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PRESYON 2 Report of the Council on Hypertension

PHA Annual Convention May 16-18, 2007. PRESYON 2 Report of the Council on Hypertension. Main Authors: Sison Jorge MD, Arceo Lea MD

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PRESYON 2 Report of the Council on Hypertension

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  1. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Main Authors: Sison Jorge MD, Arceo Lea MD Co-Authors: Trinidad Emma MD (Chair), Bautista J Antonio MD, Buan Vicente MD, Chua Philip MD, Lapitan Raul MD, Neri Rey MD, Punzalan Antonio MD, Tan May MD, Torres Dennis MD, Yape Irma Marie MD,

  2. PHA Annual Convention May 16-18, 2007 • Background • Prevalence of HPN in the Philippines has increased from 1992 -2003 (Council on Hypertension & National Nutrition and Health Surveys). • Awareness, treatment, compliance and BP control rates have been low. • 58% have TOD (PHYTON 1996) (COH) • Stroke had high correlation with uncontrolled HPN, microvasculopathy, risk factors and poor compliance (PHYTON 3, 1999) (COH) • HPN-related stroke was the most common cause of mortality among hospital-based population. Majority had uncontrolled BP and poor compliance (PHYTON 4, 2003) (COH) PRESYON 2Report of the Council on Hypertension Dans A et al. Philippine Journal of Internal Medicine May-June 2005 Sison J et al. Phil. Journal of Cardiology, Vol.33, No.4, Oct-Dec 2005 Atabug J et al. Phil J of Cardiol July-Sept. 1999 Sison J et al. Phil Journal of Cardiology 1998 Sison J et al, Philippine Journal of Cardiology, April-June 1996

  3. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension • Rationale for PRESYON update • Because of these progressive rise in HPN prevalence and its complications, the COH saw the need for an updated and a more in-depth study of the HPN problem. • Population with wider age range (adolescent age and up) • The COH added more data survey (arm circumference, waist and hip circumferences, BMI, TOD parameters for stroke, IHD, nephropathy, PVD and retinopathy. Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  4. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Objectives Primary: To determine the prevalence of hypertension in the Philippines Secondary: To determine the prevalence of hypertension by age group To assess awareness, treatment profile and control rate To determine the prevalence of target organ damage Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  5. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension • Materials and Method • Prospective, multi-staged, stratified, nationwide survey on hypertension. • Field researchers recruited and trained by an independent professional survey group and re-trained by the COH members equipped with survey forms (general data, lifestyle, perceptions) conducted the survey which involved 2 phases Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  6. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension • 2 Phases of Survey • Phase 1 (Hypertension prevalence phase): • nationwide BP screening • randomized selection of base population • 300 subjects per region (13 regions) • total target population = 3,900 • Phase 2 (Target organ survey phase): • additional BP screening in same areas surveyed to identify and include the first 30 known hypertensive subjects to boost the hypertensive population in Phase I • for assessment of target organ damage. Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  7. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension • Inclusion Criteria • Subjects aged 12 years old and above, of either sex, regardless of socio-economic status and health condition • Only one respondent will be chosen per sample household • In case >1 household member qualifies, the statistical selection key “Kish Grid” method will be implemented to choose only one respondent Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  8. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension “Kish Grid” Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  9. PHA Annual Convention May 16-18, 2007 “Kish Grid” PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  10. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Generation of samples: Multi-stage and stratified method as follows: Stage 1: Selection of sample province Stage 2: Selection of sample cities/ towns in each sample province Stage 3: Selection of sample barangays in each sample city Stage 4: Selection of sample households in each sample barangays Stage 5: Selection of one respondent from each sample household Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  11. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Classification of adult BP (JNC 7) Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  12. PHA Annual Convention May 16-18, 2007 Definitions to be determined in the data analysis: Awareness- Subject’s knowledge and recognition that he is hypertensive based on history, consultationand follow-up check-ups, intake of anti-HPN medications. Unawareness- Denial of any of the parameters of awareness but whose average BP on two separate occasions is >140 mmHg SBP and/ or >90 mmHg DBP. Treatment profile-intake or discontinuation of anti-HPN medications, compliance, untreated despite confirmation of HPN, traditional or alternative medicines or non-pharmacologic treatment. Control rate-ability of maintenance medication(s) to control BP (<140/90) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  13. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension • Body measurements: • (metric system) • Height • Weight • Left arm circumference • Waist circumference • Hip circumference • Body mass index Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  14. PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Assessment and definition of target organ damage: Heart– Angina questionnaires. ECG referral to MDs affiliated with PRESYON study group (Cardiac damage: LVH, ischemia, infarct, arrhythmia, heart blocks) Brain– Stroke / TIA questionnaires . Presence of residual neurologic deficit. Kidney- History. Microproteinuria (Micral test) Eyes- Referral to affiliated ophthalmologist for fundoscopy with official referral form Peripheral Vascular System – Claudication questionnaires Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  15. PHA Annual Convention May 16-18, 2007 Results: Adult population (>18 yrs )surveyed =3,415 Age distribution (mean age:40.76 yrs) (M: 49, F: 51) PRESYON 2Report of the Council on Hypertension *Total pop: 3901; 18 y/o= 93 Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007

  16. PHA Annual Convention May 16-18, 2007 Results: Young population (<18 yrs )surveyed = 579 Age distribution (mean age: 15.14 yrs) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 16-18, 2007 *Total pop: 3901; 18 y/o= 93

  17. % PHA Annual Convention May 16-18, 2007 Results: Prevalence of Hypertension in Adults (>18 yrs)* - 21% (M: 50%, F: 50%) PRESYON 2Report of the Council on Hypertension * 717 / 3415 Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May , 07

  18. PHA Annual Convention May 16-18, 2007 Results: Prevalence of Hypertension in the Young (<18 yrs) - 1%(6 / 579) (M: 50%, F: 50%) PRESYON 2Report of the Council on Hypertension * Total= 6 / 579; F= 3/253; M= 3/326 MMLa= 3, Ilocos= 1, So.Min.= 1, Cen. Min.= 1

  19. PHA Annual Convention May 16-18, 2007 Prevalence of Hypertension in Adults (>18 yrs) Rural vs. Urban / Socio-economic Class PRESYON 2Report of the Council on Hypertension % Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  20. 52 10 29 3 22 42 5 26 17 3 5 PHA Annual Convention May 16-18, 2007 Prevalence of Hypertension in Adults (>18 yrs) by Civil Status PRESYON 2Report of the Council on Hypertension % 8 Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  21. 54 50.5 36 29.4 26.4 11.4 PHA Annual Convention May 16-18, 2007 Prevalence of Hypertension in Adults (>18 yrs) - By Age Group - PRESYON 2Report of the Council on Hypertension % Age (yrs) Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  22. 74 65 44 55 55 52 53 48 45 47 45 26 PHA Annual Convention May 16-18, 2007 Prevalence of Hypertension in Adults (>18 yrs) - Age vs. Gender- PRESYON 2Report of the Council on Hypertension % Age (yrs) Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  23. % 59 30 3 8 Socio-Economic Class PHA Annual Convention May 16-18, 2007 On Anti-Hypertensive Medications* Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension 35% 65% • 469 / 717 • 469 / 3415= 18% treated / total population Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  24. % 34% 66% 15 14 4 1 On Medications Non-Compliant PHA Annual Convention May 16-18, 2007 Treatment Compliance*Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension • 310 / 469 • 310 / 717= 43% compliance (+ medications) Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  25. 20% 13% 80% 87% On medications* All hypertensives + meds** PHA Annual Convention May 16-18, 2007 BP Control Rate*Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension * 94 / 469= 20% ** 94 / 717= 13% Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  26. % Control Rate 81 78 22 19 PHA Annual Convention May 16-18, 2007 Compliance vs. BP Control*Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  27. % 41 34 15 8 4 4 Class of Anti-hypertensive Drug PHA Annual Convention May 16-18, 2007 Types of Anti-Hypertensive Medications Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  28. 41 87 Compliance Rate (%) 80 70 57 8 Class of Anti-hypertensive Drug PHA Annual Convention May 16-18, 2007 Compliance with Medications Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  29. PHA Annual Convention May 16-18, 2007 Types of Drug Combination Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension % 75 4 21 Drug Combination Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  30. PHA Annual Convention May 16-18, 2007 Drug Combinationvs. BP Control Adults (>18 yrs) PRESYON 2Report of the Council on Hypertension BP Control Rate (%) 18 30 10 Drug Combination Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  31. Adult (>18 yrs) Young (<18 yrs) Total Total Male Male Female Female Mean left arm circumference (cm) Mean left arm circumference (cm) 28.2 24.39 28.95 24.84 27.48 23.79 PHA Annual Convention May 16-18, 2007 Mean Left Arm Circumference (Total Population) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  32. Adult (>18 yrs) Young (<18 yrs) Normal Normal Hypertensive Hypertensive Mean left arm circumference (cm) Mean left arm circumference (cm) 27.92 24.36 29.23 27.56 PHA Annual Convention May 16-18, 2007 Mean Left Arm Circumference PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  33. PHA Annual Convention May 16-18, 2007 Mean Waist Circumference (Total population) PRESYON 2Report of the Council on Hypertension Adult (>18 yrs)* Young (<18 yrs)* Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  34. Adult (>18 yrs) Young (<18 yrs) Normal Normal Hypertensive Hypertensive Mean waist circumference (cm) Mean waist circumference (cm) 80.54 70.21 87.57 75.30 PHA Annual Convention May 16-18, 2007 Mean Waist Circumference PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  35. Male 17% Incidence of Central Obesity* (Hypertensive population, >18 yrs )= 21.6% 83% Male 21% 79% Female Female PHA Annual Convention May 16-18, 2007 Incidence of Central Obesity* (General adult population, >18 yrs )=11.62% PRESYON 2Report of the Council on Hypertension * >101.6 cm (M); >90 cm (F) waist circumference; (397 / 3415)

  36. PHA Annual Convention May 16-18, 2007 Incidence of Central Obesity, Adults (>18 yrs) By Regions PRESYON 2Report of the Council on Hypertension % Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  37. PHA Annual Convention May 16-18, 2007 Incidence of Central Obesity, Adult Males (>18 yrs) By Regions PRESYON 2Report of the Council on Hypertension % Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  38. PHA Annual Convention May 16-18, 2007 Incidence of Central Obesity, Adult Females (>18 yrs) By Regions PRESYON 2Report of the Council on Hypertension % Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07

  39. n % 4 3 4 2 2 1 1 Age PHA Annual Convention May 16-18, 2007 Central Obesity (Young , <18 yrs.)*=2.2% PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07 * 13/ 580; 3/ 327 (m); 10/ 253 (f)

  40. PHA Annual Convention May 16-18, 2007 MeanBody Mass Index (Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  41. PHA Annual Convention May 16-18, 2007 BMI vs. Socio-Economic Class (Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  42. PHA Annual Convention May 16-18, 2007 BMI Distribution (General Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension BMI 5% 27% 57% 43% Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  43. % 59 54 46 41 28 25 7 4 PHA Annual Convention May 16-18, 2007 BMI vs. Gender (General Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  44. % PHA Annual Convention May 16-18, 2007 BMI 23-24 among regions (General Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension * * 48 48 Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  45. % * 36 PHA Annual Convention May 16-18, 2007 BMI 25-29 among regions (General Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  46. % 10 PHA Annual Convention May 16-18, 2007 BMI >30 among regions (General Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  47. PHA Annual Convention May 16-18, 2007 BMI >30 vs. Gender (Adult Population, >18 yrs.) PRESYON 2Report of the Council on Hypertension % 48 52 62 38 36 64 59 41 35 23 42 24 5 5 4 12 Female Male Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07

  48. 8% 88% -Don’t know - DM + DM 49% 51% Male Female PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Incidence of Diabetes among Adult Population, >18 yrs.)* + DM 4% * No young diabetics Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07 * 0 Angina among non-hypertensives

  49. 77% +DM - DM 49% 58% Male Female PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Incidence of Diabetes among Adult Hypertensives, >18 yrs.) + DM + Don’t know 12% 11% Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07 * 0 Angina among non-hypertensives

  50. 27% 73% +Smoker +Smoker - Smoker 47% 8% PHA Annual Convention May 16-18, 2007 PRESYON 2Report of the Council on Hypertension Incidence of Smoking among Adult Population, >18 yrs.) Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07 * 0 Angina among non-hypertensives

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