressure:
• Those individuals whose BP was initially high
would probably continue the same track as
adults.
• This phenomenon of persistence of rank order of
BP has been described as “tracking”
• Hypertension is an iceberg disease.
Rule of halves:
Only about half of the hypertensive subjects are
aware of the condition, only about half of those
aware were being treated & only about half of
those treated were adequately treated.
Risk factors of hypertension
1.Non-modifiable risk factors:
a)Age:
DBP is a more potent cardiovascular risk factor
than SBP until age 50;thereafter, SBP is more
important.
b)Sex:
• In early life little difference
• Higher level in men during adolescence and
adulthood
• Late in life the difference narrows and situation
may even be reversed.
c)Genetic Factors:
• Twin studies have confirmed the importance
• BP levels among first degree relatives have also
been noted to be statistically significant.
d)Ethnicity: Black Americans of African origin have
been found to have high BP.
2. Modifiable risk factors:
a)Obesity:
• greater the weight gain greater the risk of high BP.
• Central obesity has been positively correlated with high BP in several
population.
b)Salt intake:
• High salt intake(7-8gm/day) increases BP proportionately
• Potassium antagonizes the biological effect of sodium and there by
reduces BP.
c)Saturated fat:
• raises both BP and cholesterol
d)Dietary fibre:
• Risk of CHD and hypertension is inversely related to the consumption of
dietary fibre.
e)Alcohol:
• High alcohol intake is associated with increased risk of BP.
f)Heart rate:
• Heart rate of hypertensive group were higher.
g)Physical Activity:
• Reducing body weight, hypertension can be
reduced.
h)Environmental stress:
• Over activity of the sympathetic system increases
risk of hypertension
i)Socio-economic factor:
• Both in upper & lower S E group.
Measurement of BP
• The auscultatory method of BP measurement should be used.
• Persons should be seated quietly for at least 5 minutes in a chair
(rather than on an exam table), with feet on the floor, and arm
supported at heart level.
• Caffeine, exercise, and smoking should be avoided for at least 30
minutes prior to measurement.
• An appropriately sized cuff (cuff bladder encircling at least 80
percent of the arm) should be used to ensure accuracy.
• At least two measurements should be made and the average
recorded.
• For manual determinations, palpated radial pulse obliteration
pressure should be used to estimate SBP—the cuff should then be
inflated 20–30 mmHg above this level for the auscultatory
determinations; the cuff deflation rate for auscultatory readings
should be 2 mmHg per second.
• SBP is the point at which the first of two or more Korotkoff
sounds is heard (onset of phase 1), and the disappearance of
Korotkoff sound (onset of phase 5) is used to define DBP.
Classification of BP measurement
(WHO Guideline)
CATEGORY
SBP(mmHg)
DBP(mmHg)
Normal
<130
<85
High Normal
130-139
85-90
Stage 1
140-159
90-99
Stage 2
160-179
100-109
Stage 3
180
110
Hypertension
Classification of hypertension:
(Based on JNC - 7 criteria)
• Normal- Systolic and diastolic < 120/80
• Prehypertension: systolic 120-139 or diastolic 80-89
mm of Hg
• Stage-1 hypertension: systolic 140-159 or diastolic
90-99 mm of Hg
• Stage-2 hypertension: systolic ≥ 160 or diastolic ≥
100 mm of Hg
Various forms of Hypertension:
• Essential Hypertension/Primary
Hypertension/Idiopathic Hypertension: No definable
causes are present.
• Secondary Hypertension: Individuals in whom a
specific structural organ or gene defect is responsible
for hypertension
• Isolated Systolic Hypertension: Defined by systolic
BP≥140mmHg together with a normal diastolic BP.
• White Coat Hypertension: Persistently higher BP when
measured by a professional in the office than when
measured at home.
• Accelerated Hypertension: Significant recent increase
in BP over previous hypertensive levels associated with
evidence of vascular damage on fundoscopic
examination but without papilledema.
Organ Damage
•
•
•
Left ventricular hypertrophy
Genralised and focal narrowing of retinal arteries
Micro-albuminuria,protienuria and/or slight elevation of plasma creatinine
When BP range is more than >180/110 symptoms and signs have appeared as signs of organ damage.
Heart:
• Angina pectoris
• Myocardial infarction
• Heart failure
Brain:
• Stroke
• Transient Ischaemic attack
• Hypertensive Encephalopathy
• Vascular Dementia
Optic Fundi:
• Retinal haemorrhages and exudates with or without papilloedema
Kidney:
• CKD
Vessel:
• Dissecting aneurysm
• Peripheral vascular disease
PREVENTION OF HYPERTENSION
A.Primary prevention:
a)Population Strategy:
BP towards the lower level of biological normality.
1.Nutrition:
• Reduction of salt intake to an average of not more
than 5gm/day
• Moderate fat intake
• Avoidance of high alcohol intake
• Restriction of energy intake appropriate to body
needs
• Fruit and vegetable intake
2.Weight reduction:
• Keeping the BMI within normal range; ideal is to
maintain normal body weight.
3.Exercise promotion: Regular physical exercise of
at least 30mins/day for 5 days in a week.
4.Behavioural changes: Reduction of smoking,
stress.
5.Health Education : Preventive advice on all risk
factors
6.Self-care: Maintaining log book of his readings of
BP
b)High-risk strategy:
• The family history of hypertension and
tracking of BP from childhood helps to detect
the individual at risk.
B.Secondary prevention:
a)Early case detection :
• Early case detection is problem---- High BP
rarely causes symptoms until organ damage
has already occurred.
• The only effective method is screening.
b)Treatment:
Goals of Therapy
• The ultimate public health goal of
antihypertensive therapy is to reduce
cardiovascular and renal morbidity and mortality.
Since most persons with hypertension, especially
those >50 years of age, will reach the DBP goal
once the SBP goal is achieved, the primary focus
should be on attaining the SBP goal. Treating SBP
and DBP to targets that are <140/90 mmHg is
associated with a decrease in CVD complications.
• In patients with hypertension and diabetes or
renal disease,the BP goal is <130/80 mmHg
Treatment Algorithm
Life Style Modification
Not controlled
Stage 1
Thiazides
Stage 2
Two drug combination
(one of which should be thiazide)
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