HYPERTENTION.pptx IN COMMUNITY HEALTH NURSING

HYPERTENTION.pptx IN COMMUNITY HEALTH NURSING

1. HYPERTENSION

2. Hypertension is the most commonest cardiovascular disorder, posing a major public health challenge to population in socio-economic and epidemiological Transition .It is a major condition of concern due to its role in causation coronary heart disease, stroke and other vascular complications

3. CATEGORY SYSTOLIC BLOOD PRESSURE (mm of Hg) DIASTOLIC BLOOD PRESSURE (mm of Hg) BP OPTIMAL NORMAL HIGH NORMAL <120 120-129 130 – 139 <80 80-84 85 – 89 HYPERTENSION GRADE 1(MILD) GRADE 2(MODERATE) GRADE 3(SEVERE) 140-159 160-179 >=180 90-99 100-109 >110 ISOLATED SYSTOLIC HYPERTENSION GRADE 1 GRADE 2 140-159 >=160 <90 <90 When systolic and diastolic blood pressure fall in different categories, the higher category should be selected Isolated systolic hypertension is defined as a systolic pressure of 140 mm of Hg or more and a diastolic pressure less than 90mm of Hg

4. CLASSIFICATION OF HYPERTENSION BASED ON EXTENT OF ORGAN DAMAGE STAGE 1 No manifestation of organic change STAGE 2 At least one of the following manifestations of organ involvement: Left ventricular hypertrophy Generalized and focal narrowing of the renal arteries Micro- albuminuria , proteinuria and slight elevation . of the plasma creatinine concentration (1.2-2 mg/dL) STAGE 3 Both symptoms and signs have appeared as result of . organ damage

5. MEASUREMENT OF BLOOD PRESSURE

6. WHO study group recommended that blood pressure should me measured in sitting position than in the supine position An uniform policy of measurement should be adopted in a clinic The systolic and diastolic pressure should me measured at least 3 times over a period of at least 3 minute and the lowest reading recorded The pressure at which the sound are first heard (phase I) is taken as the systolic pressure Near the diastolic pressure the sound first become muffled (phase IV) and then disappear (phase V) Errors Observer error Instrumental error Subject error

7. PRIMARY HYPERTENSION Cause generally unknown It is the most prevalent form of hypertension >90% SECONDARY HYPERTENSION When some other disease process or abnormalities is involved in it causation About 10% Some of the prominent diseases that leads to hypertension are Disease of the kidney(chronic glomerulonephritis and chronic pyelonephritis) Tumours of adrenal glands Congenital narrowing of the aorta

8. What the patient sees Complications Ice-berg Disease

9. Rule Of Halves The whole community Normotensive subjects Hypertensive subjects Undiagnosed hypertension Diagnosed hypertension Diagnosed but untreated Diagnosed and treated Inadequately treated Adequately treated

10. PREVELANCE GLOBALY AND IN INDIA- T he percentage of hypertensive adults in 2019 decreased in the WHO European region compared to 1990 but increased in Asian regions, particularly in the WHO Western Pacific Region (from 24% to 28%; including countries such as Australia, New Zealand, China, Republic of Korea, Philippines, Malaysia, Vietnam, and Japan) and in the WHO Southeast Asia region (from 29% to 32%; including countries such as India, Nepal, Indonesia, and Thailand). The number of hypertensive adults in the WHO Western Pacific region more than doubled in 2019 compared to 1990, with figures rising from 144 million to 346 million [ 1 ]. Furthermore, as depicted in the Graphic Abstract, there has been a 41% increase in the number of adult hypertension patients over the past thirty years (1999–2019) in the WHO European region and the WHO region of the Americas. In contrast, the WHO South-East Asia and the WHO Western Pacific region experienced a significant 144% increase. Emphasizing the need for hypertension control is crucial, particularly in the WHO South-East 

11. Prevalence - ( state wise) Fifth National Family Health Survey (NFHS-5) and Indian Council of Medical Research-INDIAB surveys have reported that there are substantial geographic variations in hypertension prevalence with greater prevalence in more developed states and districts of the country. There is a high prevalence of young-age hypertension, especially in the less developed states. The incidence of adverse events from hypertension-related cardiovascular disease is significantly greater in India than in more developed countries. A low level of hypertension awareness, treatment, and control, especially in rural and underserved urban populations is an important finding

12. Tracking Of Blood Pressure Children (school)have optimum BP should remain optimum in adulthood by mainteninig good habits and lifestyle modification (primordial prevention) I f the blood pressure of an individual is followed up from the childhood into adulthood, then those individuals whose pressures were initially high in the distribution would probably continue in the same track as adults (primary prevention) ie . , low blood pressure tend to remain low and high levels tend to become higher as individuals grow older This knowledge can be applied in identifying children and adolescents at risk of developing hypertension at a future date

13. Time Blood Pressure

14. Risk Factors

15. NON MODIFIABLE RISK FACTORS AGE SEX GENETIC FACTORS ETHNICITY

16. AGE BP increases with age in both sexes and the rise is greater in those with higher initial blood pressure. Age represents an accumulation of environmental influences and the genetically programmed senescence in body systems

17. SEX At adolescence, men display a higher average level. Most evident in the young and the middle aged adults. Late in life, the difference narrows and the pattern even reverses, Genetic Factors Their inheritance is polygenic The evidences are based on twin and family studies Attempt to find the genetic markers associated with hypertension are unsuccessful

18. Ethnicity Population studies has consistently revealed higher blood pressure in levels in black communities compared to other groups Average difference in blood pressure between two groups vary from slightly less than 5 mm Hg during second decade of life to 20 mm Hg during the sixth

19. MODIFIABLE RISK FACTORS OBESITY SALT INTAKE SATURATED FAT DIETARY FIBERS ALCOHOL HEART RATE PHYSICAL ACTIVITY ENIVRONMENTAL STRESS SOCIO-ECONOMIC STATUS OTHER FACTORS - oral contraception(most common) noise, vibration, temperature(require further investigation )

20. Prevention Of Hypertension Primary prevention Secondary prevention Population strategy High-risk strategy The low prevalence of hypertension in some communities indicate that the hypertension is potentially preventable The WHO has recommended the following approaches in the prevention of hypertension :

21. Primary prevention Population strategy Directed at the whole population irrespective of the individual risk levels. The concept of population approach is based on the fact that even a small reduction in the average blood pressure of a population would produce a large reduction in the incidence of cardiovascular complications like stroke and CHD. GOAL -To shift the community distribution of blood pressure towards the lower levels of “biological normality ”.

22. It involves multifactorial approach based on the following interventions: Nutrition: a. reduction of salt intake to an average of not more than 5 gm per day b. moderate fat intake c. avoidance of a high alcohol intake d. restriction of energy intake appropriate to body needs Weight reduction: Prevention and correction of over weight / obesity(BMI > 25) Exercise promotion: Regular physical activity leads to a fall in body weight, blood lipids and blood pressure. Behavioural changes: Reduction of stress and smoking, modification of personal lifestyle, yoga and transcendental medication would be profitable. Health education Self care

23. HIGH RISK STRATEGY AIM : To prevent the attainment of levels of blood pressure at which the institution of treatment would be considered. This approach is appropriate if the risk factors occur with very low prevalence in the community. Detection of high risk subjects should be encouraged by the optimum use of clinical methods

24. Secondary Prevention GOAL : To detect and control high blood pressure in affected individuals Modern hypertensive drug therapy can effectively reduce high blood pressure and consequently the excess risk of morbidity and mortility from coronary, cerebrovascular and kidney diseases Early case detection : Early detection is a major problem because high bp rarely causes symptoms until organ damage has already occurred and our aim should be to control it before this happens Only effective method of diagnosis of hypertension is to screen the population and should be linked with follow up and sustained care. Treatment: Aim: to obtain a bp below 140/90 and ideally a BP of 120/80 . In essential hypertension, we cannot treat the cause as the cause is unknown

25. Patient compliance: It is the extent to which patient behaviour(in terms of taking medicines ,following diets or following other lifestyle changes) coincides with clinical prescription. The compliance rates can be improved through education directed to patients, families and the community.

26. Thank you