Hypertension and Stroke full presentation

Hypertension and Stroke PPT

1. Hypertension and Stroke

2. Introduction Hypertension is a chronic condition due to its role in the causation of coronary heart disease, stroke and other vascular complications Major risk factors for cardiovascular mortality, which accounts for 20-50 per cent of all deaths

3. Classification Hypertension is divided into Primary (essential) Secondary

4. Essential hypertension Hypertension is classified as "essential" when the causes are generally unknown Essential hypertension is the most prevalent form of hypertension accounting for 90 per cent of all cases of hypertension

5. Secondary hypertension Some other disease process or abnormality is involved in causation 10 per cent or less of the cases of hypertension Causes: Kidney diseases: chronic glomerulo -nephritis and chronic pyelonephritis Tumours of the adrenal glands Congenital narrowing of the aorta and Toxemias of pregnancy

6. "Rule of halves" Hypertension is an ''iceberg" disease. Only about half of the hypertensive subjects in the general population of most developed countries were aware of the condition, Only about half of those aware of the problem were being treated, and Only about half of those treated were considered adequately treated

7. 1. The whole community 2. Normotensive subjects 3. Hypertensive subjects 4. Undiagnosed HTN 5. Diagnosed HTN 6. Diagnosed but untreated 7. Diagnosed and treated 8. Inadequately treated 9. Adequately treated

8. Risk Factors For High Blood Pressure Non‐modifiable risk factors Modifiable risk factors

9. Risk Factors Non‐modifiable Age Sex Genetic factors Ethnicity Modifiable Obesity Diet –Salt, Saturated fat, Dietary fibres Alcohol and Tobacco Physical activity Stress Socio‐Economic Status

10. Symptoms Headache Shortness of breath Dizziness Chest pain Palpitations Nose bleed But most people usually have NO warning signs or symptoms

11. Prevention of Hypertension Primary Prevention Population strategy High risk strategy Secondary prevention

12. Population Strategy Nutrition Weight reduction Exercise promotion Behavioral changes Health education Self care

13. High Risk Strategy Approach is to prevent the attainment of levels of blood pressure at which the institution of treatment would be considered Identifying high risk groups- family history, tracking of of blood pressure from childhood

14. Secondary prevention Early case detection- screening Treatment Patient compliance

15. Life Style Modifications to Manage Hypertension MODIFICATION RECOMMENDATION Weight reduction Maintain normal body weight reduction (BMI‐18.5‐24.9) Adopt DASH diet Consume diet rich in fruits, eating plan vegetables & low‐fat diary products with reduced content of saturated fat & total fat Dietary sodium reduction Reduce dietary sodium intake – no more than 100 Meq /D (2.4 g sodium or 6 g sodium chloride)

16. Life Style Modifications to Manage Hypertension MODIFICATION RECOMMENDATION Physical activity Engage in regular physical activity brisk walking for at least 30 min/day most days of the week Moderation of alcohol consumption Limit consumption to No more than 2 drinks / day in most men No more than 1 drink / day in women & lighter – weight persons.

17. Drug Therapy ACE inhibitors Beta blockers Calcium channel blockers Diuretics Angiotensin II receptor blockers

18. Dietary Approaches to Stop Hypertension (DASH) The National Heart, Lung, and Blood Institute (NHLBI) Flexible and balanced eating plan Low in saturated fat, cholesterol, and total fat Focuses on fruits, vegetables, and fat‐free or low‐fat dairy products Rich in whole grains, fish, poultry, beans, seeds, and nuts Contains fewer sweets, added sugars and sugary beverages, and red meats

19. JNC-8 Algorithm

20. JNC 8 Classification

21. Which is the National health programme for hypertension?

22. National Programme for Prevention and Control of Non communicable Disease

23. Objectives:- NP-NCD Health promotion through behaviour change - involvement of community, civil society, community-based organizations, media and development partners Screening, early diagnosis, management, referral and follow-up at each level of healthcare delivery to ensure continuum of care Build capacity of health care providers at various levels for prevention, early diagnosis, treatment, follow-up, rehabilitation, IEC/BCC, monitoring and evaluation, and research

24. Objectives:- NP-NCD Strengthen supply chain management for drugs, equipment and logistics for diagnosis and management at all health care levels Monitoring, supervision and evaluation of programme through proper implementation of uniform ICT application across India To coordinate and collaborate with other programmes , departments/ministries, civil societies

25. Stroke

26. Introduction Acute severe manifestations of cerebrovascular disease. It causes both physical and mental crippling. WHO defined stroke as “rapidly developed clinical signs of focal disturbance of cerebral function; lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin“

27. Introduction Caused by three morphological abnormalities – stenosis, occlusion or rupture of arteries Signs and symptoms are related to extend and site of the area involved and to the underlying causes Coma, hemiplegia, paraplegia, monoplegia , multiple paralysis, speech disturbances, nerve paresis, sensory impairement etc.

28. Aetiology A. Ischaemic stroke - Lacunar infarct - Carotid circulation obstruction - Vertebrobasilar obstruction B.Hemorrhagic stroke Spontaneous intracerebral hemorrhage Subarachnoid hemorrhage Intra cranial aneurysm AV malformation

29. Morbidity And Mortality Cerebral thrombosis followed by hemorrhagic stroke is the most common form of stroke Worldwide 6.1 million deaths, 10.8% of all deaths (2008) Prevalence rate in India – 1.54/ 1000 population

30. Risk factors Hypertension Cardiac abnormalities – LVH, Dilatation Diabetes Elevated blood lipids Obesity Smoking Glucose intolerance Oral contraceptives

31. Transcient Ischaemic Attacks (TIA) These are episodes of: Focal Reversible Neurological deficit of sudden onset Of less than 24 hours duration They show a tendency to recurrence Due to microemboli and are a warning sign of stroke

32. Host factors Age - Can occur in any age, Globally more in age >70 years India – strokes in the young Sex: M > F Personal history : a/w diseases, esp. CVS disease and diabetes

33. Stroke Control Programme Community level effective measures for the prevention Control of arterial hypertension Early detection and treatment following TIA Management of other risk factors (diabetes, smoking) Control of complications and follow up of patients Reliable knowledge and extend of the problem in the community