Friday, July 20, 2012

THE EPIDEMIOLOGICAL APPOARCH ON HYPERTENSION


ASIAN COLLEGE FOR ADVANCE STUDIES
                      SATDOBATO ,LALITPUR

THE EPIDEMIOLOGICAL APPOARCH ON HYPERTENSION



SUBMITTED TO:                                SUBMITTED BY:
Mrs.Kabita Pandey                             PBN 1st year(Roll no 31-40)
                                                       •Samikshya Bogati     •Samjhana Thapa
                                             •Sarita Silwal               •Sapana Maharjan
                                             •Shanta Rokha             •Srijana Paudel
                                             •Smriti Manandhar   •Subjana maharjan
                                             •  Sumitra Bhuju        •Yojana Shrestha
(Asian college for advance studies)


BACKGROUND

Hypertension is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. Over the past several decades, extensive research, widespread patient education, and a concerted effort on the part of health care professionals have led to decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension.

Approximately 50 million people in the United States are affected by hypertension.Substantial improvements have been made with regard to improving awareness and treatment of hypertension. However, approximately 30% of adults are still unaware of their hypertension; up to 40% of people with hypertension are not receiving treatment; and, of those treated, up to 67% do not have their blood pressure (BP) controlled to less than 140/90 mm Hg. 

 Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease. Therefore, health care professionals must not only identify and treat patients with hypertension but also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population.
  

EPIDEMIOLOGY

Definition:

The study of the distribution and determination health related states or events in specified populations and the application of the study to the control of health problem”.
-John, JohnM.last 1988.



HYPERYTENSION

Definition

Hypertension is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them. Arteries are the blood vessels that carry oxygenated blood from the heart to the body's tissues.

Description

 

As blood flows through arteries it pushes against the inside of the artery walls. The more pressure the blood exerts on the artery walls, the higher the blood pressure will be. The size of small arteries also affects the blood pressure. When the muscular walls of arteries are relaxed, or dilated, the pressure of the blood flowing through them is lower than when the artery walls narrow, or constrict.

Blood pressure is highest when the heart beats to push blood out into the arteries. When the heart relaxes to fill with blood again, the pressure is at its lowest point. Blood pressure when the heart beats is called systolic pressure. Blood pressure when the heart is at rest is called diastolic pressure. When blood pressure is measured, the systolic pressure is stated first and the diastolic pressure second. Blood pressure is measured in millimeters of mercury (mm Hg). For example, if a person's systolic pressure is 120 and diastolic pressure is 80, it is written as 120/80 mm Hg.  

Hypertension is a major health problem, especially because it has no symptoms. Hypertension is serious because people with the condition have a higher risk for heart disease and other medical problems than people with normal blood pressure. Serious complications can be avoided by getting regular blood pressure checks and treating hypertension as soon as it is diagnosed.
If left untreated, hypertension can lead to the following medical conditions:

Pathophysiology:

Directly proportion to both cardiac output and peripheral vascular resistance.
                                  ↓

Three factors affecting cardiac output and peripheral resistance.
·        Sympathetic nervous system
·        The endocrine system
·        Kidney
                                 ↓

Sympathetic nervous system results in increase cardiac output and vasoconstriction of systemic arteries and veins
                                  ↓
↑ Hormones renin, secretes by kidney aldosterone secreted by medulla
                               ↓
Results vasoconstriction
                                 ↓
↑ Na and water retention by kidney
                                 ↓
↑cardiac output.
Types of hypertension    
     I.            Primary Hypertension:
Individuals typically suffer primary hypertension as a result of poor lifestyle habits. While this type of hypertension accounts for most of the cases diagnosed by doctors, the exact cause is unknown. However, some theories have suggested that in some people, a problem with the kidneys may cause the body to retain an increased amount of sodium, which, in turn, increases blood volume and pressure in the vessels. While medication may be required, dietary changes, stress management and physical activity are essential elements of treatment. Sodium intake is a primary factor responsible for high blood pressure in many individuals, particularly the elderly and people who are obese. Fruits and vegetables are excellent sources of potassium, which, if consumed in adequate amounts, can help to decrease blood pressure.

  II.            Secondary Hypertension
Secondary hypertension is the symptom of an underlying medical condition such as kidney disease, problems with the liver, congestive heart failure, stress, sleep apnea or an endocrine disorder such as hyperthyroidism or Cushing's syndrome, which produce elevated levels of hormones. Renal artery stenosis is a frequent cause of secondary hypertension. Problems occur when the artery supplying the kidney with blood narrows. Treatment of secondary hypertension involves controlling the underlying medical condition or disease in addition to prescribing antihypertensive drugs.

III.            Alcohol-Induced Hypertension
On average, 30 to 50 percent of alcoholics have hypertension. The condition is more likely to occur in women who abuse alcohol than in men. In fact, heavy drinking of alcohol may be one of the most common causes of secondary hypertension. Numerous studies of alcoholics have shown that, in most cases, blood pressure returns to normal once alcohol is out of the person's system, and he continues to abstain. However, if a person begins to drink again, blood pressure rises. Consuming too much caffeine can also cause a temporary increase in blood pressure. Caffeine stimulates the release of cortisol and adrenaline. Because most caffeine addicts develop a tolerance over time, the question remains whether caffeine adversely affects blood pressure in the long term.

IV.            Isolated Systolic Hypertension
Isolated systolic hypertension occurs in people as they grow older. Build up of plaque in the arteries makes it more difficult for blood to flow through. A common form of high blood pressure in individuals older than 60, medication appears to reduce the risk of heart attack and stroke. Research supported by both the National Institute of Aging and the National Heart, Lung, and Blood Institute found that treating the elderly with diuretics not only decreases the risk of developing cardiovascular disease but may also reduce the risk of dementia and related depression.

  V.            Pregnancy-Induced Hypertension
Some otherwise healthy women begin to suffer from hypertension after the twentieth week of pregnancy. In the majority of cases, these women are overweight or obese. The condition can be mild or rather severe. Other symptoms include retaining water and protein in the urine. The condition normally goes away within a few weeks following delivery. Pregnancy-induced hypertension may be due to preexisting hypertension, diabetes, kidney disease or carrying multiple fetuses. Women who are diagnosed with pregnancy-induced hypertension are at greater risk of preeclampsia during pregnancy. Symptoms may include headache, dizziness, swelling of the hands and face, nausea, vomiting and pain in the abdomen. The condition usually affects pregnant women who are younger than 25 years old or older than 40 years of age. It is more likely to occur during a first pregnancy or in women who had hypertension before becoming pregnant.


VI.            Medication-Induced Hypertension
Certain prescription drugs and over-the-counter (OTC) medications can either cause or worsen hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs), decongestants and weight loss supplements are common OTC drugs that can cause an increase in blood pressure. Cortocosteroids, immunosuppressive and cancer drugs are among the prescription medications for which high blood pressure can be a side effect. These drugs constrict blood vessels and can cause kidney problems.


VII.            Malignant Hypertension
Malignant hypertension is considered to be a medical emergency as the blood pressure can suddenly rise to dangerous levels. A person can experience shortness of breath, chest pain, an excruciating headache, seizures or even loss of consciousness as the blood pressure rises. Vomiting, blurred vision or blindness can occur as well. Although the condition can be life threatening if not treated immediately, these symptoms are sometimes the first sign that an individual has high blood pressure. Because blood pressure quickly rises so high, a person is at risk for suffering stroke, heart attack, kidney damage or aneurysm causing bleeding in the brain.

Causes of hypertension

Though the exact causes of hypertension are usually unknown, there are several factors that have been highly associated with the condition. These include:
  • Smoking
  • Obesity or being overweight
  • Diabetes
  • Sedentary lifestyle
  • Lack of physical activity
  • High levels of salt intake (sodium sensitivity)
  • Insufficient calcium, potassium, and magnesium consumption
  • Vitamin D deficiency
  • High levels of alcohol consumption
  • Stress
  • Aging
  • Medicines such as birth control pills
  • Genetics and a family history of hypertension
  • Chronic kidney disease
  
Risk factors for hypertension include:
  • age over 60
  • male sex
  • race
  • heredity
  • salt sensitivity
  • obesity
  • inactive lifestyle
  • heavy alcohol consumption
  • use of oral contraceptives


 

Sign and Symptoms

Hypertension has aptly been called the "silent killer" because it usually produces no symptoms. Untreated hypertension increases slowly over the years. Everyone 18 years and older should have their blood pressure measured on a regular basis. It is particularly important for anyone with risk factors to have their blood pressure checked regularly and to make appropriate lifestyle changes. Such recommendations are especially important for individuals who have prehypertension or hypertension, a family history of hypertension, are overweight, or are over age 40
·        tiredness
·        drowsiness
·        confusion
·        irregular heart beat
·        blurred vision
·        headache
·        flushing
·        dizziness
·        fatigue
·        epistaxis
·        tinnitus


Diagnosis

Because hypertension doesn't cause symptoms, it is important to have blood pressure checked regularly. Blood pressure is measured with an instrument called a sphygmomanometer. A cloth-covered rubber cuff is wrapped around the upper arm and inflated. When the cuff is inflated, an artery in the arm is squeezed to momentarily stop the flow of blood. Then, the air is let out of the cuff while a stethoscope placed over the artery is used to detect the sound of the blood spurting back through the artery. This first sound is the systolic pressure, the pressure when the heart beats. The last sound heard as the rest of the air is released is the diastolic pressure, the pressure between heart beats. Both sounds are recorded on the mercury gauge on the sphygmomanometer.

Normal blood pressure is defined by a range of values. Blood pressure lower than 120/80 mm Hg is considered normal. A number of factors such as pain, stress or anxiety can cause a temporary increase in blood pressure. For this reason, hypertension is not diagnosed on one high blood pressure reading. If a blood pressure reading is 120/80 or higher for the first time, the physician will have the person return for another blood pressure check. Diagnosis of hypertension usually is made based on two or more readings after the first visit.

Systolic hypertension of the elderly is common and is diagnosed when the diastolic pressure is normal or low, but the systolic is elevated, e.g.170/70 mm Hg. This condition usually co-exists with hardening of the arteries (atherosclerosis).

Blood pressure measurements are classified in stages, according to severity:
  • normal blood pressure: less than less than 120/80 mm Hg
  • pre-hypertension: 120-129/80-89 mm Hg
  • Stage 1 hypertension: 140-159/90-99 mm Hg
  • Stage 2 hypertension: at or greater than 160-179/100-109 mm Hg
A typical physical examination to evaluate hypertension includes:
  • medical and family history
  • physical examination
  • ophthalmoscopy: Examination of the blood vessels in the eye
  • chest x ray
  • electrocardiograph (ECG)
  • Blood and urine tests.
The medical and family history help the physician determine if the patient has any conditions or disorders that might contribute to or cause the hypertension. A family history of hypertension might suggest a genetic predisposition for hypertension.

The physical exam may include several blood pressure readings at different times and in different positions. The physician uses a stethoscope to listen to sounds made by the heart and blood flowing through the arteries. The pulse, reflexes, and height and weight are checked and recorded. Internal organs are palpated, or felt, to determine if they are enlarged.
Because hypertension can cause damage to the blood vessels in the eyes, the eyes may be checked with an instrument called an ophthalmoscope. The physician will look for thickening, narrowing, or hemorrhages in the blood vessels.

A chest x ray can detect an enlarged heart, other vascular (heart) abnormalities, or lung disease.

Lifestyle Changes to Treat High Blood Pressure

A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes:
  • Losing weight if you are overweight or obese.
  • Quitting smoking.
  • Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).
  • Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if you have high blood pressure. Healthy adults need to limit their sodium intake to no more 2,300 milligrams a day (about 1 teaspoon of salt).
  • Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).
  • Limiting alcohol to two drinks a day for men, one drink a day for women.
In addition to lowering blood pressure, these measures enhance the effectiveness of high blood pressure drugs.

Drugs to Treat High Blood Pressure

There are several types of drugs used to treat high blood pressure, including:
Medications to treat high blood pressure
  • Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic.
  • Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks or in the elderly — but they're effective when combined with a thiazide diuretic.
  • Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
  • Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels.
  • Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks and older adults than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.
  • Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.
If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:
  • Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
  • Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
  • Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
  • Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders.
To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication — or combination of drugs — is a matter of trial and error.
Diuretics are often recommended as the first line of therapy for most people who have high blood pressure. 
However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a choice for a people with diabetes. If one drug doesn't work or is disagreeable, other types of drugs are available.
If your blood pressure is more than 20/10 points higher than it should be, your doctor may consider starting you on two drugs or placing you on a combination drug.

High Blood Pressure Treatment Follow-Up

After starting high blood pressure drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor will check the level of potassium in your blood (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and other electrolytes and BUN/creatinine levels (to check the health of the kidneys).
After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether you have other diseases such as heart failure.

Hypertension Prevention in 6 Simple Steps
Hypertension Prevention include maintaining a healthy weight; being physically active; following a healthy eating plan, that emphasizes fruits, vegetables, and low fat dairy foods; choosing and preparing foods with less salt and sodium; and, if you drink alcoholic beverages, drinking in moderation. In this website, you will learn more about healthy lifestyle habits for hypertension prevention.

Carditone
 is a supplement that promotes cardiac support for healthy blood pressure. Ever since it was first introduced into the market, it has already created a buzz in the health care industry. Thanks to the amazing herbal formulation based on Ayurvedic principles, those who have high blood pressure need not to worry anymore. 

Step 1: Following a Healthy Eating Pattern
 

Research has shown that following a healthy eating plan can both reduce the risk of developing high blood pressure and lower an already elevated blood pressure.

Step 2: Reducing Salt and Sodium in Your Diet
 

A key to healthy eating is choosing foods lower in salt and sodium. Most Americans consume more salt than they need. The current recommendation is to consume less than 2.4 grams (2,400 milligrams [mg]) of sodium a day. That equals 6 grams (about 1 teaspoon) of table salt a day. The 6 grams include ALL salt and sodium consumed, including that used in cooking and at the table. For someone with high blood pressure, the doctor may advise eating less salt and sodium, as recent research has shown that people consuming diets of 1,500 mg of sodium had even better blood pressure lowering benefits. These lower-sodium diets also can keep blood pressure from rising and help blood pressure medicines work better.

Breakthrough Discovery Reveals 
How 3 Easy Exercises
 
Lower Blood Pressure Below 120/80,
 
In As Little As A Week!



Step 3: Maintaining a Healthy Weight 

Being overweight increases your risk of developing high blood pressure. In fact, blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure? and it has the greatest effect for those who are overweight and already have hypertension.

Step 4: Being Physically Active
 

Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It also helps reduce your risk of heart disease. It doesn't take a lot of effort to become physically active.

Step 5: Limiting Alcohol Intake
 

Drinking too much alcohol can raise blood pressure. It also can harm the liver, brain, and heart. Alcoholic drinks also contain calories, which matter if you are trying to lose weight. If you drink alcoholic beverages, have only a moderate amount? one drink a day for women; two drinks a day for men.

Step 6: Quitting Smoking

Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. This applies even to filtered cigarettes. So even though it does not cause high blood pressure, smoking is bad for anyone, especially those with high blood pressure. If you smoke, quit. If you don't smoke, don't start. Once you quit, your risk of having a heart attack is reduced after the first year. So you have a lot to gain by quitting


Complications of the Hypertension:

Heart Complications

High blood pressure is a major risk factor for hypertensive heart disease, the leading cause of illness and death from high blood pressure. Hypertensive heart disease is a group of complications that include:
Coronary Artery Disease. High blood pressure contributes to the thickening of the blood vessel walls, which can cause or worsen atherosclerosis (accumulated deposits of cholesterol in the blood vessels). The end result is coronary artery disease (CAD), also called ischemic heart disease, which increases the risk for angina (chest pain), heart attack, stroke, and death. High blood pressure is the most common risk factor for heart attack and stroke.
Heart Failure. High blood pressure increases the heart's workload. Over time, this can cause the heart muscle to thicken. As the heart pumps against elevated pressure in the blood vessels, the left ventricle becomes enlarged and the amount of blood pumped by the heart each minute (cardiac output) goes down, a condition called left ventricular hypertrophy (LVH). Without treatment, this can lead to heart failure.

Cardiac Arrythmias. High blood pressure increases the risk for cardiac arrhythmias (disturbances and irregularities in heartbeats). Arrhythmias include atrial fibrillation, premature ventricular contractions, and ventricular tachycardia.

Stroke

About two-thirds of people who suffer a first stroke have moderate elevated blood pressure (160/95 mm Hg or above). Hypertensive people have up to 10 times the normal risk of stroke, depending on the severity of the blood pressure in the presence of other risk factors. Hypertension is also an important cause of so-called silent cerebral infarcts, or blockages, in the blood vessels in the brain (mini-strokes) that may predict major stroke or progress to dementia over time.

Diabetes and Kidney Disease

Diabetes. High blood pressure, and some of the medications used to treat it, can increase the risk for developing diabetes. There are strong biologic links between insulin resistance (with or without diabetes) and hypertension. It is unclear which condition causes the other.
People with diabetes or chronic kidney disease need to reduce their blood pressure to 130/80 mm Hg or lower to protect the heart and help prevent other complications common to both diseases. Up to 75% of cardiovascular problems in people with diabetes may be due to hypertension.
The United States Preventive Services Task Force recommends screening for type 2 diabetes in all patients with blood pressure higher than 135/80 mm Hg.
End-Stage Kidney Disease. High blood pressure causes 30% of all cases of end-stage kidney disease (medically referred to as end-stage renal disease, or ESRD). Only diabetes leads to more cases of kidney failure. Patients with diabetes and hypertension need to be monitored very closely for the development of kidney disease.

Dementia

Isolated systolic hypertension may pose a particular risk for dementia (memory loss).

Eye Damage

High blood pressure can injure the blood vessels in the eye's retina, causing a condition called retinopathy.

Sexual Dysfunction

Sexual dysfunction is more common and more severe in men with hypertension and in smokers than it is in the general population. Although older drugs used to treat hypertension caused erectile dysfunction as a side effect, more recent evidence suggests that the disease process that causes hypertension is itself the major cause of erectile dysfunction. Oral phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra); do not appear to pose a risk for most men who have both high blood pressure and erectile dysfunction. However, men who have uncontrolled or unstable hypertension should not take erectile dysfunction pills. Men who take nitrate medications for heart disease cannot take erectile dysfunction drugs.

Pregnancy and High Blood Pressure

Many women who are likely to develop hypertension when they are older have their first elevated blood pressure readings during pregnancy. Elevated blood pressure readings generally show up early in pregnancy, before 16 - 20 weeks. (This condition is different than preeclampsia, described just below.) These women often require antihypertensive medications during pregnancy and closer monitoring of themselves and the fetus. Continued hypertension after the pregnancy is also not uncommon.
Severe, sudden high blood pressure in pregnant women is one component of a condition called preeclampsia (commonly called toxemia) that can be very serious for both mother and child. Preeclampsia occurs in up to 10% of all pregnancies, usually in the third trimester of a first pregnancy, and resolves immediately after delivery. Other symptoms and signs of preeclampsia include protein in the urine, severe headaches, and swollen ankles.
The reduced supply of blood to the placenta can cause low birth weight and eye or brain damage in the fetus. Severe cases of preeclampsia can cause kidney damage, convulsion, and coma in the mother and can be lethal to both mother and child. Women at risk for preeclampsia (particularly those with existing hypertension) are monitored carefully for its presence. Both mother and fetus are monitored closely after a diagnosis. Blood pressure medications may be required. Delivery is the main cure for preeclampsia. In severe cases, the obstetrician will need to induce pre-term birth.


Prevalence of hypertension:

Worldwide prevalence of hypertension

The reported prevalence of hypertension varied around the world, with the lowest prevalence in rural India (3.4% in men and 6.8% in women) and the highest prevalence in Poland (68.9% in men and 72.5% in women). Awareness of hypertension was reported for 46% of the studies and varied from 25.2% in Korea to 75% in Barbados; treatment varied from 10.7% in Mexico to 66% in Barbados and control (blood pressure < 140/90 mmHg while on antihypertensive medication) varied from 5.4% in Korea to 58% in Barbados.
Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion).



Prevalence of hypertension in Nepalese community:
The prevalence of HTN according to the used World Health Organization (WHO) criteria (160/95 mmHg) in the various parts of the country was as follows:
 5.3% in Mountains (Jumla), 6% in rural Kathmandu (Bhadrabas and Alapot), 8.1% in Terai plains (Parsauni), and 9.9% in urban Kathmandu. Since then, there have been a few studies done in various parts of Nepal. These studies done in different geographical settings indicate towards a high prevalence of HTN in the Nepalese population. For example, a BP study in Dharan town of Eastern Nepal in 2005 found a prevalence of almost 23% according to the Jet Navigation Chart (JNC) VIIguidelines.
The prevalence of HTN in Bhadrabas in 2006, according to the JNC VII classification was found to be 33.8% (males: 38.3%, females: 30.8%).


The awareness, treatment, and control rates of the 2006 study are comparable to another suburban Kathmandu study in 2005 (31.8% vs 41.1%, 23.5% vs 26%, 9.5% vs 6%).
 In a study conducted in an Eastern Hilly town of Nepal called Dharan, almost 60% of the
hypertensives were aware of their disease with 50% of the hypertensives having their BP under control. Presence of a tertiary care academic hospital with community-oriented
programmes is a possible reason for this better awareness and control rates in Dharan




Epidemiological approach:
In demography, epidemiological approaches can inform about disease by identifying risk factors and determining optimal approaches to prevent undesirable consequences. 
Here we compare a few of these approaches with the idea that thinking about these approaches can help us design about the better on disease studies on Hypertension.

The Epidemiological approach to problems of health and disease is based on two major foundations.
1. ASKING QUESTION
2. MAKING COMPARISION



1. ASKING QUESTION
Epidemiology has been defined as “a means of learning or asking question s...and getting answers  that lead to further questions “for example  the following question could be asked:


Related to health events
·        What is the event ?(the problem)
Ø Hypertension

·        What is its magnitude?
Ø Worldwide in comparision to Nepal

·        Where did it happen?
Ø Worldwide
Ø Nepal

·        When did it happen?
Ø 2006(Nepal and worldwide)

·        Who are affected?
Ø Both male and female

·        Why did it happen?
Ø Lack of awae\reness
Ø Obesity
Ø age over 60
Ø race
Ø heredity
Ø salt sensitivity
Ø inactive lifestyle
Ø heavy alcohol consumption



Related to health action
·        What can be done to reduce the problems and its consequences?
Ø Lifestyle Changes
Ø Drugs
Ø Treatment and follw up

·        How can it be prevented in the future?
Ø Following a Healthy Eating Pattern
Ø  Reducing Salt and Sodium in Your Diet 
Ø Maintaining a Healthy Weight
Ø  Being Physically Active 
Ø Limiting Alcohol Intake 
Ø Quitting Smoking

·        What action should be taken by the community? By the health services? By other sectors? Where and for whom this activities be carried out?
Ø Actions like Awareness programmes,High blood pressure screening
Ø Should be conducted by the health services government,health related NGOs and INGOs and respectie sectors by the active participation of people themselves in their local accessible sector

·        What resources are required? How are the activities to be organized?
Ø The adequate information about the hypertension and its preventive measures,the resources like man, money and materials respective to the hypertension
Ø The activities are organised in the easy and effectively accesible way to the local community after analysing local people level of knowledge and the pattern how the awareness programe is to be presented

·        What different problems may arise, and how might they be overcome?

Ø The problems which may arise during the process may include the inadequate convey of information,diminished participation due to various factor,socio cultural hinderances,time management,in availabilty of adequate facilities to reach the facilities
Ø These problems can be overcomed by regular assesment of the facilities provided and overcoming the hinderence via regular communication within the people and the respective governing centers

2. MAKING COMPARISION:

The basic appoarch is to make comparisions and draw inferences or conclusions.This may be comparision of two or more groups .By making comparisions,the epidemiologist tries to find out the cruical differences between those of affected and not affected of the researched area.can be done in two or more groups eg.one group having disease or other group

Whilst analysing the availiability of the data,we can traid out the following comparisions
v    In contrast to international view,the prevalence of hypertension in  gender ratio shows in 2005/2006:
§  in rural India (3.4% in men and 6.8% in women)
§  in Poland (68.9% in men and 72.5% in women)
§  in Bhadrabas(Nepal), (38.3%in men and 30.8% women).
v    In contrast to national view,the prevalence of hypertension in  geographically exists as:
§ 5.3% in Mountains (Jumla), 6% in rural Kathmandu (Bhadrabas and Alapot), 8.1% in Terai plains (Parsauni), and 9.9% in urban Kathmandu.
v   The awareness,treatment and controlpattern of hypertension in comparision to international view shows
§ Awareness of hypertension was reported for 46% of the studies and varied from 25.2% in Korea to 75% in Barbados; treatment varied from 10.7% in Mexico to 66% in Barbados and control (blood pressure < 140/90 mmHg while on antihypertensive medication) varied from 5.4% in Korea to 58% in Barbados.
v   The awareness,treatment and controlpattern of hypertension in context of national view shows
§ The  awareness, treatment, and control rates of the 2006 study are comparable to suburban Kathmandu study in 2005 (31.8% vs 41.1%, 23.5% vs 26%, 9.5% vs 6%).
§  Similarly,in a study in Dharan, almost 60% of the hypertensives were aware of their disease with 50% of the hypertensives having their BP under control





No comments: