h ypertension and s troke jennifer scott. t oday ’ s a genda hypertension about hypertension...
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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?
HYPERTENSION CAUSES, RISK FACTORS, SYMPTOMS, AND WHY IT IS A PROBLEM
Causes Essential hypertension Secondary hypertension
Risk factors Symptoms Why hypertension is a problem
TREATING HYPERTENSION
The goal of treatment is to lower the risk of complications Lifestyle and behavior changes Medications Complications
PULMONARY HYPERTENSION
Separate from hypertension Definition 15,668 deaths, 260,000 hospital visits Affects men and women of all ages and
racial/ethnic groups
HYPERTENSION BY THE NUMBERS
KEY NUMBERS
Prevalence = 1 in 3 1 in 4 have pre-hypertension The ‘silent killer’ 326,000 deaths in 2006 $76.6 billion
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
PERCENTAGE OF ADULTS AGED 20 YEARS AND OLDER WHO HAVE BEEN TOLD THEY HAVE HIGH BLOOD PRESSURE, 2007
HYPERTENSION PREVALENCE IN U.S. ADULTS
HYPERTENSION PREVALENCE BY AGE
Age Men (%) Women (%)
20-34 9.2 2.2
35-44 21.1 12.6
45-54 36.2 36.2
55-64 50.2 54.4
65-74 64.1 70.8
75 and older 65.0 80.2
All 31.8 30.3
HYPERTENSION PREVALENCE BY RACE AND ETHNICITY
Race of Ethnic Group
Men (%) Women (%)
African Americans 42.2 44.1
Mexican Americans 24.8 28.6
Whites 31.2 28.3
All 31.8 30.3
PERCENTAGE DISTRIBUTION OF BP CATEGORIES AMONG ADULTS AGED 18 YEARS AND OLDER BY RACE/ETHNICITY
HYPERTENSION PREVALENCE VARIES BY AGE AND RACE/ETHNICITY
AGE-ADJUSTED PERCENTAGE OF ADULTS AGED 20 YEARS OR OLDER WITH HYPERTENSION, BY POVERTY LEVEL
ARE ADULTS WITH HYPERTENSION AWARE THAT THEY HAVE IT?
AWARENESS TRENDS
TREATING HYPERTENSIVES
TREATING HYPERTENSION, TRENDS
WHAT PERCENTAGE OF PEOPLE TREATED WITH ANTIHYPERTENSIVE MEDICATION HAVE THEIR BP CONTROLLED
ANNUAL NUMBER OF HOSPITALIZATIONS AMONG PERSONS WITH PULMONARY HYPERTENSION, UNITED STATES, 1980-2002
HYPERTENSION PREVALENCEUNITED STATES VS VIRGINIA
State Yes No
Nationwide, 2007 27.8 72.5
Nationwide, 2009 28.7 71.3
Virginia, 2007 27.1 72.9
Virginia, 2009 27.5 72.5
PREVALENCE IN VIRGINIA
HYPERTENSION INCIDENCE
Why do you think it is difficult to find hypertension incidence?
Harvard study, 2006 Framingham study, 1988 Canadian study, 1997-2004
HYPERTENSION RESEARCH
CURRENT CHALLENGES FACING HYPERTENSION RESEARCH
Identify key determinants Focus on genetics Collaboration between multiple fields Separate the cause and effect relationships
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
CURRENT HYPERTENSION TREATMENT GUIDELINES
Current guidelines Criticisms
Overcomplicated Insufficiently evidence based
The neglected disease?
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?
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?
STROKE
WHAT IS A STROKE?
Brain attack Devastating affects
TYPES OF STROKE
Ischemic stroke Thrombotic stroke Embolic stroke
Hemorrhagic stroke Intracerebral hemorrhage Subarachnoid hemorrhage
Transient ischemic attack
DIAGNOSING STROKE
Physical exam Neurological exam Test reflexes Imaging tests Electrical tests Blood flow tests
SIGNS/SYMPTOMS, RISK FACTORS OF STROKE, LIFE AFTER STROKE
5 most common signs and symptoms Risk factors After a stroke
STROKE TREATMENT
Emergency care Treatment to prevent another stroke Rehabilitation
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?
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
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?
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!
STROKE BY THE NUMBERS
THE STROKE BURDEN IN AMERICA
Every 40 seconds Every 4 minutes Incidence = 795,000 per year A leading cause of serious long-term
disability
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
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
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.
STROKE STATISTICS- UNITED STATES
Stroke Death Rates, United States, Total Population Ages 35+, 2000-2006
VIRGINIA PREVALENCE DATA
Told you had a stroke (response=yes)
STROKE STATISTICS- VIRGINIATOTAL POPULATION
Virginia Stroke Death Rates, Total Population Ages 35+, 2000-2006
STROKE STATISTICS- VIRGINIABY RACE
Virginia Stroke Death Rates, Whites, Ages 35+ 2000-2006
Virginia Stroke Death Rates, Blacks, Ages 35+ 2000-2006
STROKE STATISTICS- VIRGINIASTROKE HOSPITALIZATION RATES
Total population, ages 65+, Medicare beneficiaries, 2000-2006
STROKE STATISTICS- VIRGINIAAVERAGE TOTAL CHARGE
Total population, ages 65+, Medicare beneficiaries, 2006
STROKE STATISTICS
National Health Interview Survey Household, multistage probability sample survey Conducted annually Trained interviewers Data collected on 27,157 adults in 2010
THE FINANCIAL COST OF STROKE
$53.9 billion
RESEARCH
CDC ADDRESSES STROKE
National Heart Disease and Stroke Prevention WiseWoman Stroke registries Public health action plan to prevent heart
disease and stroke Healthy People 2020
MAJOR RESEARCH
National Institute of Neurological Disorders and Stroke (NINDS) From biological mechanisms to clinical trials Currently, researchers are studying:
Mechanisms of stroke risk factors Process of brain damage that results from stroke Genetics of stroke and stroke risk factors, esp gene
therapy Animal research- genetics on zebrafish to rehab on
primates Hibernation is an interesting topic Brain plasticity and neuronal rewiring Use of transcranial magnetic stimulation (TMS) in
stroke rehabilitation
NINDS ONGOING CLINICAL TRIALS
Neuroprotective benefits of albumin Field administration of stroke therapy
magnesium (tPA) trial- multicenter, randomized, double-blind trial
Insulin resistance after stroke Locomotor experience applied post stroke, to
improve walking after stroke
STROKE RESOURCES AND MATERIALS
CDC National Stroke Association American Stroke Association, a division of the
American Heart Association Brain Aneurysm Foundation National Aphasia Association Hazel K. Goddess Fund for Stroke Research in
Women
STROKE PREVENTION
Live a healthy lifestyle!
Eat a healthy diet Maintain a healthy weight Be active Don’t smoke Limit alcohol use Have your cholesterol checked Monitor your BP Manage your diabetes Take your medicine Talk with you health care provider
QUESTIONS, COMMENTS