Epidemiology of RHD & HTN Flashcards
Measures necessary for primordial prevention of Rheumatic Fever and RHD
- Improvement in the living conditions
- Improvement of sanitation ( in + around the house )
- Prevention of overcrowding
- Prevention of malnutrition among children
- Improvement in the socioeconomic condition
- Health education regarding dangers of sore throat
- ‘Health-Fair’ should be conducted in the schools to make the children health conscious
Mention the “Specific Protection “ of Rheumatic Fever and RHD
• No vaccine is available
• Chemoprophylaxis :
of the contacts in a case of pharyngitis or scarlet fever with Benzathine penicillin.
• ‘Secondary prophylaxis’ :
is given for all cases of Rh fever to prevent RHD with :
a. 1.2 million units of Benzathine Penicillin»_space;»»> once in 3 weeks»_space;»»regularly for 5 years or until the age of 18 years, whichever is later ( Can exceed 18 yrs , eg. If he started the attack at age 15 he shall continue for 5 yrs )
• If they have developed RHD, prophylaxis is continued for life.
Early Diagnosis and Treatment of Rheumatic Fever and RHD
- ‘School health survey’ —> to detect the cases of sore throat
- By surveillance of ‘high-risk’ groups such as slum dwellers
- Treatment: Detected cases of sore throat (or acute pharyngitis) are treated by ———> 1 dose of 1.2 million units of Benzathine penicillin ( a long acting one )
Why? It essentially prevents the subsequent development of Rh fever and RHD
Disability Limitation of Rheumatic Fever and RHD
- In an individual who has already developed RHD ——> This consists of limiting the development of disability
- By Intensive treatment ——> a. Aspirin for joint pains
b. prednisolone for carditis
c. life long Benzathine Penicillin : 1.2 million units , once in 3 weeks
Rehabilitation of Rheumatic Fever and RHD
- Physical by Balloon valvotomy or valve replacement
- Social, vocational and psychological measures of those who are suffering from RHD
Risk Factors of Hypertension
- Hypertension itself is a risk-factor for cardiovascular diseases, stroke and renal failure
- It has its own risk grouped into two groups—Non-modifiable and modifiable
Non-modifiable Risk Factors of hypertension
- Age:
- The prevalence of HTN rises with age - the rise is greater in those, who had higher initial BP
- high above 40 years of age - Sex:
During young age ——> there is no difference in BP in both the genders
Middle age——> there is male preponderance
In later life ——> is more among women, may be because of postmenopausal changes
- Genetic factors:
- If both the parents are hypertensives, offsprings have 45% possibility of developing HTN
- If parents are normotensives, the possibility is only 3% - Ethnicity:
- Studies have shown higher BP levels among black people than among whites
Modifiable Risk Factors of hypertension
- Occupation:
involving stress and strain including tension —> predisposes for the development of HTN, as in Doctors : ( Lawyers etc
through sympathetic nervous system and noradrenaline - Socioeconomic status:
- Prevalence of HTN is usually higher among people of higher socioeconomic status
- However, in the fast developing countries, it has been observed to be higher among lower class also, because of the changes in the lifestyle.
- Physical activity:
Physically inactive and those leading a sedentary way of life - Obesity:
- Greater the weight gain, higher the risk of acquiring HTN
- Specially central obesity (increased waste to hip ratio) has been positively correlated with HTN
5. Diet
6. Diseases: Like diabetes mellitus predisposes for HTN
- Lifestyle (Habits):
High alcohol intake raises systolic pressure more than diastolic pressure - Other factors:
Consumption of oral contraceptive pills over a long period of several years constitutes the risk of HTN ? ——> because of estrogen component
What are the “diets” that increase & decrease the risk of HTN ?
Increase risk by :
- High salt intake in the daily diet
- Food rich in saturated fats
- Food rich in fats and sweets —>predispose for obesity which —> predisposes for HTN
Decrease risk by :
- potassium : antagonizes the biological effects of sodium
- cadmium and magnesium
- Consumption of dietary fibers : reduces LDL cholesterol level
Define “Population strategy “
- This is directed at the whole population based on the fact that even a small reduction in the average blood pressure of a population would produce ———> a large reduction in the incidence of HTN and its complications.
This involves ‘health-promotive’ measures
Primary / Primordial Prevention of HTN by the “Population strategy “approach
- On nutrition:
- The dietary changes should be:
- Average consumption of the salt to be reduced to less than 5 g per day per capita (To avoid pickles, salted nuts, etc.).
- Moderate fat intake (avoiding fats of animal origin, except fish as well as coconut oil)
- Prudent diet (rich in fruits and vegetables) to be encouraged
- Consumption of alcohol to be discouraged
- Energy intake to be restricted to body needs
- The DASH diet. (Dietary Approach to Stop Hypertension)
- On weight:
- Weight reduction is done by diet control and promotion of physical activities - On behavioral changes:
- Modification in the personal lifestyle
- reduction in the stress ( meditation)
- Abstain from alcohol and smoking - Health education:
- People are made health conscious about HTN and its consequences - Self-care:
- maintaining a log-book of the BP readings, which will be helpful for follow-up - Recreation: will help to relieve the stress
What is DASH ?
- Recommended as an important step in controlling blood pressure
- This diet is not only rich in important nutrients and fiber but also includes foods that contain two and half times the amounts of :
- electrolytes
- potassium
- calcium
- magnesium
Primary / Primordial Prevention of HTN by the “ High-risk strategy” approach
- Screening of all ‘high-risk’ cases by recording BP for eg.
obese people, individuals above 50 years of age, alcoholics, pregnant mothers, etc - The aim is to prevent the attainment of levels of blood pressure at which treatment has to be started
Secondary Prevention of HTN
- Identification of hypertensive individuals (Early diagnosis)
- Instituting non-pharmocological management of HTN
- Use of appropriate drugs to control the blood pressure
- Regular follow up to ensure control of BP and compliance of management, because the drugs have to be taken lifelong
Tertiary Prevention of HTN
- Disability limitation:
If the patient comes with very high BP,
treatment is given intensively to limit the
development of disability ( to avoid complications) - Rehabilitation:
This is given for those who have become handicapped due to complications of HTN such as :
-hemiplegia (following stroke)
-blindness (due to retinopathy), etc…
