Post on 12-Nov-2014
Epidemiology of Epidemiology of Hypertension & DiabetesHypertension & Diabetes
Dr Razia Aftab
Both of these diseases are:Both of these diseases are:
Non Communicable disease المعدية المعدية غير غير
• Common عامعام
Preventable to some extent ( منها الوقاية منها يمكن الوقاية (يمكن
Cause of Great economic impact ( االقتصادي االقتصادي األثر (األثر
Cause of Serious complications ( خطيرة خطيرة مضاعفات even (مضاعفات
before any manifestations (ظهورظهور)
Silent KillerSilent Killer
1. Absence of a known agent
2. Multi-factorial causation
3. Long latent period
4. Indefinite onset
5. Non-reversible changes
Epidemiological Peculiarities Epidemiological Peculiarities
What is Hypertension?Normal blood pressure for adults is defined as systolic blood pressure below 140 mmHg and diastolic
blood pressure below 90 mmHg;
Any reading greater than this is hypertensionProvided two or more elevated readings are obtained on at least
two visits over a period of one to several weeks
In diabetics it is ≥ 130mmHg systolic and 80 mmHg diastolic
What is Diabetes mellitus?What is Diabetes mellitus?Diabetes mellitus is a
Heterogeneous disease. It comprises several distinct patho-physiologic disorders of carbohydrate metabolism, each of which
ultimately manifests with hyperglycemia Factors contributing to hyperglycemiaFactors contributing to hyperglycemia;;
• Reduced insulin secretion • Decreased glucose usage and
• Increased glucose production.
Type-1Type-1 Type-2Type-2 Gestational Gestational
Types of Diabetes mellitusTypes of Diabetes mellitus
The diagnosis of diabetes is based on one of four tests:
1. Fasting plasma glucose (FPG)= ≥126 mg/dL
2. Random elevated glucose with symptoms= ≥200
mg/dL
3. Hemoglobin A1C (A1C)= ≥ 6.5%
4. Abnormal oral glucose tolerance test (OGTT) that is
two hours postprandial glucose value = ≥200 mg/dL
If one of these criteria is met, confirmation is required by repeat testing on a subsequent day
When the fasting blood glucose is Between 100-126mg/dl
it is said to be IFG (impaired fasting glucose)
Gestational DiabetesGestational Diabetes• Screening by measuring plasma glucose
concentration 1 h after a 50-g oral glucose load is recommended between 24 and 28 weeks of gestation.
• If the glucose concentration is 7.8 mmol/L, a full 2-h OGTT should be performed.
• The only modification suggested in the revised criteria is that
screening for gestational diabetes mellitus is unnecessary in women <25 years of age who are at
low risk
Size of the ProblemSize of the Problem
The World Health Organization has 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 hypertension.
Hussein A. GezairyRegional Director for the Eastern Mediterranea
KSA Profile-2008; MOH
Prevalence of Hypertension in KSA
What are the What are the Causes of Hypertension Causes of Hypertension
& & Diabetes?Diabetes?
Causes of hypertensionCauses of hypertension
•Primary hypertension (95% of cases)
•Secondary hypertension* Renal* Drugs* Endocrine; Pheochromocytoma, Aldosteronism,
Cushing's syndrome etc.
* Coarctation of the aorta and aortitis* Pregnancy-induced hypertension
smoking
Obesity;
↑ waist
/
hip ratio
stress
Risk Factors for Primary HypertensionFa
mily
His
tory
A fa
ther
or b
roth
er w
ith C
HD
bef
ore
age
55 y
ears
or a
mot
her
or s
iste
r with
CH
D b
efor
e ag
e 65
yea
rs is
a ri
sk fa
ctor
Type 2 diabetes is considered as a complex and heterogeneous disease with a poorly understood etiology, apart from the fact that there is a strong genetic propensity that becomes overt when exposed to certain environmental factors or adopting certain behavior
Causes of Type 2 DiabetesCauses of Type 2 Diabetes
smoking
Obesity;
↑ waist
/
hip ratio
stress
Environmental Factors for DiabetesFa
mily
His
tory
DiabetesDiabetes
Age and Hypertension
0
5
10
15
20
25
30
20-29 30-39 40-49 50-59 60-69 70-79 80+ All
MALES
Females
Age & Diabetes
ObesityObesityObesity is one of the principal risk factors
for both:
Type 2 diabetes
&Hypertension
Weight gain Insulin resistance
Demand on pancreas to
secrete more insulin
Diabetes
Insulin reduction
Age related decrease
production of insulin
+
Obesity and DiabetesObesity and Diabetes
Body mass index (kg/m2): Saudi Men and Women;
28.6
39.1
Obesity Obesity
Abdominal obesity >102 cm, Men
Waist circumference
>88 cm, Women
Measured at the height of umbilicus and top of the hip bones.
25-64 yrs; 17.2% high level, 21.8% moderate level
1713 people 61.0% low level
Physical Activity in Saudi Population
In general, the recommended target for physical activity is 30-45 minutes of aerobic exercise three to five times a week.
1782 (25-64 yrs) 372 (20.9%) smoke
Manufactured Cigarettes
Hand rolled Cigarette
PipeCigar, cheroot
Shisha
Smoking in Saudi Arabia
357 smokers started
smoking at 19.7years
ComplicationsComplications
Effects of hypertension
Heart changes.
Vascular changes
Renal changes.
Brain changes.
Retinal lesions.
Causes of death ???
Morbidity Morbidity IHD Retinopathy and other eye
involvement Gangrene of the lower
extremity Peripheral and other
neuropathies. Atherosclerosis leading to
stroke and other arteritis Repeated infections like UTI Problems during pregnancy
Prevention
Primary PreventionPrimary Prevention
Primary prevention is the most cost-effective approach to containing the emerging
hypertension and diabetesepidemic
Life style Modification:Life style Modification:Perform aerobic exercise
Maintain a healthy body
weight
Follow a healthy diet
Restrict salt intake & increase potassium
Stress management
Stop smoking
Limit alcohol consumption
Consume as the basis of diet: eat mainly foods rich in starch (e.g. vegetables, beans,
fresh fruit, whole meal bread, pasta, rice)
Consume in moderation: eat small servings of protein foods (e.g., lean
meat, fish, eggs,low-fat dairy products);
Consume sparingly: eat minimum amounts of fats,
alcohol and sugars (e.g., cakes, fried
food, snacks, processed meat, honey, diabetes
‘specialist’ foods);
‘The Healthy Eating Pyramid’ is a visual way to help translate dietary advice into practical eating habits.
Foods are divided into three strata
DASH Diet for Hypertension
• This diet has low salt (or low sodium) along with additional benefits to reduce blood pressure.
• It is based on an eating plan rich in fruits and vegetables, and low-fat or non-fat dairy.
• It also has reduced content of saturated fats• Eating foods that are rich in magnesium,
potassium, and calcium
Nutritional Recommendations for Diabetes Nutritional Recommendations for Diabetes • Total daily caloric intake should be 30-35Kcal/kg.
• In the new recommendations, 40% of daily calories come from carbohydrates;
• 20% to 30% from protein (except in the presence of renal disease);
• 30% to 35% from fat, (mostly mono- and polyunsaturated fats); and
• The diet should have a minimum of 20 to 35 g of fiber.
Secondary Prevention
Screening ProgramScreening Program
The U.S. Preventive Services Task Force (USPSTF) recommends :Screening for high blood pressure in
adults 18 years and older
every two years in persons with blood pressure less than 120/80 mm Hg, and every year in persons with systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 90 mm Hg
Screening for diabetes in asymptomatic individuals: by measuring FPG is suggested At age 45 years Younger in subjects at increased risk
Follow-up testing every 3 years.
Management of Management of Hypertension and DiabetesHypertension and Diabetes
reduces the mortality and morbidity.
It is central to any strategy formulated to • Control hypertension at the community level.
&
• Control blood sugar with oral hypoglycemic agents
Guidelines for Medical Care for Patients with Diabetes to Prevent Complications
• Self-monitoring of blood glucose (individualized frequency)
• HbA1c testing (every 3 months if not controlled&6 months if controlled)
• Patient education in diabetes management (annual)
• Medical nutrition therapy and education (annual)
• Eye examination (annual)
• Foot examination(1-2 times by a physician; daily by patient)
• Screening for diabetic nephropathy (annual)• Blood pressure measurement (quarterly)• Lipid profile (annual)