HYPERTENSION IN COMMUNITY HEALTH NURSING

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

3. 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.

4. 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.”

5. 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

6. CLASSIFICATION
Hypertension is divided into primary and secondary.
1. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

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

15. 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

16. 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.

17.  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.

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

19. 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.

20. 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

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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

28. 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.

29. 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.

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. LIFE-STYLE
MODIFICATION TO
MANAGE
HYPERTENSION

38. 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

39. 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

40. 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.

41. 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.