UNIVERSITY OF BENIN, BENIN CITY

FACULTY OF EDUCATION
DEPARTMENT OF HEALTH SAFETY AND ENVIRONMENTAL EDUCATION
NAME : AMENAGHAWON SAMUEL
MAT -NO : EDU1904636
COURSE AREA : HEALTH EDUCATION
COURSE CODE : HED 423 (EPIDEMIOLOGY AND PUBLIC HEALTH )

Assignment
1. Pick 2 chronic Disease
Write on
- Ethology
-Prevention
-Natural History
- Treatment Outcome
- Distribution

What is Chronic Disease

Chronic illness affects your body persistently and frequently recurs over time. If you suffer from a chronic
disease, you may have difficulty adjusting to the demands of the illness. Therapy is often used to treat
these types of conditions and manage adverse symptoms.

Chronic illness can hinder your ability to be independent, adding additional stress to daily activities.
People who deal with chronic ailments often believe that the absence of symptoms means they are no
longer suffering from their condition. But this may not mean that the disease has disappeared altogether.

Chronic diseases are long-lasting conditions that typically progress slowly and persist over time, often
without a cure. They can significantly impact a person's quality of life and may require ongoing medical
management. Common chronic diseases include diabetes, heart disease, cancer, chronic respiratory
diseases, and mental health disorders. Prevention through lifestyle modifications, early detection, and
effective management are key strategies in addressing chronic diseases and reducing their burden on
individuals and healthcare systems.

HEART DISEASE
Although there are other conditions that fall under the category of heart disease, but it generally involves
narrowed or blocked blood vessels. Atherosclerosis may develop as a result, which causes plaque to build
up in the walls of your arteries. Plaque buildup and blood clots make it difficult for blood to flow through
your arteries.

Heart disease refers to any condition affecting the cardiovascular system. There are several different types
of heart disease, and they affect the heart and blood vessels in different ways.

This condition comes in many forms, often leading to:

1. Irregular heartbeats
2. High blood pressure
3. Heart attacks
4. Chest pain
5. Strokes

Heart disease refers to any problem affecting the heart, such as coronary artery disease, arrhythmia, and
heart failure.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of
death in the United States. Around 1 in 4 deathsTrusted Source in the U.S. occur due to heart disease, and
the condition affects all genders as well as all racial and ethnic groups.

NATURAL HISTORY OF HEART DISEASE

Heart disease can be traced back to ancient Egypt long before modern medicine could help the civilization.

Even with today’s advances in heart care, heart disease remains the leading cause of death in the United
States. According to the Centers for Disease Control and Prevention (CDC), about 659,000 people in the
U.S. die from heart disease each year – that’s 1 in every 4 deaths

The American College of Cardiology reports that the earliest documented case of coronary atherosclerosis
– a build-up of plaque in the arteries that can cause a heart attack – was in an Egyptian princess who lived
between 1580 and 1550 B.C. The study found that heart disease was more common in ancient times than
previously thought.

Between then and now, humans have been working to improve how we care for heart disease – and for a
long time, there was not a lot we could do.

HISTORY TELLS THE STORY

History tells the story of advances in heart care – which was still somewhat limited as the 20th century
began. But big changes were looming.

President Dwight D. Eisenhower’s heart attack in 1955, which shocked and worried a nation who knew
there was little that could be done for heart attack victims, was somewhat of a turning point in care.

“Up until this time, people were told to stay on bedrest for four to six weeks, which turned out to be
wrong,” says Dr. David Bull, VP and Medical Director of the Baystate Health Heart and Vascular Service. "A
prominent physician, Dr. Paul Dudley White, was called in to consult President Eisenhower’s condition and
care and he immediately began to get him out of bed and walking, which soon became standard practice.”
Not long after in the early 1960s, the first coronary care unit – specially designed, staffed and equipped
areas in the hospital – opened at Bethany Hospital in Kansas. The new critical care unit, which helped
greatly to reduce mortality from heart attacks – people were at high risk of dying within the first 24 hours
– further offered the use of the world’s first life-saving portable defibrillator used to shock the heart back
to normal rhythm for those having sudden cardiac arrest.

The Baystate heart expert says the biggest advances, which he called “game changers,” came in the 1960s
and 1970s with the ability to perform coronary revascularization, either bypass surgery or angioplasty.

More than 80% of western Massachusetts residents requiring heart surgery have it at Baystate Medical
Center, which is also the only area hospital to provide angioplasty – as well as valve surgery. With the
introduction of angioplasty and stenting, which restores blood flow to the heart by using a thin, flexible
catheter with a balloon at its tip to open the clogged artery, the volume of bypass procedures has
decreased. Bypass surgery, introduced at Baystate in 1978, now comprises approximately 50% of the total
number of open-heart procedures, with the remaining volume including valve, aneurysm and congenital
procedures.

UNDERSTANDING THE ROOT CAUSES OF HEART DISEASE

As for prevention, it wasn’t until the advent of the Framingham Heart Study in 1948 that doctors began to
understand the root causes of heart disease.

Initial results from the study published in the late 1950s established a number of risk factors – high blood
pressure, high cholesterol and smoking – which doctors could now help patients address with lifestyle
changes and the use of statins, first introduced in 1978, which drastically reduced cholesterol levels.

Types of Heart Disease

Heart disease refers to any condition affecting the cardiovascular system. There are several different types
of heart disease, and they affect the heart and blood vessels in different ways.

The sections below look at some different types of heart disease in more detail.

Coronary artery disease

Coronary artery disease, also known as coronary heart disease, is the most common type of heart disease.

It develops when the arteries that supply blood to the heart become clogged with plaque. This causes
them to harden and narrow. Plaque contains cholesterol and other substances.

As a result, the blood supply reduces, and the heart receives less oxygen and fewer nutrients. In time, the
heart muscle weakens, and there is a risk of heart failure and arrhythmias.

When plaque builds up in the arteries, it is called atherosclerosis. Plaque in the arteries can rupture from
blockages and cause blood flow to stop, which can lead to a heart attack.

Congenital heart defects

A person with a congenital heart defect is born with a heart problem. There are many types of congenital
heart defects, includingTrusted Source:

Atypical heart valves: Valves may not open properly, or they may leak blood.
Septal defects: There is a hole in the wall between either the lower chambers or the upper chambers of
the heart.
Atresia: One of the heart valves is missing.
Congenital heart disease can involve major structural issues, such as the absence of a ventricle or
problems with unusual connections between the main arteries that leave the heart.

Many congenital heart defects do not cause any noticeable symptoms and only become apparent during a
routine medical check.

According to the American Heart Association (AHA)Trusted Source, heart murmurs often affect children,
but only some are due to a defect.
Heart failure can result from untreated coronary artery disease, high blood pressure, arrhythmias, and
other conditions. These conditions can affect the heart’s ability to pump or relax properly.

Heart failure can be life threatening, but seeking early treatment for heart-related conditions can help
prevent complications

Heart failure can result from untreated coronary artery disease, high blood pressure, arrhythmias, and
other conditions. These conditions can affect the heart’s ability to pump or relax properly.

Heart failure can be life threatening, but seeking early treatment for heart-related conditions can help
prevent complications

Ethiology of Heart Disease

Different types of heart disease have different causes. Heart disease causes include:

Heart muscle scarring.

Coronary artery disease.
Genetic issues.
Problems with kidney function.
Infections, including severe infections outside of your heart.
Thyroid problems.
Rheumatic disease.
Aging.
Injury to part of your heart.
Heart attacks.
Certain diseases, like autoimmune diseases.
Pregnancy.
Certain medications, like specific kinds of chemotherapy.
Substance use, including alcohol, cocaine, methamphetamine and others.
High blood pressure.
Abnormal heart rhythm.

Smoking
Smoking is a major risk factor for coronary heart disease. Both nicotine and carbon monoxide (from the
smoke) put a strain on the heart by making it work faster. They also increase your risk of blood clots.

Other chemicals in cigarette smoke can damage the lining of your coronary arteries, leading to furring of
the arteries. Smoking significantly increases your risk of developing heart disease.

High blood pressure

High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.

High cholesterol
Cholesterol is a fat made by the liver from the saturated fat in your diet. It's essential for healthy cells, but
too much in the blood can lead to CHD.

Lack of regular exercise

If you're inactive, fatty deposits can build up in your arteries.
If the arteries that supply blood to your heart become blocked, it can lead to a heart attack. If the arteries
that supply blood to your brain are affected it can cause a stroke.
Diabetes
A high blood sugar level may lead to diabetes, which can more than double your risk of developing CHD.
Diabetes can lead to CHD because it may cause the lining of blood vessels to become thicker, which can
restrict blood flow.

Thrombosis
A thrombosis is a blood clot in a vein or artery.
If a thrombosis develops in a coronary artery it prevents the blood supply from reaching the heart muscle.
This usually leads to a heart attack.

Prevention of Heart Disease

Eat a healthy, balanced diet
A low-fat, high-fibre diet is recommended, which should include plenty of fresh fruit and vegetables (5
portions a day) and whole grains.

You should limit the amount of salt you eat to no more than 6g (0.2oz) a day as too much salt will increase
your blood pressure. 6g of salt is about 1 teaspoonful.

There are 2 types of fat: saturated and unsaturated. You should avoid food containing saturated fats,
because these will increase the levels of bad cholesterol in your blood.

Foods high in saturated fat include:

Meat pies
Sausages and fatty cuts of meat
Butter
Cakes and biscuits
Foods that contain coconut or palm oil
However, a balanced diet should still include unsaturated fats, which have been shown to increase levels
of good cholesterol and help reduce any blockage in your arteries.

Foods high in unsaturated fat include:

oily fish
avocados
nuts and seeds
sunflower, rapeseed, olive and vegetable oils
You should also try to avoid too much sugar in your diet, as this can increase your chances of developing
diabetes, which is proven to significantly increase your chances of developing CHD.

Be more physically active

Combining a healthy diet with regular exercise is the best way of maintaining a healthy weight. Having a
healthy weight reduces your chances of developing high blood pressure.

Regular exercise will make your heart and blood circulatory system more efficient, lower your cholesterol
level, and also keep your blood pressure at a healthy level.

Exercising regularly reduces your risk of having a heart attack. The heart is a muscle and, like any other
muscle, benefits from exercise. A strong heart can pump more blood around your body with less effort.
Any aerobic exercise, such as walking, swimming and dancing, makes your heart work harder and keeps it
healthy.

Give up smoking
If you smoke, giving up will reduce your risk of developing CHD.

Smoking is a major risk factor for developing atherosclerosis (furring of the arteries).

Research has shown you're 3 times more likely to successfully give up smoking if you use NHS support
together with stop-smoking medicines, such as patches or gum

Reduce your alcohol consumption

If you drink, do not exceed the maximum recommended limits.

Men and women are advised not to regularly drink more than 14 units a week
spread your drinking over 3 days or more if you drink as much as 14 units a week
If you want to cut down, try to have several drink-free days each week
Always avoid binge drinking, as this increases the risk of a heart attack .

Keep your blood pressure under control

You can keep your blood pressure under control by eating a healthy diet low in saturated fat, exercising
regularly and, if needed, taking medicine to lower your blood pressure.

Your target blood pressure should be below 135/85mmHg. If you have high blood pressure, ask a GP to
check your blood pressure regularly.

Treatment of Heart Disease

Heart disease treatment depends on the cause and type of heart damage. Healthy lifestyle habits — such
as eating a low-fat, low-salt diet, getting regular exercise and good sleep, and not smoking — are an
important part of treatment.

Medications
If lifestyle changes alone don't work, medications may be needed to control heart disease symptoms and
to prevent complications. The type of medication used depends on the type of heart disease.

Surgery or other procedures

Some people with heart disease may need a procedure or surgery. The type of procedure or surgery will
depend on the type of heart disease and the amount of damage to the heart.

Distribution of Heart Disease

The distribution of heart disease in a population can vary based on several factors including age, gender,
genetics, lifestyle, socioeconomic status, and geographical location. Generally, heart disease is more
prevalent in older individuals, males tend to have a higher risk at younger ages but the risk becomes
comparable to females later in life. 1.Genetics also play a significant role, as individuals with a family
history of heart disease are at a higher risk.
2. Lifestyle factors such as diet, exercise, smoking, and alcohol consumption can greatly influence the
prevalence of heart disease within a population.
3 Socioeconomic factors such as access to healthcare and education can impact the distribution of heart
disease.
4. Geographically, certain regions may have higher rates of heart disease due to environmental factors,
cultural practices, or access to healthcare. Understanding these distribution patterns is crucial for
developing targeted prevention and intervention strategies to reduce the burden of heart disease in
populations

HYPERTENSION

High blood pressure, or also known as hypertension, is a common condition. Some people can have the
condition for years but did not show any symptoms. However, even the symptoms do not show, the
damage to blood vessels and heart remains, and these damages are detectable. High blood pressure that
is uncontrolled will increase the risk of chronic health issues such as heart attack and stroke. The condition
tends to develop over several years and eventually affects everyone.

NATURAL HISTORY OF HYPERTENSION

The modern history of hypertension begins with the understanding of the cardiovascular system based on
the work of physician William Harvey (1578–1657), who described the circulation of blood in his book De
motu cordis. The English clergyman Stephen Hales made the first published measurement of blood
pressure in 1733. Descriptions of what would come to be called hypertension came from, among others,
Thomas Young in 1808 and especially Richard Bright in 1836. Bright noted a link between cardiac
hypertrophy and kidney disease, and subsequently kidney disease was often termed Bright's disease in
this period. In 1850 George Johnson suggested that the thickened blood vessels seen in the kidney in
Bright's disease might be an adaptation to elevated blood pressure.William Senhouse Kirkes in 1855 and
Ludwig Traube in 1856 also proposed, based on pathological observations, that elevated pressure could
account for the association between left ventricular hypertrophy to kidney damage in Bright's disease.
Samuel Wilks observed that left ventricular hypertrophy and diseased arteries were not necessarily
associated with diseased kidneys, implying that high blood pressure might occur in people with healthy
kidneys; however, the first report of elevated blood pressure in a person without evidence of kidney
disease was made by Frederick Akbar Mahomed in 1874 using a sphygmograph.The concept of
hypertensive disease as a generalized circulatory disease was taken up by Sir Clifford Allbutt, who termed
the condition "hyperpiesia".However, hypertension as a medical entity really came into being in 1896 with
the invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896,which allowed blood
pressure to be measured in the clinic. In 1905, Nikolai Korotkoff improved the technique by describing the
Korotkoff sounds that are heard when the artery is ausculted with a stethoscope while the
sphygmomanometer cuff is deflated.[2] Tracking serial blood pressure measurements was further
enhanced when Donal Nunn invented an accurate fully automated oscillometric sphygmomanometer
device in 1981.[10]

The term essential hypertension ('Essentielle Hypertonie') was coined by Eberhard Frank in 1911 to
describe elevated blood pressure for which no cause could be found. In 1928, the term malignant
hypertension was coined by physicians from the Mayo Clinic to describe a syndrome of very high blood
pressure, severe retinopathy and inadequate kidney function which usually resulted in death within a year
from strokes, heart failure or kidney failure.A prominent individual with severe hypertension was Franklin
D. Roosevelt However, while the menace of severe or malignant hypertension was well recognised, the
risks of more moderate elevations of blood pressure were uncertain and the benefits of treatment
doubtful. Consequently, hypertension was often classified into "malignant" and "benign". In 1931, John
Hay, Professor of Medicine at Liverpool University, wrote that "there is some truth in the saying that the
greatest danger to a man with a high blood pressure lies in its discovery, because then some fool is certain
to try and reduce it".This view was echoed in 1937 by US cardiologist Paul Dudley White, who suggested
that "hypertension may be an important compensatory mechanism which should not be tampered with,
even if we were certain that we could control it".Charles Friedberg's 1949 classic textbook "Diseases of the
Heart",stated that "people with 'mild benign' hypertension ... [defined as blood pressures up to levels of
210/100 mm Hg] ... need not be treated".However, the tide of medical opinion was turning: it was
increasingly recognised in the 1950s that "benign" hypertension was not harmless.Over the next decade
increasing evidence accumulated from actuarial reportsand longitudinal studies, such as the Framingham
Heart Study that "benign" hypertension increased death and cardiovascular disease, and that these risks
increased in a graded manner with increasing blood pressure across the whole spectrum of population
blood pressures. Subsequently, the National Institutes of Health also sponsored other population
studies,which additionally showed that African Americans had a higher burden of hypertension and its
complications.

Types of Hypertension

There are two main types of high blood pressure.

Primary hypertension, also called essential hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure is
called primary hypertension or essential hypertension. It tends to develop gradually over many years.
Plaque buildup in the arteries, called atherosclerosis, increases the risk of high blood pressure.

Secondary hypertension
This type of high blood pressure is caused by an underlying condition. It tends to appear suddenly and
cause higher blood pressure than does primary hypertension. Conditions and medicines that can lead to
secondary hypertension include:

Adrenal gland tumors

Blood vessel problems present at birth, also called congenital heart defects
Cough and cold medicines, some pain relievers, birth control pills, and other prescription drugs
Illegal drugs, such as cocaine and amphetamines
Kidney disease
Obstructive sleep apnea
Thyroid problems

Ethiology of Hypertension
Anything that increases pressure on the artery walls can lead to elevated blood pressure. A buildup of fats,
cholesterol, and other substances in and on the artery walls (atherosclerosis) can cause elevated blood
pressure. But the opposite is also true. High blood pressure (hypertension) can cause atherosclerosis.

Sometimes, the cause of the elevated or high blood pressure isn't identified.

Conditions and medications that can cause elevated blood pressure include:

Adrenal gland disorders

Heart problem affecting blood vessels present at birth (congenital heart defect)
Illegal drugs, such as cocaine and amphetamines
Kidney disease
Obstructive sleep apnea
Some medications, including birth control pills, cold and sinus medicines, over-the-counter pain relievers
containing caffeine, and some prescription drugs
Thyroid disease

Blood pressure is determined by two things: the amount of blood the heart pumps and how hard it is for
the blood to move through the arteries. The more blood the heart pumps and the narrower the arteries,
the higher the blood pressure.

Prevention of Hypertension

Lose weight
Being overweight forces your heart to work harder to pump blood around your body, which can raise your
blood pressure.

Healthy diet
Cut down on the amount of salt in your food and eat plenty of fruit and vegetables.

Limit your alcohol intake

Regularly drinking too much alcohol can raise your blood pressure over time.

Staying within the recommended levels is the best way to reduce your risk of developing high blood
pressure:

men and women are advised not to regularly drink more than 14 units a week
spread your drinking over 3 days or more if you drink as much as 14 units a week

Get active
Being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in
good condition.

Regular exercise can also help you lose weight, which will also help lower your blood pressure.

Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity,
such as cycling or fast walking, every week.

Physical activity can include anything from sport to walking and gardening.

Cut down on caffeine

Drinking more than 4 cups of coffee a day may increase your blood pressure.

If you're a big fan of coffee, tea or other caffeine-rich drinks, such as cola and some energy drinks, consider
cutting down.

It's fine to drink tea and coffee as part of a balanced diet, but it's important that these drinks are not your
main or only source of fluid.

Stop smoking
Smoking, like high blood pressure, will cause your arteries to narrow. This can increase your blood
pressure. If your arteries get blocked it can cause a heart attack or stroke.
If you smoke and have high blood pressure, your arteries will narrow much more quickly, and your risk of
heart or lung disease in the future is dramatically increased.

Everyone with high blood pressure is advised to make healthy lifestyle changes.

Whether medicine is also recommended depends on your blood pressure reading and your risk of
developing problems such as heart attacks or strokes.

Your doctor will carry out some blood and urine tests, and ask questions about your health to determine
your risk of other problems:

if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) and you're under 80
years old, or 150/90mmHg (or 145/85mmHg at home) and you're 80 years old or over, but your risk of
other problems is low – you'll be advised to make some changes to your lifestyle, though you and your
doctor may still choose to consider medicine
if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) and your risk of
other problems is high – you'll be offered medicine to lower your blood pressure, in addition to lifestyle
changes
if your blood pressure is consistently above 160/100mmHg – you'll be offered medicine to lower your
blood pressure, in addition to lifestyle changes

Lifestyle changes
There are some changes you could make to your lifestyle to reduce high blood pressure.

Some of these will lower your blood pressure in a matter of weeks, while others may take longer.

cut your salt intake to less than 6g (0.2oz) a day, which is about a teaspoonful

eat a low-fat, balanced diet – including plenty of fresh fruit and vegetables;

cut down on alcohol – get tips on cutting down, including downloading a drinks diary and keeping track of
your drinking

lose weight – find out what your ideal weight is using the BMI healthy weight calculator and read advice
about losing weight if you're overweight
drink less caffeine – found in coffee, tea and cola
stop smoking – get help quitting.

Distribution of Hypertension
Hypertension, commonly known as high blood pressure, affects millions of people worldwide and its
distribution varies across different populations. Several factors influence its distribution:

1. Age: Hypertension prevalence increases with age. Older adults are more likely to develop hypertension
due to changes in blood vessels and other physiological factors.

2. Gender: Before the age of 55, men are more likely to develop hypertension than women. However, after
menopause, women's risk increases and eventually surpasses that of men.

3. Genetics: Family history plays a significant role. Individuals with a family history of hypertension are at
higher risk.
4. Lifestyle Factors: Sedentary lifestyle, unhealthy diet (high in salt, saturated fats, and low in fruits and
vegetables), excessive alcohol consumption, and tobacco use contribute to the development of
hypertension.

5. Socioeconomic Status: Lower socioeconomic status is associated with higher rates of hypertension due
to limited access to healthcare, poor nutrition, and higher stress levels.

6. Ethnicity: Some ethnic groups, such as African Americans, Hispanics, and South Asians, have a higher
prevalence of hypertension compared to others.

7. Geographical Location: Hypertension prevalence varies geographically, with urban areas often showing
higher rates due to lifestyle factors and access to healthcare.

8. Chronic Conditions: Conditions such as diabetes, obesity, and kidney disease increase the risk of
hypertension.

Understanding the distribution of hypertension helps in developing targeted prevention and management
strategies tailored to specific populations. Regular blood pressure screenings, lifestyle modifications, and
medication when necessary are essential in managing hypertension and reducing its burden on public
health