h ypertension and s troke jennifer scott. t oday ’ s a genda hypertension about hypertension...

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