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Emma Stead

on 25 January 2017

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Transcript of Hypertension

Done by:
Emma Stead 15029574
Samantha Shawe 15036198
Estee Strydom 15069525
Alicia van Heerden 15006591
Why is it such an issue for public health??
high blood pressure
leading risk factor for the global burden of disease
causes over
9 million deaths
per year

80% of cardiovascular deaths occurring in low- and middle-income countries
Why do we need to treat hypertension?
Important risk factor for cardiovascular disease
Globally responsible for about 50% of MI's, strokes and heart failures
Contributes to renal disease, dementia and foetal/maternal health
increases the risk for coronary heart disease by 2-fold
increases the risk for stroke and heart failure by 4-fold
Easily Detectable
Here public health plays a major role
HT can be easily detected in screening programmes
Can be added to a multi-disease screening campaign such as HIV and Diabetes Mellitus
National Institutes of Health: National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program [Internet]. Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. United States: NIH Publication; [updated 2002 Nov 1; cited 2017 Jan 12]. Available from: https://www.nhlbi.nih.gov/files/docs/resources/heart/pphbp.pdf
Dreisbach AW [Internet]. Epidemiology of Hypertension. Medscape; [updated 2014 Dec 29; citied 2017 Jan 10]. Available from: http://emedicine.medscape.com/article/1928048-overview#a3
. World Health Organization [Internet]. Raised blood pressure. World Health Organization; [updated 2015, cited 2017 Jan 10]. Available from: http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/
Lacruz ME, Kluttig A, Hartwig S, Loer M, Tiller D, Greiser KH, et al. Prevalence and Incidence of Hypertension in the General Adult Population. Medicine (Baltimore). 2015 Jun; 94(22): e952.
. Kotwani P, Balzer L, Kwarisiima D, Clark TD, Kabami J, Byonanebye D, et al. Evaluating linkage to care for hypertension after community-based screening in rural Uganda. Trop Med Int Health. 2014 April; 19(4):459-68.
6. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension. Eur Heart J. 2007 Jun 1; 28(12):1462-536.
. Centers for Disease Control and Prevention [Internet]. High blood pressure facts. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention; [updated 2016 Nov 30; cited 2017 Jan 16]. Available from: https://www.cdc.gov/bloodpressure/facts.htm

Community health campaigns that offer hypertension screening, education, referral appointment and a travel voucher obtain an excellent linkage to care
Big impact on the developing world:
Africa, more specifically, has been reported to have the highest prevalence of hypertension (HT) among 25 year olds
(46%) whilst America
has the lowest (35%)

myocardial infarction(MI)
heart failure
cardiovascular premature death
peripheral arterial disease
Early treatment of hypertension can reduce future complications of cardiovascular disease, kidney disease and retinopathy
Most important of all,
hypertension is
and will not be detected
unless blood pressure
is measured regurlarly
linkage to care meaning visiting a health care facility within 6 months of screening
Behavioural risk factors include:
poor diet leading to an increase in obesity
lack of physical exercise
excess alcohol
continuous exposure to stress
8.6% for men
5.4% for women
1980 and 2008
the incidence of
uncontrolled HT
rose from
600 million to 1 billion
this could be due to an increase in the
population size

or that more people are being diagnosed due to
heightened emphasis
on blood pressure measurement
depends on whether or not the patient is aware of their HT
depends on patient compliance
studies show that 31% of men and 19% of women are unaware of their HT
Of people who are aware of their HT, only 18% of men and 29% of women correctly adhere to their medication
If HT is not controlled it can lead to
Prevalence of Hypertension (HT)
20% of the world's population has HT
50% of populations older than 60 have HT
as HT often goes undiagnosed, these figures might be underestimated
significant prevalence brought on by an increase in population size and an increase in behavioural risk factors
HT is the biggest contributor to the global burden of disease and is the cause of
of deaths due to heart disease and
of deaths due to strokes
Coronary heart disease, ischaemia, stroke, renal impairment, visual impairment and heart failure
It has been shown that for each 20/10 mmHg increase in blood pressure, the risk of cardiovascular disease can double
To reduce cardiovascular complications and increase the chance of survival, blood pressure must be maintained at 140/90 mmHg
HT is incurable and thus can only be managed with medication
Therefore, disability/morbidity figures will be the same as the prevalence figures
Health needs of the population
public health interventions such as:
education of the community
preventing the disease from occurring
how to manage the disease
Screening programmes for early detection of the disease
Education about what the HT is, how to prevent it and how to manage it
Appropriate treatment that is cost-effective and easily accessible
Facilities where community members can have regular check-ups to ensure that their HT is being managed correctly
Skilled health care workers that can make accurate diagnoses and treat/manage hypertension properly
Testing of other cardiovascular risk factors such as high cholesterol, smoking and diabetes mellitus
Treatment and management of the above risk factors
Testing for end-organ damage to ascertain whether the HT is malignant or benign
7/10 American adults use anti-hypertensive medications to manage their condition
combination therapy is on the rise for adequate control HT
drug treatments differ for patients older than 55 years of age or of black origin and those younger than 55 years of age
Patients younger than 55 years
Step 1=either an ACE
inhibitor or ARB
Patients older than 55 years or of black origin
Step 1: Calcium channel
blocker or a diuretic
Step 2: ACE-I/ARB in combination with a calcium channel blocker or diuretic
Step 3: ACE-I/ARB in combination with a calcium channel blocker and a diuretic
Step 4: if none of the above treatment works, then it is called resistant hypertension and the patient should be referred to a specialist
Lifestyle changes such as a healthier diet are difficult to implement as they are too costly
Many communities live far from clinics and cannot get regular screening, medication or check-ups
A large number of health care workers do not accurately diagnose and treat hypertension
Community members cannot afford medication
Reducing the burden of Hypertension
Why is it a burden??
treatment is chronic/lifelong
providing free medication at government hospitals is costly
it is a risk factor for atherosclerosis which can result in caradiovascular disease
Prevention is better than cure
Prevention strategies applied early in life tend to have the greatest long-term potential for avoiding hypertension
Inadequate resources and/or limited staff in certain clinics and hospitals
These problems need to be addressed by the government with the help of NGO's to ensure that the population has all their health needs met
Lifestyle interventions are more likely to be successful
Certain interventions need to be implemented by the government
Dietary sodium reduction
of alcohol
Blood pressure measurement at every clinic visit
Weight loss
normal adult BMI range:
18.5-24.9 kg/m2
dieticians should be freely available at hospitals
health care workers should educate patients on healthy diets
the community should receive help with vegetable gardens
increase the price of highly processed and fatty foods
educate school children about healthy eating
Increased physical activity
At least 30 minutes a day, 6 days per week
Improve sports facilities at schools
Improve or build community sports centres that are affordable to the surrounding community
Dietary sodium reduction
Moderation of alcohol consumption
<2 units for men and <1 unit for women
Increase the price of alcohol
Educate school children on the negative effects of alcohol
Free community AA groups and rehab facilities to curb addictions
Potassium Supplementation
>3 500mg per day
Educate people about potassium rich foods (spinach, sweet potato, banana etc)
Provide free supplements at clinics
Blood pressure measurements at each clinic visit
In order to detect an increasing BP early on
So that the patient can start preventative measures such as lifestyle changes
<2.4 g of sodium per day
decrease salt in cheap, processed foods such as potato chips
Full transcript