فيصل الناصر, د فيصل الناصر Prof faisal al nasser hypertension

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Hypertension the Silent KillerEpidemiology
Prof Faisal A Alnasir FRCGP, MICGP,
FFPH, PhD President, Family Community
Medicine Council Arab Board Chairman,
Department of Family Community Medicine Arabian
Gulf University
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• Hypertension
• Common
• Non Communicable disease
• Inevitable
• Preventable
• Serious complication

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WHO estimated that high blood pressure causes one
in every eight deaths, making hypertension the
third leading killer in the world. Globally,
there are one billion hypertensives and four
million people die annually as a direct result of
it. Hussein A. Gezairy Regional Director for
the Eastern Mediterranean
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• Size of the problem
• 1-World wide
• In 2010, 1.2 billion people were expected to be
  suffering from hypertension worldwide
• Sixth report of the Joint National Committee
  on prevention,1997
• Expected to increase to 1.56 billion by 2025
• International Society of Hypertension
• Its prevalence from 20 to 30 of the adult
  population.
  
  
• 
  
  Alwan A 1993
• Incidence In USA between 14 to 40 in 35 to 64
  years.
• 
  WHO 2002
• Prevalence in Canada 17.3. Most patients had
  untreated
• hypertension (68.6), and only 15.8 had
  blood pressure
• treated and controlled.
  
  
  
• 
  Petrella et al
  2007

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• Size of the problem
• 2-In the Eastern Mediterranean Region
• The average prevalence of hypertension 26 and it
  affects approximately 125 million individuals.
• Each year, there are several million new cases of
  hypertension and more of pre-hypertension
• Report
  on the regional consultation on hypertension
• UAE, 2003

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Size of the problem In Bahrain
National Non-communicable Diseases Risk Factors
Survey 2007
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Size of the problem In Bahrain
National Non-communicable Diseases Risk Factors
Survey 2007
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• In Lebanon
• 23.1 are hypertensive
• Prevalence increases with age
• Occurs more in the less educated and unemployed
• Prevalence increases significantly with an
  increase in
• body mass index particularly in female patients
• Only14.7 exercised daily
• R A Tohme, A R Jurjus, A Estephan 2005

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Size of the problem In Saudi Arabia The
prevalence range from 4 to 15.

Abolfotouh MA et al. It may reach as high as
20.4 for systolic hypertension and 25.9 for
diastolic hypertension.

Al-Nozha MM et al. In south-western
11.1.
Abolfotouh MA et
al. In Jeddah, the hypertensive were
22.6. Elkalifa Am et al.2011 In the
UAE Hypertension has become one of the leading
public health problems
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In Sudan

• of 6-12y children
• 4.9 were pre-hypertensive and
• 4.9 were hypertensive
• Salman Z, et al 2010

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Size of the problem It has been estimated that
individuals who are normotensive at the age 55
years have a 90 lifetime risk for developing
hypertension. EMR0 Technical Publications Blood
pressure is under control in less than 20 of
patients with hypertension in many countries A
joint CINDI/EuroPharm Forum project WHO
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Awareness of Hypertension Although the
prevalence of high blood pressure is high, there
is a low awareness rate (Up To 70 are
unaware) Alwan A1993
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Awareness of Hypertension
Faisal Alnasir, 2004
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Awareness of Hypertension In Egypt only 37.5
of hypertensives were aware of Having it. In
United States, Chile, and Cub, 32, 37, and 39
of the people were not aware. Pan American
Health
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• Advantage of Controlling Hypertension
• A 5-6 mmHg reduction in diastolic BP reduces
  stroke by 40.
• Joint National Committee on Detection, 1992
• lowering by 5-6mmHg can reduce mortality from
  cerebrovascular
• disease by 35-40, from ischemic heart disease
  by 15 20
• and reduction in all deaths from cardiovascular
  causes by 23.
• Psaty, et al 1997
• 3 mmHg decrease in systolic BP reduces annual
  mortality
• from stroke, coronary heart diseases and all
  other causes by 8,
• 5 and 4.
• Whelton PK, 1994
• The chances of mortality from CVD in old
  hypertensive people
• when taking anti hypertensive medications is
  decreased by 34.
• MacMahon, 1993

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• Economic Impact
• The economic burden of chronic NCDs can be
  analyzed on two levels.
• First, the effects of macroeconomic policies on
  opportunities for prevention in different
  population groups
• Second, the cost and overall efficiency of
  interventions must be evaluated in terms of
  effectiveness and health gains for the population
  at large.

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Economic Impact Direct Cost Including
prescribing medicines, inpatient visits,
outpatient visits, emergency room visits,
office-based medical provider visits, home health
visits, and other medical expenses Sanjeev Balu,
2001 Indirect Cost Productivity loss (300 per
eligible employee per year) absence short term
disability Goetzel (2004), the only study in the
U.S.
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• Economic Impact
• Poor are disproportionately affected
• more vulnerable
• Prevalence 6 time more in uneducated
• Medication cost up to US 100 per month
• further poverty
• Cost to Health Services
• USA total cost of CVD is 2 of the gross
• domestic product
• direct medical costs estimated at nearly 55.0
• billion for the year 2001
• Sanjeev Balu, 2001
• Canada 21 of all diseases costs are due to
• CVD (US12 billion/Year) direct cost is 3,072
  per person per year, and indirect cost is 854
• Guijing Wang,2008

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Economic Impact In Alkhobar the total direct
cost of hypertension care for patients registered
in the primary health care represented 6.32 of
the estimated cost of treating the expected
number of patients. Al-Shahri 1998
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Prevention Primary prevention is the most
cost-effective approach to containing the
emerging hypertension epidemic. Hussein
AlGezairy Regional Director for WHO
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Prevention Incidence of hypertension was
reduced by 20 to 50 if primary prevention were
implemented Stamler 1991 For the developing
countries prevention of hypertension should be
the goal.
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• Prevention
• Life style Modification
• perform aerobic exercise
• maintain a healthy body weight
• follow a healthy diet
• restrict salt intake
• stress management
• limit alcohol consumption

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Recommended lifestyle modifications
Approximate systolic BP reduction Recommendation Modification
520 mmHg/10 kg Maintenance of normal body weight Weight reduction
814 mm Hg Consumption a diet rich in vegetables, fruits, and low-fat dairy products with a reduced content of saturated and total fat healthy eating plan
28 mmHg Reduction dietary sodium intake to no more than 2.4 g sodium Dietary sodium
49mmHg Engagement in regular aerobic physical activity at least 30 minutes daily, most days of the week Physical activity
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• Life style Modification
• Weight reduction
• Every 1 kilogram of weight loss lower blood
  pressure by 1.6/1.1 mmHg
• Khatib et al. EMR0 Technical Publications

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Prevalence of overweight and obesity among some
countries of the Eastern Mediterranean Region
(WHO.2004)
Overweight/obesity () Males Females Overweight/obesity () Males Females Country
70.0 64.0 Saudi Arabia
53.0 60.0 Lebanon
67.7 57.0 Islamic Republic of Iran
79.0 56.4 Bahrain
43.7 46.0 Jordan
41.0 43.8 Egypt
74.9 42.5 Libyan Arab Jamahiriya
43.5 40.5 Oman
21.7 37.2 Morocco
39.9 25.5 United Arab Emirates
41.9 13.1 Tunisia
56 79 Kuwait
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In Bahrain
National Non-communicable Diseases Risk Factors
Survey 2007
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In Sudan

• of 6-12y children
• 45 (14.8) were overweight 32 (10.5) were
  obese
• Salman Z et al 2010

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• Life style Modification
• Eating habits

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• Life style Modification
• Physical activity
• Exercise lowers systolic and diastolic blood
  pressure by 5-10 mmHg
• Arakawa

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• Life style Modification
• Physical activity

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National Non-communicable Diseases Risk Factors
Survey 2007
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• Life style Modification
• Sodium moderation
• Reducing dietary sodium intake to no more
  than 100 mEq/L
• (2.4 g sodium or 6 g sodium chloride),
  reduces the blood
• pressure by an average of 46 mmHg.
• Khatib et al. EMR0 Technical Publications

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• Life style Modification
• Diabetes
• (In Bahrain)

National Non-communicable Diseases Risk Factors
Survey 2007
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• Life style Modification
• Diabetes
• (In Bahrain)

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• Life style Modification
• Tobacco
• (In Bahrain)

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National Non-communicable Diseases Risk Factors
Survey 2007
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-Lipids
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• Life style Modification
• Lipids
• (In Bahrain)

National Non-communicable Diseases Risk Factors
Survey 2007
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• Life style Modification
• Cocoa ingestion
• 100g/day of chocolate
• drink reduces the systolic BP and
• diastolic BP
• Taubert et
  al 2007

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Change in Blood Pressure reduction between cocoa
Tea
P Pooled Change (mm Hg) Blood Pressure
Cocoa
.002 -4.7    Systolic
.006 -2.8    Diastolic
Tea
.63 0.4    Systolic
.38 -0.6    Diastolic
Taubert et al 2007
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Change in Blood Pressure reduction between cocoa
Tea
The magnitude of the hypotensive effects of
cocoa is in the range that is usually achieved
with monotherapy of ß-blockers or
angiotensin-converting enzyme inhibitors
Taubert et al 2007
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• Chocolate and Coronary Heart Disease A
  Systematic Review
• This article reviews current evidence on the
  effects of cocoa/chocolate on
• clinical and subclinical coronary heart disease
  (CHD), CHD risk factors,
• and potential biologic mechanisms.
• The high content of polyphenols and flavonoids
  present in cocoa has been reported to play an
  important protective role in the development of
  CHD.
• Although studies have demonstrated beneficial
  effects of chocolate on endothelial function,
  blood pressure, serum lipids, insulin resistance,
  and platelet function, it is unclear whether
  chocolate consumption influences the risk of CHD.
  
• Khawaja O et al Current Atherosclerosis Reports,
  Volume 13 / September 2011

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• Measurement of Blood Pressure
• The "white-coat" effect
• Prevalence of white coat hypertension was 3.6
  overall and 12.8 in hypertensive patients.
• Marquez Contreras et
  al. 2006

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• Measurement of Blood Pressure
• The "white-coat" effect
• Prevalence of white coat hypertension was 3.6
  overall and 12.8 in hypertensive patients.
• Marquez Contreras et
  al. 2006

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• Measurement of Blood Pressure
• The "white-coat" effect
• Prevalence of white coat hypertension was 3.6
  overall and 12.8 in hypertensive patients.
• Marquez Contreras et
  al. 2006

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• Hypertension Control
• Very poor control of hypertension world wide
• In Egypt 23.9 were receiving treatment 8
  controlled 
• Ibrahim  et al.
• In Canada 15.8 had blood pressure treated and
• controlled
• Petrella et al, 2007
• In Saudi Arabia, 76 were receiving treatment,
  but only
• 20 were found controlled
• Abolfotouh et al,

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• Measurement of Blood Pressure
• Seated in a quiet room
• Arm muscles relaxed
• Cubital fossa at heart level
• Avoid tight sleeves
• Suitable size Cuff to be used
• Repeat if BP gt 140/90
• Measurement on both arms
• Mercury sphygmomanometers are most reliable
• Goodman and Gilman's1993

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Management Good management of hypertension is
central to any strategy formulated to control
hypertension at the community level. Randomized
trials of drugs that lower and control blood
pressure clearly show a reduction in mortality
and morbidity. Hussein A. Gezairy Regional
Director for the Eastern Mediterranean
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Management 2 mmHg reduction in systolic blood
pressure is likely to reduce the annual
mortality from stroke, coronary heart disease
and all other causes by 6, 4 and 3,
respectively
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Conclusion Hypertension is a serious problem
that could be called "the silent killer". Its
prevalence is very high especially in the GCC
countries. Effective efforts ought to be taken in
order to prevent, prevent, prevent, prevent
then diagnose and treat it.
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Conclusion Hypertension is a serious problem
that could be called "the silent killer". Its
prevalence is very high especially in the GCC
countries. Effective efforts ought to be taken in
order to prevent, prevent, prevent, prevent
then diagnose and treat it.
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Conclusion Hypertension is a serious problem
that could be called "the silent killer". Its
prevalence is very high especially in the GCC
countries. Effective efforts ought to be taken in
order to prevent, prevent, prevent, prevent
then diagnose and treat it.
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Thank you
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