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)