HYPERTENSION
DILIANTY A MANA
112011330
BATASAN HIPERTENSI
1. Bila tekanan sistolik >= 140 mmHg, dan
atau tekanan diastolik >= 90
mmHg, atau sedang mendapat obat
antihipertensi.
2. Dilakukan dua kali atau lebih pengukuran
pada dua kali atau lebih kunjungan.
CLASSIFICATION OF BLOOD PRESSURE
LEVELS OF THE BRITISH HYPERTENSION
SOCIETY
Category Systolic blood pressure Diastolic blood pressure
(mmHg) (mmHg)
Optimal <120 <80
Normal <130 <85
High-normal 130139 8589
Hypertension
Grade 1 (mild) 140159 9099
Grade 2 (moderate) 160179 100109
Grade 3 (severe) 180 110
Isolated Systolic Hypertension
Grade 1 140 - 159 <90
Grade 2 >160 <90
Brit Med J 2004 328:634-40.
HIPERTENSI
Tekanan Darah :
Rata-rata dari 2 kali pemeriksaan
Pengukuran pada waktu yang berbeda
Pengukuran pada waktu duduk
4
TD kekuatan darah ketika melewati
dinding arteri
Jenis Hipertensi
Hipertensi Resisten
Hipertensi Emergensi
Hipertensi Urgensi
Berdasarkan Penyebab
Hipertensi Primer Idiopatik 90-95%
Hipertensi Skunder Sistemik
ETIOLOGY
Primary hypertension
95% of all cases
Secondary hypertension
5% of all cases
Chronic renal disease most common
CVD RISK FACTORS
Hypertension*
Cigarette smoking
Obesity* (BMI >30 kg/m2)
Physical inactivity
Dyslipidemia*
Diabetes mellitus*
Microalbuminuria or estimated GFR <60 ml/min
Age (older than 55 for men, 65 for women)
Family history of premature CVD
(men under age 55 or women under age 65)
*Components of the metabolic syndrome.
IDENTIFIABLE
CAUSES OF HYPERTENSION
Sleep apnea
Drug-induced or related causes
Chronic kidney disease
Primary aldosteronism
Renovascular disease
Chronic steroid therapy and Cushings syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease
TARGET ORGAN DAMAGE
Heart
Left ventricular hypertrophy
Angina or prior myocardial infarction
Prior coronary revascularization
Heart failure
Brain
Stroke or transient ischemic attack
Chronic kidney disease
Peripheral arterial disease
Retinopathy
Hipertensi & Kerusakan Organ Target
10
LABORATORY TESTS
Routine Tests
Electrocardiogram
Urinalysis
Blood glucose, and hematocrit
Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium
Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
Optional tests
Measurement of urinary albumin excretion or albumin/creatinine ratio
More extensive testing for identifiable causes is not generally indicated
unless BP control is not achieved
TREATMENT
OVERVIEW
Goals of therapy
Lifestyle modification
Pharmacologic treatment
Algorithm for treatment of hypertension
Classification and management of BP for adults
Followup and monitoring
GOALS OF THERAPY
Reduce CVD and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients
with diabetes or chronic kidney disease.
Achieve SBP goal especially in persons >50 years of age.
SIGN AND SYMPTOMS
Essential HTN is usually
- asymptomatic
- undetected for many years
- headache, BP elevated systolic
beyond 200 mmHg or BP rising
rapidly (can occur in malignant
HTN)
SYMPTOMATIC ASSOCIATED WITH
MALIGNANT HTN
Headache
Blurred vision
Chest pain
Breathlessness
Nausea, vomiting
Anxiety, confusion, coma
Seizures
CONSEQUENCES OF MALIGNANT HTN
End Organ Complications
Aorta Aortic disection
Brain Hipertensive encepahlopathy
Cerebral Infarction or Haemmorharge
Heart Cardiac failure
Myocardial ischemic or infarction
Kidney Renal failure
Haematuria
Gastrointestinal Anorexia,nausea,vomiting,abdominal
pain
Placenta Eclampsia
Other Micro-angiopathic haemolytic anemia
RISK OF HYPERTENSION
Advancing age
Positive family history of premature cardiovascular disease
Smoking
Hypercholesterolemia
CLINICAL ASSESMENT
OF HYPERTENSION
Sign and symptoms
Pointers to secondary hypertension
Features of malignant hypertension
End organ damage
Hypertensive nephropathy
Left ventricular hypertrophy
Hypertensive retinopathy
TREATMENT
Non Pharmacotherapy
(lifestyle modification)
Pharmacotherapy
PREVENTIF
Upaya preventif primer:
Terhadap individu yang potensial hipertensi:
TD normal tinggi
Riwayat keluarga hipertensi
Obesitas
Konsumsi tinggi garam
Kurang aktifitas
Konsumsi tinggi alkohol
Diharapkan prevalensi Hipertensi turun
INTERVENSI PREVENTIF
PRIMER
Terbukti Efektif Efektif terbatas
Manajemen Stres
Turunkan BB
Kalium
Kurangi Garam Minyak Ikan (Fish oil)
Kurangi Alkohol Kalsium
Olah Raga Magnesium
Serat
Cegah makronutrien
LIFESTYLE RECOMMENDATIONS FOR
HYPERTENSION: PHYSICAL ACTIVITY
Should be prescribed to reduce blood pressure
F Frequency - Four or five times per week
I Intensity - Moderate
T Time - 45-60 minutes
Type Dynamic exercise
T - Walking
- Cycling
- Non-competitive swimming
For patients who are prescribed pharmacological therapy: Exercise should be prescribed as adjunctive therapy