Situationer

Cardiovascular diseases (CVD) greatly threaten Filipinos today. Atherosclerotic changes in the blood
vessels may set in early adulthood and progress to hypertension (HPN), coronary artery diseases (CAD) or
ischemic heart disease, resulting in heart attacks, common in middle age groups particularly in males. In
the elderly, the common complication of hypertension is cerebrovascular accident(CVA) or stroke.

Essential hypertension is asssociated with heredity and high salt intake. CAD is linked with smoking,
obesity, HPN, stress, hyperlipidemia, diabetes mellitus and a sedentary lifestyle.

Of all risk factores to CVD, smoking has the highest prevalence (46%). Hypertension (i.e. systolic blood
pressure greater thant 140mm Hg or diastolic blood pressure greater than 90 mm Hg) was found in 22% of
the population, with greater prevalence in males and among the poor (FNRI 1993). THe problem of HPN
control appears rooted in low perceived risk, non-compliance to medications or the prescribed lifestyle
modifications, poor monitoring and control of blood pressure. About 37% of hypertensive patients in one
survey have high cholesterol levels. Family history of hypertension is also one of the predominant risk
factores among Filipinos.

Morbidity and mortality trends for cardiovascular diseases have been rising for the past several decades.
The morbidity rate is 206.3 cases per 100,000 population while the mortality rate is 73.7 deaths per
100,000 population is 1994. CVD is now the number one cause of death and the seventh leading cause of
morbidity in the country. The region with the highest morbidity for CVD is REgion 7, followed by Regions 1,
CAR, 2 and 6.

The Philippines has the highest death rate for hypertension in the region, second to Indonesia in
mortality for rheumatic heart dieases, fourth to Singapore for CAD, and third to Japan for stroke (WHO
1990). Atherosclerotic diseases rank as first leading death among Filipinos. Overall, deaths due to CVD
comprise 25 percent of total deaths in 1995 (PHS 1995). The rise of CVD deaths is due to hypertension,
CAD and cerebrovascular accidents, all of which have more than doubled during the period 1965-90 (Facts
and Figures, CVD in the Philippines). The prevalence of congenital heart disease at birth is 5 per 1,000
livebirths. It declines rapidly as many of the cases die. At five years of age, the rate is about 1.5 per 1,000
and remains at 1.2 per 1,000 at age eight and onwards.

Applying appropriate measures at different stages of the disease must be done to prevent CVD. The first
step of prevention is to apply measures before the illness begins. It is a significant step as most CVDs are
permanent once they set in. The second step is protection through early diagnosis and prompt treatment.
This is important in disease prevention and control so that illness may not progress and lead to disability or
death. Rehabilitation to limit disability and prevent early death is the third level of CVD prevention.

What do you do once hypertension sets in?

1. Know your blood pressure

Hypertension is a silent killer. You may feel no symptoms yet the body is slowly being destroyed by high blood
pressure.

Be proactive! Be aware of the risk! Have your BP checked regularly, at least once yearly. If your BP level is
borderline or elevated (i.e., 140/90 mmHg and above), see your doctor. So together, you can make a plan to bring
your BP under control.

2. Live a healthy lifestyle

A healthy lifestyle keeps you less likely to develop high blood pressure. You will also feel good knowing that you
are protected from hypertension.

Through initially it may be hard to change your lifestyle and habits, a resolute determination, help from your
friends and loved ones will make will make it easier to overcome the difficulties you may encounter along the way.

Ways for a healthy lifestyle

* Exercise regularly
* Watch your weight
* Keep stress under control
* Avoid salty and fatty foods
* Avoid too much caffeine
* Limit alcohol intake
* Stop smoking

3. Take your medication

If you are consistently hypertensive despite undergoing a healthy lifestyle, your doctor will now prescribe a drug to
combat your high blood pressure.

Medications can safely and effectively lower high blood pressure. Your doctor can explain the medication and its
side effects. He will closely monitor how well it controls your blood pressure. Most people have few side effects
after beginning their medication. However, if you feel different or worse after taking them, tell your doctor right
away.

What is blood pressure?

Blood pressure (BP) is the force created as your heart pumps your blood and moves it through the blood vessels.
This continuous blood flow provides your body with the oxygen and nutrients it needs. In short, it keeps you alive.

Blood pressure is measured through a device called sphygmomanometer. A BP reading consists of two numbers –
the top number (systolic BP) is the measurement of BP while your heart is pumping, while the bottom number
(diastolic BP) is the measurement of your BP while your heart is at rest.

Normal BP is a level below

Systolic 140 mmHg

Diastolic 90 mmHg

BP normally fluctuates depending on the time of day, body position (sitting or lying down), mental stress and level
of physical exertion. Thus, BP determination is standardized – at the left arm, sitting position, after 5 – 10 minutes
of rest. Two or three BP levels are taken and the average is considered the final BP value.

You are HYPERTENSIVE if your blood pressure taken two or three times in a two-week period is consistently . . .

Systolic 140 mmHg and above

Diastolic 90 mmHg and above

Are you at risk of hypertension?

Though hypertension can develop anytime in an individual, in most cases, it does not occur solely by chance. Some
are more prone to develop high blood pressure than others. Know your risk level for developing hypertension by
checking which of the factors below applies to you.

Your lifestyle:

* you smoke
* you are more than 10% above your ideal bodyweight
* you regularly eat salty, fried or greasy food
* you regularly take alcoholic drinks (more than one ounce of alcohol) each day
* you are constantly under a lot of stress
* you have a “sit-down” life style, without much physical activity at work or at home

Your background:

* you are a man above 35 years

* a close blood relative has high blood pressure or heart disease

Your medical history:

* your cholesterol level is over 200 mg/dL

* you have diabetes, heart disease or kidney disease
* you had a stroke
The more boxes you have checked, the higher your risk of having or developing high blood pressure and its
complications. Act now and have your blood pressure taken! Prevention is your best protection from the Silent
Killer.

MORTALITY

MORTALITY: TEN LEADING (10) LEADING CAUSES

Number and rate/100,000 Population Philippines
5-Year Average (2000-2004) & 2005

5 Year Average
2005*
Cause (2000-2004)
Number Rate No. Rate
1. Diseases of the Heart 66,412 83.3 77,060 90.4
2. Diseases of the Vascular system 50,886 63.9 54,372 63.8
3. Malignant Neoplasm 38,578 48.4 41,697 48.9
4. Pneumonia 32,989 41.4 36,510 42.8
5. Accidents 33,455 42.0 33,327 39.1
6. Tuberculosis, all forms 27,211 34.2 26,588 31.2
7. Chronic lower respiratory diseases 18,015 22.6 20,951 24.6
8.Diabetes Mellitus 13,584 17.0 18,441 21.6

9. Certain conditions originating in the perinatal period 14,477 18.2 12,368 14.5

10. Nephritis, nephrotic syndrome and nephrosis 9.166 11.5 11,056 3.6

Note: Excludes ill-defined and unknown causes of mortality

(R00-R99) n=23,235
* reference year
** External Causes of Mortality

Last Update: June 29, 2009

TEN LEADING (10) CAUSES OF MORTALITY AMONG MALES

Number and Rate/100,000 Population
Philippines, 2005

Cause No. Rate

1. Diseases of the Heart 43,809 102.1
2. Diseases of the Vascular system 30,531 71.2
3. Accidents 27,281 63.6
4. Malignant Neoplasms 21,993 51.3
5. Tuberculosis, all forms 18,229 42.5
6. Pneumonia 18,145 42.3
7. Chronic lower respiratory diseases 14,450 33.7
8. Diabetes Mellitus 8,912 20.8
9. Certain conditions originating in the perinatal period 7,385 17.2

10. Nephritis, nephrotic syndrome and nephrosis 6,548 15.3

Last Update: June 30, 2009

TEN LEADING (10) CAUSES OF MORTALITY AMONG FEMALES

Number and Rate/100,000 Population
Philippines, 2005

Cause No. Rate

1. Diseases of the Heart 33,251 78.5
2. Diseases of the Vascular system 23,841 56.3
3. Malignant Neoplasms 19,704 46.5
4. Pneumonia 18,365 43.3
5. Diabetes Mellitus 9,529 22.5
6. Tuberculosis, All Forms 8,359 19.7
7. Chronic lower respiratory diseases 6,501 15.3
8. Accidents 6,046 14.3
9. Certain conditions originating in the perinatal period 4,983 11.8

10. Nephritis, nephrotic syndrome and nephrosis 4,508 10.6

Note: Excludes ill-defined and unknown causes of mortality (R00-R99) for males (n=11,840)
and females n=11,395
** External Causes of Mortality

Last Update: June 30, 2009

The Heart:

Blood flow, blood supply and how can we prevented heart attack

The heart

It works as a pump to send oxygen-rich blood through all parts of your body. Blood contains oxygen and nutrients
that every cell in your body needs to survive. The oxygen-rich blood travels throughout the arteries and vessels,
nourishing the body so that it can function properly.

Blood Flow

All blood enters the right side of the heart through two veins: The superior vena cava (SVC) and the inferior vena
cava (IVC).

The SVC collects blood from the upper half of the body. The IVC collects blood from the lower half of the body.
Blood leaves the SVC and the IVC and enters the right atrium (RA).

When the RA contracts, the blood goes through the tricuspid valve and into the right ventricle. When the RV
contracts, blood is pumped through the pulmonary valve, into the pulmonary artery (PA) and into the lungs where it
picks up oxygen.

Blood now returns to the heart from the lungs by way of the pulmonary veins and goes into the left atrium (LA).
When the LA contracts, blood travels through the mitral valve and into the left ventricle (LV). The LV is a very
important chamber that pumps blood through the aortic valve and into the aorta. The aorta is the main artery of
the body. It receives all the blood that the heart has pumped out and distributes it to the rest of the body.

Blood Supply
The heart requires blood to supply it with oxygen and other nutrients so that it can do its work. The heart gets its
blood supply from the right and left coronary arteries . These arteries branch off from the aorta just above the
aortic valve.

Coronary artery disease is caused by a blockage in one of the coronary arteries. When a coronary artery is partially
blocked, that artery cannot supply enough blood to the heart muscle to meet its needs during exertion. When
someone with coronary artery disease exerts himself or herself, it causes chest pain. This is due to lack of blood
and oxygen to that part of the heart muscle and is called angina. If the obstruction worsens (more frequent angina
episodes, with less exertion) a condition called unstable angina can occur. A heart attack happens when a
coronary artery is completely blocked and no blood or oxygen is getting to the heart muscle served by that artery.
This also causes chest pain and causes death to the heart muscle served by that artery.

How can we prevented heart attack

Eat a heart-healthy diet. Too much saturated fat and cholesterol in your diet can narrow arteries to your heart. If
you've had a heart attack, limit fat and cholesterol — and sodium. A diet high in sodium can raise your blood
pressure. Follow your doctor's and dietitian's advice on eating a heart-healthy diet. Prepare heart-healthy meals
together as a family. Fish is part of a heart-healthy diet. It contains omega-3 fatty acids, which help improve blood
cholesterol levels and prevent blood clots. Eat plenty of fruits and vegetables. Fruits and vegetables contain
antioxidants — nutrients that help prevent everyday wear and tear on your coronary arteries.

Consume alcohol in moderation. Drinking more than one to two alcoholic drinks a day raises blood pressure, so
cut back on your drinking if necessary. From a heart-healthy standpoint, one to two drinks daily is fine for men, and
women can have one alcoholic beverage a day. One drink is equivalent to 12 ounces of beer, 4 ounces of wine or
1.5 ounces of an 80-proof liquor.

Walking is a great exercise, burning about 180 calories in 30 minutes. Adding hills, sprints or even a few minutes
of jogging can increase the amount of calories you burn. Make sure you walk briskly--pretend you're trying to catch
a bus--and keep you head up, back straight and swing your arms.

Don't smoke.
Check your cholesterol
Control your blood pressure
Maintain a healthy weight