220_WHO_guidance_and_specifics_on_blood_pressure_devices.pptx
- 1. Measurement of Blood Pressure: Issues and Challenges Sadhana Bhagwat, NPO WCO India 13 December 2018 1
- 2. Silent killer Most hypertensive people have no symptoms 2
- 3. 0 50 000 100 000 150 000 200 000 250 000 300 000 350 000 China India UK USA Prevalance Awareness Treatment 33% 74% 85% 25% 62% 94% 33% 50% 50% 44.7% 44.7% 67% Hypertension Prevalence, Awareness, Treatment Millions 78m 12m 230m 300m China: Age 35-75. Liu J, Lancet. 2017 Dec 9;390(10112):2549-2558
- 4. Most with Hypertension in India Are Not Aware and Hence Not treated Roy A et al. BMJ Open. 2017;7:e015639. Data for Delhi National Capital Region weighted and applied nationally. 0% 20% 40% 60% 80% 100% Have high blood pressure Aware Treated Controlled <11% 218M 74M 60M 24M Barely 1 in 10 of the 218 million adults with hypertension in India have it under control
- 5. WHO Guidance on Hypertension Advocacy Surveillance Capacity Monitoring Diagnosis Assess CVD risk Innovations Essential Medicines and Technology Treatment Protocol Data System Best buys, Global action plan CVD, risk factors -STEP survey -WHS plus FDC, Blood Pressure Device, Self care Risk stratification Technical package -Screen
- 6. Diagnosis • Confirmation of hypertension: – after two visits ideally 1 to 4 weeks apart • Systolic blood pressure on both days is ≥140 mmHg and/or Diastolic blood pressure on both days is ≥90 mmHg • Patients with SBP ≥160 mmHg or DBP ≥100 mmHg may be indicated for immediate treatment based on one assessment 6
- 7. Essential technology (device and lab) Blood pressure measurement device, Stethoscope Weighing scales Measuring tapes Urine albumin strips Urine ketones test strips Glucometer, blood glucose test strips Blood cholesterol, electrolyte, creatinine, ECG Challenges at PHC at low resource settings -Affordable technology blood pressure measuring devices for low resource settings, WHO 2005
- 8. 8 Prolonged Treatment Diagnosis and treatment of hypertension Detection Diagnosis confirmation
- 9. Challenges in Diagnosis 9 Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement Diagnosis confirmation
- 10. 10 Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement
- 11. • Raise the pressure to 30mm above pulse palpation • Lower at 2mm/sec (faster rate: lower SBP and higher DBP) • Terminal digit preference: rounding off to the zero: over estimation Common errors…. *Office blood pressure measurement practices among community health providers (medical and paramedical) in northern district of India; Bishav Mohan a,*, Naved Aslam a, Upma Ralhan b, Sarit Sharma et al, India Heart Journal 6 6 ( 2 0 1 4 ) 4 0 1 -4 0 7
- 12. 12 Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement
- 13. • The best equipment???? • Calibration interval Common errors….*
- 14. 14 Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement
- 15. • Supporting the arm: lower SBP/DBP by 11 and 12mm as compared to unsupported arm • Right cuff sizes: if small (obese people) SBP can rise by 8mm • Resting the patient: food, cold weather, stress, activity, coffee, tobacco • Auscultation: 1st appearance of sound: systolic • Complete disappearance of sound: diastolic Common errors….
- 16. Common errors…. • Minimum two readings • Sitting is better than supine: 3mm SBP raised and 3mm DBP lowered in supine • Centre of the bladder: Heart level: Increases if above, decreases if below that 16
- 17. 17 WHO Guidance
- 18. Objectives of the workshop • Present the available guidelines and preliminary progress on guidance updating • Solicit practical country-level inputs from representatives on the most suitable devices for different levels of health care • Purchasing and maintaining blood pressure devices at different levels of health care provision 18
- 19. 19
Editor's Notes
- #5: Despite the heavy burden of illness and death from hypertension, many countries have been slow to respond. Just over half with HTN know they have it and just 1 in 7 globally have it under control. These proportions are significantly higher in LMICs. Yet HTN is probably the easiest to treat and effective treatment is available and can be relatively inexpensive.
- #6: Invest 1 USD on drug therapy and counselling to high CVD risk, return 3.29 USD
- #7: High blood pressure, according to the WHO-ISH guidelines, includes both hypertension (defined as 140/90 mmHg or above) and ``high normal'' (between 130/85 mmHg and 140/90 mmHg). The WHO-ISH guidelines class optimal blood pressure as less than 120/80 mmHg, 105/60
- #8: BP> From Mercury, to Aneroid, to Electronic. Cost of essential technology, point of care, validation