INTRODUCTION

“Look to your health; & if you have it praise GOD, &

value it next to a good conscience; for health is the
second blessing that we mortals are capable of; a
blessing that money can’t buy.”
Izaak Walton 1593-1683 (The Compleat angler)
Mankind is fighting against diseases from time when life on earth had
started. Up till now we have controlled many diseases and now we are also
facing new disease whose prevalence was not much in past.

Modern era is era of chronic-non communicable diseases like

cardiovascular diseases, cancers, Mental illness, Accidents, coronary heart
diseases etc. These all are slow progressive, multifactorial, not well
understood diseases. They are not curable & natural pattern of disease is
obscure so control is difficult.

Hypertension is one of the chronic non

communicable diseases. It is also responsible for
other Chronic non communicable degenerative
disease mentioned above. In lay man language it is
only high level of Blood pressure which is silent
killer of world. It leads to death by stroke, coronary
heart disease, and chronic renal failure etc
modalities. So to control hypertension is much
important for us.

DEFINITION:
According to WHO Person having systolic Blood
pressure ≥160 mm Hg &/or diastolic blood
pressure ≥95 mm Hg is called have Hypertension.

According to Joint National Committee V & international society of

hypertension “Blood pressure level ≥140 mm Hg systolic & ≥90 mm Hg is
called Hypertension.”

CLASSIFICATION:
Hypertension can be classified in various way:

According to causation:
1. Essential hypertension in which cause is unknown & is responsible for
90% of all cases of Hypertension.

2. Secondary hypertension in which other disease is responsible for it.

Example is Diabetes mellitus, Cushing syndrome

According to Blood pressure measurement:

It is done by many associations & according to level of person’s blood
pressure category of Hypertension is decide. Most commonly we are
considering WHO criteria for diagnosis. We will consider it in other chapter
method of study.

Classification by JNC-VII

CATEGORY SYSTOLIC BP DIASTOLIC BP

Normal <120 mmHg <80 mmHg
Prehypertension 120-139 mmHg 80- 89 mmHg
Stage 1 140-159 mmHg 90-99 mmHg
Hypertension
Stage 2 ≥160 mmHg ≥100 mmHg

DIAGNOSIS:
It is done by measuring the blood pressure with the help of Mercury
manometer. But due to subjective variations, anxiety, fear, hearing iniquity,
inexperienced interpretation of Korotkow sound, Faulty instrument etc factor
Errors are much. So WHO Study Group has mentioned standard method to
measure blood pressure:
METHOD TO MEASURE BLOOD PRESSURE:
- Position of patient :- Sitting position
- Position of mercury monometer :- at the
level of heart
- Arm to be used :- Any right/left but in
any clinic policy must uniform
- Systolic BP :- point at which sound 1st
heard
- Diastolic BP :- point at which sound
completely disappeared
- It should be measured at least three
times over a period of 3 minutes & lowest
reading recorded.

HYPERTENSION AS AN ICE BERG DISEASE:

Ice berg is one of the worst thing form which all sailors are fearing. Because
of its submerge 2/3 portion there is much more
damage to ship than due to its tip portion (1/3).
Hypertension evident in 1970s shows same
phenomena. From total number of cases of
hypertension only 50% are aware of this
condition & 25% are taking treatment regularly
& only 12.5% cases are controlled
successfully.(by rule of half)
These figures vary from country to country.
According to American heart association:
- One in three U.S. adults has high blood
pressure.
- 28% of people with high blood pressure
don't know they have it & 64.9% do not
have it controlled. (Though there are
advance in medical facilities than other
country).
So death due to complication of hypertension is more. But it can be
prevented by simple measure & early diagnosis and treatment of
undiagnosed, untreated/improperly treated cases which are sub merge
portion of Ice berg of Hypertension & awareness of condition in people.

STATISTICS:
Hypertension is a major health problem in world. To reveal it Incidence has
limited value because of variability in reading of an individual.

Prevalence:
- In industrialized countries 25% of adult & in Developing and
European Countries 20% of Adults are affected.

- Prevalence is high in U.S. Blacks, Russia, Finland [30%-40%], Usual in

Europe, Japan, U.S. Whites [15%-30%], low in Rural Africa, South
China [7%-15%]

- And Absent in Yanomani, Pacific island.

- In India urban areas’ prevalence rate is 164.18 per thousand & In

rural areas prevalence rate is 157.44 per thousand.

Mortality:
- 20%-50% of total death occurs due to Hypertension.

- In India 91 deaths/hour occur due to Cardiac diseases whose one of

major risk factor is Hypertension.

- From 1994 to 2004 the age-adjusted death rate from high blood
pressure increased 25.2 percent.

- High blood pressure (hypertension) killed 54,186 people in the United

States in 2004. It was listed as a primary or contributing cause of
death in about 277,000 U.S. deaths in 2004.
(American heart association)

In term of cost in U.S. 50.3 billion$ are used in 2003 behind treatment of
Hypertension. So it is great economic lost every year. (American hart association)

 So to identify risk factor & prevention is necessary to stop this slow

Epidemic.

 Risk factors associated with Hypertension are classified in two groups.

- One group is of non-modifiable risk factors like Age, Gender, Genetic
inheritance, Ethnicity.
- Second group is of modifiable risk factor like obesity, smoking, high
salt intake, stress, fatty diet, Alcohol consumption, Life style etc.

 Hypertensive patient has non specific symptoms like headache, swatting,

restlessness, palpitation, dizziness etc. so many of patient doesn’t know
about disease.

 Preventive measures include dietary modifications, weight reduction,

regular exercise, abstinence to smoking & alcohol, health education and
early treatment by means of pharmacological approach to control
hypertension.
 So let us follow motto of “Learn & Live” to overcome Hypertension.