OBAT HIPERTENSI

dr. Hj. Darmiana, MM

TUJUAN PENGOBATAN

Mencegah komplikasi
Menurunkan kejadian vaskuler
Kardiovaskuler
Serebrovaskuler
Renovaskuler

Melalui penurunan dan pengendalian

tekanan darah sesuai target serta
pengobatan faktor-faktor risiko yang
reversibel

Management of hypertension
1.

Non pharmacological

2.

Pharmacological

MODIFIKASI GAYA HIDUP

UNTUK PENGENDALIAN
HIPERTENSI
MODIFI- REKOMEN- PENURUNDASI
AN TDS
KASI
BB

BMI 18,5-24,5

5-20mmHg , setiap
turun BB10kg

DASH

Konsumsi buah,
8-14mmHg
sayur banyak, susu
rendah
lemak&lemak jenuh

Asupan
garam

2,4gr/hari

2-8mmHg

Aktifitas fisik OR teratur 30meit

perhari

4-9gr

Alkohol

2-4gr

Batasi

Pharmacological

0BAT
INDIVIDUAL
SEUMUR HIDUP
PRINSIP KENDALIKAN TEKANAN DARAH
CEGAH KOMPLIKASI

Stratification of CV risk in four

categories
Blood pressure (mmHg)
Guidelines Committee of the 2003 ESH-ESC guidelines for the management of arterial hypertension. J Hypertens 2003;21:1011-53

Other risk
factors, TOD or
disease

Normal
SBP 120-129
or DBP 80-84

High normal
SBP 130-139
or DBP 85-89

Grade 1 HT
SBP 140-159
or DBP 90-99

Grade 2 HT
SBP 160-179
or DBP 100109

Grade 3 HT
SBP 180
or DBP
110

No other risk
factors

Average
risk

Average
risk

Low
added risk

Moderate
added risk

High added
risk

1-2 risk factors

Low
added risk

Low
added risk

Moderate
added risk

Moderate
added risk

Very high
added risk

3 or more risk
factors, TOD,
DM or MS

Moderate
added risk

High added
risk

High added
risk

High added
risk

Very high
added risk

Established
CV or renal
disease

Very high
added risk

Very high
added risk

Very high
added risk

Very high
added risk

Very high
added risk

FAKTOR RESIKO
KARDIOVASKULER

Ada tidaknya Faktor Resiko

Usia lanjut
Male gender
Merokok
Riwayat keluarga prematur cardiovaskuler
disease ( laki-laki < 55 tahun dan perempuan <
65 tahun)
Gangguan lemak (kolesterol atau trigliseride
tinggi)
Pola hidup tidak sehat
Obesitas
Gangguan metabolisme glukosa

Ada tidaknya Target Organ yang rusak

Ginjal
Jantung
Mata
Otak

: laboratorium
: rekam jantung (EKG)
: funduscopy
: stroke

Ada tidaknya Aterosklerotic Vasculer

Disease
TIA / stroke
Penyakit jantung koroner
Penyakit arteri perifer

Initiation of antihypertensive treatment

Other risk
factors, Target
Organ Damage or
disease

Normal

High normal

Grade 1 HT

Grade 2 HT

Grade 3 HT

SBP 120-129 or
DBP 80-84

SBP 130-139 or
DBP 85-89

SBP 140-159 or
DBP 90-99

SBP 160-179 or
DBP 100-109

SBP 180 or
DBP 110

No BP intervention

Lifestyle changes
for several months
then drug treatment
if BP uncontrolled

Lifestyle changes
for several weeks
then drug treatment
if BP uncontrolled

Lifestyle
changes +
immediate drug
treatment

Lifestyle changes

Lifestyle changes

Lifestyle changes
for several weeks
then drug treatment
if BP uncontrolled

Lifestyle changes
for several weeks
then drug treatment
if BP uncontrolled

Lifestyle
changes +
immediate drug
treatment

Lifestyle changes

Lifestyle changes
and consider drug
treatment

Lifestyle changes +
drug treatment

Lifestyle changes +
drug treatment

Diabetes

Lifestyle changes

Lifestyle changes +
drug treatment

Lifestyle
changes +
immediate drug
treatment

Established
CV or renal
disease

Lifestyle changes +
immediate drug
treatment

Lifestyle changes +
immediate drug
treatment

Lifestyle changes +
immediate drug
treatment

Lifestyle changes +
immediate drug
treatment

Lifestyle
changes +
immediate drug
treatment

No other risk
factors

1-2 risk
factors
>3 risk
factors, MS
or TOD

No BP intervention

Goals of Therapy

Uncomplicated hypertension
High CAD risk, Stable
Angina, STEMI,
UA/NSTEMI
LVD

< 140/90 mmHg

< 130/80 mmHg
< 120/80 mmHg

Diabetes Mellitus (DM) and/or

Chronic Kidney Disease

< 130/80 mmHg

Renal Failure with

Proteinuria > 1 gr/24 hours

< 125/75 mmHg

JNC-7, 2003
WHO-ISH/ESH-ESC, 2007
Mosher M, et al. J Clin Hypertens

2007 ESH/ESC Guidelines

Diuretics

AT1-receptor
blockers

-blockers

1-blockers

CCBs

ACE inhibitors
Mancia G, et al. 2007 ESH/ESC Guidelines for the Management of Arterial Hypertension. J Hypertens 2007;25:1105-1187

TERIMA KASIH