EPIDEMIOLOGY OF HYPERTENSION

“Life is not just being alive but being well.”

Martial (In AD C-40 to c-104), Epigrammata
Hypertension is most important chronic-non communicable disease
which is also responsible for other chronic non communicable degenerative
disease.
Hypertension is a condition in which person having persistent high
blood Pressure. According to the JNC-V criteria (Joint National Committee –
V), Systolic > 140 mm Hg or a diastolic pressure ≥ 90 mm Hg is taken as the
diagnostic criteria of Hypertension.
Chronic non communicable diseases have multifactorial causation,
log incubation periods like many limitations & epidemiology is up till now
only most important tool who has explain about these diseases therefore to
understand hypertension its epidemiology is good tool.

According to John M. Last Epidemiology is “The study of the

distribution & determinants of health related states or events in specified
population & the application of this study to the control of health problems.”

So there are three aims of Epidemiology:

1. To describe the distribution and magnitude of health problem
2. To identify etiological (risk) factor in pathogenesis of disease
3. To provide data essential for planning, implementation &evaluation of
service for the prevention, control, & treatment of disease & setting up of
priorities among these services.
We will understand hypertension under headings of these three aims.

MAGNITUDE & DISTRIBUTION OF HYPERTENSION:

At International level
 Graph shown on previous page informs about percentage of
population who are aware of hypertension, taking the treatment & having
good control of hypertension in different countries of world. Hypertension is
slow Epidemic. It is an Iceberg disease. Statistics of international level
shown are proving this fact.

At National level

In India urban areas prevalence rate is 164.18 per thousand.

In India rural areas prevalence rate is 157.44 per thousand.
(By : http://www.whoindia.org/SCN/AssBOD/08-Hypertension.pdf.)

Here zone wise data is given

NAME OF CITY AREA REPRESENTED PREVALENCE (%)

BY THAT CITY
Trivandrum South India 30.7%
Mumbai West India 28.0%
Moradabad North India 22.6%
Kolkata East India 19.1%
Nagpur Central India 24.2%

Effect of Hypertension
It was found that
o 16% of ischemic heart disease
o 21% of peripheral vascular diseases
o 24% of AMI (Acute Myocardial Infarction) cases
o 29% for stroke
o 18% of cataract
cases in our country are attributable of hypertension.
(From: http://www.whoindia.org/SCN/AssBOD/08-Hypertension.pdf.)

RISK FACTORS FOR DEVELOPMENT OF HYPERTENSION:

WHO scientific group has reviewed the risk factors for Essential
Hypertension and it can be classified as below:
1. Non – Modifiable
2. Modifiable

1. Non – Modifiable :
 AGE :– Blood pressure rises
with age & prevalence of
hypertension is more in
adults after 40 years of age
but now a days it is more
also common in younger
age.
 SEX :– At adolescence men have higher level of blood pressure and
difference is evident at middle aged adults.
But later in life this difference is narrow and an even pattern seen in both
sex may be due to post-menopausal changes.
 GENETIC FACTORS :– Family studies show that children of two
normotensive parents have 3% possibility of developing Hypertension ,
whereas children of two hypertensive parents have 45% possibility.
Inheritance of genes related to blood pressure determination is polygenic.
 ETHNICITY :– Black communities have higher blood pressure levels.
Average difference in blood pressure between the two groups (blacks and
whites) varies slightly less than 5 mm Hg during 2nd decade of life but it is
20 mm Hg during 6th decade.

2. Modifiable Risk Factor :

 OBESITY :–
o The greater the weight gain, greater the risk for high blood pressure.
o “Central Obesity” indicated by an increased waist to hip ratio has
positive correlation with Hypertension.
o When person with high BP loses his weight, their blood pressure
generally decreases.
o Obesity is estimated by Body Mass Index (BMI).

BMI=Weight (kg) ÷ height2 (meter)

BODY MASS INDEX - HYPERTENSION

14 12.03
12
prevalence(%)

10 7.54 8.29
8 7.05
6
4
2
0
<18.5 18.6-24.9 25-30 >30
Body mass index

o Some analytical study results of India are given above on the basis of
BMI. Similar results have been shown by studies conducted in
different countries.
 LACK OF PHYSICAL ACTIVITY :–
o Regular exercise like walking, jogging, etc helpful in reducing body
weight. So BMI decreases and blood pressure level lowers down.
 SATURATED FAT :–
o Higher intake of saturated fat (>10%kcal/day) raises serum
cholesterol level, which will lead to oxidative damage to vessel wall
and Hypertension occurs.
o Total visible fat (>20-25gm/day) intake is positively associated with
Hypertension.
 DIETARY FIBERS AND FRUITS :–
o Higher intake of dietary fibers reduces plasma total and LDL
cholesterol by reducing their absorption and decrease blood pressure.
Fruits give vitamins which act as antioxidant and prevent oxidative
damage by cholesterol to blood vessels.(Artificial vitamin tablets have
proven to be ineffective for these actions.) <400gm/day of vegetables,
fruits, legumes, coconut is associated with Hypertension.
 SALT INTAKE :–
o A high salt intake (i.e. ≥ 7-8 gm/day) increases blood pressure
proportionately. Low sodium intake lowers the blood pressure.

SALT INTAKE & HYPERTENSION

10 8.59
7.68
Prevalance(%)

8 6.63
6
4
2
0
<8G/day 8-10G/day >10G/day
Salt intake per day

o Essential Hypertension has genetical abnormalities of kidney which

make salt excretion more difficult. Therefore if intake of salt can be
reduced, normal electrolyte level would be there.
o Potassium supplements have found to reduced mild to moderate
Hypertension.

 ALCOHOL :–
o High alcohol intake is associated with increased risk of high blood
pressure.Alcohol raises systolic BP more than the diastolic.
 ALCOHOL & HYPERTENSION

25 22.28

prevalance(%)
20
15
10 7.76 7.62
5
0
No Drinker 0-10ml/day >10ml/day
Daily alcohol consumption

 ENVIRONMENTAL STRESS AND SOCIO-ECONOMIC STATUS :–

o Modern era is the era of stress or tension. Due to high competition
and mental stress, there is overactivity of sympathetic nervous system
and catecholamine levels in blood increases, which is responsible for
high BP.
o Person having higher socio-economic group have more prevalence of
Hypertension, due to their stressful life, sedentary lifestyle, obesity,etc
 OTHER FACTORS :–
o It is not proved but observed in one study that higher levels of serum
Magnesium is associated with lower risk of Hypertension.
o Use of Oral Contraceptive pills is associated with high blood pressure.

SMOKING & HYPERTENSION

10 8.85
Prevalence(%)

7.29
8
6
4
2
0
Non- Smoker
Smoker
Group of Smoker

o Smoking is not a risk factor but it is an aggravating factor.

FOR SECONDARY HYPERTENSION:

A. Diabetes mellitus
B. Pheochromocytoma
C. Cushing’s Syndrome
D. Renovascular hypertension

PREVENTION AND CONTROL OF HYPERTENSION :

WHO recommended following approaches for prevention and control
of Hypertension –
Primary Prevention:
It is prevention by all measures to reduce the incidence of disease in a
population by reducing the risk of onset. Two strategy of it are as below :

A. Population strategy :–
- Its goal is to shift the community distribution of blood pressure
towards lower levels or “biological normality”. To achieve this goal
following multifactorial approach is necessary.
- Nutrition :–
1. Reduce salt intake average
not >5 gm/day.
2. moderate fat intake
3. Avoid alcohol and smoking.
4. Increase amount of
vegetables, fruits, etc in diet.

- Weight reduction :–
1. reduce BMI<25 .
2. Promote exercise.
3. Avoid sedentary life style.
- Self care :– e.g. by monitoring
BP by itself and making its
log-book.
- Health education:- Education
about risk factors &
complication.
- Behavioral changes :– avoid stress, do yoga, pranayam.

B. High risk strategy :-

- for persons at risk , that is with Family history of Hypertension
and/or normal high BP level , pharmacological treatment should
be added.

Secondary Prevention:

- In it we detect and control cases of Hypertension. Modern anti-HT

treatment with ACEI and ACE antagonists, ß-blockers, diuretics and
Calcium Channel Blockers are effective ways to control high BP.
- This can be achieved by Early case detection, Effective Treatment, and
Patient Compliance.

COMPLICATION OF HYPERTENSION IF LEFT UNTREATED:

1. Stroke:-
2. Blindness:-
3. Ischemic heart
disease:-
4. Impaired renal
function:-
5. Peripheral vascular
disease:-
So let’s try to control hypertension –modern monster.