CRUSADE AGAINST THE SILENT KILLER

DR.R.BALASUBRAMANIYAM

CONSULTANT NEPHROLOGIST

KG HOSPITAL

CHANGING HEALTH SCENARIO - MAJOR FACTORS OF MORTALITY

MALNUTRITION

INFECTION

CHANGING HEALTH SCENARIO - COMMON CAUSES OF MORTALITY

CARDIO - VASCULAR DISEASES

CEREBRO - VASCULAR DISEASES

RENAL DISEASES

COMMON DENOMINATOR

UNDERLYING HYPERTENSION

WHY THIS SHIFT?

IMPROVING HYGEINE

INFECTION CONTROL STEPS

BETTER DRUGS & VACCINES

BASIC MEDICAL FACILITY AVAILABLE

TO COMMON MAN

THE URBAN LIFE

INCREASE STRESS LEVELS

SMOKING

ALCOHOLISM

CHANGING FOOD HABITS

SEDENTARY JOBS

NO PHYSICAL EXCERCISE

THE PRICE WE PAY

10 - 20% PREVALENCE OF HYPERTENSION

ALL OVER THE WORLD

APPLY TO INDIAN SCENARIO

THE HYPERTENSIVE POPULATION IS

APPROXIMATELY 10CRORES

HTN IN INDIA PREVALENCE

1960 - 1.24 to 4.24%

Urban

2000 - 3.8 - 30% (Males)

1.45 - 7.65% (Females)

Rural

1.57 - 6.93% (Males)

2.38 - 7.5% (Females)

PREVALENCE VARIES ACCORDING TO

AGE

SEX

BP CUT OFF VALUE

DEVELOPING vs DEVELOPED COUNTRIES

ETHNIC

“WHO” - ON HYPERTENSION

A MAJOR HEALTH PROBLEM

COMPLEX AND MULTI DIMENSIONAL

APPROACH

DEFINITION OF HYPERTENSION

FIFTH JOINT NATIONAL COMMITTEE CRITERIA

THREE SETS OF READINGS, AT 1 WEEK INTERVAL

MINIMUM AVERAGE LEVEL

140 - SYSTOLIC

90 - DIASTOLIC

BAD NEWS

Patients with DBP > 105mmHg - 10 fold

in stroke 5 fold in Cardio vascular

disease

GOOD NEWS

PERSISTANT REDUCTION OF DBP

DBP CVD CORONARY

DEATH

5mmHg 34% 21%

7.5mmHg 46% 29%

10mm Hg 56% 37%

AWARENESS ABOUT HTN -(USA)

65% OF HYPERTENSIVES LACK

AWARENESS

49% RECEIVE TREATMENT

21% HAVE BP < 140/90 mmHg

THE INDIAN SCENARIO

MYTHS & FACTS

MYTH - HYPERTENSIVES ARE

SYMPTOMATIC

FACT - 90% ARE ASYMPTOMATIC

MYTH - HYPERTENSION IS

DISEASE OF ELDERLY

FACT - NO AGE FOR HYPERTENSION

MYTH - ONCE DIAGNOSED START

DRUGS

FACT - EVALUATE FOR SECONDARY HTN, STRESS ON LIFE

STYLE

MODIFICATION

MYTH - STOP DRUGS ONCE BP IS

NORMAL

FACT - HTN IS CONTROLLABLE,

NOT CURABLE

MYTH - REGULAR INTAKE OF DRUGS

CAN PRODUCE SIDE EFFECTS

FACT - UNCONTROLLED HTN PRODUCES

ENDORGAN DAMAGES

NEED FOR THE HOUR

POPULATION APPROACH

SCREEN EVERY ONE

INDIVIDUAL APPROACH

SCREEN THOSE AT RISK

AIM

INCREASE AWARENESS ON HTN BY

PUBLIC EDUCATION - RADIO, TV,

PAPERS, SCHOOLS ETC

PROFESSIONAL EDUCATION

PATIENT EDUCATION

WHY SHOULD WE DO THIS?

PRIMARY PREVENTION - CHEAPER & SAFER

THAN

SECONDARY & TERTIARY PREVENTION

COST OF ONE HYPERTENSIVE PATIENT MANAGEMENT

Drugs Per Month - Rs.250/-

Per Year - Rs.5,000/-

Evaluation cost - Rs. 1,000/- Per Year

Assume he is going to live for 20 years

Investigations for 20 Years - Rs.20,000/-

20 Years of Anti HT drugs - Rs.1,00,000/-

COMPLICATION MANAGEMENT

HEART ATTACK } Rs.1.5 - 2.5 lakhs

& BY PASS SURGERY

KIDNEY TRANSPLANTATION Rs.2 - 4 lakhs

STROKE MANAGEMENT Rs. 1 lakh

NOT INCLUDED

LOSS TO HIS FAMILY

LOSS OF HIS EARNINGS

HIS CONTRIBUTION TO THE

COMMUNITY

IF THIS HAPPEN TO ONE PATIENT -

KINDLY EXTRAPOLATE IT TO 10

CRORES OF PEOPLE

DR.MK.MANI’S APPROACH

IDENTIFIED VILLAGES

INVOLVES HEALTH WORKERS

DOOR TO DOOR BP & SUGAR CHECK UPS

LOW COST DRUG DISTRIBUTION

PERIODIC MONITORING

WHAT CAN BE DONE

ENLARGE HIS CONCEPT

APPLY TO EVERY VILLAGE IN THE COUNTRY

THROUGH GOVT (OR) NON GOVERNMENTAL

ORGANISATIONS

ROLE OF PRIMARY HEALTH CENTRES

HEALTH EDUCATION IN SCHOOLS

TRAIN HEALTH WORKERS, STUDENTS

WHAT CAN BE DONE BY OUR GOVT?

HEALTH EDUCATION

AGRICULTURAL POLICIES - K+ RICH

NATURAL FOODS, VEGETABLES, FRUITS

LOW SALT & FAT IN FOOD CONTENTS

CREATE FACILITIES FOR OUT DOOR ACTIVITIES

CONTROL SMOKING

ENSURE AVAILABILITY OF CHEAP ANTI - HT

DRUGS

INTEGRATED PROGRAMMES

WHAT HAVE WE DONE ? STEP - 1

FREE BP CLINIC

POPULATION SCREENED - 1,64,685

HTN DETECTED - 16,576

FREE SCREENING, EXAMINATION & MEDICAL

ADVICE. INVESTIGATION AT CONCESSIONAL

CHARGES

STEP - 2

SCREENING BP BEYOND KG HOSPITAL

SCHOOLS , COLLEGES, OFFICES &

RESIDENTIAL AREAS

TARGET - CITY OF COIMBATORE

WE REQUIRE

HUMAN RESOURCES

FINANCIAL SUPPORT - TRANSPORT

INSTRUMENTS

DRUGS

WE REQUEST OUR HONOURABLE

DR. K.VENKATASUBRAMANIAN

MEMBER OF PLANNING COMMISSION, GOVT OF INDIA

YOU SUPPORT US - WE TAKE CARE OF OUR DISTRICT

OUR REQUEST

PLEASE SPEND MONEY NOT ONLY TO

REDUCE TENSION ACROSS BORDERS

BUT ALSO TO REDUCE

HYPERTENSION WITHIN BORDERS

THANK YOUTHANK YOU