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:
- arteriosclerosis, also
called atherosclerosis
- heart attack
- stroke
- enlarged heart
- Kidney damage.
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
- 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
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