Epidemiology of Hypertension & Diabetes

Dr Razia Aftab

Both of these diseases are:

Non Communicable disease Common

Preventable to some extent () Cause of Great economic impact ()

Cause of Serious complications ( ) even before

any manifestations ()

Silent Killer

Epidemiological Peculiarities
1. Absence of a known agent 2. Multi-factorial causation 3. Long latent period 4. Indefinite onset 5. Non-reversible changes

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 hypertension
Provided 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?

Diabetes mellitus is a Heterogeneous disease. It comprises several distinct pathophysiologic disorders of carbohydrate metabolism, each of which

ultimately manifests with hyperglycemia

Factors contributing to hyperglycemia; Reduced insulin secretion

Decreased glucose usage and

Increased glucose production.

Types of Diabetes mellitus

Type-1 Type-2 Gestational

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 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 2h 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 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. Gezairy Regional Director for the Eastern Mediterranea

KSA Profile-2008; MOH

Prevalence of Hypertension in KSA

What are the Causes of Hypertension & Diabetes?

Causes 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

Family History A father or brother with CHD before age 55 years or a mother or sister with CHD before age 65 years is a risk factor

Risk Factors for Primary Hypertension

dyslipide mia

Causes of Type 2 Diabetes 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

Environmental Factors for Diabetes

Family History

dyslipide mia

Diabetes

Age and Hypertension

Age & Diabetes

MALES Females

30 25 20 15 10 5 0

20-29 30-39 40-49 50-59 60-69 70-79 80+ All

Obesity
Obesity is one of the principal risk factors
for both:

Type 2 diabetes & Hypertension

Weight gain

Insulin resistance

Demand on pancreas to secrete more insulin

Obesity and Diabetes

Insulin reduction

Diabetes

+
Age related decrease production of insulin

Obesity
Measured at the height of umbilicus and top of the hip bones.

Body mass index (kg/m2): Saudi Men and Women;

39.1

28.6

Abdominal obesity

>102 cm, Men

Waist >88 cm, Women circumference

Physical Activity in Saudi Population

25-64 yrs; 1713 people 17.2% high level, 21.8% moderate level 61.0% low level

In general, the recommended target for physical activity is 30-45 minutes of aerobic exercise three to five times a week.

Smoking in Saudi Arabia

1782 (25-64 yrs) smoke
Cigar, cheroo t Shisha Pipe

372 (20.9%)
357 smokers started smoking at 19.7years

Hand rolled Cigarette

Manufacture d Cigarettes

Complications

Effects of hypertension
Heart changes.

Vascular changes
Renal changes.

Brain changes.
Retinal lesions. Causes of death ???

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 Prevention
Primary prevention is the most cost-effective approach to containing the emerging hypertension and diabetes epidemic

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

The Healthy Eating Pyramid is a visual way to help translate dietary advice into practical eating habits.
Foods are divided into three strata
Consume sparingly: eat minimum amounts of fats, alcohol and sugars (e.g., cakes, fried food, snacks, processed meat, honey, diabetes specialist foods);

Consume in moderation: eat small servings of protein foods (e.g., lean meat, fish, eggs, low-fat dairy products); Consume as the basis of diet: eat mainly foods rich in starch (e.g. vegetables, beans, fresh fruit, whole meal bread, pasta, rice)

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

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 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 Hypertension 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)