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    Hipertensi Esensial

    Uploaded by

    Krabu Laksana Badruzaman
    This document discusses hypertension (high blood pressure) and its treatment. It defines essential hypertension as high blood pressure with no known cause. It classifies blood pressure levels according to JNC 7 and ESC-ESH 2007 guidelines. The document notes that hypertension is inadequately treated, with only 34% of people with high blood pressure in the US having their condition adequately controlled. It discusses the pathogenesis, consequences, target organ damage, cardiovascular risk factors, evaluation, and treatment of hypertension. Treatment aims to lower blood pressure below 140/90 mmHg to reduce cardiovascular risks and complications like kidney disease. Lifestyle and drug therapies are used to control hypertension.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Hipertensi Esensial

    Uploaded by

    Krabu Laksana Badruzaman
    122 views22 pages
    This document discusses hypertension (high blood pressure) and its treatment. It defines essential hypertension as high blood pressure with no known cause. It classifies blood pressure levels according to JNC 7 and ESC-ESH 2007 guidelines. The document notes that hypertension is inadequately treated, with only 34% of people with high blood pressure in the US having their condition adequately controlled. It discusses the pathogenesis, consequences, target organ damage, cardiovascular risk factors, evaluation, and treatment of hypertension. Treatment aims to lower blood pressure below 140/90 mmHg to reduce cardiovascular risks and complications like kidney disease. Lifestyle and drug therapies are used to control hypertension.

    Original Description:

    kuliah anti hipertensi

    Original Title

    HIPERTENSI ESENSIAL

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    This document discusses hypertension (high blood pressure) and its treatment. It defines essential hypertension as high blood pressure with no known cause. It classifies blood pressure levels according to JNC 7 and ESC-ESH 2007 guidelines. The document notes that hypertension is inadequately treated, with only 34% of people with high blood pressure in the US having their condition adequately controlled. It discusses the pathogenesis, consequences, target organ damage, cardiovascular risk factors, evaluation, and treatment of hypertension. Treatment aims to lower blood pressure below 140/90 mmHg to reduce cardiovascular risks and complications like kidney disease. Lifestyle and drug therapies are used to control hypertension.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    122 views22 pages

    Hipertensi Esensial

    Uploaded by

    Krabu Laksana Badruzaman
    This document discusses hypertension (high blood pressure) and its treatment. It defines essential hypertension as high blood pressure with no known cause. It classifies blood pressure levels according to JNC 7 and ESC-ESH 2007 guidelines. The document notes that hypertension is inadequately treated, with only 34% of people with high blood pressure in the US having their condition adequately controlled. It discusses the pathogenesis, consequences, target organ damage, cardiovascular risk factors, evaluation, and treatment of hypertension. Treatment aims to lower blood pressure below 140/90 mmHg to reduce cardiovascular risks and complications like kidney disease. Lifestyle and drug therapies are used to control hypertension.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 22

    HIPERTENSI

    ESENSIAL
    FAKULTAS KEDOKTERAN
    UNIVERSITAS MALAHAYATI
    2011

    DEFENISI

    Hipertensi esensial adalah hipertensi


    yang tidak diketahui penyebabnya.
    Klasifikasi tekanan darah menurut
    JNC 7 :
    Klasifikasi
    tekanan darah

    TDS (mmHg)

    TDD (mmHg)

    < 120

    < 80

    Prahipertensi

    120 139

    80 89

    Hipertensi derajat
    1

    140 159

    90 99

    Hipertensi derajat
    2

    160

    100

    Normal

    Classification of Blood
    Pressure
    ESC-ESH 2007

    JNC-VII

    Optimal
    : <120 and < 80
    Normal
    : 120-129 and/or 80 - 84
    High Normal : 130-139 and/or 85-89
    Grade 1 : 140-159 and/or 90-99
    Grade 2 : 160-179 and/or 100-109
    Grade 3 : > 180 and/or > 110

    Normal
    Pre-hypertension
    Stage 1
    Stage 2

    H
    Y
    P
    E
    R
    T
    E
    N
    S
    IO
    N

    JNC VII committee, JAMA 2003: 289;2560-2572

    Epidemiology of
    Hypertension

    90% lifetime risk of developing hypertension in


    people normotensive at age 55

    People with lower educational and income levels


    tend to higher levels of blood pressure

    American Heart Association Heart Disease and Stroke statistic 2006 Update, Texas, AHA2006

    Hypertension in Asia Pacific

    Alexandra L.C. Martiniuk et.al J. Hypertension 2007 ; 25 : 88-92

    Hypertension is Not Adequately


    Treated
    Off all the USA people with high blood pressure:

    11% are not on treatment regimen


    25% are not on adequate treatment
    34% are on adequate treatment

    American Heart Association Heart Disease and Stroke statistic 2006 Update, Texas, AHA2006

    The Cardiovascular
    Continuum
    Myocardial
    infarction

    Coronary
    thrombosis

    Sudden Death
    Arrhythmia &
    loss of muscle

    Myocardial
    ischaemia
    CAD
    Atherosclerosis
    LVH

    Risk factors

    Remodelling
    Ventricular
    dilatation
    Congestive
    heart failure

    Death

    Hypertension, smoking, cholesterol, diabetes

    Dzau V. Braunwald E, Am Heart J. 1991

    PATOGENESIS
    Faktor yang mendorong terjadinya hipertensi :
    1. Diet & asupan garam, stress, ras, obesitas,
    merokok, genetis
    2. Sistem saraf simpatis :
    - Tonus simpatis
    - Variasi diurnal
    3. Keseimbangan antara modulator vasodilatasi &
    vasokonstriksi
    4. Pengaruh sistem endokrin setempat yang
    berperan pada sistem renin, angiotensin &
    aldosteron

    Consequences Structural
    Changes in Hypertension
    Loss of buffering
    Function

    Increased blood pressure


    Structural changes in
    compliance arteries

    Transmits
    Systolic pressure
    Wave to small arteries

    Compliance

    Shear stress on
    Artery wall
    Endothelial
    dysfunction

    Load on heart
    Perpetuation of
    Hypertension

    Left Ventricular
    Hypertrophy

    Predisposes of
    Atherosclerosis
    Dzau VJ. Hypertension. 2001;37:1047-1052

    The Progression from


    Hypertension
    to Heart Failure
    LVH

    Diastolic
    dysfunction
    CHF

    Hypertension
    MI

    Death

    Systolic
    dysfunction

    LV
    Subclinical
    Overt
    Normal LV
    Structure & Functionremodeling LV dysfunction Heart Failure
    Time
    (decades)

    Time
    (months)

    Vasan RS, Levy D. 1996. Arch Intern Med 156 : 1759-1796

    Cumulative Incidence of Heart failure in


    Normotensive and Hypertensive Patients
    20

    Stage 2 hypertension

    15
    CHF
    Cumulative
    Incidence 10
    (%)

    Stage 1 hypertension

    5
    Normal BP

    5
    10
    Years From Baseline Exam

    15

    Lenfant C, Roccella EJ. J Hypertens Suppl. 1999;17:S3-S7.


    Data from Levy D et al. JAMA. 1996;275:1557-1562.

    KERUSAKAN ORGAN TARGET


    1.

    2.
    3.
    4.
    5.

    Jantung :
    - Hipertrofi ventrikel kiri
    - Angina atau infark miokardium
    - Gagal jantung
    Otak :
    - Stroke atau Transient ischemic attack
    Penyakit ginjal kronis
    Penyakit arteri perifer
    Retinopati

    Faktor resiko penyakit kardiovaskuler pada


    hipertensi :
    Merokok
    Obesitas
    Kurangnya aktivitas fisik
    Dislipidemia
    DM
    Mikroalbuminuria
    Umur ( laki-laki > 55 thn, perempuan 65
    thn)
    Riwayat keluarga dengan penyakit jantung
    kardiovaskuler prematur (laki-laki < 55 thn,
    perempuan < 65 thn)

    EVALUASI HIPERTENSI
    Tujuan :
    1.Menilai pola hidup & identifikasi faktor-faktor
    resiko kardiovaskular lainnya
    2.Mencari penyebab kenaikan tekanan darah
    3.Menentukan ada atau tidaknya kerusakan
    target organ & penyakit kardiovaskular

    Menentukan adanya penyakit


    penyerta sistemik, yaitu :

    Aterosklerosis

    Diabetes

    Penyakit ginjal

    PENGOBATAN
    Tujuan pengobatan :

    Target tekanan darah < 140/90 mmHg

    Penurunan morbiditas & mortalitas


    kardiovaskular

    Menghambat laju penyakit ginjal


    proteinuria

    Pengobatan hipertensi terdiri dari :


    1. Terapi nonfarmakologis
    Berhenti merokok
    menurunkan berat badan
    mengurangi konsumsi alkohol berlebih
    latihan fisik
    menurunkan asupan garam
    meningkatkan konsumsi buah & sayur
    menurunkan asupan lemak

    2. Terapi farmakologis
    Jenis-jenis obat yang dianjurkan :

    Diuretika
    Beta blocker
    Calsium Channel Blocker atau Calcium antagonist
    Angiotensin Converting Enzyme Inhibitor
    Angiotensin II Receptor AT1 receptor
    antagonist/blocker (ARB)
    * Tunggal atau kombinasi

    Possible Combinations of
    Antihypertensive Agents
    Diuretics

    Angiotensinreceptor blockers

    Beta-blockers

    Diltiiazem
    Alpha-blockers

    Calcium
    channel blockers

    ACE inhibitors
    Guidelines Committee. J Hypertens 2003; 21:
    21: 1011-53.

    LIFESTYLE MODIFICATIONS
    Not Goal BP

    INITIAL DRUG CHOICES

    Without Compelling Indications With Compelling Indications

    Stage 1

    Stage 2

    Thiazide-Type
    diuretics for most.
    May consider ACEI,
    ARB, BB, CCB, or
    combination

    Two Drug
    combination for most
    (usually thiazide-type
    diuretic and ACEI, or
    ARB, or BB, or CCB

    Drug(s) for the


    compelling
    indications.
    Other antiHT Drugs
    (Diuretics, ACEI,
    ARB,

    BB, CCB) as
    needed

    US-JNC VII Report

    Renal Protection
    Strict BP Control
    Target BP:
    <130/85 mm Hg
    130/80 (ADA guidelines)
    <125/75 mm Hg
    (if proteinuria > 1g/24h)
    Control of Proteinuria
    Ideally = 0 mg/24h Mikroalbumiuri (0-300mg/24h)
    American Diabetes Association. Diabetes Care. 2002;25 (Suppl.1):S85-S89.

    Pemilihan obat antihipertensi dipengaruhi


    oleh beberapa faktor, yaitu :
    Faktor sosio ekonomi
    Profil faktor resiko kardiovaskular
    Ada tidaknya penyakit penyerta
    Variasi individu thd obat antihipertensi
    Kemungkinan adanya interaksi obat
    yg digunakan pasien utk penyakit lain

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