6^th World Congress on Hypertension and Public Health November 21- 22, 2018 | Paris, France

Diagnosis of hypertension is conducted on the basis of a persistently high resting blood pressure. Proper blood pressure measurement technique is essential for accurate diagnosis of high blood pressure. Improper measurement of blood pressure is common and can lead to misdiagnosis and misclassification of hypertension. Population strategies and lifestyle changes are required for management and prevention of hypertension. Lifestyle changes are considered to be the first line of action against hypertension. These changes include maintaining normal body weight, reducing dietary sodium intake, limiting alcohol consumption, eating diet rich fruits and vegetables, engaging in regular physical exercises etc. These lifestyle changes are much effective and may lower blood pressure as much as an individual antihypertensive medication. One can combine two or more lifestyle modifications to achieve even better results.

Cardiac arrest is described as an unexpected disruption in effective blood flow due to the failure of the heart. Cardiac arrest happens when the heart stops completely or has a dangerous rhythm and sometimes can be caused by heart attacks. It can also be caused by sepsis, trauma, a pulmonary embolism, infection, heart rhythm problems, malfunction in heart’s electrical system and use of recreational drug. Cardiac arrest is a very serious condition which can lead to death. Symptoms for the cardiac arrest include sudden loss of response, fatigue, dizziness, abnormal breathing, shortness of breath, chest pain, weakness and nausea. Coronary heart disease is the most common cause of cardiac arrest which often results in coronary ischemia and ventricular fibrillation. With cardiac arrest, people may feel dizzy or light-headed and suddenly black out. Immediate treatment with a cardiac arrest includes CPR and a shock with defibrillator to jump-start a person’s heart followed up with a breathing tube and other medicines or machines to support the heart. When one of the main arteries of the heart gets blocked, causing the heart to not get enough blood flow, the condition is termed as heart attack. Stroke is classified into two major types, ischemic and hemorrhagic. In ischemic strokes, a blood clot cuts off the supply of blood to an area of the brain. In hemorrhagic strokes, bleeding in the brain occurs via a ruptured blood vessel. This session aims to discuss major issues related to cardiac arrest, heart attack and stroke and the role of hypertension in all these.

As an important public health challenge, the importance of hypertension and obesity is increasing worldwide. As compared to year 2000, the number of adults affected with hypertension is predicted to increase to a total of 1.56 billion by the year 2025. The increasing commonness of obesity is recognized as one of the most important risk factors for the development of hypertension. Excess body weight is the sixth most important risk factor adding to the overall hardship of disease in the world with more than 1 billion adults and 10% of children are now classified as overweight or obese. Obesity and specifically central obesity have been persistently involved with hypertension and increased cardiovascular risk. Population studies suggest that at least two-thirds of the prevalence of hypertension can be directly associated to obesity. There is growing evidence of obesity contributing to the development as well as to the growth of chronic kidney disease. Glomerular hyperfiltration, increased urinary albumin loss and progressive loss of renal function caused by focal segmental glomerulosclerosis are results of obesity. Obesity accelerates progression in patients with established renal disease.

Pulmonary hypertension affects the arteries in your lungs and the right side of your heart. In pulmonary hypertension, tiny arteries in your lungs, called pulmonary arterioles, and capillaries become narrowed, eventually blocked or destroyed. As a result it is harder for blood to flow through your lungs, which raises pressure within your lungs' arteries. Your heart's lower right chamber must work harder as the pressure in your lung arteries increases in order to pump blood through your lungs, eventually making your heart muscle to weaken and fail. There are some forms of pulmonary hypertension which become worse upon progression and can be fatal. Also there are some forms of pulmonary hypertension which aren't curable. The symptoms of pulmonary hypertension in its early stages are generally not noticeable for months or even years but as the disease progresses, symptoms become worse. Symptoms for pulmonary hypertension include Shortness of breath, Fatigue, Dizziness or fainting spells, Chest pressure or pain, swelling in your ankles, legs and eventually in your abdomen, Bluish colour to your lips and skin, heart palpitations etc. This session aims to emphasize on the classification, signs, symptoms and treatments of the Pulmonary Hypertension.

Renal hypertension is the elevated blood pressure caused by nephrosis. Also known as Reno vascular high blood pressure, it's a syndrome that consists of high pressure caused by the kidneys' secretion response to narrowing of the arteries activity in the kidneys. The condition is called renal artery stenosis. The narrowing in one or both renal arteries is most often caused by atherosclerosis, also known as hardening of the arteries. This process leads to many heart attacks and strokes. Fibromuscular dysplasia is a less common cause for the narrowing of the arteries. In this condition, the structure of the renal arteries grows abnormally for uncertain reasons. The vast majority of individuals affected with renal hypertension never experience these symptoms. Because there are no symptoms, organ damage can occur slowly without being recognized resulting to chronic kidney disease. It is termed as a slow decline in kidney function. Chronic kidney disease also shows no sign or symptoms unless it is well advanced. Doctors may suspect for renal hypertension when someone has uncontrolled high blood pressure despite multiple medications or has unexplained chronic kidney disease as there are usually no clear symptoms. Medications are generally used to try to control high blood pressure in renal hypertension. The most important blood pressure medications in renal hypertension treatment include ACE inhibitors and ARBs. In most individuals, medications can effectively control blood pressure for renal hypertension due to renal artery narrowing. However, more than one blood pressure drug is often needed. But in some cases, even taking three or more medications every day may not sufficiently control blood pressure. A procedure to improve blood flow to the kidneys may help in this kind of situations. Procedures include Angioplasty, Stenting and Surgery. Surgery is the most effective at correcting renal hypertension and it is considered only when angioplasty and stenting are not possible. Procedures are more effective to treat renal hypertension when only one kidney's artery is narrowed rather than both. In this session we are focusing on the causes and symptoms of reno-vascular hypertension, alongside of its pathological process, diagnosis and treatment.

Hypertension affects approximately 8–10% of pregnancies. It can be classified as pre-existing hypertension, gestational hypertension, or pre-eclampsia. Pre-eclampsia is a disorder of pregnancy distinguished by the outset of high blood pressure and often a significant amount of protein in the urine. If arises, the pre-eclampsia begins after 20 weeks of pregnancy. In severe conditions there may be red blood cell breakdown, a low blood platelet count, kidney dysfunction, impaired liver function, swelling, visual disturbances, or shortness of breath due to fluid in the lungs. For both the mother and her baby, pre-eclampsia enhances the poor outcomes and if left untreated, it may result in to eclampsia. Eclampsia is a life-threatening condition which is a hypertensive emergency. It has several serious complications including seizures, vision loss, brain swelling, pulmonary edema, kidney failure, and disseminated intravascular coagulation. In approximately 5% of pregnancies, preeclampsia occurs and it is responsible for about 16% of all maternal deaths globally. It also doubles the risk of death of the baby around the time of birth. It is more frequent in a woman's first pregnancy and mostly if she is carrying twins. In most cases, pre-eclampsia is diagnosed before delivery. In some rare cases, pre-eclampsia may begin in the period after the delivery of the baby. Women affected with pre-eclampsia during their pregnancy are at increased risk of heart disease and stroke later in life. In recommended treatments for prevention of pre-eclampsia, there are several such as providing aspirin in individuals at high risk, calcium supplementation in areas with low intake, and treatment of prior high blood pressure with medications. This session is aimed at discussing the various issues related to pre-eclampsia, its diagnosis and treatment. Additionally, the session also aims to discuss about other hypertensions during pregnancy i.e. pre-existing hypertension and gestational hypertension.

High blood pressure is found to be a growing health issue that is often ignored by physicians. Regular blood pressure values for children and adolescents are calculated based on their age, sex, and height, and are available in conventional tables. With renal parenchymal disease and renovascular disease being the most common, a secondary etiology of hypertension is much more likely to be found in children than in adults. Primary hypertension in children is strongly correlated with Overweight and obesity. A history and physical examination are required to draw out the underlying medical disorder in children newly diagnosed with hypertension. Children diagnosed with hypertension should also be examined for other risk factors such as cardiovascular disease, including diabetes mellitus and hyperlipidemia. They should also be evaluated for target organ damage with a retinal examination and echocardiography. Generally hypertension in children is treated by making lifestyle changes which include weight loss for those who are overweight or obese, regular physical activity, a healthy low-sodium diet, and avoidance of tobacco and alcohol. Children diagnosed with target organ damage, diabetes, symptomatic hypertension, secondary hypertension, or persistent hypertension should be treated with antihypertensive medications in addition to nonpharmacologic measures. Antihypertensive medications in children include Thiazide diuretics, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and angiotensinconverting enzyme inhibitors which are considered safe, effective, and well tolerated. High blood pressure in childhood generally leads to adult hypertension which is the leading cause of premature deaths around the world. This session will cover the emerging issues related to hypertension in children and adolescents, treatments and therapies available and the recent research findings.

Increasing rates of cardiovascular diseases are forcing each and every country to revise their public health policies to counter this emerging epidemic. Over the years, hypertension has become a major issue for public health. Statistics show that hypertension has become one of the leading causes of death in elderly people. The rates are relatively higher in developing countries. Therefore, adequate measures are required to be taken by the government to fight this epidemic. Creating awareness in people, educating doctors about the on-going research and findings in treatment and therapy may help to reduce its growing rate. Initiatives such as screening camps, awareness camps are going to help a lot in effective control but it will require much support from the people also. Community participations should be launched in each area. Life style modifications are immensely beneficial and can be considered as the primary line of defence against hypertension. Effective lifestyle changes can help reducing the use of antihypertensive medicines. Thus effective strategies should be made in order to help people to get educated about these lifestyle modifications and to get adapted to these changes. We aim to cover the recent trends related to hypertension and public health in this session.

In majority of individuals with established primary high blood pressure, high pressure is due to increased resistance to blood flow while cardiac output remains normal. There are reports showing some younger individuals with prehypertension having high cardiac output and normal peripheral resistance. It is known as hyperkinetic borderline hypertension. For these individuals, as their cardiac output falls and peripheral resistance rises with age, they develop the typical features of established essential hypertension in later life. Whether the same pattern is being followed for each individual who finally develops hypertension is debatable. In established hypertension, although a reduction in the number or density of capillaries may also contribute, the increased peripheral resistance is mainly due to structural narrowing of small arteries and arterioles. Isolated systolic hypertension is a condition found in elderly people in which the systolic pressure is abnormally high, but diastolic pressure may be normal or low. There are many mechanisms which have been proposed to account for the rise in peripheral resistance. The most evident mechanisms found are either disturbances in the kidneys' salt and water handling or abnormalities of the sympathetic nervous system. This session is going to emphasize on different pathophysiology of hypertension.

If we define hypertension as BP in excess of 140/90 mm Hg, approximately 20% of the world’s adults estimated to approximately 1 billion people worldwide are expected to have hypertension which is contributing to more than 7.1 million deaths each year. The commonness of the disease has been found to be significantly higher in patients older than 60 years. In many countries, 50% of individuals belonging to this age group have been found to be affected with hypertension. Several health surveys in various countries have reported a high degree of poor control of hypertension. According to the reports, prevalence of hypertension in Canada is 22%, of which 16% is controlled. In Egypt it is 26.3%, of which only 8% is controlled and in China it is 13.6%, of which only 3% is controlled. A progressive rise in BP is observed in people with increase in their age. Hypertension due to aging appears to be mainly systolic rather than diastolic. It is evident that the prevalence of hypertension is more in black individuals than white persons. Most studies concluded in the United Kingdom and the United States shows not only a higher rate but also a lower awareness of hypertension among black people than in white people.

In public health, epidemiology plays an integral part. Epidemiology in public health aims to provide different ways to prevent disease and to promote the health of populations through the study of the occurrence and distribution of health-related states or events. This includes the study of factors influencing such states. Adequate data is required for determining the factors and minimizing or eliminating them. Epidemiologist are expected to gather these data via campaigns, health events, etc. and use them to put forward proposals that can aid the government in eliminating public health issues.

Primary hypertension or essential hypertension which has multiple risk factors such as obesity and a family history of high blood pressure is more common in adolescents. It. Unhealthy lifestyle practices such as high sodium intake, drinking of alcohol, lack of physical activities are also risk factors for hypertension. Secondary hypertension can be determined through laboratory tests. Sometimes it is passed down from mother to child during the time of pregnancy. In such cases effective lifestyle changes such as maintaining a healthy diet, proper physical exercises, etc. along with antihypertensive medication are necessary for the treatment. Even for individuals not affected with hypertension it is recommended to maintain at least one healthy lifestyle activity to prevent the risk of hypertension in their later life. Lifestyle modifications are immensely recommended for individuals with pre-hypertension as adapting such lifestyle modification will surely help such individuals to avoid antihypertensive medication and also it will effectively control their blood pressure levels. Additional tests should be performed to determine whether damage has been caused by hypertension to the heart, eyes, and kidneys. Diabetes and high cholesterol levels are also considered as additional risk factors for the development of heart disease and may require treatment. Thus these conditions require proper examinations to determine the severity of the disease and to determine the required medication and treatment.

There are several classes of medications available for treating hypertension, collectively known as antihypertensive medications. Thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers are considered as first-line medications for hypertension. Although these medications may be used alone or in combination, ACE inhibitors and ARBs are not recommended to be used in combinations. ARBs minimize counter-regulatory mechanisms that act to reverse blood pressure values to pre-treatment levels. Previously, as first-line therapy for hypertension, Beta-blockers were thought to produce similar beneficial effects as ARBs. However, a review that included 13 trials conducted by Cochrane showed that the effects of beta-blockers in treatment are less than that of other antihypertensive medications. More than one medication is required to control high blood pressure in most individuals affected with hypertension and these medications for blood pressure control should be implemented with a stepped care approach when target levels are not reached.

Public health is termed as the science and art of preventing diseases. The purpose of public health is to analyse a population’s health and the threats toward it. Its objective is to prolong life and promote human health through coordinated labour and informed choices of individuals, organizations, public and private communities and societies. The term public encompasses small group of individuals or an entire village or several continents and Health relates to physical, mental and social well-being of individuals. The aim of public health is to improve the quality of life through prevention and treatment of disease. This includes the surveillance of cases and health indicators and the promotion of healthy lifestyle. Creating awareness towards hand washing and breastfeeding, delivery of vaccinations, prevention of suicides and distribution of condoms to control the spread of sexually transmitted diseases comes under the common public health initiatives. Multidisciplinary teams of public health workers and professionals such as epidemiologists, medical assistants, biostatisticians, public health nurses, midwives or medical microbiologists are required in modern public health practices. In both the developing and the developed countries, public health plays an important role in disease prevention through the efforts made by the local health systems and non-governmental organizations.

The term global means international. Thus Global mental health defines the international viewpoint on various aspects of mental health. Its overall aim is to strengthen mental health all over the world by providing information about the mental health conditions in all countries, and classifying mental health care requirements in order to develop economical interventions to fulfil those specific requirements. Global mental health puts priority on improving mental health and achieving fairness in mental health for all individuals worldwide by study, research and practice. Lately, the global mental health movement has met with some criticism. It has been labelled as a cover for the pharmaceutical companies searching for new consumers for psychiatric drugs. Mental disorders are considered as health conditions categorized by changes in state of mind, mood and behaviour that are associated with pain or potentially disability in working. Mental illness refers to all diagnosable mental disorders. Mental disorders are one of the most well-known causes for disability and may incorporate death in some cases. Approximately, one in four people in the world is somehow affected by mental or neurological disorder at some point in their lives. Although there is rise in interventions for treatment of mental disorders and awareness about mental disorders among people, the so called treatment gap is still very high. The treatment gap is estimated to be in between 76–85% for low- and middle-income countries and 35–50% for high-income countries.

Reproductive medicine is an important part of public health and it aims to improve or maintain reproductive health and to allow people to have children at their chosen time. It deals with the diagnosis, management and prevention of reproductive difficulties. This branch of medicine is based on the knowledge of endocrinology, physiology, and reproductive anatomy, and it includes important aspects of biochemistry, molecular biology and pathology. Birth control, family planning, infertility, puberty, sexual education, sexual dysfunction and reproductive system diseases including sexually transmitted diseases are the issues addressed by reproductive medicine. Reproductive medicine also addresses ovulation, menstruation, menopause and pregnancy, as well as gynecologic disorders that affect fertility in women. In reproductive medicine, methods for diagnosis include imaging techniques, reproductive surgery, and laboratory methods. In treatment pharmacology, surgery, counseling, and other methods are considered.

General practice is an integral part of medicine, connecting it to the community more than any other medical specialty by providing health information about populations more than any other medical source. General Practitioners provide information about emerging epidemics, effect of environmental calamities, results of changes in social function and economic status of a community through their intelligent awareness and observation. In countries such as New Zealand, UK, Canada and Australia, healthcare costs are kept within reasonable limits due to the effective use of general practices. Also the community satisfaction with healthcare is high and services are matched to different extent of severity and complexity of illness in such countries. It is evident that there is a strong relationship between general practice and public health but there is also significant difference between the two. General practice focuses on providing primary healthcare to individuals and public health aims to fulfil healthcare needs of entire population. General Practitioners try to deliver comprehensive, individual tailored and evidence based care to their patients by the trust and long-term relationship that they have with patients and their families which leads to understanding of their patients’ cultural and socioeconomic backgrounds and lifestyles.

Infectious diseases are a major concern for the public health because despite some predictions, they remain the leading causes of death globally. There have been some staggering impacts of the HIV/AIDS, malaria and tuberculosis epidemics globally. Furthermore, the emergence of previously unrecognised pathogens and the threat of resistant pathogens have collective put everyone’s attention towards the importance of public health and also the requirement of well trained professionals in infectious diseases. The diseases are generally caused by the pathogenic microorganisms such as bacteria, viruses, parasites or fungi can spread, directly or indirectly, from one individual to another. The role of Infectious disease epidemiology is to monitor the emergence of infectious diseases and develop strategies for control and prevention of diseases. Traditional epidemiologic methods as well as methods such as mathematical modelling are used for analysis. Knowledge in laboratory techniques for the identification and quantification of infectious agents as well as clinical and biological features of important infectious diseases are required of the epidemiologists dealing with infectious diseases.

Diabetes is considered as a major public health issue which is emerging as a pandemic. In 1995, an estimated 135 million people had diagnosed diabetes worldwide and by 2025, the projected number is expected to reach at least 300 million. In developed countries the number of diabetes affected individuals will increase by from 51 million to 72 million and in developing countries the number are expected to rise from 84 million to a staggering 228 million. Insulin resistance, physical inactivity, obesity, and dietary factors are a few potentially modifiable risk issues associated with diabetes. Although there are various types of diabetes, it is generally categorised into 3 major types. Type 1 diabetes is the one in which the body loses its ability to produce insulin. Type 2 diabetes occurs due to a combination of resistance to insulin and insufficient insulin production. Gestational diabetes is the third major type of diabetes. A common complication during pregnancy, it can lead to perinatal complications in mother and child and significantly increases the chances of caesarean section. It is also considered as a risk factor for the mother and the child’s subsequent development of type 2 diabetes later in life after the affected pregnancy. Visits from public health individuals are necessary as some patients require regular insulin injections. If left untreated diabetes can lead to various other diseases and at sometimes it can be as severe as a potential life risk for the patient. Diabetes also poses greater difficulty in treatment of other diseases as diabetic patients require very specific medications.

Health informatics or Health Information Technology is defined as information engineering applied to the field of health care. It involves the management and healthcare information of patients. Health IT is regarded as a multidisciplinary field, using health information technology to improve health care with any combination of high quality, high efficiency and new opportunities. The aim is to incur lower cost and thus greater availability. Computer science, Information science, behavioral science, social science, management science, etc. come under the involved disciplines in Health Informatics. Health informatics involves the study of design, development, adoption and application of IT-based innovations in healthcare services planning, management and delivery. Computers, information and communication systems, clinical guidelines, and formal medical terminologies amongst others are the tools required for Health informatics. The applicable areas for health informatics are pharmacy, dentistry, nursing, clinical medicine, public health, physical therapy, occupational therapy, biomedical research, and alternative medicine. All of these areas are designed to increase the overall effectiveness of patient care by ensuring high quality of generated data for the analysis.

Public health nursing or community health nursing is a specialty of nursing focused on public health. The primary role of Public health nurses or community health nurses is to combine community association and knowledge about the entire population with their personal, medical understandings of the health and illness experiences of people and families within the population. The work of Public health nurses is within communities and they focus on different areas to improve the overall health of the people within that community. Areas of employment include school districts, county or state health departments, and departments of correction. Their aim is to look for areas of concerns within the community and to plan ways to minimize the concerned issue for the community. Public health nurses work on various health concerns such as infection control, health coaching, health management, home care visits for welfare etc.

Hypertension or high blood pressure has been termed as the leading cause of cardiovascular mortality by The World Health Organization. According to the World Hypertension League, more than 50% of the hypertensive population worldwide are unaware of their condition. In 2005, the World Hypertension League began a worldwide awareness campaign on hypertension and they assigned May 17 as World Hypertension Day in order to address such issues. In USA, hypertension is the most common chronic medical issue resulting visits to primary health care providers. As estimated by the American Heart Association, the direct and indirect costs of high blood pressure in 2010 were $76.6 billion. According to reports in The USA, approximately 80% of people affected with hypertension are aware of their condition and 71% are taking some antihypertensive medication. Proper management of hypertension is often hampered by inadequate diagnosis, treatment, or control of high bold pressure. Healthcare professionals face difficulties in controlling blood pressure of patients due to resistance shown in taking multiple medications by their biological system. People affected with hypertension also face great difficulty in adaptation to their new lifestyle and medications. Public health deals with all the diseases and conditions that may affect the people. Public health officials are keen in their approach to deliver better diagnosis, treatment and care to people. For that the government is spending significant amount of money each year in research and development of medicines and new treatment methods in order to effectively and efficiently counter the emerging issues in public health. Awareness programs have been initiated by the government to increase the awareness among people about public health and its importance. Moreover, people are receiving necessary knowledge about various diseases. An active participation from both ends is required to effectively neutralize the epidemics.

Treatment of high blood pressure is an extended approach which includes medication, diet changes, and physical exercise. High blood pressure is dangerous to health as it leads to heart attack, stroke, heart failure, or kidney disease. As there are rarely any specific symptoms involved, generally it is not identifiable until proper medical diagnosis done by a physician or catastrophic complication such as stroke or heart attack exhibited due to hypertension. It is essential for people above 40 years of age to have a proper diagnosis by blood pressure measurements on monthly basis. Several causes such as diabetes, obesity, kidney disease, aging, etc. are associated with hypertension. Kidney diseases are the leading cause of secondary hypertension and also lead to secondary hypertension in children and adolescents passed from their mother during the time of pregnancy. A hypertension treatment aims at lowering high blood pressure thereby reducing the occurrence of stroke, heart attack, and heart failure and protecting important organs such as the brain, heart, and kidneys from damage.

Healthcare technology also known as Health IT, defined as the application of collective knowledge and skills in the form of medicines, vaccines, devices, procedures and systems developed to solve a health issue and improve quality of lives. Health IT intends to provide earlier diagnosis, less intrusive treatment options and reduction in hospital stays and rehabilitation time for patients. Using such technology, public health providers are able to get data specified to individuals and they are able to implement specific treatments on each and every individual separately and effectively. During this session, we aim to discuss the recent innovations and research topics on healthcare technologies.