HYPERTENSION IN COMMUNITY HEALTH NURSING

HYPERTENSION IN COMMUNITY HEALTH NURSING

1. hypertension Presented by: Harsh Rastogi , M.Sc. Nursing 1 st year, King George’s Medical University, Institute of Nursing, Lucknow .

2. INTRODUCTION Hypertension is the commonest cardiovascular disorders, posing a major Public Health challenge to population in social-economic and epidemiological transition. It is one of the major risk factors for cardiovascular mortality, which account for 20 to 50% of all deaths.

3. DEFINITION “ Isolated systolic hypertension” is defined as a systolic the pressure of 140 mm of Hg and a diastolic blood pressure of less than 90 mm of Hg.”

4. Or Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure the harder the heart has to pump. -WHO

5. Classification Hypertension is divided into primary and secondary. Hypertension is classified as essential when the causes are generally unknown. Essential hypertension is the most prevalent form of hypertension accounting for 90% of all cases of hypertension.

6. Cont… 2. Hypertension is classified as secondary when some other disease process or abnormality is involved in its causation. Prominent among these are diseases of kidney (chronic Glomerulo -nephritis and chronic Pyelo -nephritis ), Tumors of adrenal glands, congenital narrowing of the aorta and toxemias of pregnancy.

7. Magnitude of the problem Rules of halves Hypertension is an “iceberg” disease. it became evident in the early 1970s that only about half of the hypertensive subject 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.

8. Cont… Incidence Worldwide, raise blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all annual deaths. This account for 57 million DALYs or 3.7% of total DALYs.

9. Cont… Globally, the overall prevalence of raised blood pressure in adult aged 25 years and over was around 40% in 2008. The proportion of the world's population with high blood pressure, or uncontrolled hypertension, fell modestly between 1980 and 2008. However, because of population growth and ageing, the number of people with hypertension rose from 600 million in 1980 to 1 billion in 2008.

10. Cont… Across the income groups of countries, the prevalence of raised blood pressure were consistently high, with low, lower-middle and upper-middle income countries all having rates of around 40% for both sexes. The prevalence and high income countries was lower, at 35% for both sexes.

11. Prevalence in India Community based survey was carried out by ICMR during 2007 and 2008  to identify the risk factors for non communicable diseases under state base Integrated Disease Surveillance Project Phase 1.The survey was carried out in the state of Andhra Pradesh, Kerala, Madhya Pradesh, Maharashtra, Uttarakhand , Tamil Nadu and Mizoram.

12. Cont… According to the survey report, the prevalence of hypertension was varying from 17 to 21% in all the states with marginal rural-urban differences. An overall pattern of prevalence was found increasing with age group and all state.

13. Cont… Hypertension was prevalent in all educational level; it was high in higher education level of Uttarakhand , Mizoram and Madhya Pradesh.

14. Risk factors for Hypertension WHO scientific group has recently reviewed the risk factors for essential hypertension. These may be classified as: Non-modifiable risk factors Modifiable risk factors

15. Non-modifiable risk factors Age: blood pressure rises with age in both sexes and the rise is Greater in those with higher initial blood pressure .

16. Sex: early in life there is little evidence of a difference in blood pressure between the sexes. However, at adolescence, men display a higher average level. This difference is most evident in young and Middle aged adult. Late in life the difference narrows and the pattern may even be reversed. Post menopausal changes in women maybe contributory factors for this change.

17. Cont… Genetic factor: There is considerable evidence that blood pressure levels are determined in part by genetic factors, and that the inheritance is polygenic.

18. Cont… Ethnicity: population studies have consistently revealed higher blood pressure levels in black communities then other ethnic groups. Average difference in blood pressure between the two groups varies from slightly less than 5 mm Hg during the second decade of life to nearly 20 mm of Hg during the sixth.

19. Modifiable risk factors Obesity: epidemiological observations have identified obesity as a risk factor for Hypertension. The greater the weight gain, the greater the risk of high blood pressure. Dietary fibers: several studies indicate that the risk of CHD and hypertension is inversely related to consumption of dietary fibers. Most fibers reduce plasma total and LDL cholesterol

20. Cont… Salt intake: there is an increasing body of Evidence to the effect that a high salt intake (i.e. 7- 8 gram per day) increases blood pressure proportionately. Low sodium intake has been found to lower the blood pressure. Beside sodium, there are other mineral elements such as potassium which are determinants of blood pressure. Potassium antagonizes the biological effect of sodium, and thereby reduces blood pressure, potassium supplements have been found to lower blood pressure of mild to moderate hypertensive. Other cations such as calcium, cadmium and magnesium have also been suggested as of importance in reducing blood pressure levels.

21. Cont… Saturated fat: the evidences suggest that saturated fat raises blood pressure as well as the level of serum cholesterol. Alcohol: high alcohol intake is associated with an increased risk of blood pressure. Physical activity: physical activity by reducing body weight may have an indirect effect on blood pressure.

22. Cont… Heart rate: When groups of normo-tensive and untreated hypertensive subjects, matched for age and sex are compared, the heart rate of the hypertensive group invariably higher. This may reflect a resetting of sympathetic activity at a higher level. The role of heart variability in blood pressure needs further research to elucidate whether the relation is casual or prognostic .

23. Cont… Environmental stress : the term hypertension itself implies a disorder initiated by tension of stress. Since stresses nowhere defined, the hypothesis is untestable . However, it is an accepted fact that the psychosocial factors operate through mental processes, consciously or unconsciously, to produce hypertension. Virtually all studies on blood pressure and catecholamine levels In young people revealed significantly higher noradrenaline level in hypertensive done in normotensive . This support the contention that over activity of sympathetic nervous system has an important part to play in pathogenesis of hypertension.

24. Cont… Socio - Economic status: In countries that are in post transitional stage of economic and epidemiological changes, consistently higher level of blood pressure have been noted in  lower socioeconomic groups. This inverse relation has been noted with level of education, income and occupation. However, in societies that are transitional or pre transitional, a higher prevalence of hypertension has been noted in upper socio economic groups. This probably represents the initial stage of epidemic of CVD.

25. Cont… Other factors: the commonest present cause of secondary hypertension is oral contraception, because of the estrogen component in combined preparations. Other factors such as noise, vibration, temperature and humidity require further investigation.

26. Prevention of hypertension The low prevalence of hypertension in some communities indicates that hypertension is potentially preventable. The WHO has recommended the following approaches then the prevention of hypertension: Primary Prevention Population strategy High risk strategy Secondary Prevention  

27. Primary Prevention Primary prevention has been defined as “all measures to reduce the incidence of disease in a population by reducing the risk of onset.” The earlier the prevention starts the move likely it is to be effective . In connection with primary prevention terms such as “population strategy” & “high risk strategy” have become established. The WHO recommended these approaches in the prevention of hypertension.

28. Cont… Population strategy: the population approach is directed at the whole population, irrespective of individual risk levels. The concept of population approach is based on the fact that even a small reduction in the average blood pressure Of population would produce a large reduction in the incidence of cardiovascular complications such as stroke & CHD.

29. Cont… This involves a multi-factorial approach, based on the following non- phramaco -therapeutic intervention: NUTRION: Dietary changes are of paramount importance. These comprise: Reduction of salt intake to average of not more than 5g per day Moderate fat intake The avoidance of high alcohol intake & Restriction of energy intake appropriate to body needs.

30. Cont… WEIGHT REDUCTION: The prevention & correction of over-weight/obesity (BMI >25) is a prudent way of reducing the risk of hypertension & indirectly CHD ; goes with dietary changes. EXERCISE PROMOTION: The evidence that regular physical activity leads to a fall in body weight, blood lipids & blood pressure goes to suggest that regular physical activity should be encouraged as part of strategy for risk factor control.

31. Cont… BEHAVIOURAL CHANGES: Reduction of stress & smoking, modification of personal life-style, yoga & transcendental, medication could be profitable. HEALTH EDUCATION: The general public requires preventive advices on all risk factors & related health behavior. The whole community must be mobilized & made aware of the possibility of primary prevention. SELF CARE: An important element in community-based health programmes in patient participation. The patient is taught self-care, i.e. to take his own blood pressure & keep a log-book of his readings .

32. Cont… HIGH RISK STRATEGY: The aim of this approach is “to prevent the attainment of levels of blood pressure at which the institution of treatment would be considered.” Detection of high-risk subjects should be encouraged by the optimum use of clinical methods. Since hypertension tends to cluster in families, the family history of hypertension & “tracking” of blood pressure from child hood may be used to identify individuals at risk.

33. Secondary Prevention The goal of secondary prevention is to detect & control high blood pressure in affected individuals. EARLY DETECTION: Early detection is major problem. This is because high blood pressure rarely causes symptoms until organic damage has already occurred, & our aim should be control it before this happens. The only effective method of diagnosis of hypertension is to screen the population.

34. Cont… TREATMENT: In essential hypertension, as in diabetes, we cannot treat the cause, because we do not know what it is. The aim of treatment should be to obtain a blood pressure below 140/90, & ideally a blood pressure 120/80. Control of hypertension has been shown to reduce the incidence of stroke & other complications.

35. Cont… PATIENT COMPLIANCE: The treatment of high blood pressure must normally be life-long & this presents problems of patient compliance, which is defined as “the extent to which patient behavior (in terms of taking medicines, following diets or executing other lifestyle changes) coincides with clinical prescription.

36. Life-style modification to manage hypertension

37. MODIFICATION RECOMMENDATIONS APPROXIMATE SYSTOLIC BP REDUCTION RANGE Weight reduction Maintain normal body weight (BMI: 18.5-24.9). 5-20 mm Hg/10 Kg weight loss Adopt DASH eating plan Consume a diet rich in fruits, vegetables & low-fat dietary products with a reduced content of saturated fat & total fat. 8-14mm Hg

38. Dietary sodium reduction Reduce dietary sodium intake to no more than 100 mEq /d (2.4 g sodium or 6 g sodium chloride) 2-8 mm Hg Physical activity Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day, most days of the week). 4-9 mm Hg Moderation of alcohol consumption Limit consumption to no more than two drinks per day (1 oz or 30 ml ethanol e.g., 24 oz beer, 10 oz wine, or 3 oz 80- proof whisky) in most men, & more than one drink per day in women & lighter-weight persons. 2-4 mm Hg

39. Cont… For overall cardiovascular risk reduction, stop smoking. The effects of implementing these modifications are dose & time dependent & could be higher for some individuals. BMI- body mass index calculated as weight in kilograms divided by the square of height in meters; DASH- Dietary Approaches to Stop Hypertension.

40. conclusion Hypertension is the commonest cardiovascular disorders. It is mainly categorized in two. The causes are modifiable and non modifiable. This can be diagnosed by monitoring blood pressure. This disease can be prevented by the following measures like modifying the diet and change in a lifestyle etc.