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Hypertension and Stroke

Hypertension and Stroke . Jennifer Scott. Today’s Agenda. Hypertension About hypertension Hypertension by the numbers Research Stroke About stroke Stroke by the numbers Research. Hypertension. What is hypertension? How is hypertension categorized?.

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Hypertension and Stroke

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  1. Hypertension and Stroke Jennifer Scott

  2. Today’s Agenda • Hypertension • About hypertension • Hypertension by the numbers • Research • Stroke • About stroke • Stroke by the numbers • Research

  3. Hypertension • What is hypertension? • How is hypertension categorized?

  4. Hypertension causes, risk factors, Symptoms, and Why it is a problem • Causes • Essential hypertension • Secondary hypertension • Risk factors • Symptoms • Why hypertension is a problem

  5. Treating Hypertension • The goal of treatment is to lower the risk of complications • Lifestyle and behavior changes • Medications • Complications

  6. Pulmonary hypertension • Separate from hypertension • Definition • 15,668 deaths, 260,000 hospital visits • Affects men and women of all ages and racial/ethnic groups

  7. Hypertension by the Numbers

  8. Key Numbers • Prevalence = 1 in 3 • 1 in 4 have pre-hypertension • The ‘silent killer’ • 326,000 deaths in 2006 • $76.6 billion

  9. Health Care Use • 46.3 million ambulatory care visits • 790,300 nursing home residents with hypertension (53%) • 25,734 deaths in 2009 • 8.4 deaths per 100,000

  10. Percentage of adults aged 20 years and older who have been told they have high blood pressure, 2007

  11. Hypertension prevalence in U.S. adults

  12. Hypertension Prevalence by Age

  13. Hypertension Prevalence by Race and Ethnicity

  14. Percentage Distribution of BP Categories Among Adults Aged 18 Years and Older by Race/Ethnicity

  15. Hypertension prevalence varies by age and race/ethnicity

  16. Age-adjusted percentage of adults aged 20 years or older with hypertension, by poverty level

  17. Are adults with hypertension aware that they have it?

  18. Awareness Trends

  19. Treating Hypertensives

  20. Treating Hypertension, Trends

  21. What percentage of people treated with antihypertensive medication have their BP controlled

  22. Annual number of hospitalizations among persons with pulmonary hypertension, United States, 1980-2002

  23. Hypertension PrevalenceUnited States vs Virginia

  24. Prevalence in Virginia

  25. Hypertension Incidence Why do you think it is difficult to find hypertension incidence? • Harvard study, 2006 • Framingham study, 1988 • Canadian study, 1997-2004

  26. Hypertension Research

  27. Current challenges facing hypertension research • Identify key determinants • Focus on genetics • Collaboration between multiple fields • Separate the cause and effect relationships

  28. Possible Future Programmatic Activities in Hypertension • Continue genotypic characterizations of hypertension • Develop mathematical modeling and quantitative biological approaches • Establish biological mechanisms for factors known to associate with hypertension • Identify pre-hypertensive phenotypes and biomarkers • Understand global cardiovascular risk factor clustering in hypertension • Develop novel treatment paradigms

  29. Current Hypertension Treatment Guidelines • Current guidelines • Criticisms • Overcomplicated • Insufficiently evidence based • The neglected disease?

  30. Strategic Plan • Shift the balance of priorities from individual-based strategies to population-based strategies • Strengthen collaboration among CDC units • Strengthen CDC’s leadership in monitoring and reducing sodium intake • Improve surveillance and reporting of hypertension • Promote policy and system change approaches • Improve the quality of care • Increase the importance of treating systolic hypertension • Remove economic barriers to effective antihypertensive medications • Provide community-based support for individuals with hypertension through community health workers What do you think of this strategic plan?

  31. Question Considering how long we have known about the dangers of hypertension and the large role that behavior plays in the development of hypertension, how dangerous is the problem of hypertension? How promising is a solution? What can be done to encourage behavior changes? What policies can you suggest?

  32. STROKE

  33. What is a Stroke? • Brain attack • Devastating affects

  34. Types of Stroke • Ischemic stroke • Thrombotic stroke • Embolic stroke • Hemorrhagic stroke • Intracerebral hemorrhage • Subarachnoid hemorrhage • Transient ischemic attack

  35. Diagnosing stroke • Physical exam • Neurological exam • Test reflexes • Imaging tests • Electrical tests • Blood flow tests

  36. Signs/Symptoms, Risk Factors of Stroke, Life after Stroke • 5 most common signs and symptoms • Risk factors • After a stroke

  37. Stroke Treatment • Emergency care • Treatment to prevent another stroke • Rehabilitation

  38. Question: • How much more prevalent is breast cancer than stroke? • How concerned are you about experiencing a stroke in your lifetime? • How many women suffer a stroke each year?

  39. Spotlight:Stroke and Women • Stroke kills twice as many women as breast cancer every year • 40% of women said they were only somewhat or not at all concerned about experiencing a stroke in their lifetime • 425,000 women suffer from stroke each year

  40. Spotlight:Stroke and Women Compared to white women, African American women have more strokes and have a higher risk of disability and death from stroke. Why do you think this is?

  41. Spotlight: Stroke and Women • Unique risk factors • Birth control • Being pregnant • Using Hormone Replacement Therapy • Having a thick waist and high triglyceride level • Being a migraine headache sufferer • Unique symptoms Empower women!

  42. Stroke by the Numbers

  43. The Stroke Burden in America • Every 40 seconds • Every 4 minutes • Incidence = 795,000 per year • A leading cause of serious long-term disability

  44. Prevalence of Stroke in the United States, 2005 • 3rd cause of death • Prevalence increases with age • Geographic differences • Connecticut = 1.5% • Mississippi = 4.3% • Prevalence by ethnicity/race

  45. Prevalence of Stroke in the United States ~ Morbidity and Mortality • 6.2 million Americans have had a stroke (2.7% of the total non-institutionalized adult pop) • Average length of stay in hospital = 5.3 days • 42.0 deaths per 100,000 population

  46. After Stroke, United States, 2005-2006 Of the 700,000 persons in the United States who have a new or recurrent stroke each year, 15-30% become permanently disabled, and 20% require institutionalization during the first 3 months after the stroke.

  47. Stroke Statistics- United States • Stroke Death Rates, United States, Total Population Ages 35+, 2000-2006

  48. Virginia Prevalence Data • Told you had a stroke (response=yes)

  49. Stroke statistics- VirginiaTotal Population • Virginia Stroke Death Rates, Total Population Ages 35+, 2000-2006

  50. Stroke Statistics- VirginiaBy Race • Virginia Stroke Death Rates, Whites, Ages 35+ 2000-2006 • Virginia Stroke Death Rates, Blacks, Ages 35+ 2000-2006

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