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