Hypertension: A Cardiac Chronic Condition

Today we'll be looking at a

cardiovascular condition called

hypertension.

Hypertension is a chronic condition

characterized by elevated blood

pressure. It is often also called a

silent condition because many

individuals experience no noticeable

symptoms until serious complications

develop. And over time uncontrolled

hypertension damages blood vessels and

significantly increases the risk of

heart disease and stroke. And in Canada,

hypertension remains one of the most

common chronic diseases affecting adults

and contributes substantially to

cardiovascular morbidity and mortality.

Through this presentation, we hope you

learned more about the background in

epidemiology, clinical features, and the

complexity aspect of hypertension.

Finally, we'll also be going through a

rehabilitation strategy/program

for hypertension.

How is hypertension consistent with the

definition of chronic disease? Chronic

disease is ultimately defined as

longasting,

rarely curable, so it can be controlled

or managed and progresses with severity.

Likewise, hypertension is long in

duration such that once it's diagnosed,

it usually lasts for years and often for

life and does not resolve on its own,

usually requiring regular monitoring. It

also slowly progresses. If it's left

untreated or is poorly controlled,

hypertension can slowly worsen over

time, which increases the risks of

complications such as heart disease and

stroke. Hypertension is also normally

not considered curable. It's instead

controllable. This can be done through

lifestyle changes such as improved diet,

lower sodium intake, regular physical

activity, and medication when it's

necessary.

But it's important to note that stopping

medication typically results in blood

pressure rising again. So as

hypertension is long-asting, progressive

and managed rather than cured, it

clearly fits within the definition of

chronic disease.

For descriptive epidemiology, I will be

discussing the prevalence, incidence,

and demographic patterns of hypertension

in Canada. Prevalence of hypertension in

Canadian adults is assessed using the

Canadian health measure survey from 2007

to 2019. and this classified 23% of the

population to be hypertensive which is

around a quarter of the population

during the time of the study. When

looking at the incidence of

hypertension, a study from 2012 which

looked at the population of Canadian

adults in 2007 to 2008 found that there

was around 2.4 new diagnosis per 100

adults per year for hypertension.

According to Statistics Canada, some

demographic patterns include patterns in

age, sex, and body weight. In age, we

can see that the presence of

hypertension increased with age as only

22% of the population aged 40 to 59 has

stage 2 hypertension or were receiving

treatment for it. But individuals aged

60 to 79, 51% of the population had

hypertension or were receiving

treatment. When looking at the sex, it

can be noted that 25.1% of males had

hypertension and 20.9% of females in the

same age group had hypertension.

Although it's pretty close, males can be

seen to be more likely to be affected by

it. For body weight, 31% of the

population that was obese or overweight

had hypertension. Whereas in the

population with normal weight, only 11%

were affected by hypertension.

Continuing with the descriptive

epidemiology, now we'll be looking at

some risk factors and trends. So in

Canada, hypertension is influenced by

both non-modifiable and modifiable risk

factors. age, genetics, and biological

sex increase susceptibility. However,

modifiable risk factors like obesity,

physical inactivity, high sodium intake,

alcohol consumption, and smoking play a

major role in disease development.

Looking at the trends, national data

show that approximately 1 in four

Canadian adults is affected by

hypertension with prevalence rising more

so among older adults. These patterns

also reflect both aging demographics and

ongoing lifestyle related risk factors

highlighting the importance of

prevention strategies.

Now looking at the public health impact,

hypertension is one of the leading risk

factors for cardiovascular disease in

Canada and contributes significantly to

hospitalizations and long-term

complications. It places a substantial

burden on the health care system due to

treatment costs and chronic disease

management. And most importantly,

because many contributing factors are

modifiable, hypertension is largely

preventable through early detection,

lifestyle modification, and population

level health promotion initiatives.

A complex disease is a disease that has

multiple causes, involves many body

systems, varies per person, is

influenced by genetics, environment, and

lifestyle, and also needs long-term

management. Hypertension fits the

definition of a complex disease for the

following reasons. Firstly, it can be

caused by genetics, environment, and

lifestyle. Genetics account for around

30 to 50% of blood pressure variation.

While stress, high salt intake,

sedentary behavior, and alcohol can also

contribute. Some cases have secondary

causes like kidney disease can cause

hypertension.

It also varies between people with older

adults in certain ethnic groups such as

black, African, Caribbean populations

more affected by having an increased

risk of hypertension. Hypertension also

impacts various body systems. the heart,

the blood vessels, the kidneys, and the

eyes. Because it's often asymptomatic,

it needs long-term management, both

medications and lifestyle changes and

monitoring to reduce health risks.

The clinical features of hypertension.

Hypertension is often called the silent

killer because most people don't have

any symptoms in earlier stages. When

symptoms do appear, they are usually

mild and common ones include headaches,

especially at the back of the head in

the morning, dizziness, palpitations, or

a fast heartbeat, fatigue, and blurred

vision. During a physical exam, doctors

may even notice high consistent blood

pressure readings. In chronic cases,

there can be changes in the retina,

enlargement of one's left heart

ventricle, or an extra heart sound

called S4.

Now moving on to a brief overview of

pathophysiology.

The causes of hypertension are complex

and usually involve multiple factors

acting together. One key mechanism is

increased resistance in blood vessels

which makes it harder for blood to flow

through them. The renin angotensin

aldoststerone system or the RA can also

ra raise blood pressure by increasing

sodium and water retention which

increases blood volume. The sympathetic

nervous system can contribute by

increasing heart rate and tightening

blood vessels. And finally, the

endothelial dysfunction reduces the

ability of blood vessels to relax,

further raising the pressure. All these

mechanisms together lead to persistent

high blood pressure, which over time can

damage the heart, kidneys, brain, and

eyes. Understanding these features is

important for early detection and

prevention of complications.

Now moving on to signs and symptoms.

Hypertension often starts quietly and

most people don't notice any symptoms.

Many patients only find out during a

routine checkup when their blood

pressure is measured by a doctor. When

symptoms do appear in the earlier

stages, they are usually mild and these