PRESYON 2 Report of the Council on Hypertension Main Authors: Sison Jorge MD, Arceo Lea MD Co-Authors: Trinidad Emma MD (Chair), Bautista J Antonio MD,

PRESYON 2Report of the Council on Hypertension

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,

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,

PHA Annual Convention May 16-18, 2007

PRESYON 2Report of the Council on Hypertension PRESYON 2Report of the Council on Hypertension

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)

Dans A et al. Philippine Journal of Internal Medicine May-June 2005Sison J et al. Phil. Journal of Cardiology, Vol.33, No.4, Oct-Dec 2005Atabug J et al. Phil J of Cardiol July-Sept. 1999Sison J et al. Phil Journal of Cardiology 1998Sison J et al, Philippine Journal of Cardiology, April-June 1996



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



ObjectivesPrimary: 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





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





2 Phases of SurveyPhase 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.





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




PRESYON 2Report of the Council on Hypertension PRESYON 2Report of the Council on Hypertension PHA Annual Convention

May 16-18, 2007

List in the KISH Grid all the names of family members who are 12 years old and above. Arrange the list from oldest down to the youngest. Draw a horizontal line from the youngest person in the list up to the assigned column for this interview, i.e., the column whose top-most number is encircled. Then, draw a vertical line on the assigned column starting from the top of the column down to the horizontal line drawn earlier. The number found at the intersection of the horizontal and vertical lines tells you that the family member who bears this number in the list should be the probability respondent.

“Kish Grid”




May 16-18, 2007

“Kish Grid”No. Qualified members Sex Age Household Number

1 2 3 4 5 6 7 8 9 10

1 Member A M 64 1 1 1 1 1 1 1 1 1 1

2 Member B F 62 1 2 1 1 2 2 1 1 2 2

3 Member C M 38 3 3 2 2 1 3 2 3 1 1

4 Member D F 36 4 1 3 4 3 1 2 2 1 2

5 Member E F 30 1 1 5 3 2 2 4 5 4 1

6 Member F M 27 6 4 1 5 4 1 2 6 3 5

7 5 2 3 1 7 7 3 2 6 4

8 2 5 4 1 6 3 5 4 8 7

9 3 4 6 7 5 8 1 9 2 6

10 7 8 3 2 4 1 6 10 5 9




Generation of samples:Multi-stage and stratified method as follows:

Stage 1: Selection of sample provinceStage 2: Selection of sample cities/ towns in each

sample provinceStage 3: Selection of sample barangays in each

sample cityStage 4: Selection of sample households in each

sample barangaysStage 5: Selection of one respondent from each

sample household





Classification of adult BP (JNC 7)

Systolic Diastolic

NormalPre-hypertensionHypertension Stage 1 Stage 2

< 120120 – 139140 – 159

> 160

andororor

<8080 – 8990 – 99 > 100





Definitions to be determined in the data analysis:Awareness- Subject’s knowledge and recognition that he is hypertensive based on history, consultation and 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)





Body measurements: (metric system)•Height•Weight•Left arm circumference•Waist circumference•Hip circumference•Body mass index





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





18-29 28%

30-39 25%

40-49 20%

50-59 13%

60-69 9%

70 & Up 5%

Results: Adult population (>18 yrs )surveyed =3,415Age distribution (mean age: 40.76 yrs) (M: 49, F: 51)

*Total pop: 3901; 18 y/o= 93





Results: Young population (<18 yrs )surveyed = 579 Age distribution (mean age: 15.14 yrs)

12 years12%

13 years15%

14 years15%

15 years11%

16 years15%

17 years16%

18 years16%

*Total pop: 3901; 18 y/o= 93





Results: Prevalence of Hypertension in Adults (>18 yrs)*

- 21% (M: 50%, F: 50%)

16

27

12

21

17

23

18

6

14 15

7

16

12

8

5

6

5

1

4

3

5

3

7 6

5

4

49

0

5

10

15

20

25

30

35

Total Phils. MetroManila

Ilo CVal CLuzon STag Bicol WVis CVis EVis WMin NMin SMin CMin

Aware Not Aware

Sample 3415 191163257281198521340152221439 199 260 192

21

1616

20

12

2122

9

23

26

2222

17

33

%

* 717 / 3415


Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May , 07Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May , 07


Results: Prevalence of Hypertension in the Young (<18 yrs)

- 1% (6 / 579) (M: 50%, F: 50%)

* Total= 6 / 579; F= 3/253; M= 3/326 MMLa= 3, Ilocos= 1, So.Min.= 1, Cen. Min.= 1

Age (yrs)Age (yrs) SexSex Aware?Aware? Treated?Treated?

1212 FF NoNo NoNo

1515 MM YesYes YesYes

1717 MM YesYes NoNo

1717 FF NoNo NoNo

1717 FF YesYes NoNo

1818 MM NoNo NoNo



Prevalence of Hypertension in Adults (>18 yrs)Rural vs. Urban / Socio-economic Class

1619

13 13

25

16

11

5

5

5

10

5

4

5

0

5

10

15

20

25

30

35

Total Phils. Urban/Rural Urban Rural SEC AB/C+ Broad C D E

Aware Not Aware

Sample 3415 68221585116416981717

21

16

21

29

22

18

24

%


Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07


Prevalence of Hypertension in Adults (>18 yrs) by Civil Status

0

10

20

30

40

50

60

Single Married Separated Widow(er)

Unaware

Aware

3

5

8

22

5

17

293

26

52

10

42

%




Prevalence of Hypertension in Adults (>18 yrs) - By Age Group -

%

0

10

20

30

40

50

60

18-29 30-39 40-49 50-59 60-69 70 &above

Total

29.4

11.4

26.4

36

50.554

Age (yrs)




Prevalence of Hypertension in Adults (>18 yrs) - Age vs. Gender-

%

0

10

20

30

40

50

60

70

80

18-29 30-39 40-49 50-59 60-69 70 &above

Male

Female

74

26

55

45

5248

4753

45

55 44

65

Age (yrs)




On Anti-Hypertensive Medications* Adults (>18 yrs)

MedsNo Meds

35%65%

0

10

20

30

40

50

60

AB/Upper C Broad C D E

%

Socio-Economic Class

3

30

59

8

• 469 / 717

• 469 / 3415= 18% treated / total population


Sison J MD, Arceo L MD, Trinidad E. MD et al, PHA Annual Convention, May 07



0

2

4

6

8

10

12

14

16

Mostly Sometime Rarely Never

%

Non-Compliant

15

14

4 1

• 310 / 469• 310 / 717= 43% compliance (+ medications)

CompliantNon-Compliant

34%66%

On Medications

Treatment Compliance* Adults (>18 yrs)





ControlledUncontrolled

20%

80%

On medications*

ControlledUncontrolled

13%

87%

All hypertensives + meds**

* 94 / 469= 20%

** 94 / 717= 13%

BP Control Rate* Adults (>18 yrs)





0

10

20

30

40

50

60

70

80

90

Compliant Non-Compliant

Controlled BP

Uncontrolled

%

Contr

ol R

ate

19

81

22

78

Compliance vs. BP Control* Adults (>18 yrs)




Types of Anti-Hypertensive Medications Adults (>18 yrs)

0

5

10

15

20

25

30

35

40

45

Beta-Blocker

CCB ACEI ARB Central Others

41

34

15

84 4

Class of Anti-hypertensive Drug

%




Compliance with Medications Adults (>18 yrs)

0

10

20

30

40

50

60

70

80

90

Beta-Blocker CCB ACEI ARB

41

5770

8

8087

Class of Anti-hypertensive Drug

Com

plia

nce

Rate

(%

)




Types of Drug Combination Adults (>18 yrs)

0

10

20

30

40

50

60

70

80

Single Double Triple

75

21 4

Drug Combination

%




Drug Combination vs. BP ControlAdults (>18 yrs)

0

5

10

15

20

25

30

Single Double Triple

18 30 10

Drug Combination

BP

Con

trol

Rat

e (%

)




Mean Left Arm Circumference (Total Population)

27.4828.9528.2

Mean left arm circumference

(cm)

FemaleMaleTotal

Adult (>18 yrs)

23.7924.8424.39

Mean left arm circumference

(cm)

FemaleMaleTotal

Young (<18 yrs)




Mean Left Arm Circumference

29.2327.92

Mean left arm circumference (cm)

HypertensiveNormal

Adult (>18 yrs)

27.5624.36

Mean left arm circumference (cm)

HypertensiveNormal

Young (<18 yrs)




Mean Waist Circumference (Total population)

Total Male Female

Mean waist circumference

(cm)82.01 82.75 81.30

Adult (>18 yrs)*

Total Male Female

Mean waist circumference

(cm)70.26 71.09 69.17

Young (<18 yrs)*




Mean Waist Circumference

87.5780.54

Mean waist circumference (cm)

HypertensiveNormal

Adult (>18 yrs)

75.3070.21

Mean waist circumference (cm)

HypertensiveNormal

Young (<18 yrs)




Incidence of Central Obesity* (General adult population, >18 yrs )= 11.62%

* >101.6 cm (M); >90 cm (F) waist circumference; (397 / 3415)

17%

83%

FemaleFemale

MaleMale

21%

79%

FemaleFemale

MaleMale

Incidence of Central Obesity* (Hypertensive population, >18 yrs )= 21.6%



0

5

10

15

20

25

30Male

Female

%



Incidence of Central Obesity, Adults (>18 yrs)By Regions


Incidence of Central Obesity, Adult Males (>18 yrs)By Regions

0

5

10

15

20

25

+HPN

-HPN

%




0

10

20

30

40

50

60+HPN

-HPN

%

Incidence of Central Obesity, Adult Females (>18 yrs)By Regions




Central Obesity (Young , <18 yrs.)*= 2.2%

0

0.5

1

1.5

2

2.5

3

3.5

4

Male Female

1

4

%

* 13/ 580; 3/ 327 (m); 10/ 253 (f)

AgeAge

n

0

0.5

1

1.5

2

2.5

3

3.5

4

12 13 14 15 16 17 18

3

1

2 2

4


Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07


Mean Body Mass Index (Adult Population, >18 yrs.)

AllAll HypertensiveHypertensive Non-Non-HypertensiveHypertensive

AllAll 22.8322.83 24.3024.30 22.4322.43

MaleMale 22.7022.70 23.8723.87 22.3822.38

FemaleFemale 22.9622.96 24.7424.74 22.4922.49




BMI vs. Socio-Economic Class(Adult Population, >18 yrs.)

Total Phils.

Socio-Economic Class

AB/C+ Broad C D E

Total 22.83 24.16 24.12 22.75 21.99

Male 22.70 23.36 24.29 22.59 21.81

Female 22.96 25.45 23.96 22.91 22.17




BMI Distribution(General Adult Population, >18 yrs.)

<2323-2425-2930 & over

57%43%

27%5%

BMI




BMI vs. Gender(General Adult Population, >18 yrs.)

0

10

20

30

40

50

60

Male Female

<23

23 & over

25 & over

30 & over

%

5446

28

7

59

41

25

4




BMI 23-24 among regions(General Adult Population, >18 yrs.)

4848

* *

0

5

10

15

20

25

30

35

40

45

50

MetroManila

Ilocos Cag.Valley

Cent.Luzon

SouthTag

Bicol WestVis

CentVis

EastVis

WestMin

NorthMin

SouthMin

CentMin

%




BMI 25-29 among regions(General Adult Population, >18 yrs.)

0

5

10

15

20

25

30

35

40

MetroManila

Ilocos Cag.Valley

Cent.Luzon

SouthTag

Bicol WestVis

CentVis

EastVis

WestMin

NorthMin

SouthMin

CentMin

36

*

%




BMI >30 among regions(General Adult Population, >18 yrs.)

0

1

2

3

4

5

6

7

8

9

10

MetroManila

Ilocos Cag.Valley

Cent.Luzon

SouthTag

Bicol WestVis

CentVis

EastVis

WestMin

NorthMin

SouthMin

CentMin

10

%




BMI >30 vs. Gender(Adult Population, >18 yrs.)

%

0

10

20

30

40

50

60

70

+HPN -HPN +HPN -HPN

<23

23-24

25-29

30 & over

36 64

42

12

62 38

23

4

48 52

35

5

5941

24 5

MaleMale FemaleFemale



Incidence of Diabetes among Adult Population, >18 yrs.)*

* 0 Angina among non-hypertensives

- DM -Don’t know

88%8%

4%+ DM


May 16-18, 2007

FemaleMale

51% 49%

+ DM

* No young diabetics


Incidence of Diabetes among Adult Hypertensives, >18 yrs.)


- DM

77%

11%

+ DM


May 16-18, 2007

12%

+ Don’t know

FemaleMale

58% 49%

+DM+DM


Incidence of Smoking among Adult Population, >18 yrs.)


- Smoker +Smoker

73%27%


May 16-18, 2007

0

10

20

30

40

50

Male Female

47%

8%

+Smoker


Incidence of Smoking among Young Population, <18 yrs.)


- Smoker

+Smoker*

89%11%


May 16-18, 2007

0

5

10

15

20

Male Female

19%

1%

+Smoker

* Only 3% are hypertensive* Only 3% are hypertensive



Incidence of Angina among Adult Population, >18 yrs.)*

* All hypertensives. No Angina among non-hypertensives

+ Angina -Angina

55% 45%

FemaleMale

53% 47%


Sison J MD, Arceo L MD, Trinidad E MD et al, PHA Annual Convention, May 07



52

61

39

48

Angina Distribution by Gender among Hypertensives

(General Adult Population, >18 yrs.)

%

0

10

20

30

40

50

60

70

Male Female

+Angina

-Angina

-Angina

3961 52

48




Incidence of Angina among Young Population, <18 yrs.

- Angina

+ Angina*

83%17%

n= 6

* All are hypertensive

1


n

0

0.5

1

1.5

2

2.5

3

Male Female

3

2

0

+ Angina

-Angina

+ Angina

-Angina



History of MI Among Adult Population( >18 yrs.)

* All are hypertensives; No MI among young subjects

- MI

+MI*

99%

1%

Female

Male

75%

25%

+MI





History of Stroke Among Adult Population( >18 yrs.)

* All are hypertensives; No stroke among young subjects

- stroke

+ stroke*

91%

9%

Female

Male

57%

43%

+MI





0

5

10

15

20

25

MetroManila

Ilocos Cag.Valley

Cent.Luzon

SouthTag

Bicol WestVis

CentVis

EastVis

WestMin

NorthMin

SouthMin

CentMin

*

%

22

Stroke Distribution by Regions(Adult Population, >18 yrs.)




Incidence of Claudication Among Adult Population ( >18 yrs.)

* >All are hypertensive; Young population = only 1 hypertensive male had claudication

+ claud*

- claud

93%

7%

Female

Male

44%56%

+claud*





Incidence of Microproteinuria* Among Adult Hypertensives ( >18 yrs.)

* >20 mg on Micral test; (+) 527/1063; (-) 536/1063; **M:265/518; F:253/518

+ micr*

- micr

50% 50%

Female

Male**

51%

49%

+micr





Incidence of Microproteinuria Among Young Hypertensives ( <18 yrs.)

* All are hypertensive

+ micr*

- micr

50% 50%

Female

Male33%

67%

+micr

n=6




Summary 1•Prevalence of hypertension in the Philippines is 21%•Male: Female is 1:1•16% are aware, 5% are unaware•Treatment rate is 65%•Compliance is 66% among treated; (43% among treated / untreated)•BP control rate is 20% among treated subjects (13% among treated / untreated)•Most common drug is beta-blocker•2-drug combination is most frequent•Compliance is highest with ARBs




Summary 2

The following measurements are greater among

hypertensive than normotensive subjects:

•Mean left arm circumference (male > female)

•Mean waist circumference (male > female)

•Central obesity incidence (female > male)

•Mean BMI (female > male)

•Overweight & obesity (based on BMI) (female > male)




Angina (55%) (female > male)History of MI (1%) (male > female)Stroke (9%) (male > female)Claudication (7%) (female > male)


Summary 3•The following were present only among hypertensive subjects:

•Diabetes was 4% in the general population; 11% among hypertensives (female > male)•Microproteinuria among hypertensive subjects was 50% (male > female)



May 16-18, 2007

The Council on Hypertension extends its gratitude to the following:

PHA officers & board of directorsPHA Research CommitteeSanofi-Synthelabo

Applied Marketing Research,Inc (AMAR)- Patricio Barretto, Alby TalagPhil. Academy of OphthalmologyPHA members (free ECG service)


Documents

PRESYON 2 Report of the Council on Hypertension Main Authors: Sison Jorge MD, Arceo Lea MD Co-Authors: Trinidad Emma MD (Chair), Bautista J Antonio MD,